So we had an assignment, this week, to write a post on our class discussion forum in Pharmacology that included choices to be made when choosing birth control, side effects, risks, etc.
You were assigned to list 2 of this, 3 of that, etc. (i.e. risks, risk mitigation, symptoms, etc.) that were listed in the book.
Being an older student and no longer needing birth control - and not wanting to regurgitate or plagiarize our textbook - I decided to write this particular post from a more personal perspective to include not just birth control, but HRT for menopausal and post-menopausal women because they are often the same hormones.
(This was discussed in our chapter, but wasn't required as part of the assignment.)
I wrote the following ... and I like it.
Not sure how many points I get, but I like it lol.
Is it the best thing I've ever written?
No, of course not.
Is it something I think all women should read, regardless of age, learning from my experience (especially what NOT to do)?
Absolutely.
Keep in mind, this is a discussion post for class for points, not a true paper, written from a more personal perspective to make it more interesting.
(Other people do that, too, and it's okay, as long as you include the required points requested.)
So without further ado, here it is ...
______________________________
Birth Control (and HRT) – One Size Does NOT Fit All
Just a bit of background first, using personal example of how we’ve come a long way, baby, since my first experience with birth control in the 1980s.
At that time, I was not a smoker and I was put on Ortho-Novum. Within 3 days, I was vomiting profusely, to the degree that I ended up in the emergency room needing an IV in my arm from dehydration. (It was very similar to the severe morning sickness I had with my daughter later.)
When the ER doctor assessed me, he pronounced me with “gastroenteritis,” despite the fact that it didn’t feel like gastroenteritis and no one around me was sick.
I politely asked “Is there any way that it’s the estrogen amount in the pill?”
You would've thought I had asked him if the earth revolved around the sun in the 1500s, rather than vice versa - and he behaved as if I was a heretic for even asking lol.
He literally raised his voice and said “No! God, that’s ignorant, all women have estrogen, it can’t give you side effects.”
Um … my boyfriend and I just looked at each other, blinked twice, said nothing, politely thanked him, and left.
I stopped the pill anyway and lo and behold, the nausea/vomiting stopped along with it.
I went to Planned Parenthood, where a female nurse practitioner pronounced him ignorant for not knowing that although all women have estrogen, the amount tolerated differs for each person, with some women being especially sensitive to estrogen (like me).
I was initially placed on Loestrin. After the birth of my daughter, I was diagnosed with hormone-induced migraines at age 29, plus I had started smoking (I know), putting me now at higher risk for DVT or PE. The Depo-Provera shot had just come out and I was switched to that, but I experienced breakthrough bleeding.
So it was back to Loestrin until the NuvaRing came out, with less estrogen and more progesterone; plus as now a busy mom, there was less worry about missing a pill and doubling up. I still had one migraine a month, but it was less severe, and sometimes just the “aura” with no pain. I continued with the NuvaRing until menopause (but shouldn't have, being a smoker and over age 35, but no one suggested otherwise).
Fast forward to menopause - age 52, still smoking (ashamedly), and now I had abnormal heavy bleeding and fibroids.
Knowing that I was especially sensitive to estrogen and a smoker, my OB/GYN put me on a “mini-pill” called Heather with 0.35 mg of norethindrone (progesterone) to control the bleeding and help shrink the fibroids.
(I cannot tell you what a Godsend this adjustment was for my menopause symptoms, to the degree that even when I was through menopause, I wanted to keep taking them, I felt so much better. I mean, I've never been much of a drinker or drug person, but I also have never in my life felt as good as when on these things! lol)
However, the fibroids were gone and birth control was now inappropriate, considering I was over 35 and smoking and now recently postmenopausal and at risk for osteoporosis.
But as soon as I quit taking them – and they were not tapered, just stopped - I immediately went back to extreme tiredness and PMS symptoms including lower pelvic discomfort and hot flashes, and I was told that estrogen will still spike up to years after menopause is over. Great, the party continues!
