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?!

No I wouldn’t be angry as I read the side effects of medicine.

Not sure where you went to medical school, Chanelprincess, but I think you have overlooked something rather important:

All the information on the eMC website comes directly from pharmaceutical companies. Approximately 200 pharmaceutical companies subscribe to the eMC and so pay Datapharm to publish their information on the eMC website

The EMC is a Pharma-funded website. Pharmaceutical companies have an extremely low threshold for advising against prescribing their drugs for anyone trying to conceive, pregnant, breast-feeding or for children, because they are worried about being sued. It is totally normal to prescribe drugs against EMC guidance, which is primarily designed to protect Pharma companies, not patients.

In the UK, the definitive advice on prescribing is the BNF which, as posters have explained above, does not advise against prescribing naproxen when TTC. A GP who followed the EMC guidance over the BNF would be at odds with NHS and NICE guidance. HTH.

I am a gp too and not heard of this and I train GPs. The study was only done in 39 women and no peer reviewed. So not great evidence currently and it was reversible. Don't think you should be angry but choose carefully where you get your information.

Did you read the patient information leaflet because that states that Naproxen may make it more difficult to get pregnant?

True - but there are also 56 side effects listed... the PILs are not really fit for purpose

OP, re the painful periods - have you had your thyroid checked lately? I had mine at a routine check and discovered it was underactive, so have been on a low dose of levothyroxine. My periods are no longer as heavy and painful, in fact I don't know how I managed them before (I'm 46, so have had 20+ years of pain)

That's interesting @onefootinthegrave There is a history of that in my family, both my dad and aunt have it so that's definitely worth me asking about. Thank you!

I think you perhaps should ask for a referral to a gynaecologist. The naproxen might just be a coincidence. If you’ve been expecting painful periods you may well have endometriosis. Push for the referral though as it took me three visits to gps with pain and I just demanded a referral third time around. I was diagnosed with endometriosis and had it quite severely. I have had two children though, so lucky. It can affect fertility which is why I think you should get checked out for this.

• experiencing

I might expect the GP to check the BNF. As pps say, the BNF only mentions long term use (of NSAIDS as a group) being associated with reduced fertility. A couple of days a month wouldn't strike me as long term use.

Non-GP doctor.

Not sure where you went to medical school, Chanelprincess, but I think you have overlooked something rather important:

I'm not a practicing physician in the UK so don't need to follow BNF guidance. However, I do use the SMPC/PI as the main source of information on potential side effects of a drug. I'm not sure why you're referring to an SMPC as "EMC guidance". The following EMA guidance (that's the European regulatory body for the approval of all new drugs within Europe) provides a clear explanation:
www.ema.europa.eu/en/human-regulatory/marketing-authorisation/product-information/how-prepare-review-summary-product-characteristics
The key information here is: "SmPCs are a key part of the marketing authorisation of all medicines authorised in the European Union and the basis of information for healthcare professionals on how to use a medicine safely and effectively."
The BNF states: 'In general the doses, indications, cautions, contra-indications, and side-effects in the BNF reflect those in the manufacturers’ data sheets or Summaries of Product Characteristics (SPCs) which, in turn, reflect those in the corresponding marketing authorisations (formerly known as Product Licences).' The BNF guidance at times may be at odds with the SMPC of a particular drug, but there is no question of "protecting" pharmaceutical companies. Patient safety is the key focus of any regulatory approval. Therefore, its not unreasonable for GPs in the UK to be familiar with using SMPCs.

None of that changes the fact that UK doctors follow the BNF Chanelprincess and that your earlier post suggesting that a GP might not be fit to practise because of anything on the EMC site (or indeed SPCs, PILs etc) that contradicts the BNF betrays a total ignorance of UK prescribing norms. You don't know what you're talking about and you are whipping up misplaced anger at a GP who has done nothing wrong.

have you researched Endometriosis ?

Presumably if that's the case it would have highlighted in the patient info leaflet with the meds that it's contraindicated or cautioned for women trying to conceive. It's up to you to read the leaflet

Should the GP not be trying to establish why the OP has such excruciating periods in the first place?

The findings of an observational study in 39 patients really shouldn't influence practice. You can use Google to find poor studies that will show an association between just about any drug and any side effect. I didn't know about this (weak) association before and I'm not really any better informed having now read about it. DOI: Doctor, researcher, wouldn't be a GP for 5x their salary because they really can't win whatever they do.

