How do I find a good gynecologist if I only get one visit a year?
October 14, 2010 7:52 PM   Subscribe

How do I find a gynecologist who will respect my wishes for hormone free birth control?

My question and circumstances are identical to this recent question, but I live in Pittsburgh instead of Chicago:

I had what I thought was a great gynecologist, but when I mentioned wanting to get an IUD, she immediately started talking to me about Norplant. When I specified that I was interested in a copper IUD to avoid hormones she acted like I'd asked her to treat me with leeches. She said she only placed Mirena IUDs now, and that she'd only placed one copper IUD recently and that the girl had gotten an infection and was now unable to have children. She then said she'd only be willing to place the copper IUD if I didn't care about my future ability to have children. I was completely taken aback and of course frightened, so I backed out of the whole thing and went back to my barrier method for the past year. But now I'm interested in an IUD again.

I phrased the question like I did because this is the third or so gynecologist I've gone through. This is the first time I've tried to get an IUD, but previously I've gone to providers and when they've seen on my chart that I use a barrier method of birth control, they immediately try to push birth control pills onto me, even though I didn't mention anything about wanting to change my birth control method.

I'm pretty leery of Planned Parenthood, to be honest, because I went there when I first became sexually active and they basically did exactly what all their critics say they do: tried to shove birth control pills in my hand and get me out the door. It's left a bad taste in my mouth about the organization ever since.

For the record, I want hormone free bc because I've had problems with depression in the past. It's finally under control so I'd rather not do anything that will mess with my moods. I tried Depo Provera once about 10 years ago but it left me terribly depressed and I haven't tried any hormonal birth control since.
posted by anonymous to Health & Fitness (25 answers total) 5 users marked this as a favorite
Call the company that makes them. They will direct you to a doctor who will prescribe it.

Questions? Call the ParaGard® Info Line
posted by Ironmouth at 8:03 PM on October 14, 2010 [6 favorites]

Also, FYI every Planned Parenthood office has a different vibe. Maybe try a different one.
posted by BlahLaLa at 8:05 PM on October 14, 2010 [1 favorite]

I went to PP clinics for years and had the opposite experience, they listened to my concerns and let me choose the method I felt was best for me. I urge you to give them another try. Call around and find out who is willing to give non-hormone IUDs.

The scare tactics deployed by the one doc you mentioned are despicable.
posted by mareli at 8:05 PM on October 14, 2010

Well, I guess you've got your make-or-break issue. The short answer is to find another OB/GYN who will respect you, period. Just ask the nurse when you call for an appointment; they should be familiar with whether or not the doctor in question does copper ones, and that shouldn't cost you a whole visit to find out.

Of course, not to sound disrespectful here, but...

For the record, I have depression and was very sensitive to changes in hormonal birth control. Which was unfortunate, because due to formulary changes with my insurance I had to change pills maybe four or five times. It was SO FRUSTRATING. I finally went off them for good because the mood swings were too much. I was even on a low-dose pill, with no luck.

When I got a Mirena, however, I was so, so pleased with it. I never had a single issue with my moods, and it had just enough hormones to keep my skin looking good. Sadly, I expelled it twice (AFTER my six-week checkup, which is exceedingly rare), so I am not a candidate for that anymore. But during the three months I had it, I was so VERY happy with my birth control situation. It was the best damn thing ever.

I am one of many people with depression who have used Mirena successfully, including at least three or four in my immediate circle of friends and acquaintances. I have never heard anything but good stories. And Depo, Norplant, any of the implants, or even NuvaRing -- my god, I've just heard complete nightmares. I have one friend who likes her implant, and... well, she's crazy :) She also has other health issues that probably either preclude other methods or are less than the side effects. But every other person I've known who has experienced the implants has had horrible tales. Everyone I've known with Mirena? The exact opposite.
posted by Madamina at 8:13 PM on October 14, 2010 [3 favorites]

I'm another person with depression issues who has found Mirena to be pretty near a miracle appliance, but that said, you should be able to get what you want.

A lot of OB/GYNs work under the slightly outmoded belief that IUDs are a) not great in general and b) shouldn't be inserted into women who haven't had children. And OB/GYNs are at high risk for malpractice suits. It behooves them to an extent to be conservative, but it doesn't let them be good doctors sometimes. I agree that you should contact the Paragard customer service line and see if you can find out who does support them in your area.

And if you do have access to a different Planned Parenthood clinic than the one you visited previously, don't rule it out--or even the same one, you won't necessarily see the same caregiver. I know that my own hangups as a young woman just becoming sexually active colored my experiences with medical professionals, but as a rule my experiences with PP have been overwhelmingly positive and you really seem to know what you want, and perhaps it's been long enough that you'll have the poise to know how to get it.
posted by padraigin at 8:34 PM on October 14, 2010

Kudos to you for not giving in to hormones you don't want!

