The Hard Pill to Swallow: Women and GPs have to talk

Imagine your doctor prescribes a daily glass of wine for you.   

We all know that drinking too much can be risky, but you trust that your GP has appropriately judged your case. Ultimately, you not only discover that their treatment was wrong for you but that they should have known better.

Now imagine, instead of wine, it is a pill- a pill that should treat your excessive, heavy bleeding that makes you vomit from the pain, lasting anywhere from 4 days to 3 weeks to 2 months.

Suddenly this advice is a bit more important.

The combination pill is the go-to birth control for menstrual treatment and contraception in Australia. To get it, you need a doctor’s prescription which means discussing your suitability in a likely 16-minute consultation.

You expect your GP will inform you of the pill’s side effects and ask about any medical history that predisposes you to its risks. You assume they will discuss alternative contraceptives to give you all the options. And you hope, seeking the pill for your irregular periods, that your GP will recognise and conduct tests to diagnose the possible menstrual condition cause.

But your GP might do none of these. Are doctors solely to blame for this lack of discussion? Or does it take two to talk? With blood on everyone’s hands, the fact remains that women are suffering because of this silence.

Within Facebook, where only those looking can find it, lives the world of private girl’s advice groups. The lengthy search list unveils sister groups spanning Australia, each with cutesy butterfly, flower or pink love heart emojis in their name, and girls standing arm-in-arm as their group photo.

Canberra Girls Advice is the largest city group where discussions on everything from gift recommendations to contraception advice are always taking place. Nearly twenty thousand women are eager to talk about your problems. Instead, I asked about theirs.

The women below represent the 35 who shared their stories with me, and their names have been changed for their privacy.

“I don’t feel like a healthy woman anymore because I cannot do the one thing every woman does, all because of birth control.”

Danny’s Facebook profile picture is a fairy-tale moment of bliss: she kisses her husband on their special day; gown, enchanting woods, and all. Seeing this, you’d have no inclination of the painful ordeal Danny has been, and is still, going through.

A 24-year-old Cardiac Physiologist, Danny started the pill to regulate her lengthy periods when she was 20. After two years, the thing all women fear about taking the pill happened. Danny found a blood clot in her right lung.

I message her privately to talk about it.

“At no point were the risks discussed with me until I attended the GP appointment with chest pain when inhaling.” Danny tells me she has “a number of blood disorders” in the family but is unsure whether her GP knew that.

While the clot dissolved, stopping the pill left Danny with an unrelenting side effect.

“I now have no natural hormone regulation and am stuck on day 1-2 of my cycle, I require medication to ovulate and most likely will for the rest of my life.”

This means Danny no longer menstruates which is a condition called post-pill amenorrhea.

Some long-term pill users experience this, but their periods commonly return within 6 months. Danny has had the condition for 2 years. Without an underlying cause to treat, women with amenorrhea can do nothing but hope it subsides.

Danny’s family history of blood disorders should have reduced, if not eliminated, her suitability for the pill. At the very least, there should’ve been a discussion about it.

But, GPs have a strenuous job. According to RACGP’s 2020 Health of the Nation report, GPs see 102 patients each week, spending 16 minutes with each one on average. Maybe they should be cut some slack for occasionally underperforming. Especially considering how well known the pill and its side effects like blood clots are. How could she not know to ask?

But medication horror stories run amuck online, so doctors prefer you go to them for the facts. Surely, if they don’t mention a risk, it must not apply. Perhaps women also need to be more aware of the questions to ask.

Think about all the Dannys whose side effects could have been prevented with one conversation.

“I got tired of them not listening.”

Carter’s Facebook reflects the excitable, easy-breezy life of a 21-year-old. There are quirky screenshotted Snapchats, superstar formal photographs and a momentous picture from a trip to America as her cover photo.

Yet beneath that, Carter struggled with a different problem to Danny’s: her issues seemed beyond the scope of a standard GP. As the mysterious menstrual irregularity story goes, Carter spent years seeking the information and treatment she needed from several GPs, but they did not know enough, to do enough.

