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.

A smear is not appropriate, it is a screening tool and not an investigative procedure. If there are concerns about the cervix a colposcopy is warranted. If gynae haven’t done this then they aren’t worried about the bleeding coming from the cervix.

The implant or injection had the potential to cause irregular bleeding, so if a woman is bleeding on the OCP then the injection or implant isn’t a good idea, especially as they’re long term options and so not easily rectifiable.

A laparoscopy sounds like a reasonable next step given you’ve had normal swabs and scans. If you have endometriosis this would enable a diagnosis.

You are entirely within your rights to refuse a coil but given there aren’t unlimited options for you, you need to have an idea of what you’re hoping to achieve here. If pregnancy is a definite no no and you don’t want to rely on condoms then some sort of hormonal contraception, especially LARC is the best choice and a Mirena IUS is potentially the “best” option for you. However if you are adamant you don’t want one you have to accept there are limitations in what HCPs can offer. GPs aren’t offered a cash incentive to fit coils 🙄, but are obviously encouraged to promote them when appropriate and a hospital gynae has no financial incentive at all - if they offer something it’s because they think it’s clinically indicated.

I hope you get some resolution soon.

@rosawaiting

I think so too. I’ll chase after the laproscopy he mentioned after my last appointment and like other users have said, perhaps look into paying for a private smear.

That really doesn’t surprise me sadly!!

@sidge

Does it not screen for abnormal cells though which can be related to symptoms such as abnormal bleeding, pain during sex etc?

What is the difference between a smear and a colposcopy?

Also does a coil not class as a long term option that is not easily rectifiable? One of my main concerns is that i will have the same problems on the coil (if I were to go on it) and then have the doctors refuse to remove it. I’m all for giving things a good chance so if this were to happen I wouldn’t ask unreasonably soon but I guess its kind of scary not having that control over my body and having that worry of something being stuck inside me and I’m not able to do anything about it? I know I’m being very negative but I’m just really quite scared of the situation being worse or not changing and I guess quite scared that if this is the case, there is something more serious going on which isn’t being found.

Ah okay, makes more sense, I’d just read it somewhere and it does make you panic a bit about it all! Its just upsetting when you get referred and you don’t even get to explain your symptoms without being interrupted by them to promote the coil. Given the history of health problems in my family I’m very much a believer that ‘just because something/someone looks healthy, doesn’t mean they are’. I just worry that because I’m young, petite, don’t smoke, don’t drink, someone who ‘looks’ healthy, that bleeding problems are easily passed off, and just with my more recent symptoms it worries me more so I find myself questioning everything, including why the coil is being pushed so much.

I guess its hard when you’ve had such bad experiences with various forms of birth control to have faith in the next thing. I know its pessimistic but its exhausting, and as the nurse so rudely pointed out, I’ll be on birth control till I’m 50 so I need something that works!! 😂

I just want these problems to to away and to be taken seriously.

thank you for your advice, I’ll speak to them at my next appointment about a laproscopy x

Hi Bea

Re your earlier comment:-
"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"

This re your periods being relatively painful and heavy, the clots (mine were brown and red, the brown blood being "old" blood) and now pain arising from sex made me think of endometriosis as well.

If your current gynae is hopeless then seek a second opinion; there are gynaes out there who will listen to you properly. I have also come across medical professionals re the Mirena as well and have refused it because I have endo (diagnosed through laparoscopic surgery) and I have read that it is still not a licenced treatment for endometriosis. Some women do end up having this removed anyway because they cannot tolerate the issues re bleeding.

www.endometriosis-uk.org/ is a useful website.

I also had normal looking internal ultrasounds as well; because the endometriosis deposits are so small such scans do not detect it.

@BeaLou95 colposcopy is a subspecialty of gynae, so they see women with cervical abnormalities that have been picked up on screening, and other issues that have needed referral from a GP. They would look closely at the cervix with magnifying and microscope equipment that we just don't have in a surgery, and take any samples or biopsies as necessary. They are also tested more rapidly than screening samples.

Yes a coil is classed as LARC but because it acts locally rather than systemically it is more 'rectifiable' than an implant, or the injection. As soon as you take it out you're "back to normal" hormonally. I have never come across an HCP who has refused to take an IUD/IUS out when a woman has been insistent however I have seen women be persuaded to try it for a bit longer as most bleeding issues do settle down (I'm talking women who have had them in for days or weeks rather than months).

In the vast majority of young women using artificial hormones the irregular bleeding is hormonal or due to infection and not related to malignancy or anything sinister. Clear swabs and scans and a normal looking cervix are reassuring; I'd suggest the laparoscopy and take it from there. If it is endo then there are treatment options.

If you get a mirena it has strings you can feel to check it's there, and if you want it removed then practice nurse can do it by pulling on strings and pulling it out.
Mirena has to be put In by gynae / sexual health clinic /gp with special training, but can be taken out very easily (I took my own one out when expat abroad and no access to gp/nurse)

The only contraceptive that's not removable if you don't like it is the depot injection, so I'd avoid that one

Could you not go somewhere else to get an implant fitted?

The waiting list at my GP was too long so I booked in at a sexual health/contraception clinic in the next town and got it done quickly and hassle-free.