How can I get my gynaecologist to listen to me?

[BeaLou95]

Hi all,

I hope you don’t mind me posting here. I’m not actually a mum but I don’t have a mum to ask this advice of, she passed away four years ago.

I’ve got a follow up gyno appointment in a few weeks time. I’ve been referred because for the past three years I’ve had difficulty with bleeding which the doctors have always put down to the pill. I’ve tried every pill in the book now and nothing really seems to work. Ideally the doctors want me to ‘tricycle’ my pill, so take three packets at once, but I can’t make that time without bleeding, and its not spotting either, its like a full blown period. The only way to stop the bleeding is to take my week’s break and then start again. Often I can’t even make the full first month of pills without bleeding. It’s very frustrating!

I’ve had an ultrasound last year and nothing came of that, and I’ve had a cervical examination, which looked normal but they wouldn’t do a smear test because I’m only 23. I have been tested so I haven’t got an STI that could be causing the problems.

The doctors won’t give me the implant or the injection (I’ve tried the injection before and just bled constantly) because they say I’ll just bleed, but they are really trying to force the coil on me, which I absolutely don’t want.

I feel like whenever I talk to them, they are absolutely awful to me. They are so rude and assuming. One nurse told me ‘well you need to sort something out because you’ll be on contraception until you’re 50’. I was like, that’s why I’m here!! She said ‘you can’t even have sex if you’re always on your period anyway’. I sat and cried in the room and she was just awful. She kept saying ‘get the coil!’ And wouldn’t listen when I tried to explain why I didn’t want it.

I don’t want to come off contraception because I don’t want to rely on condoms. I am terrified of getting pregnant - I don’t actually want children (I realise mumsnet isn’t the best place to say something like this, so please don’t judge me) - but of course, I’m treated like I cannot possibly know that about my own body and life and constantly told by the medical professionals, who are strangers, that I’ll ‘change my mind’. I’ve had several incidents where condoms have broken, thankfully being on the pill pregnancy wasn’t a risk, but if I came off some form of alternative contraception, it could be. (Also please don’t judge me for using both condoms and the pill - I don’t sleep around, but I am so scared of getting pregnant that I like to use both to be completely comfortable in the idea that I won’t get pregnant).

My last few appointments have just been awful, they haven’t listened to me at all, they just keep saying they want me to get the coil.

But since February I’ve been seeing someone new and have had more symptoms than just the bleeding (I hadn’t slept with anyone in quite a while, so for a long time bleeding was just the issue).

I am finding sex painful, I’m incredibly sore afterwards and my last period was really different to usual - this is very gross and probably too much information - but I was passing entirely clots. There wasn’t any liquid blood, just clots (I wear a mooncup so I know this). Again, too much information, but in the three weeks since my last period, I have been having significantly more discharge than usual. I’m really sorry if this information is inappropriate for the forum!! I’m happy to remove this post - just let me know.

I want to explain all this to my gyno at my next appointment, just because these aren’t ‘normal’ experiences for me, but based on our previous appointments, he won’t let me get a word in edge ways! I’ve seen female and male nurses and my gyno is male, and it’s like non of them have time to listen to me but only have time to tell me how I should get the coil, even though I keep telling them I don’t want it!!

Just to note, my concerns are with the coil; if I have the same problems on the coil with my bleeding, I know I’ll have to fight to get them to remove it. The pill I’m on at the moment is the strongest dose pill they offer and I still have these problems, so I’m skeptical as to weather an IUD, which is a lower strength, would be successful. I also suffer severely with anxiety, so I like taking a pill every day and knowing that I am actively preventing pregnancy, I struggled on the injection because I felt unsafe because I wasn’t ‘actively’ doing something each day to prevent pregnancy. The very idea of pregnancy absolutely terrifies me, and so I like taking the pill and feeling in control, if this makes any sense? And lastly, I absolutely do not want anyone going down there to insert it! I know it sounds silly but unless its someone I absolutely trust, and its happening because we’re both in the mood, the thought of someone being ‘down there’ feels very violating. I can’t explain why I feel like that, I just do. when I had my cervical examination I had a very lovely nurse do it who I have seen a lot and I still cried. I can’t even voice these concerns to my gyno because he doesn’t let me get a word in!

So basically I know its all very silly, but I don’t have my mum here to ask for advice, or to come with me to helpme have my voice heard, but how can I make sure my gyno listens to my problems rather than just trying to force me to get the coil and not even listening to what’s going on?

