To be angry that my doctor won't prescribe the drug I want

[DazeyandConfused]

I went to the doctors today to try and get a prescription for diannett. It is a 'skin friendly' contraceptive pill. In other words it nukes spots and considering I'm long past the age when spots are appropriate, it is a god send. I've been on and off it for 9 years. There is a slight increase in the risk of blood clots/stroke/heart attack after two but that has never been a problem. I'm fit, healthy and every time I try another pill/acne combination, it doesn't work/I feel ill. Today the doctor put his foot down and wouldn't prescribe it. AIBU to get really angry over this? Is there anything I can do?

He's not being unreasonable. The wrong pill type can vastly increase your risk of strokes, for example. It's negligent for him to prescribe something he has reasonable cause to suspect would harm you. It doesn't matter if you're fit and healthy - certain risk factors (age, migraines, etc) make it risky to be on the pill.

The pill is a crap way to sort acne out anyway! If you need longish term reliable contraception go get yourself an IUD. They're easy and generally fabulous. The copper one has zero hormone and the mirena a teeeeeeny tiny amount.

Then get yourself a referral to a dermatologist. :) much better.

I should clarify, certain types of migraines, not all.

reliable contraception + dermatology consult is your answer.

I would be asking for a referral to a dermatologist who could give you a far better treatment plan for your acne.

PLEASE don't do it, this is why they don't like to prescribe it, no evidence or not...
www.dailymail.co.uk/wires/pa/article-2803141/Acne-drug-girl-committed-suicide.html

I had to change to the minipill from Microgynon a couple of years ago after my GP sent me to the stroke clinic for tests to make sure I hadn't had a TIA. It turned out to have been an atypical migraine (I've had occasional optical migraines over the years, about 5 or 6 in my lifetime, but this was a bit different) but because I was also over 35 I wasn't allowed to switch back to Microgynon. One contraindication is acceptable, two are not. That may be what has happened in your case OP, that you now have two contraindications which means your GP cannot prescribe you with the same drug. Although your GP should have explained that to you if that was the case.

Interesting that you skin got worse after stopping Dinnet tell. I took it from age 17 to 22. When I stopped I had a reflex testosterone surge and got terrible acne and temporal baldness. I was then prescribed roaccutane by a dermatologist which made a massive difference. I was also helped my guinot hydroderme therapy and their desensitising product range which was very gentle and soothing. Dinannette is not a good drug .

For what gynaecological indication would a gynaecologist recommend Dianette?

PCOS for a start. If your acne clears up with hormone treatment, a gynaecologist is a very good place to start. Speaking as someone who was sent by a dermatologist to see a gynaecologist.

Ah, ok, fair enough.

Apart from progesterone Dianette contains an 'anti-testosterone' which is why it helps with acne (including that caused by PCOS).
Interesting about the testosterone surge after stopping, olympicrock.

Dianette is not a 'bad drug', it's a very effective drug. And like all effective meds it comes with considerable unwanted effects. It has it's place. Long-term contraception is not it.

I had far less side effects from Dianette compared to all the other pills I've been on especially compared to Yasmin. My GP sent me for periodic blood tests to check my liver function, but for me it was a wonder drug.

You see a doctor for a medical opinion. They're not just a shop to get what you want.

Prescription only medications are not available over the counter because they are thought to require a medical opinion, though I appreciate that what drugs these are varies from country to country.

I was last told that they could only give me a max 3 month prescription of dianette in a year which is not practical as a contraceptive so very reluctant to prescribe. I had some success with marvelon and applying dalacin t lotion or solution depending how dried out my skin is. Yasmin never worked for me as tried it when came off dianette as had been on it for 10 years after moving doctors

Yasmin I'd be careful with. I know people who tried this and they ended up severely depressed and covered in more acne then it started. I know from there experiences that it's not uncommon so if you try it watch out for that.

Lymecycline, one went on after an it worked, another went on another version of the pill and it worked. They also used Red Clover or something?

YADNBU, I can see myself having the same argument in the not-too-distant future.

PacificDogwood A gynaecologist?!
For what gynaecological indication would a gynaecologist recommend Dianette?
PCOS is a gynaecological indication, and for some of us, Dianette is one of the few treatments that works.

The pill is a crap way to sort acne out anyway! If you need longish term reliable contraception go get yourself an IUD. They're easy and generally fabulous. The copper one has zero hormone and the mirena a teeeeeeny tiny amount.
An IUD isn't acceptable to everyone - a lot of women find the very idea of IUDs to be distasteful, (or even abhorrent) and it's possible to react very badly to the type of progestogen mirena contains. (and if you do react, you can have a very hard time getting the thing removed)

and Roaccutane is much better, is it? ha ha. It can have hellish side effects, liver damage for one, lips peeling painfully, unable to go in the sun etc. Also once you stop on it (and it does work wonders) your problem will likely come back if it's sever and if you are mature (i.e. acne isn't just a phase) so it's not worth it.