This may sound kinda "duh," but just in case:
I went through a couple doctors of my own before I found one I really liked. What worked for me: I asked (via facebook/twitter) my female friends/relatives if any of them had a doctor they really liked. I got several recommendations, and called up the doc recommended by the friend whose personal philosophies most lined up with mine. I guess in your case, the next step would be to call that office and ask if they do Paragard there. If they sound enthusiastic, sign on up. If they sound skeptical, move on to the next recommendation.
posted by hishtafel at 8:52 PM on October 14, 2010 [1 favorite]

Planned Parenthood & the Paragard info line are good ideas ... definitely call the office and tell them you want to make a fitting appointment (it takes two appointments, one for fitting and then a second, ideally during your period, for insertion). Good luck!
posted by amber_dale at 9:06 PM on October 14, 2010

Lady Comp is another option that is hormone free, safe and about as reliable as other forms of birth control.

I might not suggest it if an accidental pregnancy would be a horrible outcome, because you never know, but I don't think any form of BC is 100%.
posted by rainydayfilms at 9:09 PM on October 14, 2010

As others have said, good on you for refusing the hormones you don't want. I have a Paragard IUD, after discovering that every time I went on hormonal birth control pills I also had to go on antidepressants (really, the correlation is ridiculous in my case). I have never been pregnant. My paragard has been AMAZING, and I strongly encourage you to keep looking for a supportive physician.

It's true that insertion sucks for nulliparous women, but for me, it has been so incredibly worthwhile.

I, surprisingly, actually found the nurse practitioner and doctor who gave me my Paragard through the county health department. I couldn't get my insurance to cover it, but my county's health department/family health development clinic covered my IUD. It was not only easier, but about 1/10th the cost. If you are in the US, look for local department of health covered institutions.
posted by amelioration at 9:17 PM on October 14, 2010

I forgot to mention that there was a slight waiting list for me to get my IUD. In my county, the health services offices only get a certain number of IUDs each month, so a waiting list builds up. Still, totally worth it.
posted by amelioration at 9:19 PM on October 14, 2010

I've had two Paragard IUDs inserted at Magee-Womens Hospital. My awesome PCP had me call this clinic for the first one, and I had a completely positive, nonjudgmental experience. The second one was done in the Outpatient Clinic and was an equally great know, as great as inserting an IUD can be.
posted by squeaky at 9:30 PM on October 14, 2010

I am a man, but I have spent many, many hours helping my partner find, audition, and evaluate gynecologists. Basically, many of them aren't very good, as you have found. Or rather, many of them are fine if you are a standard case, fitting into a predetermined category. If you have more complicated issues, you are stuck trying to find the minority of GYNs who are adaptable and listen well.

I like Ironmouth's suggestion of calling the company directly -- we have had good luck with a similar approach -- and the other hope is for a direct recommendation from someone local in a similar position.

Having said all that, my partner has found that the right hormonal BC has helped her depression enormously. So be careful that you are not rejecting an entire class of options based on some of them not working well for you. In our experience, the ideal doctor is less one who gives you exactly what you are asking for, and more one who helps work through possibilities in a far more informed way that can be done by reading on the internet.

Honestly, I wish we could clone her current gynecologist. He listens, he is super up to date on the latest research, he takes everything she says seriously, and he makes all the time that is needed to work through as many experiments as is needed to find what works, with of course adjustments whenever things change. He has never pressured even one iota about kids/no-kids, hormonal/non-hormonal, or any of the other things that previous doctors have pressed agendas on. It's not easy, but trust me, it's worth the time and stress to interview enough doctors to find a good one.
posted by Forktine at 9:38 PM on October 14, 2010 [1 favorite]

I have some specific gynecological concerns and have seen so many terrible gynecologists who didn't take me seriously that I refuse to see any more bad ones.

So when I moved to a new town and needed a new gyno I asked my (fantastic) previous doctor for a recommendation. She had none. So I got recommendations from all of my acquaintances and then I called each and every one of them. I spoke either to the doctor directly or the head nurse and I asked all kinds of specific questions about my concerns and treatment and symptoms and history. I was able to get a good sense of whether this doctor would believe me and be able to work with my concerns without putting my feet into stirrups.

