How do I ensure a productive gynecologist appointment?

June 8, 2009 1:09 PM

Please help me figure out how to have a productive appointment with the gynecologist to deal with severe menstrual cramps.

After having increasingly unbearable, debilitating pain from menstrual cramps for the last couple of years, I have gotten a referral to a gynecologist from my GP. Obviously I would like him to a) find out what is causing the pain and b) get it to stop, but I am wondering if there are any specific questions I should be asking. This is my first time visiting a gyno and I don't know what to expect. I've heard this particular doctor is very good and empathetic, and I am sure he will know how to elicit important info from me, but I would also like to prepare myself as much as I can to ensure an effective appointment.

Have any of you gone to a gynecologist for debilitating cramps? Did s/he help you? What questions did you ask, or what do you wish you had asked? Was there any particular info (family history, etc.) that was important for you to bring?

I'm at the end of my rope with this pain, so as you can tell, I'm staking a lot on this appointment. Thanks for any advice!

posted by hurdy gurdy girl to health & fitness (14 answers total)

Generally speaking, it's good to go into any doctor's appointment with, at sort of the same time, an open mind but also an idea of what you'd like to get out of the appointment. You may have an awesome gyno who pulls out all the stops to fix this problem or you may have one who is more of the "it's all in your head" school that you will have to be a bit more firm with. Keep in mind that if the gyno is truly terrible you can go to another one if they do not help you and the problem is not solved so while I encourage you to be proactive and all the rest, it's an escape hatch.

It's okay to write down a list of things to remember to tell the doctor. In this case this would include stuff like

- a timeline of your discomfort including things like when it's worse, when it's best
- how long you've been having these problems
- if they've gotten worse or better over time
- if they're affected by anything [mood/food/setting] external
- what you and your GP have tried, what the GP thinks
- what happened when you tried those things
- what sorts of things you're willing to try, what sort of things you are NOT willing to try
- what you think might be happening to you
- family history of this sort of thing

I had terrible cramps and pms when I was in college and had one of those "well just stay away from things that bother you..." responses from the school health services [alas this is not atypical] which made me incredibly furious, so while I haven't had your particular situation, I am a little versed on not just how to be a decent patient [don't show up with a bunch of pages printed from the wikipedia and a request to get an MRI unless you know what you're talking about] but how to advocate for my own health care.
posted by jessamyn at 1:30 PM on June 8, 2009 [3 favorites]

I agree with jessamyn's list. I'd add that you should mention any pain you have at other times, such as during sex, as well as any other symptoms you have during your period, such as diarrhea or an irritated bladder.

But mostly I want to emphasize that you should make very clear how the pain is affecting your life. I had endometriosis for decades and I now wish I had been much more aggressive in my response to it.

Early on a smart gynecologist told me, "Do something about your pain now, or you'll just keep telling yourself it's not that bad until it takes over your life." I ignored him. The pain took over my life. I ate codeine every month, rarely traveled because it was hard to schedule anything, and used up all my sick days and much of my vacation time in pain. I started my own business partly so it would be easier to work around my pain, and I'm convinced I would be financially better off now if I hadn't spent so many years hunched over and miserable.

I ended up having surgery (ovaries removed), which certainly isn't the only solution, but the huge improvement in my quality of life was astounding.

So be sure the doctor takes your pain seriously.
posted by PatoPata at 2:04 PM on June 8, 2009

I used to have terrible cramps too, and they've been MUCH better since going on the pill. S/he will probably suggest trying it, so you may want to think ahead of time about whether you're willing to do that.
posted by kestrel251 at 2:06 PM on June 8, 2009

I have chronic pain and so I have a lot of experience with doctors. Jessamyn's advice is right on--I usually walk in with a written list and refer to it so I don't end up in the car on the way home thinking, "Shoot, I forgot to ask about X." I also have a bad memory for certain things so it helps to have a rough timeline written down, so that when the new doctor says, "What tests have you had? What meds have you tried?" I'm not saying, "Um, sometime I had some test where I was in this one kind of machine thing...and then I tried that one pill, the little blue one, you know? Starts with an E?"

