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?!

If you don't ovulate you aren't having actual periods, although the bleeding is similar.

OPKs do not confirm ovulation. They indicate that it could be about to take place, but they don't confirm that is has. If you're only testing once a day, you can easily miss a surge (I ovulate perfectly normally but I've missed the surge before when TTC, including the cycle where I actually conceived). They can be an initial indication you're not ovulating, but they're not a way of confirming it, and if you're not tracking ovulation signs other way (BBT, cervical mucus), they aren't reliable for ascertaining either when or even if you've ovulated. That's why assuming you aren't ovulating based off OPKs isn't a good idea, particularly after only three months.

@BrokenWing
Are you trying to be funny? The op told the GP she was trying to conceive. Is it such a huge intellectual leap for a GP to say ah, ok, let's just check these drugs are okay for you?

I think you are playing semantics here.

The onus is on the GP to check when they know someone is trying to conceive. She told him. He ought to have researched; took me less than 5 mins on google.

It’s contraindicated in women trying to conceive because NDAIDs are contraindicated in pregnancy, so if you put someone on naproxen to take daily for their sore knee and they’re trying to conceive then that’s not good because they’re likely to still be taking the drug when they conceive. The case with periods is different- even if you’re trying to conceive, the point at which you are having your period, you are not pregnant, so it’s ok to take drugs that aren’t safe in pregnancy. If you became pregnant that cycle then you wouldn’t be taking the medicine at that point.

This is why the leaflet says speak to your doctor if you are pregnant or trying to conceive. The potential fertility issue is a separate one. There is not enough evidence about that at the moment (that study is tiny) and even the evidence there is would suggest it would be ok to take short term.

Pressed post too soon.
I think you realised that you were unfair to be unspeakably angry about naproxen being prescribed. However you are right to be angry at not being referred to gynae a lot earlier for the painful periods.
Mefenamic acid has similar warnings about potential impact on fertility by the way.

Also bear in mind that with longer cycles, you will ovulate later: with a 36-day cycle, ovulating around day 22 would be normal. Make sure you aren't stopping testing with OPKs too early - depending on your luteal phase, you could feasibly ovulate anywhere from day 20ish to day 25ish. And if you're only testing once a day, try testing more frequently or changing the time you test - I had to shift the time I tested with my fertility monitor because I never got a peak reading in the morning. I only get positive OPKs in the afternoon and they are negative again by the next morning usually. If I just tested with first morning urine, I'd miss it.

Did you not read the leaflet insude the box, which would have explained this. The Dr does not have time to explain every side effect - patients also have a duty if care to look after their own health. Before I take any pill I always read the leaflet in full

Another one who had no idea about this link (though having just read the article, it does seem a bit woolly).

As others have pointed out, NSAIDs are contraindicated in pregnancy so the fact that your GP prescribed them would raise more of a red flag for me the fact that they were also unaware of the potential for suppressing ovulation.

Also if you’ve had normal periods in the last three months then odds are you are ovulating normally anyway. It’s normal for TTC to take a while, so the fact that you’ve been trying for three months doesn’t mean there’s necessarily something wrong.

Also a GP and never heard of this. I know this isn't the point of the thread but it's interesting to learn a new thing.
The list of SE for a medication can be extensive and there is just no way we would be aware of something like this (as evidenced by all the doctors on this thread!) I'm sorry that's disappointing to some but it's the truth. I keep really up date and am reading guidelines all the time and have an extra diploma in reproductive health and have never come across this.
Good luck TTC! X

If your periods are longer you might ovulate later, or not. I didn't necessarily ovulare 14 days before the start of my period. 12 days lots of times, 16 days sure, 17 days also happened. I do have pcos so that might explain the irregularity.

I didn't get on that well with OPK's. I never had a real positive but they went a bit darker (but not dark enough) and then lighter. Even when I had a confirmed ovulation (by the fertility clinic).

Three people could have told you - the doctor, the pharmacist or you.

You only had to take a bit of responsibility and read the leaflet.

Or the doctor or pharmacist only have to remember your exact circumstances, the drug side effects and interactions between naproxen and any other drugs you might take including over the counter.

There have been some comments about the GP prescribing when it's not recommended to use it pregnancy - It's fine to give a medication that isn't safe in pregnancy if the condition you give it for (period pain) doesn't occur when you become pregnant.

I take Naproxen for pain. I have done for at least 2 years and it says very clearly on the patient information leaflet that it might affect fertility. Whenever I get prescribed a new drug I check the leaflet thoroughly because at the end of the day I'm responsible for what goes in my body

Ok I take the point, I should have been more thorough in my reading of the leaflet. As I said previously that's on me I'm aware of that. I just found it surprising that after explicitly telling the dr we were trying to TTC (it says on the leaflet to consult a doctor if TTC) which is basically what I was doing.