Has anyone had anything similar?

Sorry if this isn’t the best place to post, please advise me if there is somewhere better.

Have you checked your symptoms to see if they are similar to endometriosis?

What's your blood loss like - bright red or is it darker almost brown blood?

I have endo and my symptoms were similar to yours, except I had painful periods too. Pain during sex was caused by endo adhesions at the top of my vagina.

Hope you get sorted soon x

I also thought maybe endometriosis (I don’t have it but there’s an advert running on TV here to raise awareness and a lot of the systems are as you’ve described). I also don’t think it’s uncommon for women to struggle to get a diagnosis even if they see a gynaecologist.

Systems, sorry I meant symptoms

Hi BeauLou, first can I say you absolutely will not get judged on here for not wanting children or for taking sensible precautions to avoid an unwanted pregnancy.

I'm not a doctor but based on what you said I think you absolutely should have a smear test to rule out cervical cancer. Your GP surgery should be able to do this, but if they won't, a sexual health clinic can too. You might find it helpful to chat to a sexual health clinic as I think you will find them a lot less dismissive and patronising.

I am sorry you have had such a negative experience with your consultant and other HCPs. I can only advise you to keep pushing, be clear about what you want and don't let the patronising comments get to you. You have the right to a second opinion, so if your consultant isn't listening, you could try someone else.

You are absolutely right to keep pushing for an answer to this. There are organisations like PALS who can help you make a complaint if you need to.

Sounds like endo to me. Have you had any investigations for that?

I agree with embarrassed it does sound a bit like endo or maybe polyps. It maddens me when the refuse to perform a smear test because of your age when you are presenting with symptoms and they should want to rule it out.

Firstly though, although this is "Mums"net you don't have to be a Mum to post.

This is the site where anything goes (we are known as a nest of vipers but we are also loving and supportive, we tell you straight what we think) so if you are posting in Women's Health about your gynae then of course there will be information about what is happening to you.

Have you a trusted friend you could take in with you? I found it helpful to have a list of statements I wanted to make about my symptoms, a list of questions and also a list of things I wanted to say.

I was lucky that my gynae (male) was lovely, and did listen even when he recommended a treatment and I said no and explained why. I think you need to do your own research about bleeding through the pill and then you can ask questions.

I think having a list of all the pills you have tried just to recap for your gynae would make sense. Good luck.

Thank you all so much for replying and all of you for being so lovely and not judging.

I wasn’t sure where to go to for advice, but I’m glad I came here, thank you. I’m still not quite sure how to reply to each individual - still figuring the forum out!!

But @embarressedbymyhouse, my bleeding whilst I’m taking the pill is brown, I only have red blood for the first two days of my period during my week break, then during the rest of my break it is darker. But it is pretty much always brown when I bleed during the pill. What does colour mean in terms of endometriosis?

My periods were relatively painful and heavy when they were natural - i.e before I went on birth control, but its been about five and a half years since I’ve had a ‘natural, real’ period, so I’m not too sure what my real periods would be like now if I wasn’t on contraception. Even on the pill I do get quite bad period pains, but usually only for the first couple of days and I can usually control it with painkillers. I’m not sure that the pain I experience is more excessive than what most women experience? What I do know though is that my periods haven’t been lighter or less painful than the periods since being on the pill than the periods I was having at 18 were and this has been the case with All of the pills I have tried. I often actually think that the pill has done little to my body (except prevent pregnancy of course and potentially cause or contribute to these crazy abnormal periods); my periods are the same as they were pre-birth control in terms of pain and heaviness, my boobs never grew on them like everyone else reports (very disappointing as I’m petite framed and so naturally flat chested!! 😂), and I never experienced mood swings or depression or weight gain.

@expressedways, @babysharkah, @electriclions - it seems a few of you are suggesting endo. My gyno suggested a laproscapy to rule this out, but again, because he was so focused on ‘get the coil!’ He kept talking about how they could insert it while I was under general. This freaked me out even more - I’m not comfortable with the idea of someone inserting one while I’m awake, so I definitely don’t want someone down there while I’m unconsious, on drugs and have absolutely no control over what is happening to my body! Then I had a follow up appointment with a nurse (for the gyno, he wasn’t available) and she was talking about me getting this laproscopy (it seemed as though my gyno had requested it), and again, mentioned the coil, which again, I said I didn’t want and after some arguing she said ‘okay I’ll put a note on your records that you don’t want the coil inserted during your laproscopy’. I was fuming because I didn’t think they would do it given how much I had refused at my last appointment. This all happened about two months ago and I never got a letter through about my laproscopy and I didn’t chase it because I was so put off by the thought that even after I’d said, they’d put a coil in while I was under. I know I’m being very dramatic and over the top but the idea now terrified me because what if I wake up and they’ve done it anyway! I spoke to my doctor about it and he said they absolutely cannot do that and when I get my letter through to bring it to him and he’ll check they haven’t put to do that, but obviously a letter never came and I never chased it. Maybe there has been some miscommunication about whether I’m to go ahead with the proceedure, I’m not sure.

