PCOS Messages for November, 2001: Re: Advice please! How to be assertive with doctor? (Long, sorry!)

Re: Advice please! How to be assertive with doctor? (Long, sorry!)

From: jodi (anonymous@obgyn.net)
Thu, 29 Nov 2001 09:49:26 -0600 (CST)

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In reply to: Chris: "Advice please! How to be assertive with doctor? (Long, sorry!)"

i know what you mean about having toruble being assertive with doctors. I feel like it's a special kind of assertiveness... you're not just voicing your needs, you're telling a doctor he/she might be wrong!

My doctor is pretty good about addressing my medication concerns. She told me if I ask questions, she can answer... so I have learned to be as specific as possible when I have concerns with amedication. If she can offer reasonable assurance, I trust her. :-) Ask your doctor what she means by "she's had success with estrostep." Did she use it in patients with acne? PCOS? High DHEAS?

A little while ago, Dona posted an excellent site for info on which BCPs are good for PCOS and other issues. it is at:

http://www.wdxcyber.com/ncontr13.htm

It lists estrostep as a pill that worsens aondrogen problems. :-) (Maybe you already saw this...) You could show her this...

One problem I find, though, is so much of the information I have on PCOS & medications comes from the web... and really anyone can say whatever they want on the web. For some reason I take printed things - books, journals - to be a more reputable source of info... and I am always hesitant to tell me doctor I want to try this or that or don't want to try this or that because I read it on the internet! If you feel this way, too, you might want to check out Smauel Thatcher's PCOS book... the section on BCPs says which are good, which are bad for androgen problems and PCOS... I know he says monophasics are better... and I know he lists which progesterones are least androgenic...

there is one other thing to consider, though. note that not all women have the same problems with the same birth control pills. i was once on ortho-trycyclin and while I can't say it helped my hair problems... it didn't make them any worse. in fact, that is probably the pill i had theleast problems with in terms of side effects, but now I wouldn't go back on it because it might be bad for PCOS. I have no idea what was going on internally, cyct wise, while I was on it... but I know i didn't have an increase in hair or acne, even though it was a triphasic. of course, it is not one of the more androgenic ones so...

also, alesse is listed as a more androgenic BCP. i was on alessa for several months, and I saw a lessening in hair problems!!! i really did. but i was spotting all the time on alesse, so i switched to another pill... and I have yet to find a pill i am happy with it. it seems i have to pick, do i want to be bleeding all the time or crying all the time? those are my main reactions to BCPs...

i am taking a print out of the above web site to the health clinic tonight when i'm getting an exam and going to discuss yet another BCP... i'm really afraid to try anything at this point, but maybe we'll come up with something...

and oh, yes, if all else fails... lie and say you had bad results. i am not above lying if it's the only way to get out of taking a med you are not comfortable with when there are better solutions. :-)

- jodi

At Wed, 28 Nov 2001, Chris wrote: >
>Hi-
>
>I finally have a follow up appointment with my new endocrinologist. She
>drew blood the last time, and my results were normal except for high
>DHEAS (400), low estradiol (30), and a funky LH:FSH ratio (2:1). So
>anyway, here's my question...when you know what drugs may help you,
>*how* do you ask the doctor for them without seeming pushy? I have
>really made great strides in the last few months with getting more
>assertive, but I still have a problem with requesting drugs. For
>example, when I left the lst appointment, she gave me a sample of
>Estrostep bcp. I asked, "Wouldn't a monophasic pill be better?" And she
>said no, she's had good luck with this pill. So what could I say? Well,
>I got home and went into one of my research frenzies (!) and found that
>Estrostep has one of the highest androgen contents of all the bcps.
>(Acne is my main complaint of PCOS.) So I didn't take it. What I think
>I need is a higher estrogen, lower progestin and androgen monophasic
>pill for birth control (like Ovcon or Orthocyclen) and possibly a little
>extra estrogen, (like Alora or Vivelle but NOT Premarin) to help my
>fatigue and memory loss. I have read several articles that indicate
>that Premarin is the most widely prescribed estrogen, but contains no
>17-beta estradiol, which is our natural estrogen, and therefore many
>women do better with actual 17-beta estradiol given transdermally. But
>I can just see it now, she'll say, "Let's get you on a low dose of
>Premarin and keep taking the Estrostep." So, do I lie and say I spotted
>on the Estrostep (which I never took) and I'd like to try Ovcon? Do I
>say my mom had bad results with Premarin (another lie, my mom never took
>it) and I'd like to try a 17-beta estradiol? I hate to lie, but I also
>hate to be pushy and act like I know more than she does. How do I
>assert myself without sounding like a know-it-all? Help!!!!
>
>Thanks so much for your time-
>Chris

Next message: Belle: "Re: Dizzy spells"
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In reply to: Chris: "Advice please! How to be assertive with doctor? (Long, sorry!)"

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