Why are doctors so bothered about other people's contraception choices?

[allergyupset]

This is a request for medical professionals to stop raising their eyebrows and looking at their patients as if they're weird.

First of all I've had a very shit, stressful day full of medical upset that's been going on for years, so please take this rant within the wider context of me having a generally shit day.

Why are doctors and sexual health workers so bothered? Are they on commission or something?

I've been with my DH for over ten years. We still use condoms. It works for us. We buy them with our own money and don't get them free from the NHS. I am well aware of other options such as contraceptive pills, injections, coils etc. I am also not interested. We will choose the method that suits us best and it's frankly not your business to start asking me questions like "Are you happy with that?" Yes I'm fucking happy with that. If I wasn't, I would've asked for something else long ago. Just give it a rest and stop questioning people's choices.

They hate prescribing the evra patch I know that much

If they ever ask me I say:

I HAVEN'T HAD SEX FOR 3 YEARS.

That shuts them the fuck up.

Because 50% of pregnancies are unplanned, and condoms are pretty ineffective as long term contraception. It would be medical negligence not to explore contraceptive choices when relevant.

I wish my GP was interested in my contraception. My mirena (which I'm happy with) is 2 years overdue to be changed and I've just been informed, after 3 months on the waiting list, that they're not running contraceptive services at the moment.

The consultant doing my ablation tried to push the coil on me
I was mid forties and had been sterilised 7 years earlier
But he still ‘thought I should have it’

I was on the pill for years, not now as I’m 54 and past it . I’d used the mini pill for about ten years without any issues, when every appointment I had, the question of swapping to the coil was brought up. Each time i refused. Eventually I asked why they kept pushing the coil and the nurse said it was down to cost. I asked that it was put on my medical notes, to stop asking as I had absolutely no intention of getting the coil fitted and I was getting annoyed at the constant questioning. It was never mentioned again.

Mirena can also be used as part of hrt so it’s actually a good choice if you are perimenopausal or going into menopause
It’s also the most effective contraceptive (stats would say more effective than female sterilisation), can deal with heavy periods and lasts for 5 years. Surely it’s a win win for a huge number of women rather than it being some devious plot by HCPs to promote mirena! Admittedly not suitable for everyone of course

It's hard to deal with medical upsets allergyupset. I hope you get some relief soon.

On one hand, I agree that some medical professionals can be very unprofessional and disrespectful around the topic & seem to be out to make women feel like shite whatever we pick. I used a cervical cap for years before my spouse got the snip, loved it, worked well for me. I am aware it's not very popular (some seem to forget they still exists) and I accept it does have a higher user failure rating than the coil - I just liked physically having an item and with my medical conditions, finding something safe for me is harder than some professionals seem to think.

I've been the patient where the solution for practically any medical issue I've had was the pill (distant second was beta blockers, until they take my blood pressure and realize I was telling the truth when I said I didn't think it would be safe with my level of hypotension and start freaking out that I might pass out on them). It felt like they're throwing a hormonal bandaid at me rather than looking at the actual issues (my sex hormones are fine, it's other parts that are fucked up that sometimes affect how my sex hormones are used -- adding more isn't a good solution to that).

On the other hand, yes, it is kinda a medical professional business when many contraception can affect things like test results or can conflict with other medications before getting into risks from sex. The 'are you happy' is standard in part because some people won't bring it up to a professional unless asked directly. As long as they drop it after "Yes, I am", I don't think it's a sign of being bothered. It's when they go on after that that there is an issue.

Always find it weird that someone working in sexual health wouldn't be pro condom use.

"They are on commission and they seem to think that we're all idiots and can't look after our own sexual health"

As someone who discusses contraception very often, I can assure you you'd be surprised of the high proportion of the population are actually idiots who cannot look after their own (let alone their significant others') sexual health.

So as we don't have a crystal ball to know which of our patients don't fall into this category, and as it is eventually the public health system (and police, and social services, and prison systems) which ends up paying for their stupidity, we have to give the same information, and be pushy about contraception, to everyone we encounter.

I got questioned on what method of contraception I was going to use in front of my then dh & my parents as I was packing my things after I had discharged myself from the post natal ward. I just pointed to ds in his car seat & told the midwife that after what I had gone through there was no way I would be having sex ever again. She said I would be back having another baby in a couple of years, I told her the only thing I would be back for was to be sterilised.