The truth is, there is no cure or even a reliable treatment for acne. Antibiotics work but you have to be on/off then permanently, hardly healthy either especially for you gut health, though it's much less riskier than Dianette and Roac. But any -cyclines cause migraines if you are susceptable. Whereas erytromycine and that group causes indigestion. The whole thing is a f* joy!

but yes, they don't prescribe D for over-35s as the hormone level is too high and can cause blood clots. So yabu.

So I get another two years of my acne being controlled and then I can't take it anymore?
Fucking hoo-rah...
I have been going to the Drs about my acne for well over five years and it was only last year after mentioning pain during intercourse, that my pcos finally got diagnosed.
Are the risks really that high? Surely as long as your blood pressure remains in normal range and you make sure to do a reasonable amount of physical activity and you are a healthy weight, this should be available?

It's not the case that "they don't prescribe D for over-35s as the hormone level is too high and can cause blood clots", that's way oversimplified.
Unfortunately, a lot of GPs also oversimplify the problem.
Dianette isn't recommended if you're over 35, but the "being over 35 thing" isn't a blanket contraindication. If the benefits outweigh the risks to a particular patient, even with an actual contraindication,

Urgh, it posted too soon!
Anyway, even with an actual contraindication, Dianette can be prescribed until menopause - provided the benefits outweigh the risks. It's not a blanket thing, this varies from patient to patient. Thankfully, consultants are often a LOT happier to prescribe Dianette than your average GP!

Grumpy, by 'they' I do mean GPs and whether they are right or not to oversimplify, they just do that! I'm not the one prescribing or oversimplifying. When you say 'benefits outweigh the risks', it's impossible to prove that they do to a GP before they actually insist prescribing the whole range of other meds first, to prove if you like that nothing else works.
Dermatologists, esp private ones, may prescribe it if you are over 35 on condition that you do not have high blood pressure or smoke. If you do/have, they will not do it either as this really is dangerous. They may allow a few extra years if you a very healthy over-35 and preferably never smoked (not just currently) but again I don't think anyone would be happy to prescribe it for many years after that age.
The problem is, a skin condition like this isn't seen as such a serious thing that it's worth risking serious life-threatening side-effects. It's considered a lesser evil than any of these side effects, and a poster above agrees that she'd rather have acne so it's not just doctors. It's considered also that it can be treated cosmetically (laser, facials) and can be covered up. So overall doctors are very reluctant to give Dianette to 35+ women, especially not for years. It's hard work to find one who would.

GP's nowadays (unlike GP's of old) seem to be scared to use their own judgement and tend to rigidly follow 'Current Guidelines', even though often 'Current Guidelines' are fond of stating that, even if there is a 'slight' risk involved with a medication, it shouldn't be prescribed

As a GP, can I just say piss off?

I sign hundreds of prescriptions a day. Every single one of the drugs has potential side-effects, some of them fatal. At each signature, I am balancing the risks of those side-effects with the potential benefit to the patient - if I get it wrong, a patient could die and (clearly less important but still a big deal to me) my career could be over. You have absolutely no idea what my job involves. And, FYI, developments in case law mean that all doctors are obliged to consider current guidelines - we can be struck off and sued if we don't.

OP, I feel your pain because I had acne for years and indeed took Dianette. But that was before so much was known about its side-effects. I wouldn't touch it with a bargepole now and I wouldn't prescribe it - not least because it is no longer licensed for use as a contraceptive. Yasmin is a good alternative for most people and, if that doesn't work, there are far more effective treatments for acne than Dianette.

What Turps said.

I've been on diabetes twice for my skin. The first time it worked and my skin improved but when I stopped taking t (as you have to as you can't take it long term due to the risks) my skin quickly went back to being bad.

I restarted it and diameter had no effect at all. Possibly made things worse. I'm now on an antibiotic called lymecycline which appears to be working.

My GP has always been very good at discussing all the options with me. It took me years to go to the GP abouty skin and wish I had done so earlier

Can you book an appointment with a different GP and ask about alternative medication?

Diabetes/ diameter = diannette.

Have to say that I would prefer that my gp followed 'current guidelines' (ie the weight of clinical opinion as emerges from a range of double blind tests analysed by experts) rather than just listening to 'his own judgment' (ie a gut feeling he has perhaps based on the handful of patients he has prescribed a drug to, the leaflet he got from a medical rep that morning, something he learned in medical school 29 years ago etc). I feel so sorry with the level of ignorance doctors have to put up with!