To be unspeakably angry at the doctor?!

[showmethegin]

I have been having really awful, incredibly painful periods from the age of 11 so 19 years of agony. My GP finally relented and prescribed me naproxen which has helped. In the same appointment I explained that me and DP are TTC. After 3 months of relentless negative OPKs, wondering what the hell was wrong with me I've now found out that Naproxen stops ovulation for approximately 27% of women.

AIBU to expect the doctor to have told me that?!

Just to add, there is currently no blood or hormone test that will diagnose endometriosis, and most sonographers are not capable of spotting it on a scan, so don't be fobbed off with an offer of an ultrasound because the rate of false negatives is so extremely high, it's more often than not a complete waste of time and NHS money.

Usually blood tests and ultrasounds are usually important part of a full investigation into gynaecological issues of which endometriosis is only one possible answer. They can provide answers in their own right to what is causing problems so it’s not a case of being fobbed off by having them. A laparoscopy is much more invasive and difficult to recover from so it makes far more sense to carry out the minor/less invasive checks first.

Yes she should have told you.

However...

“Before taking this medication ensure you have read the accompanying leaflet.”

That is what it would have said.
You didn’t do that. Or you waited 3 months to do so

So you were also in error

Well if it is on the leaflet, then I wouldn't honestly expect a GP to know the potential side effects for every medication prescribed.

When the DC or I have a new medication I always read through the leaflet before using it, as should anyone. If you have specific difficulties (sensory impairment, learning disability etc) then I would suggest that it is the responsibility of the pharmacist dispensing it to ensure that you are able to access the patient information.

I should imagine that the GP would have been thinking more along the lines of harm to a potential foetus when you mentioned that you are trying to conceive. It may be that there are other reasons for you not ovulating, and this medication may not be an issue, but it's impossible to know without further investigations.

Good luck with ttc.

I am a GP and had no idea about the potential link between naproxen and infertility. It is certainly not common knowledge that I would expect most GPs to know.

Doctors are only human and cannot be expected to know the results of every study (quick google search suggests the potential link was found in one small study in 2015 with a total of 39 patients). On average, we have 10 minutes to see a patient. This doesn't just involve seeing the patient but also reviewing the previous consultations/results and writing up, let alone any 'thinking time'. Please give us a break! We are trying to sabotage your health or being deliberately useless. The majority of us are trying to do a decent job despite the constant crap the job throws at us.

This possible side effect was investigated by testing just 39 women and the evidence has not been peer reviewed, meaning that there is no quality assurance or corroborating evidence so therefore cannot be cited as a fact. A much wider study would have to be carried out under clinical trial conditions to validate their findings.
That's why GPs wouldn't know about it. It's not been proved. The only reason it may be on the box leaflet is for the pharmaceutical company to cover its back! They could also print in the leaflet that they may turn your pee green. Doesn't mean it's true.
How long have you been trying to conceive?

For the reasons PPs have given, 'unspeakably angry' is way OTT, though I can understand that it's your immediate reaction when you've just found out.

But I agree with others, we have to take some responsibility for ourselves in these things. The patient information leaflet is there for a reason.

I would expect a doctor tonkow about something like this, when it can affect 25% of women. That's not a small offchance effect! Especially given the OP had said they were TTC.

GPs are not experts in the possible side effects of medication. Pharmacists are normally good if you ever have questions outside of what's covered in the leaflet. You do have to take responsibility in at least reading the leaflet before taking medication though.

YABU to not read the leaflet that comes with any new medication, or to not read the leaflets of any medication you are on if you are starting to TTC.

If you had directly asked the doctor if it was ok to TTC or be pregnant on this medication and they said yes without checking their system I could understand your upset, but you didn't.

It's taken 19 years to get your GP to prescribe something for agonising period pain?!

I'd be looking for a different doctor. One who take painful periods seriously.

Didn't know that about Naproxen - not that I will ever be TTC again.