I had problems for years and was referred to a gynaecologist eventually who finally listened to me and didn't try to push the mirena coil. He admitted that some big pharmaceutical companies paid for their products to be pushed and they are not always the best option.

I think Drs may underestimate how many women experience distressing side effects from hormonal contraception.
If I say I'm not interested because I don't want the weight gain/moodiness/lethargy/loss of sex drive I've had in the past they'll insist these effects are very rare. We'll yeah, maybe, but I seem to get them every single time. And now with hyperthyroidism I battle all this anyway and don't want it to get worse.
So I just tell them no thanks.

@WillaWeatherspoon

They questioned my contraception too when I asked for the mini pill. The nurse said being busy with two children she doubted I'd remember to take it every day and I should get the injection every 12 weeks instead .

I pointed out I somehow remember to brush my teeth every single morning without fail, and since I keep my pill packet next to my toothbrush I don't think there's any chance I'm going going forget.

As if trying to get a GP appointment every 3 months and then go in for it in the middle of the day would be easier!

@ThedaBara

Only circumstance I can think of is in the context of a c section. Quite dangerous to get pregnant within a year of having one, so they are quite nosy to make sure you have a fool proof method (I was pressured to have the coil fitted 'while they're down there'). Other than that it's wierd that they have an opinion

If it was the Mirena I’d say they put a lot of pressure on at every opportunity, almost as if there’s a financial incentive.

@urbanbuddha

Condone are only 97 or 98% effective or something.

That's with "perfect use". With normal use they are only 82% effective so 1 in 5 women will get pregnant this way.

We’ve been using condoms for over a decade with no pregnancy so they are absolutely fine if used well. Better than shoving hormones I don’t need into my body. ( for me)

My sisters and actually some friends too have all fell pregnant on the pill!

Woman who did my smear the other day was heavily pushing the coil. Even when I explained that I'm currently TTC she felt the need to triple check I didn't want a coil fitting.

They care because of the massive cost to the NHS of abortions. Yes, it is their business

Yes I buy my combined pill from Superdrug Online Doctor now. Worth £20 to me not to be pushed other contraception every time which pushed my blood pressure up. Thanks to a MNer who let me know about it.

Because they get paid for providing contraceptive services, the same as they get paid for most things they do.

Long term options such as Mirena are hands down the most effective forms of contraception, and imo get an unfairly bad press - often safer and better tolerated than other (systemic, higher dose or oestrogen containing) contraceptives, whilst still being fully reversible. Mirena is very popular amongst doctors (for) themselves!

Yes GPs are paid for coil fittings but it's not ridiculously lucrative (nothing in primary care is) and some practices under financial/staffing stress or without a GP trained in coil fitting are having to drop the service altogether - which I think is very sad and a poor outcome for women. Where the resources for coil fitting exist then yes, GP surgeries will want to use those resources.

Unwanted pregnancy is rife and hugely costly (and not just financially) to the individuals involved, the NHS and wider society.

Doctors should of course be polite and respectful, and aren't always(!). There are some sexist dinosaurs out there. Equally, in most cases the doctor does not know you well - and it would be problematic/judgemental for them to guess how informed and responsible you are based upon your appearance / age / professional status. You might have your life together but many patients don't. GPs meet people from all walks of life and often it is those from more chaotic or disadvantaged lives that they see the most of, and sort of end up catering their approach to, for better or worse.

Annoying you may be the price to pay for helping to prevent pregnancy in an another woman who is less informed or has a more chaotic life. That can make a really huge positive difference to that woman and her family, and potentially saves the NHS a lot of money - money that's desperately needed.

I didn't know condoms were 'frowned' upon. DH and I have been using them for 30 years, never had an issue. I know so many women who have had unwanted pregnancies all whilst on the pill.

What’s the drama with asking if you’re happy with your choice? They have to ensure women know their options, can’t see the problem tbh (OPs situation)

I agree my dr is always pushing the coil onto me always always when I say I'm not on contraceptives. I don't want to be, we do the natural family planning method as well as condoms and if I get pregnant it's ok for us but we've done this for 5 years only have one dc am in an excellent position for any accidental dc but don't want any and because we're so strict about condoms and which dates we have sex nothings come about.

But nope not good enough for the dr. Have you heard of the coil? Yep everyone I'm in the doctors actually ...

Every time not everyone *