Most the medical professionals have said though that they don’t think I have endo, and they’re just blaming the pill, but my experiences aren’t like any of my friends experiences on the pill so I don’t know what to think!

@Gintonic @electriclions - I know, I have asked my doctor for a smear test. It is so frustrating that they did a cervical examination, where they put a speculum in and looked at my cervix, but refuse to take a sample whilst down there. They even did a swab because she thought I had thrush (which I did as it turns out!) But refuse to take a cell sample from my cervix!! When I’ve really tried to get them to agree to do one, they just said that even if they did one, as soon as the laboratory saw my the age on the records attached to my sample, they would throw it away. A girl i am friends with is training to be a doctor and said the same thing 😔

I haven’t asked at the sexual health clinic though, so I’ll try go there next week and speak to them about it.

It is so frustrating though, like you say, they should want to rule it out, and with cervical cancer often being caused by HPV, surely women should start getting tested from the age that they become sexually active!

@electriclions - thank you, I’m glad you’ve all welcomed me here.

I haven’t got a friend I can take with me, they all work during the day, whilst I’m at Uni still doing my Masters, but I think I’ll write down everything I want to say, that’s a good idea. I’m just going to have to try and keep my cool; if he says ‘coil’ one more time I may flip!! Hopefully once I get a chance to explain the problems I’m having with sex, my last period etc, he’ll be more forthcoming. I’ll ring the doctor for a list of all the pills I’ve tried too, I can’t remember all of them.

When I’ve researched bleeding on the pill, it always just talks about ‘normal spotting’ and how it isn’t long term.

Even more frustrating is, they keep saying ‘if we give you the coil and you do end up bleeding, we’ll leave the coil in and just put you on the pill as well!’ Apart from that absolutely not solving the problem, when I’ve asked if I could maybe try the injection and the pill, they’ve said no?! But when I tried the injection and couldn’t stop bleeding, I went back on the pill whilst the injection was still in my system (at the doctors advice) to stop the bleeding!

They’ve said they can give the pill to stop bleeding from the injection, but not vice versa? 🤔

I’ve also asked if they could do a test to measure my hormone levels to see if I was reacting enough to the hormones in the pill, and had the right, expected level in my body (I wondered if a hormonal imbalance was causing my bleeding) but apparently they can’t do that either.

Its all so frustrating.

Thank you all so much for replying, I really appreciate it. I’ll push on a smear and speak to my gyno about testing for endo - but only if I can gaurentee that they wont put a coil in during these tests.

OP I can’t comment on the most recent problems but just wanted to say that I spent all of my early 20s with pill related bleeding as you describe and no one able to help. Just wanted to let you know it was all caused by the pill, i came off it at about 28 after I started getting migraines and they started refusing to prescribe it. Bleeding stopped straight away and I started having perfect 28 day cycles with straight forward bleeds which have continued for 10 years. We have had 2 planned pregnancies but used condoms as protection at all
Other times

@ElectricLions - seems I’ve misspelt so I’m not sure if you’ll get a notification of my above reply

@Passthecherrycoke - oh really? I’m glad to hear it was just the pill - even if it was a nightmare for you I’m glad you were eventually able to sort it.

I really wish I could do that but just using condoms scares me so much. I think because I’ve had quite a few incidents where they’ve broken. My older sister also has a three year old daughter who was conceived despite using condoms. And what if something like that happened and I didn’t realise and couldn’t get the morning after pill? Although I am personally pro-choice, it isn’t a choice I would want to hav to make myself - another reason why I am so scared! I know it all seems very dramatic and over the top, but I really don’t see a future with children so the fear of just using condoms is a real extreme thing for me 😔

Hopefully everything I’m experiencing is just down to the pill. I’m so pleased everything worked out for you. Thank you for replying ❤️

sorry OP just to be clear

have you had any ultrasounds etc? What happened about the laproscopy?

