To think my doctor should take my mirena out when asked???

[ScienceIsTruth]

Just that really.

Went to see consultant today as still bleeding constantly 2 years after having mirena fitted for heavy periods, although not as heavily.

Asked them to remove it as it's not really helping and the side effects (no libido, etc) are really getting me down, and they've basically refused.

They want to try me on another hormonal medication for 6 months first, whilst keeping the mirena in (because I had trouble when it was put in!).
But there's a waiting list for this medication as it's an injection they have to do, and I'm looking at least an 8 week wait.

GP here. There’s a few things I feel I need to put straight.
First, no-one has any financial incentive to insert mirenas or any other contraception. There used to be a bit of money for advising women about LARC but that’s all.
I think mirenas are around £80-90 a pop plus the cost of clinic time for fitting etc so there is a cost implication for binning them too quickly but it’s certainly not a fortune.

The reason we promote them a fair bit is that for most women they provide a great solution for bleeding and contraception with very few side effects. Most side effects do settle within the first 6 months which is why we do try and persuade people to give it a chance to settle.

After that though if a woman wants it removed it should really just be done with no problem and I’m shocked by some of the stories here. I will say that not every nurse or GP will be trained/skilled to remove them and I don’t think it’s unreasonable to have to book a special appointment for this which you may need to wait a few weeks for. This isn’t the establishment oppressing women, just the current state of the NHS.

No-one should be removing their own coil. Yes they normally come out easily but if they are embedded or get stuck in the cervix this could be very dangerous.

As for the OP’s story. They are suggesting a very intensive treatment for endometriosis. If this helps they then often suggest removing your ovaries as a long term solution pushing you into the menopause. It sounds as if they were trying to avoid another GA more than anyone else. I think a pp’s suggestion of calling the consultant’s secretary is a good one. Ask if there is any reason why you can not have your GP remove your mirena and ask them to write to you and your GP with the answer. Then hopefully your GP will be happy to arrange removal.

This isn’t the establishment oppressing women, just the current state of the NHS.

I beg to differ when women are expected to put up with negative side effects from contraception for '6 months' at a minimum but they pulled trials of the male pill because the delicate flowers had side effects.

Karlkennedy that's interesting. I would also be interested in your take on why it might be that a number of HCPs appear to be unconcerned about patient consent, or autonomy? And also what consequences there might be for a HCP who ignores a patient removing consent for treatment?

Some of these stories suggest the days of the medical profession taking a paternalistic view that they know best for the patient are not yet over. Very worrying.

"This isn’t the establishment oppressing women, just the current state of the NHS.

I beg to differ "

I also beg to differ.
How can anyone read this thread and say that is beyond me.
Medical establishment response to women's stuff >> mental health, pregnancy, childbirth, contraception, gynae issues & lots of not-so-easy to diagnose stuff often seems to come from an underlying idea that women exaggerate their symptoms, that symptoms are often not physical (imaginary), that we don't know our own bodies.

I know of women being sent away by their male GP and told to make a new appointment with a female if they mention ‘women’s problems’.

That is establishement oppression.

Two women on this thread have said they have been given STD swabs by HCPs who didn't ask for consent.

Multiple women have said they have taken matters into their own hands as their health was being so negatively affected and the doctors refused their wishes. Pulling own coils out, one cutting out an implant with a stanley knife.

That report into impact of hormonal contraception on teens & young women was really incredibly shocking (but really, how man women didn't know already?) and what has changed? Nothing except now contraception that you can't just stop taking if it doesn't suit you is pushed.

With little regard for teh consequences because hey teenage girls well they're all "emotional" anyway aren't they, depressed and fucked up and self harming.... They keep saying MHPs in girls has exploded and handwringing but reluctance to really look at the role of articifical hormones in this. Maybe there is no link. That would be great. But - we've all been there or have friends who have. We KNOW there is a link. And oh look it's even listed on the side effects.So why do docs NHS society just not give a toss? I suppose teens gettign pregnant is a more obvious bad thing.