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.

I have to agree with the above. There is thought to be a possible link but not unequivocal and not confirmed. It is mentioned in BNF/PIL because all reported side-effects are included (however anecdotal). The study does suggest a link, but needs to be taken consistently for at least 10 days- even then, because the study is small it really cannot be stated that naproxen definitely causes suppression of ovulation in a certain % of women.

However, if you don't like or trust your GP you may be better off seeing someone else if at all possible. That would be a reasonable course of action.

Naproxen can be bought over the counter? The one I bought is one tablet per twelve hours. Brilliant for very painful periods, I don't know about side effects though. I wouldn't bother with the GP, just treat yourself. It's easier.

My GP didn’t know about this side effect either. She’s an excellent GP who I have every faith in. I don’t think doctors can be expected to know every single side effect for every medication.

XXcstatic
Hardly 'whipping up misplaced anger'. My wording clearly stated that I personally would question their suitability to practice. If I was in the OP's shoes with access to the information in the PIL, I would expect to have a discussion to better understand the evidence behind this, before making an informed decision.

Dear showmethegin I take it that comment regarding NHS time and money for an otc drug was aimed at me?
I stand by what I said.
Irrespective of where the pain is I would expect somebody to do research first. Plus speak to a pharmacist for advice, the NHS is in crisis and its not helped by people getting otc meds prescribed for them, the surgery is charged for every prescription cashed as well as the NHS for the meds,
And I am speaking as a chronic pain sufferer,as a result of a massive car accident 20 years ago where i nearly lost my arm and breaking my back in three places plus having arthritis all over my bod, AND drug allergies limiting what I can use. So I do speak from personal experience as well...
I am currently paying for a sports therapist to help with my back pain to stave off an operation my consultant wants me to have a long with accupunture. I also check with anything the dr offers as to whether it can be purchased otc and usually consult my amazing pharmacist before seeing the dr... and if anyone comments on affordability, I am currently in receipt of free prescriptions but still prefer to do the above at my own expense.

If I was prepared to take it again I would. If the doctor was aware I could buy it over the counter and had advised me of this then I would have (probably would have been cheaper). But funnily enough when I'm crying out with pain with my head in the toilet, getting on google and trying to diagnose myself isn't top of my list.

As it is I will be going back to the doctor to get more investigations done. Pain relief isn't the only reason I went to the doctor it was to see if they could do something about it.

"Should the GP not be trying to establish why the OP has such excruciating periods in the first place?" Yes. But they don't. Frequently patients are fobbed off, left suffering or if lucky might be given treatments for the SYMPTOMS without a cause being established until fertility issues come to light or even mc, early and late or premature births and even stillbirths.

Even then you need to have 3 consecutive mc to even get that investigated and that's been the case for at least 3 decades to my knowledge.

It's an invisible scandal in my opinion.

OJZJ - the op went to see the GP AGAIN about a chronic pain issue she's been suffering from for a long time and quite possibly the pain is too severe for otc meds - for all we know the prescription is for a stronger firm of this med. She couldn't predict what the GP would do either.

In addition not everyone can afford to buy meds otc, it seems to have passed you by that there's a major poverty crisis happening in the uk right now and the sick and disabled are among those suffering most.

You are lucky, financially, to be in a position to pay for a sports therapist and any meds which are available otc. Many aren't that fortunate.

I thought all anti inflammatory meds and also pseudoephedrine can stop you ovulating

Have you tried buscopan and co codamol together for the pain

Difficult one. I’ve been in a similar situation whereby my Dr told me to use ibuprofen when I had leg pain after a virus. I explained exactly as you did above and his words were ‘many women conceive while taking ibuprofen’. I was a bit surprised but then, I put it down to the fact he’s a GP, not necessarily a fertility consultant and a little bit of not always what you read is true. That said, I believe what I read about it. So I don’t know. Interestingly though, I ovulated a week late that month. I only really worked it out when I was a week late but not pregnant.
Maybe worth seeing someone to see if there is an alternative you can use while you are TTC x

GPs are nothing more than the first line of defence to fob you off at the first instance to save the NHS money.
It seems that you have to thoroughly do your research online now before even visiting the GP (and let's face it, when you're ill you can't get an appointment for toffee, so you have to prepare plan that as well 😯).
I'm glad that you found out now op and yes, I'd complain to the doctor about it, they get paid enough to be on top of all this.