I also used Pill + condoms, it's hugely sensible.

I can't understand why they are fobbing you off. Have you tried different brands of Pill?

essentially, they don't seem to care why you are having this regular bleeding. They are OBSESSED with giving the coil, I know. It's bonkers.

But what do you actually want them to do? If the pill isn't working then it sounds like the next step would be laparoscopy/ coil (and you would have to sign a consent form with coil insertion on it before they would do this).
It really isn't clear from your OP what you actually want them to do? It is possible that there isn't another option other than coil (not a gynaecologist).
Are you in America, I ask as you're using the term gyno, which isn't really used in the UK? If so it's a very different health system.

@BeaLou95 I did get a notification.

Right, the only way to definitively diagnose endometriosis is by the laparoscopy. Firstly, even if they suspect endo they give you a shit ton of meds to see if it helps and only after you have tried all of that do they give you the laparoscopy on the NHS.

If they are offering I would take it, ultrasound scans can show up some things but not everything, mine showed cysts - caused by endo. You might have fibroids or anything so have a think about booking the lap.

Now I was private for my endo lap but you still should have to sign a consent form so I would just write across it NO COIL and sign next to that so they cannot fit one. Secondly, my lap was a lap and dye which means they checked if my tubes were blocked but this involves inserting a thin tube into the vagina and through the cervix and forcing liquid up through the uterus and they visually see it come out of the tubes inside you. So I woke up with a sanitary pad between my legs. Even though I knew they would do that it still felt like I had been violated

You may well have to accept that the pill is just not for you. That is especially shit when you have no intention of having children because contraception options aren't numerous.

Re the smear, I would book one at a clinic and pay. I had a friend who paid to have one every year as cervical cancer ran in her family.

If you gynae mentions the coil one more time I would ask if he has shares in the company

Thing is Rosa, you can sort of see their point, that If you are taking a medication that causing bleeding as a side effect, and you just refuse to stop taking it, they’re not sure what else to do for you?

They can’t change your body, and there are only so many brands of pill available to try to.

I have to say it wasn’t suggested to me throughout all of my 20s that the pill in general caused the bleeding, they seemed to focus on switching brands to fix it.

I wasted a lot of my 20s worried about it, feeling mucky all the time, worried in front of new partners etc.

Personally I wouldn’t go for the coil anyway since you haven’t had children, but there are alternatives that the OP has some emotional issues with.

A Gynaecologist isn’t really the right person to treat this side of it so it might be worth contacting your GP/ paying privately for some sexual therapy? Thats not something you can sort quickly.

@RosaWaiting

Sorry it wasn’t very clear!

I had an abdominal and transvaginal ultrasound last summer and it came back clear.

I haven’t had a laproscopy, they were talking about me having one (I wasn’t actually sure if I needed one) but then nothing ever came of it.

Glad its not just me that likes to use pills and condoms!

I’ve tried lots of different pills - dianette (a few times) cerezette, yasmin, microgynon - these are all the ones I can remember, I’ve tried a few more too!

I know, they really push on it! I can’t understand why because I have seen really mixed responses as to whether women are happy with it or not.

I'm not clear from OP posts what, if any, investigations she has had.

It would be wrong for them to just decide "it's the Pill" without doing any other investigations into her health.

@NaughtyLittlePassport

I’m not sure what I want them to do really, but I do want them to listen to me. The gyno wouldn’t listen or let me even explain my symptoms properly because he was so intent on trying to get me to agree to the coil. I just wanted some advice on how I can make myself heard especially when I’m now having other problems (painful sex, blood clots as periods, extra discharge - problems which are not typical for me) which I want to be able to tell a professional about, in case they are problematic (I know that they may not be) without being interrupted, not allowed to speak or having the idea of a coil forced on me. Even though these problems may be nothing, they are worrisome to me because my body hasn’t reacted like this before, so I want someone to listen to me and not just dismiss it. Even if its nothing if I at least have my problems listened to then I’ll know its nothing.

I just wondered if anyone else had had a gyno that didn’t listen and how they were able to make themselves heard. My next appointment is in two weeks so I just wanted it to be a successful appointment in terms of actually being listened to.

No, not American, I’m British, live in the UK, but really bad at spelling so ‘gyno’ is the easiest option for me 😂😂

OP
go in with a friend and state that you want whatever investigative tests are available and that they cannot assume your problems are caused by the Pill.

you might want to write your points down. Also say "we are NOT discussing the coil in this meeting".

point out that you were referred to a gyno in the first place because you have related problems and so far they have offered no checks at all to investigate them.