The implant made me really mentally ill. I was a mess and in a very dark place.

I went to the FPC to get it out and they tried to refuse, saying I needed to give it more time. Thankfully my husband was with me and he managed to get them to remove it. If he wasn't there I would probably have walked out with it in because I don't think I would have been able to fight for myself. So they listened to my husband but not me. Even when I described how unwell I was they still didn't want to remove it, but wanted me to give it more time. If I gave it more time I dread to think what could have happened to me.

I saw an article in the guardian today about how women’s health isn’t taken as seriously as men’s. Wasn’t very in depth but interesting nonetheless.

Argh, threads like this give me the rage! Why won't HCPs listen to women and respect when they withdraw consent for a particular line of treatment.

Like you, OP, I react badly to artificial hormones - the pill gave me depression, PMT (which like you, I hadn't had before) and complete loss of libido (that's what accounts for its high efficacy, IMO - you don't sodding want sex once you're on it). Mercifully when the doctor said "you should keep taking them and see if the side effects go away with time" I could just stop taking them.

Like others have said, try a GUM clinic, and do not, whatever you do, let them give you a long-lasting injection.

Just book in as Mirena removal and take your partner with you if possible. 'This is not working for me. I no longer consent to having it in so am here to have it removed.'

This consultant isn't listening to you. I'd ask your GP to refer you to another one and complain about her formally. It's her bloody job to listen to you.

I was fobbed off for months, offered more drugs to help it 'settle' and even anti-depressants. And it was for contraception! WTAF? There's no way on this Earth a man would be expected to put up with this so a fig for 'there's no systemic misogyny in medicine'. And I'm another one that they listened to my spouse more than they did me.

Even after my spouse had a vasectomy, I was hard sold that fucking coil every time I went in, for whatever reason, until I told them I wanted it put on my notes that I did not want a coil again for ANY reason because it caused very adverse side effects. Was even told I should have one because 'vasectomies can fail'. FFS! Years after he had the all-clear. Then what was the point of his going through with it? Load of BS. 'If it fails I'll have a termination,' now, here's why I'm here and it's not to discuss this.' 10 years later, the vasectomy still working!

In fairness I think the 'This isn’t the establishment oppressing women, just the current state of the NHS.' Bit referred to having to make an appointment which may not be able to be immediate, rather than any of the other issues.

I'm also a GP and have used LARC personally since my late teens - I had the injection for years then I had an implant for 6 years. I'm now pregnant and have asked to have a mirena inserted during my planned section.
Almost all my close friends who are GPs or obgyn use these methods too.
We promote them because lots of people find them really good. Some don't and that's totally fair enough - they're much more likely to post on these kinds of threads than those who get on with them though.

I've learned from these threads to always say to patients 'if you really want me to arrange for it to be removed I will, but I'd recommend..... what would you like to do?'
I don't think I know any doctors who would refuse to arrange removal if told clearly that the alternative advice is not acceptable to the patient, but I'm not denying it happens, it must as there's so many threads about it! I also suspect that some patients feel unable to express this clearly for whatever reason - some of which are mentioned upthread, so that's why I've changed my practice to make it clear I will never refuse, but I suspect some doctors do not take this into account enough.

I would love for there to be better options developed but for now can only work with what's available to me.

All I've read on the hard sell of mirena and then the refusal to remove infuriates me.

Women shouldn't be treated like this!

It's my understanding GP's get a "bonus" for patients agreeing to have a mirena...which they lose if the patient has the mirena removed before it's due to be.

"First, no-one has any financial incentive to insert mirenas or any other contraception" I'd like proof of that please. Because I've read a LOT that says GP's ARE. I'd certainly like proof there's no disincentive to remove.

I've read of patients ending up going to sexual health clinics often out of area, going private or even threatening or even attempting to remove themselves!

Since when do we not have bodily autonomy on these devices?!

I'd ban the damn things!