Enduring sporadic month-long periods, Carter started the pill when she was 15 years old but her mental health suffered because of it. At 19, she switched to the depo-provera shot.

Haven’t heard of the depo shot? Neither had Carter’s GP. It is a contraception injection taken every 12 weeks. Carter says her GP was hesitant to ask another doctor who knew slightly more about it.

“I get they can’t hold all that information, but it was concerning.”

Carter tells me she saw three GPs about her mental health and period pain on the pill but “I was a teen, so they just assumed it was normal.” Antibiotics was their only suggestion.

“I knew something was wrong with my body,” Carter says, “so I kept changing until I found someone who did listen.”

This someone was Carter’s fourth GP, a young doctor who sent her for an ultrasound this year which discovered an ovarian cyst. While it was not a concern, this GP referred her to a gynaecologist anyway.

Per their recommendation, Carter had the Mirena intrauterine device inserted to prevent the growth of endometriosis which runs in her family and is the likely culprit of her irregular periods. She tells me it is “amazing so far.”

Carter is finally at peace with the right period treatment for her that doesn’t induce horrible side effects, all thanks to a gynaecologist and the GP who thought to send her there. Did that doctor know something about ovarian cyst symptoms that others do not?

To get some answers, I book an appointment.

Dr Taiye Oguns joins our Zoom meeting from a consultation room in her practice, KENOLTA Medical Centre and we pause for her to see a patient. Her African accent punctuates her medical vocabulary, creating a captivating voice of authority as we discuss the GPs under fire.

“They should know all of the methods of contraceptives,” Dr Oguns states, but “general practice is quite broad, and they can’t know everything.”

Dr Oguns says while it’s assumed that GPs ask about their patient’s family history, “unfortunately some people don’t get to be asked.”

“[As a GP,] you’re thinking of a patient that you just saw that, ‘oh, I probably should have given this to.’ You might not be in the right frame of mind at that time to ask some screening questions” to your next patient. Remember, 102 patients per week. That’s roughly 20 per day.

I ask whether women should accept some responsibility for being silently misinformed.

Dr Oguns grimly laughs then says “I feel that the responsibility is on the doctor. Their job is to provide the patient with adequate information.”

Talking menstrual issues, Dr Oguns says a “GP might find it a bit daunting or challenging to make some diagnosis.” She describes the number of examinations and tests that investigate irregular periods; I recount women from Facebook saying their GPs simply “throw the pill at it”. Dr Oguns suggests this is because they lack experience diagnosing it.

Plus, the pill is extremely easy for any GP to prescribe because there’s no special training required compared to something like an IUD insertion. Instead of consuming time by explaining alternative options to unaware patients, then referring them to someone with that training, Dr Oguns says these GPs think ‘this is what I’m able to do so this is what I’m giving you.’

But she also describes the common interaction:

A patient simply says, ‘hello, I’m here for the pill.’

So, the GP says, ‘oh, you’re here for the pill? Easy, here is your pill, take it.’

Your GP can perceive this differently to: ‘I’m considering contraception would you be able to advise me on the options available?’

Women single it out because “everybody knows about the pill” compared to alternatives which deters discussion.

Now, Dr Oguns is no standard GP. She is specialised. Despite the oxymoron, specialised general practitioners, with special interests in certain areas, are becoming more common. Dr Oguns’ special interest is, of course, women’s health. This fact changes the game.

How can women ensure there are better discussions with their GPs? Dr Oguns might be the answer, herself.

If you cannot see a specialised GP, Dr Oguns suggests booking a longer appointment which tells any GP that you seek more information: a discussion. If that’s too pricey, Dr Oguns proposes that women ask the ‘options available’ question to prompt, even the most preoccupied GP, to start that discussion.

While I had an hour, free of charge, to talk with Dr Oguns, you will probably only have 16 minutes.

It is the GP’s responsibility to provide you with information, but you can help them help you by being aware.

You only have 16 minutes, and so much could go wrong.

So, make sure you and the GP, use them wisely.