Just had a quick google and it says after 10 days which implies that you need to be taking it regularly to inhibit ovulation. It may be that you aren't taking enough to cause problems but in your position, I'd be doing a lot more research. 3 months isn't that long to be TTC.

Have you tried mefanemic acid? That's what we've all been prescribed over the years. No idea whether that has the same affect on ovulation though.

If you have had painful periods for 19 years why have you not insisted on treatment before now OR pushed to see a gynaecologist? Why on earth have you had to BEG for something so routine as treatment for painful periods? You ought to have changed your GP!!!

It is also a drug you can buy OTC as FEMINAX.

The NHS gives this info online:
Naproxen isn't suitable for certain people. Tell your doctor or pharmacist if you:

have had an allergic reaction to naproxen or any other medicines in the past
have had an allergic reaction to aspirin or other non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen
have or have had stomach ulcers, bleeding in the stomach or intestines, or a hole in your stomach
have high blood pressure
have severe liver or kidney failure
have severe heart failure or other heart problems
have Crohn's disease or ulcerative colitis
have lupus
have a blood clotting disorder
are pregnant, planning to become pregnant, or breastfeeding

So yes, I think your GP ought to have known, it's on the NHS site and is fairly basic 'medicine' - by that I mean it's not exactly brain surgery or cancer, it's a NSID for periods. They are surely used to prescribing this.

I'ma a doctor (and work in women's health) and did not know about this link. As others have said, having looked it up it was just a very small observational study and there is definitely not enough evidence to state without equivocation that the drug prevents ovulation. As you can see, lists of side effects of drugs on patient info leaflets are very long and many of them are often based on small studies or anecdotal evidence - you can't expect a doctor to know them all. Doctors definitely should know about the most potentially harmful or well established (and evidenced) side effects though and warn you about these but this doesn't fall into that category.

As such you are being a little unreasonable I'm afraid. You should definitely read the patient info leaflets of any drug you are taking - esp when TTC!

It sounds from your post that you don't have much faith in or respect for your GP anyway so maybe you should thinking about switching GP's. Good luck with TTC (we had years of infertility too and I came to the conclusion that OPK's were the devil but that might just be me...)

NSAIDs are the first drug mentioned on the NHS infertility page

www.nhs.uk/conditions/infertility/causes/

I didn’t know this either btw (not a GP) but perhaps it is something GPs ought to know. But then you can say that about so many conditions and medicines and it must be difficult to keep abreast of everything as several actual GPs have said.

If you had directly asked the doctor if it was ok to TTC or be pregnant on this medication and they said yes without checking their system I could understand your upset, but you didn't

Eh? Maybe RTFT.

The OP TOLD the GP she was trying to conceive- how much clearer did she have to be????

I guess it's annoying but it's only 3 month delay. I don't think a 3m delay merits 'unspeakably angry'. I'm not sure how you'll cope without those types of painkiller, though, tbh, coz the others are probably even more contra-indicated when TTC.

I keep reading that all the NSAIDs have delayed ovulation in some patients, there's even a MN thread about ibuprofen having this effect.

I'm not sure why you've been prescribed naproxen....have you tried mefanemic acid or transxemic acid?

3 months of relentless testing?

Gently OP, 3 months isn't a long time anyhow.

I think the GPs who are posting here are making excuses.

If this drug is said - BY THE NHS- to be contraindicated for women trying to conceive, then a GP ought to know of that.

Surely as a GP you are going on CPD and something as common as painful periods and drugs that may affect conception are basic information- and even if it was a small study it is listed on the NHS website.

Also, OP although I sense your GP is useless, you need to calm down because 3 months is nothing.

If you get so wound up you are likely to inhibit conceiving anyway.

It took me 8 months at your age to conceive and I didn't even think of it as an issue.

Yes - YABU & very OTT.

I'd be more cross that the GP had ignored requests for support for extremely painful periods for 19 years tbh op. If you have suffered this why on earth haven't you requested referral to a gynae consultant?

OPKs aren't evidence that you are or are not ovulating. Are you continuing to have periods as usual?