"I've heard so many stories lately that really reinforce how little women's bodies are respected in the medical profession." You might be interested in my thread:

https://www.mumsnet.com/Talk/amiibeingunreasonable/3402449-Aibu-to-ask-you-to-tell-me-your-experiences-of-being-dismissed-by-medics-as-a-sick-woman-I-promise-to-listen

"and if you choose expensive long term contraception..." Many of the women who end up with them DON'T freely choose them! They're pressured into having them. I get the spiel EVERY time I have an appointment related to my endo even though I've repeatedly said I'm absolutely against the coil. And it's not just one mention they go on until I say usually almost shouting "I do not want the coil ever!" It's appalling.

"You're doctor is paid to do what on balance is medically best for you, not what you ask them to" yes that's supposed to be what happens - the reality is often different.

"A man would NEVER be treated like this. NEVER. ANY drug that killed his libido would be stopped unless his life depended on it." They couldn't even cope with the MILD side effects of hormonal contraception long enough to complete clinical trials of male pill! Side effects that MILLIONS of women are expected to tolerate for YEARS.

"They will look at your symptoms, listen to you’re concerns and act in you’re best interests. They are medically trained" wow you didn't just drink the koolade you bought shares didn't you? Suggest you also look at my thread.

"lol @ thinking the medical profession always acts in your best interests" precisely!

"Yes doc knows best shut up you silly women." Yes and if we disagree we're still being Dx as "neurotic" or "hysterical"

"Unfortunately the NHS is at heart a deeply misogynistic organisation that doesn’t give women the autonomy they should have." Totally agree

Sittingbythefire - thats absolutely fucking atrocious behaviour! Did you complain? They CANNOT perform tests without your consent like that!

"I feel now I should warn my daughters" I warned mine and she told me she was already aware as 2 of her friends older sisters have had similar issues.

"I feel like there is some massive journalistic expose to be had on contraception. It would only take a few well placed questions via the freedom of information act." I would LOVE for an investigative journalist to do an expose on misogyny in heakth care specifically on contraception and approach to gynae issues.

"cause negative side effects and does in about 15% of users." I reckon the problems are hugely underreported I don't trust GP's to report as they should.

"I beg to differ when women are expected to put up with negative side effects from contraception for '6 months' at a minimum but they pulled trials of the male pill because the delicate flowers had side effects." Me too - especially as I'm well aware of how poorly women & girls are treated on many medical issues not just this one.

It’s actually on my notes to not even bother recommending any contraception I cannot personally control after a rather heated polite but heated conversation with a newly qualified nurse trying to push it on me. She was insistent that I should have whatever it was and that any horror stories from my actual rl friends of side effects and hops refusing to remove where all clearly made up and that she wasn’t going to re issue my pill for me as I needed a larc. I told her that I would never have anything inserted into my body that I could not personally stop and that if she was not going to re issue my pill I would simply order it online. She went and spoke to a more senior member of staff and I got my repeat. I’ve never seen her since and all other nurses I’ve had have been fab.

I too think the 15% estimate is way too low - I've certainly seen estimates that a third of women on hormonal contraception suffer depression as a side effect.

(Incidentally, men do get procedures performed which screw up their sex lives - prostate operations have a high rate of impotence as an after effect, and these are not all "life saving" - many are performed on non-cancerous enlarged prostates. Though I suspect ageism may come into this - they'd be much more careful with a younger man. But the medical profession undoubtedly suffers from massive institutionalised sexism.)

It's on my notes, too, chilli, as I got thoroughly sick of being asked about contraception despite telling them that my husband had the snip years ago and that is our contraception. I was hard sold it even when in for something else. 'And what are you using for contraception?' 'Vasectomy. My husband had a vasectomy. He's had the all-clear since X.' 'But.' 'No 'buts'. Successful sterilisation is permanent contraception. If you're here to question my fidelity to my spouse then we need to terminate this appointment now so I can initiate my complaint about your professionalism, but surely there's no need for that, so shall we carry on with the matter at hand?'

