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Original poster

No pill without smear test?

121 replies

eilidhfi · 07/08/2008 16:20

I've just been told off for missing my appointment for a smear test today (I forgot I booked it, does your memory ever come back after pregnancy?!) anyway the nurse told me that they wouldn't prescribe me any more contraceptive pills until I've had a smear test.

I've made an appointment for next week so it's not a problem but out of interest are they allowed to do that? Are smear tests mandatory?

OP posts:

expatinscotland · 07/08/2008 20:49

i'm shocked the age for a first smear has been raised so high when the average age of first sexual intercourse is falling, too.

saralou · 07/08/2008 20:49

lubyloo, taking the piil doesn't impact on wether you get cervical cancer

tissy · 07/08/2008 20:51

The money from screening quotas (which isn't a huge amount compared to the practice budget) goes to the practice, and not straight into the GPs pocket. It may pay for another nurse, a surgery refurb, secretaries or leaflets. Not the GP's second Porsche.

tissy · 07/08/2008 20:53

sarahlou, but being sexually active and not using barrier methods does. How else do you suggest the GP's identify the people most likely to be at risk of catching HPV?

tissy · 07/08/2008 20:54

(may have been confused at the questions batted back and forth between sarahlou and lubyloo

expatinscotland · 07/08/2008 20:56

i'm just so sad when i read of young women not having their smear tests .

it's so, so awful, when you find out you even have an abnormal one. the wait for the colposcopy, biopsy, treatments.

you're scared you're going to die or not ever be able to have any kids.

there's a poster here, fairly young but had fortunately completed her family, who recently had to have a hysterectomy for cervical cancer.

please, please, put aside your anger and just go for one!

potoroo · 07/08/2008 20:56

A dear friend found lumps in her breast through self examination. She had a mastectomy and year of radio/chemo, but survived. I don't think self examination was a waste of time in her case.

My father underwent a routine prostate screening (not in UK) because that was the recommendation for people his age. He had no symptoms at all, but he was found to have cancer. It was detected early, he had surgery and is fine.

saralou · 07/08/2008 20:56

tissy, thats what lubyloo said, i asked her who says, she then asked me to clarify...

i agree with you, it's the people saying it doesn't i'm disagreeing with!

ElfOnTheTopShelf · 07/08/2008 20:57

My doctors at my surgery look poor as church mice, but they have always been nice and I have always felt they have looked after me - several home visits during my really ill period at Christmas - even a home visit from the doc on Xmas Eve, who followed my case at the hospital for two months to get me more information about what was happening (as the hospital didn't have a clue).
Very nice letters about smear tests and a drop in clinic of a Thurs evening to get your BP done & repeat prescription for the pill.

lulumama · 07/08/2008 20:58

i think it is silly to suggest that denying the pill would cause women to get pregnant.... get alternative contraception instead if you feel that strongly.. and totally agree with combustiblelemon and tissy

i had abonormal test results back in november and had to have another test in april, whihc came back normal thank god.. it is so worth having it done.

expatinscotland · 07/08/2008 21:01

potoroo, my father's prostate cancer was detected after he went to see his doctor about erectile dysfunction.

right away, they checked his prostate, because in men his age, an enlarged prostate is a more common cause of ED.

luckily, his was also caught early and prostatectomy and a short course of radiation got rid of his cancer and recurrence of it.

Sidge · 07/08/2008 21:15

I'm a practice nurse and would never withold the pill prescription from a woman due it without VERY good reason - being due a screening test is not a very good reason for refusing contraception.

Having a smear is a really good idea but getting your prescription shouldn't be dependent on having it. I always take the opportunity when doing a pill repeat to check if a woman is due her smear and if she is I advise her to make an appointment and talk through any questions she may have.

And that Daily Mail article has an incredibly misleading headline - the current guidelines are that women should be breast aware, rather than religiously checking their boobs monthly. That does not equate to not checking your breasts at all.

And also if you read it they say it has no impact on breast cancer deaths, not the incidence of cancer itself. I would be interested to see if women who are not breast aware have a higher incidence of invasive cancerous tumours.

Back to the OP - I would write a letter to the senior GP partner and practice manager and express your concerns at the nurse witholding your prescription.

potoroo · 07/08/2008 21:21

Expat - glad to hear he is well. It is possible my father was suffering from erectile dysfunction and I have just blocked that bit of the conversation from my mind ;)

Anyway, my point was that, yes, I do think prostate screening should be routine...

Upwind · 07/08/2008 21:40

So being on the pill increases your chances of being sexually active. Being sexually active increases your chances of contracting HPV. Contracting HPV increases your chances of cervical cancer. Therefor women should be denied the pill, unless they consent to regular smears, because it increases their chance of cervical cancer?