I asked if I could be on something, for a little while, but not true HRT.
I was never obese and always active, with normal BP and cholesterol, which mitigates the risk - but 52, postmenopausal, and smoking outweighs all the other risk factors.
Thus, at first, she said she didn’t want to put me on anything at all with my risk factors, and she “didn’t know much about HRT.”
I told her I didn’t want ongoing HRT, just transition cycling rather than abrupt discontinuation like this.
She saw me for a total of 3 minutes at my last 2 visits, which I found odd. She was always super nice (and still was), it's just 3-minute visits now?
I didn’t know how to interpret that, and I'm sure she didn't mean it like that - and God knows healthcare has become like a business now, get 'em in, get 'em out - but it felt to me like now that I was no longer of childbearing age/bleeding, whatever was going on was no longer a “real” concern.
Then her MA called me 2 days later with a prescription for 200 mg of progesterone daily.
Um again – 200 mg of pure progesterone?
That’s like swatting a fly with a sledgehammer, right?
I never picked up the prescription. I wasn’t sure why we swung from being concerned about prescribing anything at all to me over age 35 and a smoker to the other extreme, using a sledgehammer and increasing the risks by using maximum dose.
However, not wanting to be a Karen about it, I simply switched to another OB/GYN quietly.
This time, I found the only practitioner in town that was a certified NAMS (North American Menopause Society) provider.
You may be surprised to learn there was only one in my entire city of Lexington, but as our book says, this society has only been around since 2012, and some people still do not realize the importance of addressing menopause correctly, and how not doing so can lead to breast and endometrial cancers, osteoporosis, and other long-term conditions to contend with.
Thus, I would highly recommend when it’s “that time” for any women reading, look for an NAMS-certified professional.
I’m now on a cycling mix compound of mostly progesterone and a tiny bit of estrogen based on my labs, a few months on and off, and that works for me (and mitigates the risk), which we’ve tapered down as time has gone on (though I still experience some estrogen spikes every now and then).
As for mitigating risk factors, because there is a bit of estrogen in the compound and especially because I still smoke, I try to stay active/exercise (though it’s been hard this winter), watch my BP and cholesterol (still controlled with exercise only), stop the car on car trips and walk or get up and walk on planes, and I’m not ready for TED hose compression stockings yet, but those are also an option to mitigate the risk.
So my advice when it comes to birth control today – and the book’s advice – would be to take advantage of the plethora of options we have now and the percentage mixes of estrogen and progesterone or one or the other, balancing that with your age (especially over 35), your medical history, and the side effects.
Yes, these are hormones that all women have – but no 2 women are the same - and your body chemistry evolves over time.
Also, learn from my experience how NOT to do things – meaning report side effects right away and if something isn't right, ask questions and speak up.
Especially if you’re having chest pain and/or shortness of breath, and calf pain or redness, as these can be symptoms of PE or DVT and potentially life-threatening.
If they are dismissive, you can either try to educate them on things they’re outdated on by bringing in reputable studies or peer-reviewed journal articles to show evidence basis, or you can just find someone else who isn’t dismissive and is up to date.
I’m often afraid to speak up for myself when things go wrong, as I don’t want to be perceived as a Karen – but as my new OB/GYN said, “It’s not being a ‘Karen,’ it’s advocating for yourself. No sense in suffering in silence because of someone else’s arrogance.”
And if the symptoms turn out to be musculoskeletal or due to something else, even if the cause of the new symptom isn’t found or is an unusual side effect, that doesn’t mean it’s not real or that you’re nuts or being overdramatic - at least you ruled out the worst, right? No reason to be embarrassed.
Plus if you DO end up acting like a Karen, you have hormones to blame it on!
(Just kidding, NEVER do that – it only perpetuates that dismissive attitude in healthcare that women are being overdramatic or crazy that still exists - sometimes even with other women.)
When it comes to your body and your health, advocate for you – because nobody else is going to!