As a person with chronic pain, it can sometimes feel like I'm a whiner if I list _everything_ but I make myself do it anyway. Sometimes that small symptom that hardly is worth mentioning in the context of everything else going on is the one that makes the doc perk up her ears and say, "oh, with the left big toe itch, it could be Syndrome X..." I recently received a life-changing referral because one doctor knew to ask me about things I hadn't even realized qualified as symptoms! Which is to say, I'm seconding PatoPata.

It's also OK to mention things you're not sure about. Jessamyn mentioned external things; one of those might be something akin to, "Sometimes it seems to be worse if I'm drinking a lot of caffeine, but other times caffeine doesn't seem to make a difference."

If I have a lot of questions, I let the scheduler know when I make my appointment, so they can give me a long enough appointment to get through everything.

Don't be afraid to call the office afterward if a new question comes up or you realize something you thought was clear when you were in the office isn't.
posted by not that girl at 2:18 PM on June 8, 2009

One of the first things that a lot of docs will recommend is using birth control pills to "lessen" the cramps (I've personally been waiting for that feature to kick in for, oh, about 5 years, and I'm still waiting... but it does help to know WHEN the periods--and thus cramps--are going to happen, so I can pre-medicate them with Aleve). If the doctor tries to throw a prescription at you and send you on your way after a couple of minutes, either press on to get him to listen, or get a new doc. Be assertive about getting this doctor to listen to you, because you deserve that.
posted by so_gracefully at 2:34 PM on June 8, 2009

You have my full sympathy. Cramps in my family skips generations, as silly as that seems. My mother and daughter suffer(ed) terribly; my grandmother and I, not at all. The doc told my mother that there was a simple operation to sort out some internal kink (OK, that's what she told me) and too bad she hadn't come to him some time before menopause. My DD is now on some meds that suppress periods given her getting the usual 'it's all in your head, dearie' response from doctors so much so that she won't go to another doctor.

I agree: take a list. And add, try to keep it factual given doctors still, even women doctors, sometimes think women exaggerate. And, if you get a twit the first time out, ask for a referral to another specialist. If they can send robots to Mars, surely someone can fix menstrual cramps. This advice is from a woman's medical condition took 10 years to properly diagnose and who refused to give up until someone, somewhere found the answer.
posted by x46 at 2:39 PM on June 8, 2009

Thank you everyone for all these answers! They've given me some good ideas for what to ask (I am definitely going to write out a list tonight).
posted by hurdy gurdy girl at 2:55 PM on June 8, 2009

If the doctor tries to throw a prescription at you and send you on your way after a couple of minutes, either press on to get him to listen, or get a new doc. Be assertive about getting this doctor to listen to you, because you deserve that.

second this! if you've done as jessamyn suggests and the doctor doesn't take you seriously, just walk.

i had super bad cramps as a teenager which kept getting worse and worse as the years went by, and by worse i mean horrible—i have a pretty high pain threshold and still i would get up completely debilitated from the pain, even passing out a few times and being brought to the er just in case. after going through a whole string of ob-gyns, i finally found one who listened to me and recommended another doctor that she said she would trust enough to do the work on her, and ended up having an endoscopy to diagnose/treat mild endometriosis. i don't always have cramps now and when i do it's a) mild, b) usually when i forgot to take a few advil even knowing that my period was around the corner (it's irregular and i track via monthlyinfo.com).
posted by lia at 3:37 PM on June 8, 2009

A lot of women with bad cramps (or who otherwise hate getting their *%ing period) are now on birth control to skip as many periods as possible a year. I hope you can reduce your pain, but also keep in mind that there's a good way to put up with whatever you end up having to put up with only four times a year instead of twelve.
posted by you're a kitty! at 3:49 PM on June 8, 2009

Yeah, that list will help. I don't think anyone has mentioned that you may want to have a list of goals on that list, too: Do you want the pain to go away completely? Will you accept slightly less pain?

