A girly rant
So my birth control prescription ran out last week.
Usually, I'm pretty good about getting up to snuff, but for whatever reason, I've been swamped lately, and I haven't had time (or, to be honest, the inclination) this year to do my well-woman exam, which is usually when I get the prescription refilled. A physician friend of mine gave me a three month reprive by calling in a refill for me, but I knew I'd have to go through my own clinic to get back on track.
So on Friday, I called the refill line and asked them to refill the prescription. I didn't hear anything back then, so I called again on Monday.
They called me back and told me that they couldn't refill my prescription because I hadn't had a PAP smear in a year. I said, fine, but now is not a good time for a PAP smear (IYKWIM), and I have to have the prescription refilled by Wednesday, or else I'm screwed on keeping up with my artificial hormones.
The nurse said she'd call in one pack, but I HAD to come in before that ran out for a new prescription. Fine. Whatever. I'll deal with that after Thanksgiving.
Pissed off that my birth control is being held for ransom by a PAP smear, I did some research.
The American Cancer Society, the the American College of Obstetricians and Gynecologists, and Agency for Healthcare Research and Quality all recommend that annual PAP smears are NOT necessary after three or more normal PAP smears in a row. I could find no evidence that oral contraception increases the risk of cervical cancer, and the prescribing information for physicians of my particular birth control says, in the "cancer" section of the warnings, that "In spite ofmany studies of the relationship between oral contraceptive use and breast and cervical cancers, a cause-and-effect relationship has not been established." (page 5) That I am sexually active increases my risk of HPV, which in turn, increases my risk of cervical cancer, but that doesn't have anything whatsoever to do with whether or not it's safe to refill my birth control prescription.
Now, I'm not bitching if the clinic insists on a physical examination before refilling my prescription for another year. I fully understand that it's good practice to physicially examine a patient from time to time if they're on any prescription medication. I'm bitching about the emphasis on the PAP smear in the physical examination. The physician information for the drug does say that It is good medical practice for all women to have annual history and physical examinations, including women using oral contraceptives. The physical examination, however, may be deferred until after initiation of oral contraceptives if requested by the woman and judged appropriate by the clinician. The physical examination should include special reference to blood pressure, breasts, abdomen and pelvic organs, including cervical cytology and relevant laboratory tests. In case of undiagnosed, persistent or recurrent abnormal vaginal bleeding, appropriate measures should be conducted to rule out malignancy. Women with a strong family history of breast cancer or who have breast nodules should be monitored with particular care.
Page six. Given the risk factors of taking birth control, taking my blood pressure every year is vastly more important than looking at the cells on my cervix.
I don't mind going to the doctor. I don't mind having a checkup. I'm 35 this year, so I should be getting my first mammogram, so I have to go anyways. I don't even really mind having a PAP smear. I think, though, that getting a PAP smear for the sake of refilling a birth control prescription, when there's no family history of cervical cancer and I've had three normal PAP smears in a row, is a waste of medical resources. I think that a quick chat with my healthcare provider that indicates that everything is hunky dory health-wise especially with my circulation and breasts, and a promise that I'll come in for a check-up should suffice.
I do recognize the importance of screening. Two years ago, a good friend discovered she had cervical cancer caused by HPV during a routine PAP smear and ended up with a hysterectomy. She was not yet thirty. (She's fine now, and she never planned on having children of her own, wanting to adopt instead. She's a truly awesome person.)
ETA: There was an editorial in the Lancet (note, this is a link to a Wall Street Journal blog note on the editorial, as the journal is subscription only) earlier this year that oral contraceptives should be available without a prescription.
Again, I don't mean to undermine the importance of the annual examination, but I'm still baffled as to why the PAP smear in particular is important.
Usually, I'm pretty good about getting up to snuff, but for whatever reason, I've been swamped lately, and I haven't had time (or, to be honest, the inclination) this year to do my well-woman exam, which is usually when I get the prescription refilled. A physician friend of mine gave me a three month reprive by calling in a refill for me, but I knew I'd have to go through my own clinic to get back on track.
So on Friday, I called the refill line and asked them to refill the prescription. I didn't hear anything back then, so I called again on Monday.
They called me back and told me that they couldn't refill my prescription because I hadn't had a PAP smear in a year. I said, fine, but now is not a good time for a PAP smear (IYKWIM), and I have to have the prescription refilled by Wednesday, or else I'm screwed on keeping up with my artificial hormones.
The nurse said she'd call in one pack, but I HAD to come in before that ran out for a new prescription. Fine. Whatever. I'll deal with that after Thanksgiving.
Pissed off that my birth control is being held for ransom by a PAP smear, I did some research.
The American Cancer Society, the the American College of Obstetricians and Gynecologists, and Agency for Healthcare Research and Quality all recommend that annual PAP smears are NOT necessary after three or more normal PAP smears in a row. I could find no evidence that oral contraception increases the risk of cervical cancer, and the prescribing information for physicians of my particular birth control says, in the "cancer" section of the warnings, that "In spite ofmany studies of the relationship between oral contraceptive use and breast and cervical cancers, a cause-and-effect relationship has not been established." (page 5) That I am sexually active increases my risk of HPV, which in turn, increases my risk of cervical cancer, but that doesn't have anything whatsoever to do with whether or not it's safe to refill my birth control prescription.
Now, I'm not bitching if the clinic insists on a physical examination before refilling my prescription for another year. I fully understand that it's good practice to physicially examine a patient from time to time if they're on any prescription medication. I'm bitching about the emphasis on the PAP smear in the physical examination. The physician information for the drug does say that It is good medical practice for all women to have annual history and physical examinations, including women using oral contraceptives. The physical examination, however, may be deferred until after initiation of oral contraceptives if requested by the woman and judged appropriate by the clinician. The physical examination should include special reference to blood pressure, breasts, abdomen and pelvic organs, including cervical cytology and relevant laboratory tests. In case of undiagnosed, persistent or recurrent abnormal vaginal bleeding, appropriate measures should be conducted to rule out malignancy. Women with a strong family history of breast cancer or who have breast nodules should be monitored with particular care.
Page six. Given the risk factors of taking birth control, taking my blood pressure every year is vastly more important than looking at the cells on my cervix.
I don't mind going to the doctor. I don't mind having a checkup. I'm 35 this year, so I should be getting my first mammogram, so I have to go anyways. I don't even really mind having a PAP smear. I think, though, that getting a PAP smear for the sake of refilling a birth control prescription, when there's no family history of cervical cancer and I've had three normal PAP smears in a row, is a waste of medical resources. I think that a quick chat with my healthcare provider that indicates that everything is hunky dory health-wise especially with my circulation and breasts, and a promise that I'll come in for a check-up should suffice.
I do recognize the importance of screening. Two years ago, a good friend discovered she had cervical cancer caused by HPV during a routine PAP smear and ended up with a hysterectomy. She was not yet thirty. (She's fine now, and she never planned on having children of her own, wanting to adopt instead. She's a truly awesome person.)
ETA: There was an editorial in the Lancet (note, this is a link to a Wall Street Journal blog note on the editorial, as the journal is subscription only) earlier this year that oral contraceptives should be available without a prescription.
Again, I don't mean to undermine the importance of the annual examination, but I'm still baffled as to why the PAP smear in particular is important.