Make sure to go over your entire health history and lifestyle with your provider and make the choice together that’s right for you, and don’t be afraid to tell the provider it’s not working for you due to side effects (keeping in mind that they subside after that initial 2 weeks, when you should also be using backup birth control). And remember, they do NOT protect against HIV or other STIs.
Stay healthy, stay safe 😊
Is it the best thing I've ever written?
No, of course not.
Is it something I think all women should read, regardless of age, learning from my experience (especially what NOT to do)?
Absolutely.
Keep in mind, this is a discussion post for class for points, not a true paper, written from a more personal perspective to make it more interesting.
(Other people do that, too, and it's okay, as long as you include the required points requested.)
So without further ado, here it is ...
______________________________
Birth Control (and HRT) – One Size Does NOT Fit All
Just a bit of background first, using personal example of how we’ve come a long way, baby, since my first experience with birth control in the 1980s.
At that time, I was not a smoker and I was put on Ortho-Novum. Within 3 days, I was vomiting profusely, to the degree that I ended up in the emergency room needing an IV in my arm from dehydration. (It was very similar to the severe morning sickness I had with my daughter later.)
When the ER doctor assessed me, he pronounced me with “gastroenteritis,” despite the fact that it didn’t feel like gastroenteritis and no one around me was sick.
I politely asked “Is there any way that it’s the estrogen amount in the pill?”
You would've thought I had asked him if the earth revolved around the sun in the 1500s, rather than vice versa - and he behaved as if I was a heretic for even asking lol.
He literally raised his voice and said “No! God, that’s ignorant, all women have estrogen, it can’t give you side effects.”
Um … my boyfriend and I just looked at each other, blinked twice, said nothing, politely thanked him, and left.
I stopped the pill anyway and lo and behold, the nausea/vomiting stopped along with it.
I went to Planned Parenthood, where a female nurse practitioner pronounced him ignorant for not knowing that although all women have estrogen, the amount tolerated differs for each person, with some women being especially sensitive to estrogen (like me).
I was initially placed on Loestrin. After the birth of my daughter, I was diagnosed with hormone-induced migraines at age 29, plus I had started smoking (I know), putting me now at higher risk for DVT or PE. The Depo-Provera shot had just come out and I was switched to that, but I experienced breakthrough bleeding.
So it was back to Loestrin until the NuvaRing came out, with less estrogen and more progesterone; plus as now a busy mom, there was less worry about missing a pill and doubling up. I still had one migraine a month, but it was less severe, and sometimes just the “aura” with no pain. I continued with the NuvaRing until menopause (but shouldn't have, being a smoker and over age 35, but no one suggested otherwise).
Fast forward to menopause - age 52, still smoking (ashamedly), and now I had abnormal heavy bleeding and fibroids.
Knowing that I was especially sensitive to estrogen and a smoker, my OB/GYN put me on a “mini-pill” called Heather with 0.35 mg of norethindrone (progesterone) to control the bleeding and help shrink the fibroids.
(I cannot tell you what a Godsend this adjustment was for my menopause symptoms, to the degree that even when I was through menopause, I wanted to keep taking them, I felt so much better. I mean, I've never been much of a drinker or drug person, but I also have never in my life felt as good as when on these things! lol)
However, the fibroids were gone and birth control was now inappropriate, considering I was over 35 and smoking and now recently postmenopausal and at risk for osteoporosis.
But as soon as I quit taking them – and they were not tapered, just stopped - I immediately went back to extreme tiredness and PMS symptoms including lower pelvic discomfort and hot flashes, and I was told that estrogen will still spike up to years after menopause is over. Great, the party continues!
I asked if I could be on something, for a little while, but not true HRT.
I was never obese and always active, with normal BP and cholesterol, which mitigates the risk - but 52, postmenopausal, and smoking outweighs all the other risk factors.
Thus, at first, she said she didn’t want to put me on anything at all with my risk factors, and she “didn’t know much about HRT.”