And I want to second (third?) the "If this doc doesn't seem to be taking you seriously, just get the hell out of Dodge and go find another." Really, there are huge differences between doctors--I know that sounds like a "no shit" statement, but as someone who is likely to think I'm doing it wrong, it would have been excellent advice for me.

I had horrible problems with my periods after a series of miscarriages, and my gynecologist tried the pill route and d&c route and then it was kind of "well, this is just something you'll have to deal with." And I did. For five years. With the problems becoming progressively worse, until I was horribly anemic and just barely dragging myself through my life.

I finally decided, "Enough already!" and picked an ob-gyn out of those listed on our plan. I wrote out my list and carried it clutched in my (sweaty) hand to her office. She took me seriously and could see no reason for me to have to put up with the cramps and bleeding. There are lots of reasons for cramps, and lots of tests to discover what they are and lots of treatments to reduce or eliminate them. Don't accept anything less than an attentive, respectful doctor who will carefully and thoroughly address your problem and fix it. You're worth it! Your life is worth it.
posted by miss patrish at 4:14 PM on June 8, 2009

I had horrible, horrible cramps in my younger days; not much worked, until the gyn I'm currently seeing recommended that I go on continuous birth control (no "week off" pills, hence no periods). It was the silver bullet for me, and I've been 100% period-free for over 8 years now. You might ask your doctor if this is something you can look into, if you're interested.
posted by TochterAusElysium at 6:01 PM on June 8, 2009

There is some evidence that women with dysmenorrhea show significant improvement when they supplement their diet with omega-3 fatty acids. More from google scholar
posted by zentrification at 8:45 PM on June 8, 2009

I had menstrual cramps so painful that even with birth control I was still debilitated. I would medicate with ibuprofen and later, Tramadol (before and during) but that stopped working after a while. My gynecologist put me on Ponstel, a prescription medication that really helped. My cramps and non-cramping pain were related to ovarian cysts--the fluid that can leak from functional ovarian cysts can be irritating to your insides and cause intense pain during menstruation and when you're not bleeding.

By the way, now that I have had a baby, the cramps are much, much better. I have heard that is what happens in many cases where the pain is due to ovarian cysts. Walking for 30 minutes also helps a lot and many times I am able to skip the ibuprofen altogether.

I have found that many female gynecologists seem to be dismissive of menstrual pain and problems relating to menstrual pain. Since they "live it" too, sometimes it turns into a contest to see who has it worse. That is so not helpful.

Pain is a very individualized thing and clinicians should not make judgments about it. They should offer you support and ways to combat it so that you are comfortable.

We tend to take pain as a way of life. But it's not. Pain means your body is stressed about something. You are doing the right thing by doing something about it.

Documentation is key. Keeping a pain diary--on paper, on your phone, whatever--describing the pain, when it happens, what you're doing, what you do to alleviate it, etc.--can offer valuable evidence to help your gynecologist to formulate a treatment plan.

It may take a few cycles to feel a modicum of relief. I do hope you get there. Chronic pain is a major cause of depression and this should also not be ignored. Good luck to you.
posted by FergieBelle at 6:58 AM on June 9, 2009

Well, I went to my appointment today, armed with my list of things to ask, and I think it went well. The doctor has put me on hormonal bc right now to manage the next few periods and has ordered an ultrasound. (My GP had me do one a couple of years ago but it didn't show too much.) He has scheduled a follow-up appointment so we can discuss the ultrasound results as well. I am really hoping he finds some answers...I just think it can't be normal to have the kind of pain that winds up with me on oxygen, an IV, and a painkiller drip.

Thanks to all of you for your practical advice, anecdotes, and encouragement to make sure the doctor took me seriously. After reading your responses, I would definitely have gone back to my GP and asked for a referral to someone else had this doc been less than thorough.

I'm not marking best answer but only because there are so many excellent answers here!
posted by hurdy gurdy girl at 11:13 PM on June 9, 2009