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Forum Name: Gynecology

Question: Birth control at age 45??


 rsaj - Mon May 04, 2009 1:32 am

Roughly 5 years ago my husband had a vasectomy so that I could get off of birth control pills following my doctors wishes. A couple years ago I started having heavy vaginal bleeding on occasion with bowel movements. My doctor sent me to a gynecologist who took a biopsy that came back fine. He put me on a generic birth control pill because I didn't want to spend the money for Yaz which he strongly wanted me on. Because of breakthrough bleeding he raised the birth control to Ogestrel 0.5/50 which he said is a higher dose that he had wanted. I have a lot of trouble with my arms going to sleep at night and I thought the Ogestrel made it even worse so I went off of it. Since going off I only have periods every 3 or 4 months but have not had any bleeding with bowel movements for quite a while. My last period lasted 10 days. I have felt fine. Recently I went back for a pap. He was very unhappy that I was not on any hormones. He is very upset with all the publicity of problems with hormone replacement. He says he is pretty sure my body is not producing progestin and I need protection. He wants me inserted with Mirena or on something like Yaz or Yazmine. I am so confused. Why did I get off birth control to get right back on birth control. So far I am holding out but he's waiting for my answer. According to him, I would be very foolish if I didn't follow his advise.
 Debbie Miller, RN - Wed May 13, 2009 10:31 pm

User avatar Hello,
Estrogen therapy is a very controversial subject. If you are not having other symptoms besides irregular menses, I would not feel the need to take the hormones. Feel free to get a second opinion from a doctor who is not pushing this treatment. Many physicians have fallen prey to the aggressive campaigns of drug manufacturers who make millions of dollars on hormone sales. Never underestimate the money to be made in the pharmacological industry and as they "educate" there is often a conflict of interest. Decreasing hormone levels are a normal part of our aging process and it is not necessarily pathological. The Women's Health Initiative gave us valuable information and dispelled some long-held opinions about the benefits of estrogen therapy. Convincing women that they need 30 or 40 years of daily hormones is definitely in their interest. Just make sure it is really in yours before you fall prey.

Many doctors feel you are foolish not to follow their advice. The trouble is, it is often their opinion which is sometimes biased. The next doctor might advise you the opposite way and think you foolish not to follow that. However, a good physician will discuss the pros and the cons, consider the symptoms and determine if there truly is real risk with either decision, explain ALL your treatment (and non-treatment) options and leave the final choice to the patient. Informed consent should be standard and respect for your "gut feeling" about the side effects or the need for medication should be considered seriously also. You should not feel railroaded into a controversial treatment for which there are just concerns and reasons for not taking, just as there may be reasons to take it. It is not "hype" that hormonal contraception has serious side effects for some women and if you don't need it for birth control, I would recommend seeking alternative treatment too.

Irregular menstrual periods is a common and normal event n the perimenopausal period. If this is not causing you distress and you are not losing too much blood as to cause anemia, it may not need treatment. You do not need a predictable period to be healthy. Menopause is as natural a process as the onset of menstruation and variations in the cycle are normal. Making certain the cells are normal is wise to rule out something abnormal, so the biopsy was responsible. If the bleeding becomes too bothersome, there are other treatments. Some women need hormones, especially after surgical menopause when there are no more hormones produced. Natural menopause is a gradual decrease without complete cessation of hormones and often does not require intervention.

If you would like to read a little more on the other camp, Barbara Seaman's book, The Greatest Experiment Ever Performed on Women - Exploding the Estrogen Myth, is a good read. I happen to believe there are some cases where estrogen can help, but it should not be standard treatment for all women past a certain age. You have choices and all options should be explained and offered. I would suggest a second opinion. It is your body and your health.

Best wishes.

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