I told her I didn’t want ongoing HRT, just transition cycling rather than abrupt discontinuation like this.
She saw me for a total of 3 minutes at my last 2 visits, which I found odd. She was always super nice (and still was), it's just 3-minute visits now?
I didn’t know how to interpret that, and I'm sure she didn't mean it like that - and God knows healthcare has become like a business now, get 'em in, get 'em out - but it felt to me like now that I was no longer of childbearing age/bleeding, whatever was going on was no longer a “real” concern.
Then her MA called me 2 days later with a prescription for 200 mg of progesterone daily.
Um again – 200 mg of pure progesterone?
That’s like swatting a fly with a sledgehammer, right?
I never picked up the prescription. I wasn’t sure why we swung from being concerned about prescribing anything at all to me over age 35 and a smoker to the other extreme, using a sledgehammer and increasing the risks by using maximum dose.
However, not wanting to be a Karen about it, I simply switched to another OB/GYN quietly.
This time, I found the only practitioner in town that was a certified NAMS (North American Menopause Society) provider.
You may be surprised to learn there was only one in my entire city of Lexington, but as our book says, this society has only been around since 2012, and some people still do not realize the importance of addressing menopause correctly, and how not doing so can lead to breast and endometrial cancers, osteoporosis, and other long-term conditions to contend with.
Thus, I would highly recommend when it’s “that time” for any women reading, look for an NAMS-certified professional.
I’m now on a cycling mix compound of mostly progesterone and a tiny bit of estrogen based on my labs, a few months on and off, and that works for me (and mitigates the risk), which we’ve tapered down as time has gone on (though I still experience some estrogen spikes every now and then).
As for mitigating risk factors, because there is a bit of estrogen in the compound and especially because I still smoke, I try to stay active/exercise (though it’s been hard this winter), watch my BP and cholesterol (still controlled with exercise only), stop the car on car trips and walk or get up and walk on planes, and I’m not ready for TED hose compression stockings yet, but those are also an option to mitigate the risk.
So my advice when it comes to birth control today – and the book’s advice – would be to take advantage of the plethora of options we have now and the percentage mixes of estrogen and progesterone or one or the other, balancing that with your age (especially over 35), your medical history, and the side effects.
Yes, these are hormones that all women have – but no 2 women are the same - and your body chemistry evolves over time.
Also, learn from my experience how NOT to do things – meaning report side effects right away and if something isn't right, ask questions and speak up.
Especially if you’re having chest pain and/or shortness of breath, and calf pain or redness, as these can be symptoms of PE or DVT and potentially life-threatening.
If they are dismissive, you can either try to educate them on things they’re outdated on by bringing in reputable studies or peer-reviewed journal articles to show evidence basis, or you can just find someone else who isn’t dismissive and is up to date.
I’m often afraid to speak up for myself when things go wrong, as I don’t want to be perceived as a Karen – but as my new OB/GYN said, “It’s not being a ‘Karen,’ it’s advocating for yourself. No sense in suffering in silence because of someone else’s arrogance.”
And if the symptoms turn out to be musculoskeletal or due to something else, even if the cause of the new symptom isn’t found or is an unusual side effect, that doesn’t mean it’s not real or that you’re nuts or being overdramatic - at least you ruled out the worst, right? No reason to be embarrassed.
Plus if you DO end up acting like a Karen, you have hormones to blame it on!
(Just kidding, NEVER do that – it only perpetuates that dismissive attitude in healthcare that women are being overdramatic or crazy that still exists - sometimes even with other women.)
When it comes to your body and your health, advocate for you – because nobody else is going to!
Make sure to go over your entire health history and lifestyle with your provider and make the choice together that’s right for you, and don’t be afraid to tell the provider it’s not working for you due to side effects (keeping in mind that they subside after that initial 2 weeks, when you should also be using backup birth control). And remember, they do NOT protect against HIV or other STIs.
Stay healthy, stay safe 😊
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