And in response to the pp saying this is a doctor bashing thread, not at all. I've already said my title was written out of shock and was OTT. I absolutely respect dr's and the NHS. I think they do an incredibly difficult job, under a lot of pressure. I also take the point from helpful dr's in this thread that it appears this study is potentially unreliable.

Thank you to the pp with the book recommendation! Will get educated!

JinglingHellsBells
We all know that Dr Google knows far more than any GP 😫😫😫

well most of the time it does.

Especially this time when it was an NHS information site that came up at the top of the search for that drugs.

I've lost count of the times people I know have been misprescribed by GPs and my father was almost killed by being given the wrong drugs by a GP that were contraindicated for anyone with his condition.

I'm responsible for what goes in my body

And a GP could be sued or struck off for giving inappropriate drugs.

If this wasn't 'only' fertility as the issue, and more life threatening, would you say the same thing- that the patient is the one to check the drug's safety? It's the dr first, the pharmacist 2nd and the patient last of all.

What about patients who are illiterate / or dyslexic and cannot read 2 sides of small print of all the possible side effects?

JinglingHellsbells - I see what you’re saying but this wasn’t a life-threatening omission by the GP.

They can't know every single side affect for every medication, they will be ensuring it's safe for you and that it won't affect any other medication you are on but they can't expect to know all the others, it's a common painkiller for women with endometriosis and often prescribed for women TTC me included, you read the insert which you are expected to do and you don't feel it's suitable so you can ask for something else now

The naproxen is the least of it!

19 years of painful periods with seemingly no investigations, no referral to a gynae is outrageous but sadly not uncommon.

As you're wanting to ttc you need to push to get a proper Dx and treatment.

I have endo - one of the symptoms is painful periods.

It's also a symptom of fibroids, adenomyosis and pelvic inflammatory disease all of which can affect fertility.

Agree about not being fobbed off with an ultrasound as they don't show endo.

Certainly upon learning that you're now also wanting to conceive there's really no excuse at this point for STILL not referring to a gynae!

If you usually see the same dr you need to see a different one and do what you can to get a referral - not easy unfortunately.

Gynaes too are frustrated that women are not usually referred to them until they experience fertility issues or even mc.

"Women's health care is sadly lacking and GPS need to come up to speed." It's really shocking how badly women are treated in primary care and not just on "women's" issues.

"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 but too often endo sufferers are/have been told there's "nothing wrong cos nothing showed in bloods and ultrasound" when endo wouldn't on these anyway. If these show another condition that precludes endo fair enough

"I'd be looking for a different doctor. One who take painful periods seriously." Sadly this is very common. Gp's that ARE good on women's health are very rare

"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!!!" Don't presume. Entirely possible the op has raised the issue many times and been dismissed. I'd had endo textbook symptoms and regular GP visits due to the symptoms to different GP's, male, female, old, young, even some with gynae qualifications pre gp training and STILL never got a go referral to gynae. It was discovered by accident upon surgery for 2nd mc.

My dd has had an ongoing gynae issue almost a year, seen Gp's in our surgery at least once a month, they keep temporarily treating symptoms. She's now extremely distressed and worried it may be something serious that may impact her future fertility - she's almost 18. Last 2 visits have been to a GP with a gynae qualification. I'm an ex nurse and I'm honestly stumped what to do next - making a formal complaint round here often leads to being removed from list and not getting another GP until a higher authority intervenes which as dd also has a disability is really not a road we want to go down. I've even spoken to practice myself (with dds permission). It's infuriating. I'm seriously considering asking my parents if they'll pay for her to see a gynae privately. I can't afford that neither can dd. Parents aren't wealthy but could possibly cover this.

"I'm not sure why you've been prescribed naproxen....have you tried mefanemic acid or transxemic acid?" After 19 years treating the symptoms is unacceptable. Op needs a gynae referral.

I note NONE of the GPs responding have said anything about 19 years without a referral or Dx!

"I then hit a bit of a wall and realised it's not normal at all and pressed my GP more. I had an ultra sound (plus an internal) and they said there was nothing there to suggest endometriosis" ffs! Sorry op NEITHER of those will definitively rule out endo, you need an exploratory laparscopy.

The query was about naproxen and fertility.

I'd be annoyed with the doctor.

Yes, of course you could have read the leaflet more carefully but expecting your doctor to give you accurate medical advice is hardly having unreasonably high expectations. Doctors can't rely on all of their patients having the ability/capacity to understand the information that accompanies medication.

Here the consequences weren't life threatening but the doctor's attention to detail in this instance hardly inspires confidence that he/she isn't making mistakes elsewhere.

Yes, YABU “unspeakably angry” is a ridiculous overreaction to a short delay in TTC.

I found recording my temperature incredibly helpful. Having totally irregular periods, I never knew when I was in the 2 weeks between ovulation and period.
Knowing when I'd ovulated reduced the amount of time I was wondering am I/aren't I.

Not sure it helped us concieve as such but I always had a better idea of whether we had DTD within the right timeframe! 😉 From a psychological point of view it was invaluable.

Good luck.