@BeaLou95
Ok, it's fine to ask for a second opinion, and you can highlight the reasons why.
Have a list of issues, things that are unacceptable to you, and questions- it's very easy to forget all the points you want covered. If you can take a friend/ relative as an advocate it could help.
Don't refuse to see a registrar. They are often more sympathetic and sometimes more up to date.
Ultimately if you are saying no to the recommended next steps it may be (i don't know) that there isn't anything else they can offer you.

@Passthecherrycoke

I haven’t actually refused to stop taking the Pill - the doctors don’t want me to come off it. They just keep putting me on different ones, like they did with you. I also take the pill for other medical reasons (acne) which I also take antibiotics and skin lotion for too.

I have asked to try different forms of contraception, like the implant but they wouldnt let me try that. I think they think I’ll just bleed on that too. I did read somewhere once (but I’m not sure how true it is) that doctors get paid for every IUD they insert.

I don’t need sexual therapy, I’m just not a sexually confident or body confident woman, and for me, having people ‘down there’ is a very intimate thing and not something I am otherwise confident about. There aren’t any underlying emotional issues nor bad experiences so to speak - just my personality! I have friends like that too and others who couldn’t care less!

@ElectricLions

Okay, I’ll raise the idea of a lap with the gyno again at my next appointment (it was his suggestion last time, just nothing seemed to come of it) and I think thats a great idea about putting ‘no coil’ on the consent form, thank you so much. It’ll definitely make me feel better!

Oh my gosh, that sounds like a horrible procedure!! I would feel violated too. I guess even if you know that they will do that, its still the reality of them actually doing it and it can just be uncomfortable knowing they did it, especially when you’re not awake! I’m glad you managed to go through with all your tests though and I hope they’ve managed to find suitable treatment for your endo.

This is the thing! Its stressful wanting to enjoy my sex life with my partner, whilst not risking pregnancy and not bleeding all the time 🙄

Okay, I’ll start looking into where I can get a smear done around the area and how much it will be.

Thank you!

@RosaWaiting thank you i will!

I’m not sure why nothing more has come of the laproscopy. Even though I wasn’t sure if I needed one (I wasn’t sure if my symptoms were related to Endo or not), I was under the impression that I was being referred for one anyway and that I should expect a letter.

Good idea, I’ll say that at the start!

Yes, I’m definitely going to write down all the problems I’ve been having with periods/pain etc. Fingers crossed he listens!!

@naughtylittlepassport

Okay, I’ll take in a list of symptoms, questions the lot. Hopefully I’ll get a chance to talk about them, if not, I’ll leave the piece paper with him.

It’s not that I’m trying to be difficult or refuse help, I’m just conscious of the coil also not working and I don’t like how they’re attempting to force it on me and dismissing my worries. I’m not sure how they can help me either 😭😔

Not sure if this has been suggested or not but could you possibly come off your pill just for a couple months, either sticking to only condoms (I know you're anxious about that but maybe for a month or two could be ok?) or refrain from having sex for those couple of months. Doing that would allow you to know whether the problem is the pill or not, and then at least you could go back to the doc and gynae and know whether it is the pill and you need a different form of contraception (that isn't the coil) or whether more investigation needs done because it isn't the pill?

Maybe worth a shot!
I've had similar symptoms to you, tried running pills together and coming off the pill, neither helped, I had a laparoscopy in Feb, they couldn't see anything but my symptoms have got worse recently too with more pain during sex to the point I have to stop constantly (were TTC so this isn't ideal!) and constant bleeding yet no actual periods if that makes sense! I asked for a smear test too and also got told that I was too young so they won't do one, I'm looking to pay to get it done privately.

Have you had a colposcopy? I have a cervix exam at the docs on Monday and she said if anything seems abnormal she'll refer me for one of them rather than a smear!

Hope you get to the bottom of the issues OP!

tbh OP given that you've tried other sorts of Pill, it seems to me that they should be investigating. I don't want to alarm you, I just think it's worth looking into.

It sounds like the gynae is useless. Have you talked to the GP who referred you, might be worth saying you feel you have been fobbed off.

what you describe are all symptoms that should be looked at. There's a thread somewhere on MN with women reporting their health problems that didn't get taken seriously and it's a very long list.