EVERY single issue with perimenopause and it's 'Get a Mirena' so I had to have it put in my notes. I don't want a fucking Mirena again. EVER. So don't ask anymore! If you are then going to deny me treatment, we have a much bigger issue on our hands.

Oh, it's all over the place! Just go onto the Menopause topic and see what a fight some women have to get HRT, or HRT that is best suited to their needs and then come back and tell me there's no bias against females in medicine.

We get paid to fit them graphista - to cover the clinic time, space and that most GPs now have a clinical assistant present who also needs to be paid, plus the additional insurance we have to pay. I think it's about £80. We also get paid to remove them, about £30 - which given it's a far quicker, less skilled, lower risk and single handed process is much better value for us!
The money goes into the practice budget not to each GP doing it or recommending it and is honestly a drop in the ocean.
There's no incentive to do a certain number to get a 'bonus' and certainly no removal of funds if women have them out early. If anything we'd profit most by inserting loads then removing them quickly, I suppose! But I can promise you it doesn't cross my mind. Can't vouch for every doctor of course but if we want more money we'd be far better off using the time we spend fitting coils doing a general locum. Or changing career altogether but that's a whole other thread!

I'm not really sure how I can prove to you that this 'bonus' doesn't exist... but it doesn't.

I'd want to know where the estimates came from too. I was on hormonal contraception for years and had it removed to start ttc, so on my records my reasons for stopping were nothing to do with side effects. But within weeks my mental health massively improved and I haven't had any MH problems since. (And I should point out that my life got objectively worse for a couple of years, but I coped so well I surprised myself.)

I really think there is a blind spot here too - despite numerous doctors visits for self-harm, suicidal thoughts etc, nobody even suggested it could be linked to hormonal contraception.

Regardless of whether there is a bonus or not, it's very apparent that many women are being denied the right to withdraw the treatment when it does not suit them. That's a big issue because it overrides their consent and the consent process as enshrined in law. And it is entirely sexist because there is no way a man would be expected to put up with negative side effects for a minimum of 6 months as a mode of contraception.

As for women subjected to STD swabs without their consent, that's assault.

But there's no denying it goes on.

Flamingo, if LARCs is much harder/more complex, why (in my area at least) is there a 6 week wait to get the implant out, but they will be fitted on demand at the GUM clinic? I was told that it's because getting them out required an additional level of skill and fewer people were trained in it.

I had the implant after being told it was the same as the depo which I had been on for 13 years and really suited me.
2 years later, 2 stone on, awful pmt and depression and bleeding 16 days plus every month. I paid £150 to have it removed, best money I ever spent. Now I pay £30 every 3 months for the depo injection. I never thought I would go private to get the contraceptive that works for me.

The NHS tariff is a public document btw - you should be able to see how much trusts get paid as well as GPs. Hospital doctors get paid a lot more than GPs for procedures generally, though again it goes to the trust not the individual doctor so no real incentive there either.

dont, you could argue that it is, at very least, indirect discrimination. It is a policy/procedure/way of working which negatively and disproportionately affects a group with a protected characteristic. Men have easy access to all medically safe male contraceptives and the ability to stop whenever they want. Women don't.

Implants are kind of the opposite of coils in that regard - putting them in is much easier than taking them out! Coils are harder to fit but generally easy to remove.
I remove coils but I don't have anything to do with implant fitting / removal, or coil fitting.

In GP land I'm not aware of anyone being trained to insert and implant but not to remove it though, having said that.
GUM clinics use more nursing staff than doctors though who do tend to be trained in specific things rather than more generally so it might be different there I suppose.

Yanbu at all. My cousin had a different form of LARC, the implant. She experienced significant weight gain and developed depression- and her GP insisted in prescribing anti depressants and leaving the implant in rather than removing it- it wasn't until she took her mum to the GP with her to support her in insisting that they agreed. An adult woman, needing to take her mum to a GP appointment to get listened to... it boggles belief.