Birth Control Redux

July 6, 2011 1:43 PM

How do I take control of my reproductive health when stressing about it is sabotaging everything?

So I asked this question quite a while ago, regarding high blood pressure and hormonal birth control.

More recently, I was off it for a 3 month trial while monitoring my salt intake and losing weight. I currently take in about 1500-1600 mg/day and weigh 134 pounds at 5'3.5". (Lost about 20 pounds.) BP seemed normal, so my OBGYN put me back on Yaz- but is now demanding, 2 weeks from my next pack, that I come into the office before she prescribes another month's worth.

I already explained to her that office visits cause my blood pressure to spike, not to mention visits that are marked by 'if you fail this blood pressure test your hormones will be all over the place because she won't prescribe' will just make it worse but she won't budge.

Now I'm panicked that I'll have to deal with going off it again so soon, and I'm anxious near-constantly and have been for a week. I have no idea what to do and I feel powerless. Now I know that any office visit regarding my BP is going to make me panic because so much hinges on it.

My long-distance boyfriend will be here right around the time the pill runs out, I'm stressing out like crazy and have no clue where to go from here. I considered Planned Parenthood but know they measure BP too.

I'm considering non-hormonal long-term BC methods but I didn't think I'd have to do that less than a month into the post-trial month back on the pill.

Please advise. I haven't taken a Klonopin in a long time but I feel like I need to because it feels like I'm on an anxiety jag that won't end 'til I get this sorted out.

posted by rachaelfaith to health & fitness (20 answers total)

If you suspect that you have "white coat syndrome" (IE, going to the doctor's office causes a spike in your BP, which is so incredibly common), you can get a long-term BP monitor from your doctor. It straps to your arm and monitors your BP over a whole It's sort of a hassle but in the long run it gives a much better picture compared to a one-shot BP reading while you are all stressed out.

If this ob isn't willing to accommodate you, then in the long run you need to consider whether she's a good fit (ie, move on if that's feasible).

FWIW my blood pressure occasionally spikes to 130/90, especially when it's monitored in the dr's office, and while it is being monitored neither my internist nor my gynecologist took me off birth control.
posted by muddgirl at 1:53 PM on July 6, 2011 [2 favorites]

Your doctor is trying to keep you from having a stroke. She is doing the right thing. You may want to consider non-hormonal methods.
posted by yarly at 2:00 PM on July 6, 2011 [1 favorite]

I am just as concerned as she is about my health, I just think I could have used a heads-up about only having a month to see what happened and maybe discussing options with me- I'm left to my own devices here and stuck in a tight spot with only two weeks left in my cycle.

I understand about looking into non-hormonal methods for later, but what do I do now? Just... go off of it and let my hormones go nuts again?
posted by rachaelfaith at 2:04 PM on July 6, 2011

It may be you need the tests, but it doesn't sound like your OB is being particularly sympathetic to your anxiety around doctor's offices.

The first course of action may be to follow the doctor's medical advice for now to be on the safe side.

The second may be to find a new practitioner. If you specifically need an OB due to high-risk issues, then definitely seek out another OB. If you don't necessarily need to have an OB for this, maybe try out a midwifery or family medicine practice. My personal experience has been that their models of care is much better for my mental health as they take so much more than just my physical well being into account at each appointment.

When I was in similar shoes, but still different, I had to seek out a second opinion from a much more understanding OB than the one I was dealing with. There's nothing wrong with doing that, and you know what? After I saw her and she appropriately referred me to a more specialized OB for my issue, the issue I had went away. The first OB I saw completely dismissed the issue, and she shouldn't have.

Don't think this is necessarily all in your own mind. Some practitioners really do just suck.
posted by zizzle at 2:06 PM on July 6, 2011 [1 favorite]

I think that the very first that any doctor suppose to do is to make your health better , whatever it is that you need for bettering of overall health . If , as a result of your interactions with this office/doctor your health is not better but worse (stress, blood pressure spikes, feeling panicked and powerless ) , than this doctor is not doing a job of helping you (or maybe you two are not a good match ?) . I have seen doctors like this , and also other kind , good doctors -- they do exist , please keep looking .
posted by Oli D. at 2:07 PM on July 6, 2011

Can you start monitoring your own blood pressure prior to the visit so that at least you are not going into the great unknown where she has ALL the data? That's what I'd do, and I'd go in with my daily log of pressure readings for backup.
posted by DarlingBri at 2:09 PM on July 6, 2011 [1 favorite]

I do indeed have "white coat syndrome", and I used to see doctors that were happy to write me a birth control prescription anyway, since my blood pressure is quite normal when I am feeling more calm. I had a doctor who set up an appointment with me JUST to check my blood pressure, which it sounds like yours is doing as well. Rather than panicking about it, I had much lower blood pressure because I knew that was all that was happening at that appointment — no speculum, no needles, no paper gown, just a blood pressure cuff.

Now I have a doctor who isn't nearly so forgiving, and if my blood pressure is too high in her office, she won't write the prescription. She pointed out that if I am responding to a doctor's visit with spiked blood pressure, I am responding to all kinds of stress and anxiety in my daily life in the same way all the time, and that is indeed important to consider with hormonal birth control. The last couple doctors I've seen have told me the same thing, and it seems to be a growing point of view.