So I recommend you calling a bunch of different offices, talk to the doctor or the head nurse, and ask if the doctor places copper IUDs. If not then all you've wasted is 10 minutes on hold rather than an entire judgmental appointment.
posted by rhapsodie at 10:40 PM on October 14, 2010 [1 favorite]

Doctor shopping based on a preconceived desire for a specific treatment is good way to get a bad doctor. You go to a doctor to benefit from their expertise, training, and judgement, not for them to act as a rubber stamp for your layman's opinion.

You are essentially asking the doctor to sign off on implanting a riskier class of IUD based on the errant notion that all forms of hormonal birth control have been shown to interere with the management of depression, when, in fact, the majority of the most commonly used hormonal methods show no significant likelihood of aggravating depression.

A better approach would be to find an OBGYN with reputation and with whom you feel comfortable going in with an open mind, and with whom you would be able to talk over your concerns, and ultimately arrive at a treatment plan that the both of you are comfortable with.
posted by patnasty at 11:23 PM on October 14, 2010 [9 favorites]

When I moved to a new town and wanted hormone-free birth control (i.e. copper IUD), I just went down the physician directory, calling each one, asking two questions:

1. Do you prescribe the copper IUD?
2. Yes, great. Are you taking new patients?

If no on the second one, I explained how difficult it was to find an OB/GYN who prescribed the copper IUD. They set me right up.

There are some downsides to the copper one, which every doctor will be happy to tell you about ad nauseum, but IMHO, the upsides far outweigh them.
posted by iamkimiam at 1:22 AM on October 15, 2010 [1 favorite]

Bizarre, and unfortunate. I'm very sorry that you've experienced this, particularly so in light of the fact that my own prescription and insertion of Paragard about 6 weeks ago was very easy. I called up Magee Gynecologic Specialties which squeaky mentioned, asked for the first available appointment with a female doctor, and went in for an exam and consultation with Dr. Heather Hohmann three days later. While she did recommend Mirena, primarily citing the tendency for lighter periods, she didn't try to persuade me against the Paragard, as I was able to demonstrate that I had chosen it after researching all available options as being the best fit with my needs and desires. For me, the increased potential risk of medical side effects was preferable to the mental health risk presented by the reported incidence of altered mood in users of Mirena, even as low as that was. I was asked to call when my next menses began, did so, and was scheduled four days later (unfortunately we ran into a weekend) for insertion with Dr. Beatrice Chen. About as simple as I could have hoped, really, and both physicians, as well as the assistants and office staff, were very friendly and respectful during my visits. Feel free to memail me about anything to do with this.

I guess I also have to add that I'm sorry your desire to find a workable solution that considers your wish to avoid hormones at least as much as it takes into account the opinion of one physician is written off as "doctor shopping". The physician's recent experience with the device in practice, while sad, does not change the fact that incidence of PID leading to infertility is still rare. Yes, the hormones in Mirena appear to provide protection against infection, which is a strong point in its favor, but overall infection rate after insertion of either IUD drops after the first few weeks. While it's certainly the physician's right to counsel against this or that device based upon their own judgment, it is your right to seek other opinions and providers which hopefully will be more informed by long-term study results.
posted by notquitemaryann at 2:37 AM on October 15, 2010

You are essentially asking the doctor to sign off on implanting a riskier class of IUD based on the errant notion that all forms of hormonal birth control have been shown to interere with the management of depression, when, in fact, the majority of the most commonly used hormonal methods show no significant likelihood of aggravating depression.

However, the OP has had problems with hormonal birth control and depression.

Dear OP. Its your body. I advise that you trust yourself.
posted by Ironmouth at 5:57 AM on October 15, 2010 [5 favorites]

Trust your gut and shop for a doctor you trust and will listen to you on this issue. It's important to you to not have hormone BC.

My PCP tried to prescribe Depo for me, but I thought that was a weird since I was extremely high risk for breast cancer. (Call it fate, but I was diagnosed with cancer before I got the shot.) When I asked for hormone-free BC, my new gyno at first tried to sell me on something hormone-light, so I just got a new one. She's great, listened to me, and got me the ParaGard right away.
posted by kendrak at 6:37 AM on October 15, 2010

I would just add to patnasty's response - a truly good doctor does not rule out any safe treatment for a patient for whom that treatment is a good/the best course. So find a doctor that has a good reputation (I've referred everyone on the planet to my GYN because she's awesome, so if you are in the Atlanta area, hit me up) and you're going to be about halfway there. My doctor offered me either the Mirena or the Paraguard, but I went for the Mirena because the issues you get with the copper IUD were not on my list of things to do in this life. (FWIW, after being on hormonal BC for +/- 10 years I started not tolerating it well, but the Mirena has been a full on revelation. )
posted by Medieval Maven at 6:44 AM on October 15, 2010 [1 favorite]

IANAD, but having worked with a GP practice for a decade I've dealt with a lot of OBGYNs and I can tell you they vary a LOT, and annoyingly, sometimes the best ones come across the worst way. It's not entirely clear to me if the OP told her doctor why she wanted the IUD, which might make a difference. Popular opinion on them seems polarized: they are either magical, risk-free birth control or hideous torture devices. Also, it sounds like the doctor was spooked by this bad experience of her patient's...doesn't help the OP of course, but doctors are people too and can become set against things that they (or their patients) have had bad experiences with.

