BEHIND THE PRESCRIPTION PAD
Is there a reason your doctor picks certain meds for you over others? Absolutely, there is. Here’s how to do your part to ensure that little scribbled note is marked with your perfect contraception match
by NICOLE BELAND
The most surprising thing about oral contraceptives is how many gynecologists prescribe them carelessly.
“Gynecologists will prescribe the pill they have the most experience with or the one they currently have free samples of in the closet,” says James Simon, M.D., of the Women’s Health Research Center in Laurel, Maryland. Why are docs so blasé about birth control?
“Because all brands of the pill are equally effective at preventing pregnancy, and all are FDA-approved as safe,” Dr. Simon says. Since it’s difficult to predict how a patient will react to any specific pill, the standard of care is to start with one–any one–and switch to another if there are problems.
Yes, making an informed selection is more difficult, but it’s hardly impossible. “In choosing a pill for a patient, a clinician will review the patient’s medical history in order to select one that is easy for her to take and that will maximize her health benefits,” says Anita Nelson, M.D., professor of obstetrics and gynecology at UCLA’s David Geffen School of Medicine.
“That’s why women who are thinking of changing their pill, or who are considering the pill for the first time, might want to pay attention to what happens to their bodies throughout their menstrual cycle.”
An easy thing you can do is to mark a calendar on the days when you feel certain symptoms, then take that calendar with you to your appointment. And the more you know about your options, the better.
“It’s up to you to do the research, because a lot of doctors won’t,” says Michael Thomas, M.D., a contraceptive researcher at the University of Cincinnati Medical School.
One effective but seldom-used tool for pinpointing the right pill is a hormone test. The test is easy — you just spit into a small plastic tube once during the second half of your cycle. The small sample of saliva is a snapshot of how your levels of estrogen, progesterone, testosterone, and cortisol fluctuate during the course of your menstrual cycle.
“I give all of my patients a saliva test before prescribing them a pill,” says Kenna Stephenson, M.D., of the University of Texas at Tyler. “If a woman feels good about her menstrual cycle, I put her on the pill that contains a combination of hormones closely matching her own natural levels–she’s less likely to experience negative side effects. If a woman is already experiencing moodiness or other uncomfortable symptoms, I’ll prescribe a pill that may balance her hormone levels and alleviate the symptoms.”
Many doctors dismiss hormone tests as unnecessary. But for women who experience side effects, particularly moodiness, not having a test can mean more than just enduring unnecessary PMS.
“After prescribing two or three types of pills for a patient who complains of moodiness, many doctors will throw up their hands and suggest that she go on antidepressants,” Dr. Stephenson says.
“So now you have a woman on psychoactive drugs who may have simply needed a different pill.”
If you think you might benefit from a hormone test, find a doctor who is willing to take the time to give you one. Or do it yourself. Two certified labs that offer at-home hormone tests are ZRT Laboratory (Innovative Hormone Testing) in Beaverton, Oregon, and Genova Diagnostics (BodyBalance) in Asheville, North Carolina.