The fact that you are responding to this snag with such high anxiety and panic — which really does come through in this question, in a big way — kind of proves your doctor's point. Actually, your last question REALLY proves your doctor's point. It sounds like hormonal birth control probably isn't your best option because of your blood pressure, but it also sounds like you have a doctor who has your best interests in mind.

I understand about looking into non-hormonal methods for later, but what do I do now? Just... go off of it and let my hormones go nuts again?

This is exactly the question your doctor can answer for you. You aren't being left to your own devices at all, quite the opposite — your doctor has requested that you come in and see her again! So let her know you're concerned about your hormone levels going out of control, and ask what your options are in terms of mitigating that effect.
posted by adiabat at 2:10 PM on July 6, 2011 [2 favorites]

DarlingBri, yes, that's what the 3-month trial off Yaz was for. I measured my BP thrice daily to make sure it was normal. Average measurement was about 123/83- when I got the go-ahead to go back on the pill, I thought it'd be for the same 3-month period test. When I called about a refill, I was told it was only for one month and that's when I got panicky.

adiabat, I totally understand your post. I am quite worried that my BP spikes easily, I just think I got tossed into a bad situation where I didn't necessarily have to be as anxious as I am and I don't know how to proceed.

I don't know if I'm ready to switch doctors as I've been a patient at this one for years, but I feel like I'm not being taken care of, shown other options, et cetera. I suppose my top options would be a progestin-only pill or an IUD, but I'm not mainly on Yaz for pregnancy prevention- I have awful, painful periods. I've also never been pregnant and I took Depo-Provera and Implanon off the table.

I just feel like this is all last-minute-panicky and I don't have someone who is willing to help me navigate this situation.

I guess I should just breathe. I was going to use condoms as a backup method while Boyfriend was here anyway, so I guess if I have to go off it, it won't be the end of the world. Then I'll likely get my period, though, hooray.
posted by rachaelfaith at 2:19 PM on July 6, 2011

In general, I have used hypnosis to help me get past some anxiety-aggravated issues. I've never had that kind of therapy in person, but rather listen to MP3 audios that I downloaded from their site. There are several companies out there that offer these on a variety of topics. Contact me if you'd like a specific recommendation.

Have you shared your concerns with your boyfriend? Perhaps having him share reproductive responsibility will be the best "non-hormonal method" of all.
posted by markhu at 2:23 PM on July 6, 2011

Consider taking the klonopin before you go to the doctor so it has enough time to kick in. Will that help the doctor-induced blood pressure?
posted by the young rope-rider at 2:24 PM on July 6, 2011 [1 favorite]

If you can, spend your time before the appointment learning breathing exercises to help with stressful situations. Hypnosis is great; yogic breathing and meditation are all also great. If you have frequent bouts of anxiety *anyway,* this can help you keep your blood pressure low during any stressful period of time, which is good for your overall health. And, it should help with the doctor's visit.

I watched this work while I was pregnant (another time when they monitor BP frequently). Went to a visit angry at the dog, and my normally-quite-low BP was super high. The midwife said, "Let's take it again at the end of the visit." We chatted for a while, I did some calming breathing exercises while thing was happening, and then she took it again. Back to normal.
posted by linettasky at 2:36 PM on July 6, 2011

Can you start monitoring your own blood pressure prior to the visit so that at least you are not going into the great unknown where she has ALL the data? That's what I'd do, and I'd go in with my daily log of pressure readings for backup.

Do this.

My girlfriend had similar issues re: blood pressure tests. She'd go to the doctor and BOOM her blood pressure would be through the roof. So she started monitoring her blood pressure daily (she bought a machine, but you can probably just use the free one that most drugstores have). Sure enough, her blood pressure was totally normal except for days that she went to the doctor's office.
posted by asnider at 2:44 PM on July 6, 2011 [1 favorite]

My mom has low blood pressure all the time--except when she's at the doctor. Goes through the roof. In her case, it's not from anxiety, but from the rush-rush-rush of getting to the appointment (she's chronically late). It's a common issue, so don't get too hung up on it.

Do some scouting to find one of those in-store BP machines near you (supermarkets, pharmacies, walmart, etc). Go in every day and check your blood pressure. They're generally pretty low-traffic areas, so spend as long as you want there. Take your blood pressure. Then spend a few minutes just sitting there, focusing on relaxing and breathing calmly, then take it again. Take a little notebook with you, and record the results. You'll be able to figure out what your baseline BP is, and you'll know how to calm yourself down in the event that it's higher than what is normal for you.

When you see your doctor, you'll know what to expect. If they take your BP at the start of your appointment and it's higher than what you expect, tell them so. Show them your logs. Ask them to let you take a few minutes to calm yourself down (maybe take a book to read a few pages of to take your mind off of it) and then measure your BP later in the appointment.

