Who do I complain to about being refused a smear? I'm going round in circles, help

[CheeeseOnToast]

Rather long backstory, full story here, brief resume below:

Have a history of abnormal/borderline smear tests, but last one came through fine so been requested a recall in 3 years time. That's May 2011. For the last year I've been getting breakthrough bleeding on my combined pill (Microgynon, was then changed to Celeste 6 months ago, problem persists). I've also been getting worse and worse cramps and the BTB is lasting longer (last month I had almost three weeks of bleeding out of the month, 3 days for my 'period' the rest a persistent spotting).

I saw my local family planning centre three months in to taking Celeste, and told them I was still having the breakthrough bleeding and I was concerned about my smears and asked if I could have an early one. They said no, and that I should rule out any other potential causes before having a smear, and they told me to come back in four months for pill renewal if all was negative. So i had a full STI screening, including HPV, HIV, and everything else - all negative. I didn't want to hang around for four months so I bypassed the FPC and went to my GP, and he said of course I could have a smear test, and recommended I book it in with the nurse at reception. That appointment was today - and she refused to do me a smear test.

She instead said she'd change my pill to a progestogen only pill (Cerazette) which she said would control the bleeding. I told her I wasn't happy about not being given a smear test, and she said that unless it was decided by the local health authority, she 'wasn't allowed' to give me one.

So now I'm home I've done some research online into this pill and it states that this pill should not be given to anyone with "Abnormal vaginal bleeding of unknown cause". Is this not what I've got?

I'm really cross. I am 28, which she seems to think puts me in the 'don't bother with' category, despite the fact that my good friend - younger than me - recently had to have surgery for abnormal cells. And another friend had cervical cancer at 25.

So what do I do now? I really don't want to just wait until next May, it feels too long away. Can I contact my local health authority directly (somehow bypass the GP?) and get them to send me an 'invite'?

I'm getting quite stressed about all this and it's all rather ridiculous, I don't understand why they can't just do it, then if it's ok I just wait three years from now, it's not like I'm saying I want one now and then another again in May.

What do i do? On the other thread I started (link earlier in post) someone suggested getting a smear done privately, I will do this if necessary but just think I should be able to get one on the NHS. And why am I being prescribed a pill that specifically states should not be given to someone with unexplained bleeding? how will I know if there's a problem or not if I start taking a pill which in its own literature states that it causes changes to bleeding?

Sorry this is so long. Please someone help, I'm so confused.

Purplepeony - as you say most/many take their lead from their GP or Dr.
That is why I post on here to try to:
(a) explain as with the OP's case why her primary care won't do an early rpt test/out of programme testing
(b) encourage women to seek appropriate tests/investigation for their symptoms
(c) link to information that is available for women to educate themselves about screening, what results mean, about treatment
(d) and understand what treatment and investigation they should expect under the NHS guidelines

A smear test won't tell give the answer to many of the causes that cause symptoms such as vaginal bleeding such as chlamydia and OCP incompatibility; to do one can be wrongly reassuring.
Just because a test is perceived as cheap doesn't mean it's the right one to do. Managing the demand for and use of appropriate testing is a major problem in hospitals, as less experienced clinicians fire off requests for a battery of lab tests, it looks good to the patient and their family, but if they're not relevant or won't give the answer then its not a good use of resources.
Often women think because they've had a recent negative test that it's not worth them going back to see their GP or accept no further testing.
For the majority of women with symptoms such as vaginal bleeding and pain, a smear test is not an appropriate investigative test - HVS, visualisation of the cervix and possible referral to gynaecology is.

ater 1st abnormal smear i was checked 6mnthly had 2nd abnormal smear and was adviced the prcedure was if 3rd abnormal would be sent for coloscopy and if necc a biopsy if another was abnoral after this. 3rd was normal so no coloscopy but will be called back every year now for rest of life regardless of next reults...is this not standard if it is nationwide screening program?

hi everyone, thanks so much for your input. Especially Bela and PP - much appreciated.

I understand now that I need other investigatory tests etc rather than another smear. It didn't help that my GP didn't suggest anything else - i didn't realise there was a better route of investigation. I have an appointment on Wednesday night with a female locum GP at my usual practice who hopefully will refer me to a gynaecology dept which might shed some light on what's going on.

In the meantime, does anyone think it would be worthwhile stopping taking my pill? As it might help determine whether the bleeding is being caused by my pill somehow? It wouldn't be ideal, DP has a latex allergy, but we could work around. Or should I just continue as I am and wait for referral?

good luck for tomorrow =- probably a question to ask tomorrow

Thanks Stealth, I'll ask tomorrow.

Thought I'd update, for anyone interested. Saw the locum last night and she wouldn't refer me to a gynae dept because she said "they wouldn't do anything anyway".

She recommended that I stop taking my pill at the end of this packet and see how it goes - if I still get BTB then she will refer me to a specialist but if not then we'll know it was the pill causing the bleeding, and she'll change my pill. She seems to be very pro-cerazette (which would actually be suitable once we've ruled out that the breakthrough bleeding wasn't "unexplained vaginal bleeding" but just hormone inbalance caused by current pill).

But I think I'll research into other POPs and see if I can try another - seen quite a bit of anecdotal evidence on here that when people come off cerazette and try to conceive there seems to be a high instance of miscarriage. But nothing's been proven... will try and look into that properly nearer the time.

So, that means taking "extra precautions" for the next few months. What fun!

so you wait! Well I suppose that's better than them doing nothing at all

Almost didn't recognise you there, SPB

Yep, just wait now. It does actually make sense, it would have been good for someone to recommend it earlier though (like the GP, FPC, nurse...) but hopefully the problem will stop then I'll know it was just the pill doing it.

Hallo Cheeese and thanks for the update.
Another possibility could be conditions such as endometriosis or adenomyosis as these can cause both the increase in cramping and prolonged bleeding. Fibroids can also cause this (all of these are benign conditions BTW).
I used to get incredibly painful periods, which eventually turned out to be cause by endometriosis, adenomyosis and an ovarian cyst (I have got experience of being a patient too!).
Years ago when I was on OCPs I had to change types because of the problems with 3rd gen pills and the one I got changed to was horrendous and made me really crotchety, cross and miserable. It took several months to twig that's what had caused it but with another change the mood swings went.

Interesting that the locum wouldn't refer you to gynae at this point. Did you ask if they'd seen the NHS guidelines on vaginal bleeding doc (I linked to it earlier on the thread)? Part of the doc says a visual examination of the cervix should be part of the investigation so did they do that as well as the infection testing?

If stopping the OCP doesn't sort out then I would push for a referral - there are gynae who specialise in areas such as this.

Hope it's sorted soon, but please do go back to your GP and push them for a referral if it doesn't resolve.

Hiya Bela. I did say to her "don't the guidelines state that as I have vaginal bleeding there should be an examination of the cervix at some point?" but she brushed me off and said she doesn't think it's necessary. She said I can come and see her again after I've had a few months off the pill. Not sure how I can arrange to see her again seeing as she's a locum covering my usual GP's holiday . No the FPC didn't examine me either, just took bloods and I did the DIY swabs in the bathroom.

I will definitley push for a referral if it doesn't sort itself, believe me. Thanks for all the advice, I really appreciate it.

Hmmm, tricky one that,
Is there another GP you can see, or perhaps when your usual one is back from holiday?
Anyway don't give up - if it doesn't improve soon, hassle them.