That is both incredibly patronising and an illogical approach. It assumes that women don't know whether they are at higher risk of HPV. And that they don't know what is good for them - for some the fear of a smear is worth the very tiny risk of cervical cancer going undetected.

Why can't they cut to the chase and just test for HPV as they do in other countries? That way people who have it would be aware that they may spread it (my best friend has it). I am certain that if I've not caught it by now, my risk of catching it is effectively zero.

Even if I was abstaining from sex for some reason, I would still take the pill, because I have the menstrual cycle from hell. The pill means I don't have to spend a few days out of each month dosed up on painkillers and I don't get crazy mood swings.

expatinscotland · 07/08/2008 21:47

Because believe it or not, you CAN get cervical cancer and not have HPV.

You can have HPV forever and never have an abnormal smear. Or have normal ones for decades and then get an abnormal one.

Also because it is extremely easy and cheap to treat pre-cancerous lesions which are detected by smear before they have the chance to become cancerous, if they ever will.

And sadly, not everyone is as educated as the norm on MN .

Certain strains of HPV make it more likely that a woman may develop cervical cancer - and it's not just 'the wart virus'.

I do not have genital warts. I have two strains HPV discovered during biopsy.

Testing for HPV is far more costly.

ChukkyPig · 07/08/2008 21:50

I am amazed that people are agreeing that women who do not wish to have a smear, for whatever reason, should be denied access to contraception on the NHS.

In my case I have been called for a smear every 6 months for the last 15 years. And sometimes I leave it a year because frankly it's a lot of time to have off work and a lot of hassle and it's an unpleasant thing to have done just to get yet another "unclear" result and another 6 month call back. On this basis presumably I should have been denied access to the pill. I think that's ridiculous. Whether I attend for my smear on time, or at all, is my decision as an adult woman. I should not be held to ransom. I am sure that this is unethical.

And what about women who are not sexually active but take the pill for heavy periods? Should they have to sit down and explain over and over again why really they should be allowed to have the pill please and not have to have a smear if that's OK?

expatinscotland · 07/08/2008 22:16

I just think it's sad that people are so reluctant to have one.

Upwind · 08/08/2008 08:35

Expat, IIRC it is extremely rare to get cervical cancer and not have HPV. No time to follow the links to check the sources but from wikipedia:

An infection with one or more high-risk HPV types is believed to be a prerequisite for the development of cervical cancer (the vast majority of HPV infections are not high risk); according to the American Cancer Society, women with no history of the virus do not develop this type of cancer. However, most HPV infections are cleared rapidly by the immune system and do not progress to cervical cancer. Because the process of transforming normal cervical cells into cancerous ones is slow, cancer occurs in people who have been infected with HPV for a long time, usually over a decade or more.[17][18]

------

An alternative approach to denying women the pill if they don't have regular smears would be to make people more aware of the risks of contracting HPV. The types of it that lead to warts are not the ones that cause cancer.

expatinscotland · 08/08/2008 12:29

Someone on here managed to get it without the HPV, Upwind. Rare as it is, it does happen and man, I'd hate to be the one it did happen to and not have it caught. As it is, the poster had a hysterectomy.

I don't agree with denying hte Pill to someone because of a test, but it continually saddens me that people don't have one done.

Yes, it's invasive and not pleasant, but lemme tell you, the treatment for cervical cancer is FAR more invasive and painful. Not to mention, being dead is no fun.

It really and truly is the cheapest and most effective way to detect the precancerous changes that may lead to cervical cancer.

expatinscotland · 08/08/2008 12:29

I don't agree with denying hte Pill to someone because of a test, but it continually saddens me that people don't have one done.

Yes, it's invasive and not pleasant, but lemme tell you, the treatment for cervical cancer is FAR more invasive and painful. Not to mention, being dead is no fun.

It really and truly is the cheapest and most effective way to detect the precancerous changes that may lead to cervical cancer.

zippitippitoes · 08/08/2008 12:46

my gp practice doesnt prescribe the pill to women over 49

which surprised me so i went toi the family plnning clinic instead

i think they asked how recent a smear test id had but i doubt they are going to check

what is hp/v

expatinscotland · 08/08/2008 12:49

human papilloma virus, zippi.

there have been many strains identified already.

some cause warts and verrucas. others can cause cervical cancer.

zippitippitoes · 08/08/2008 12:50

my knowledge of sexually transmitted disesase is pretty low

expatinscotland · 08/08/2008 12:56

some of these strains of HPV can be transmitted just by sexual contact, not even needing to have intercourse.

zippitippitoes · 08/08/2008 13:01

presumably they show up when you have those std tests

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