The above suggestions are good, except that the idea of a non-patient interviewing a prospective OBGYN without at least a face to face meeting would be impossible in the system I worked Toronto, Canada, so YMMV.

In addition to the suggestion of calling the IUD company, I might add: (1) if you have a mental health professional, they might be able to suggest someone sensitive to that element of your medical history; (2) in my experience, naturopaths are pretty anti-hormone treatment, so if you have or know one they might be able to refer you to a good OBGYN; (3) women's hospitals, especially those with both OBGYN and mental health/psych/neuro departments might be a good place to look; (4) a lot of migraine sufferers are in the same boat, so think of friends with migraines when looking for referrals; (5) make sure you are fully informed about the pros and cons, and can prove it to the doctor--this might not be your job, but it might also get you what you want. Googling spits out this article, mentioning this doctor (also here), who has studied the copper IUD and if not in clinical practice may be able to refer you. Good luck!
posted by sarahkeebs at 6:47 AM on October 15, 2010

Mirena is being pushed, hard, by the pharma companies. They are somewhat easier to insert, and offices get good deals on them. The price of copper has shot up, so the Paragard has gotten pricier.

That said, I had a Paragard nulliparous, a Mirena between pregnancies, and now I'm back to the Paragard. I hate hormones. My belly gets puffy, my skin gets gross, and I just feel weird. None of that would show up on a list of important factors in a major study, but you know what? It sucks, just the same.

The reason docs want you to have a baby first is because a stretched out uterus is more forgiving. Placing an IUD in a "virgin" uterus is trickier, it's easier to screw up and pierce the uterine wall.

So if your OBGYN is weird about placing IUDs, for god's sake, go elsewhere! Chances are they don't do many, or many on childless women, and you want someone who knows what they are doing.

I understand that you feel weird about Planned Parenthood, but they really, truly are the best place to start.

Getting an IUD is the best thing I ever did. Good luck.
posted by Leta at 7:58 AM on October 15, 2010 [1 favorite]

Your physician may regard the copper IUD as not good for anybody's health. That's a valid opinion. But this health care provider hasn't spent adequate time addressing your concerns about birth control, and that's not okay. Base your search on finding somebody who listens. I had fantastic, respectful care from Planned Parenthood.
posted by theora55 at 8:27 AM on October 15, 2010

Have you considered a diapragm or cervical cap? Or have you been using them (barrier method is unclear).
posted by WeekendJen at 8:45 AM on October 15, 2010

I tried Depo Provera once about 10 years ago but it left me terribly depressed and I haven't tried any hormonal birth control since.

It's somewhat imprudent to judge all HBC based on your experience on Depo. Combined HBC doesn't work the way Depo does, and neither do low-progestin products like Mirena. I sympathize with you because I too have had birth control destabilize my moods. A competent gyno can help you choose an appropriate pill or IUD -- it's not impossible to have well-managed depression while on HBC. Don't assume that non-hormonal options are your only (or best) choice.
posted by thisjax at 11:42 AM on October 15, 2010 [2 favorites]

You are essentially asking the doctor to sign off on implanting a riskier class of IUD based on the errant notion that all forms of hormonal birth control have been shown to interere with the management of depression, when, in fact, the majority of the most commonly used hormonal methods show no significant likelihood of aggravating depression.

Combined HBC doesn't work the way Depo does, and neither do low-progestin products like Mirena.

Combo pills made me suicidally depressed. Low-progestin pills made me suicidally depressed. Those two strikes have left me fervently and passionately unwilling to use any form of hormonal contraception. OP, I fully support you in what sound like a rational, considered decision that hormones are wrong for you and you're not willing to put them in your body.

I've had a Paragard for a little less than five years now and love it. I'm not only nulliparous, I'm nulligravida, and other than some trouble getting it placed correctly the first time (which a second insertion attempt, aided by an intrauterine sonogram, solved), I have zero complaints about it.

My snarky impulse would be to ask your doc "Do the lawyers at Duramed know you're telling patients that their product will render them infertile? Because if not, I'd bet they'd like to know. Shall I give them a call?"
posted by Lexica at 2:34 PM on October 15, 2010

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