And now that I've gone and read a few responses...what everyone else said already.
posted by phunniemee at 3:02 PM on July 6, 2011

you can get a long-term BP monitor from your doctor. It straps to your arm and monitors your BP over a whole [day?]

fwiw, I had one of these once and woke up in a blind panic everytime it squeezed my arm, meaning every 20 minutes. I have no idea how these can give accurate blood pressure readings.

I really think you should consider changing doctors. I had an ob/gyn like yours once and it made going in SO stressful!
posted by small_ruminant at 3:40 PM on July 6, 2011

I too suffer from White Coat Syndrome but you CAN beat it! I start taking full, slow, calm breaths while they get the cuff ready, and keep it up right until the damn cuff comes off. Result: last reading was 132/78 instead of the usual 175/90 (which only happens in the doctors office - everywhere else, including ER is normal - go figure). I figured out that I was shallow-breathing during the whole thing and actually holding my breath when the cuff was being pumped up (because I find it really uncomfortable) which resulted in the BP spike. If you don't normally hold your breath and stress out in the course of a normal day, chances are your BP isn't zinging around all over the joint and you're not actually a stroke candidate.

That said, all the advice above is really good - but at a pinch you could try going in anyway and see if you can face down the damned BP machine. Good luck. :)
posted by ninazer0 at 4:27 PM on July 6, 2011

I've had trouble for years w/panic attacks around OB/GYN exams. Learning some good relaxation exercises in conjunction with a focused round of CBT sessions made a huge difference for me. Also helpful: imagining my drs visit step-by-step in advance with lots of detail, writing it all down, and then reading it back to myself with frequent stops to perform said relaxation exercises.

If you do go in and your BP results are high at first, ask if you can hang out in the exam room for 15 minutes and have them do the check again. My midwife did this a few times at the beginning of my first pregnancy. It gives your white-coat hypertension a chance to calm down (esp. after a few deep breathing exercises).

I also think it might be helpful to think of this as two separate problems. Problem #1 is birth control - solvable, maybe w/a transfer to a specialist. Problem #2 is your anxiety about the drs office - needs to be solved, since medical exams are going to be an ongoing issue.

In regards to the high BP - I hope your doc will explain why hormonal birth control is triggering high BP. Would this be true for you of all BC pills? What does this indicate for future pregnancies? Should you get a referral to a specialist for more of a workup?

In regards to the anxiety - if your overall stress level is high, then it's really easy to trigger panic attacks. Daily relaxation exercise practice, regular counseling, and/or daily medication bring down your general stress level and panic attacks become much less common. I think that might be more effective in the long run than situational use of an anti-anxiety med -- I could very well be wrong, just something to think about.

Good luck - I hope your BP is normal!
posted by hms71 at 8:02 PM on July 6, 2011 [1 favorite]

I always have BP spikes at the doctor too. I have learned a few ways to minimise these - counter-intuitively, a cup of coffee a few minutes before the appointment lowers my blood pressure; also deep slow breathing during the BP test, and visualising a warm relaxing beach helps.

However, my BP spikes were alarmingly high over the past few years, and even the lower BP with the relaxation techniques was only just in the okay zone, so my doctor eventually got concerned anyway, and we tried a couple of different birth control pills. I don't know what the concentration of hormones in Yaz is, but what I'm on now is Microlevlen, and my blood pressure is significantly lower, so that even when it spikes at the doctor's office, it doesn't go into the bad zone. I.e. previously it would be 80/120 when I took it at home, and spike to 90/140 or so at the doctor. Now it is 70/110 at home, and spikes to 80/120.

Also, my resting pulse used to get scary-high at the doctors, but since I started even just light jogging a couple of times a week for 10-15 minutes at a time, it dropped a lot.
posted by lollusc at 10:02 PM on July 6, 2011

I've been more-or-less where you are, including in tears on the way to the doctor's about running out of BC options. I had also taken depo and the implant off the table so I didn't feel like I had many choices. I ended up getting the Mirena, the IUD that has progesterone in and it was the best decision ever. My periods have been non-existent ever since.

Unfortunately the IUD may take longer than a couple of weeks to organise since (at least in the UK) they need you to have swabs to ensure you don't have any infections that could flare up. If you feel like the mirena could be an option for you, maybe you could persuade your doctor to give you another months worth of pills while you are organising the mirena?
posted by *becca* at 12:43 AM on July 7, 2011

Thank you all. I spoke to my doctor today and I'm actually stopping the pill this week, mid-pack, because whether it's the pill itself or my anxiety causing the blood pressure, I've been measuring it at 150/90 yesterday and today.

She took some time out to discuss options and I believe I will be doing research on the Paragard and Mirena as my long-term options.

In the meantime, I'll just have to deal with a super-messed-up cycle.

As for the anxiety itself, back to meditation/breathing practices. I have gotten very good at avoiding the actual panic attacks but I still have difficulty controlling the physical symptoms that come with them.
posted by rachaelfaith at 10:45 AM on July 7, 2011

There are a lot of us IUD users who will be delighted to discuss our experiences, if you wind up posting a question about that. (I love my Paragard. LOVE it.)
posted by Lexica at 1:41 PM on July 7, 2011