GPs keeping trying to push the Mirena on me but I'm happy on the pill

[CurlyhairedAssassin]

Hi there, sorry this is a bit long....

I'm 38 and have been on the combined pill since I was diagnosed with PCOS at the age of 23 (Dianette at first for that, and then Cilest after a few years and ever since). It has been perfect for me all these years - pre and post babies. As well as being a fab contraceptive, it's worked on all my PCOS symptomes too.

However, various GPs (well, registrars) I have seen when getting repeat prescriptions (large practice so I usually see different registrars) keep trying to push the Mirena coil on me and I don't bloody want it! The pill works brilliantly for me. One of them has said I'm getting a bit old for the pill, another has said that my strong family history of breast cancer (mother's side) is a risk factor for the pill (despite there being no breast cancer gene involved and a permanent older doctor at the practice telling her there is no definitive evidence of risk either way for non-gene-related breast cancers), and a couple have said that my blood pressure has been high a couple of times so I shouldn't be on it (the first time it was raised was during a week that my husband was in a car crash, my little boy started school, and I had added stress at work covering for my boss, yet this wasn't taken into account - had white coat syndrome a few times since because of that I think but it was actually fine on a GP visit today). I have a good digital bp monitor at home and 9 times out of 10 my bp is totally fine, even if I've done it after something relatively stressful like the morning school run!

One of the registrars was finally persuaded a while back by one of the permanent doctors at the practice that my "high" blood pressure readings were only borderline anyway, and weren't high on every visit so staying on the pill even at my age is not a problem, especially given the fact that it's controlling my PCOS symptomes.

Has anyone got any advice? I'm sick of seeing various GP registrars who although they are very nice, I think are quite often overcautious, and every time I see a different one I have to discuss the whole shenanigans again with them. They all without fail try to push the Mirena coil on me and I have told them time and again I know too many people who have had problems with it, and why should I risk that when I don't get ANY side effects with the pill?

I know I should plan more in advnace and make sure I get an appointment with the permanent older practice doctor but I'm a bit disorganised with making appointments in time before I've run out of pills, and there is always a long waiting list for the permanent doctors - there isn't with the registrars.

I just feel a bit bullied all the time into switching to the Mirena and it's starting to piss me off - is there any incentive for them to prescribe it instead of the pill? Financial or otherwise?

[Nevercan]

I would stick with the pill if it works for you. If it ain't broke don't fix it

[CurlyhairedAssassin]

Well, yes, it seems the obvious thing to do, just don't know why they are obsessed with the mirena!

[Bunbaker]

I suspect that nowadays doctors are being more cautious because they are afraid of being sued for negligence. These doctors don't know your body as well as you do and the evidence they are presented with when they see you point to the pill being higher risk for you, so I can see why they are being careful.

[Ponyofdoom]

I had this last year at 40. I had to come off the combined Pill because of my blood pressure, which had recently gone high due to the Pill. I was given the minipill Cerazette instead which I was very upset about at the time; however it has actually been fantastic, much better than the combined Pill, because it has totally stopped my periods and my blood pressure is now normal. However when I went to my GPs they did just the same as to you; ie hard-core selling the Mirena, showing me a model of it etc etc. I made it extremely clear (just short of screaming and running) that I really didn't fancy it and wanted to stick with Cerazette for now, though would consider the Implant in the future. Lo and behold next time I went along, my notes read that I was interested in having Mirena fitted! Nooooo! Still on Cerazette, still very happy. Stick to your guns, I think they are on commission :-)

[Ponyofdoom]

Oh and maybe do try Cerazette, then they can't say anything about the oestrogen risks/high BP

[FlossieFromCrapstonVillas]

I'm on my second Mirena, there are side effects but I'd rather have those than the unbearable pain of my periods, and it means I don't have to have a hysterectomy, which is, of course, major surgery. Doctors do, I believe receive a payment for each Mirena fitted. It's not for everyone but it's good for me.

[sleeplessinderbyshire]

NICE guidelines suggest that all women are offered a long acting reversible method (coil/implant) rather than the pill. GPs are assessed against quality standards that say they have to offer these methods to every woman on the pill at least annually which is why you'll keep being asked

[Hollyfoot]

I've had my Mirena for 5 years. For the first time since I was 13 (and thats a blardy long time ago) I have escaped the misery of really heavy periods. My lovely GP has agreed I can keep it for 2/3 more years if I want to. They will have to catch me first if they want to take it out any sooner.

[CurlyhairedAssassin]

Thanks for all the replies. I am quite shocked to hear that there is money involved in fitting these things, no wonder they are keen for me to agree to it!!

pony, your gp sounds really pushy. I think if that were me, I would ask to have it taken off my notes. Sounds a bit fishy actually, do they have to exceed a certain quota of women they've discussed the mirena with before they get their bonus or whatever they want to call it? I remember my sil being shocked to notice on her gp's screen that she was down as an ex smoker and being given regular anti smoking advice, she had never smoked in her life and went ballistic when she saw it and told the doc to remove it from her notes. So immoral.....

Does cerazette tend to give you more spots than the combined pill? I have found that the combined pill ha helped enormously with this (pcos symptom). I thought it did, which was why I was against it, but maybe the modern ones are different?

[Ponyofdoom]

Curly, I had more spots with Cerazette for the first couple of months, but it settled down and now my skin is very much better than when I was on the combined Pill. With the latter, I got cyclical bad skin, but as I have no 'cycles' now its just pretty much OK all the time.

[pumpkins34]

I totally think they are getting kickbacks. I, like you am very happy on the pill. I went to my GP for a refill and he started raving about the Mirena. I repeatedly said "I don't want it !" and then he wrote me only a three month prescription and angrily said to me " next time you come in you're getting a breast exam and you better start thinking about something more permanent!"
I cannot see why he would get angry unless he is getting a good reward. I have heard they get $300-400 PER Mirena. I can't confirm it but it seems like it must be true.
Anyway I am so angry at this I looked at alternative way to get the pill and I found that you can buy them legally form UK pharmacies. You get an online consultation with a doctor and they write a script. I am never asking my GP for the pill again.

[sleeplessinderbyshire]

rubbish. I am a GP. we don't get anything like that money. we get paid for the time to fit the thing (about £40 for a 30 mins appt for me and the nurse together and the cost of the equipment but not the mirena itself comes out of that) we also get a quality payment if we recommend long acting methods to women (as they are considered by NICE and the gynaecological world to be better - more effective and safer than pills) that is based on us giving advice about the coil/implant/injection to at least 90% of women who request the pill/patch. We are not doing it for the money (but without the money we couldn't offer the service to the patients that want coils/implants etc as the money pays for a nurse) Our quality funding (from all different clinical areas not just contraception) pays for at least 2 docs and 1 nurses salary so without it we'd be scuppered

[OnTheBen10DaysofChristmas]

My practice nurse has to give out a LARC leaflet to every woman on contraception every 12 months. I guess that means that they get the payment that sleepless refers to. I'm happy with the patch but in my area there are lots of v young mothers who don't have any support from a partner so it would be sensible to ensure that these girls don't have accidents from pills/patches.

[pumpkins34]

"sensible to ensure that these girls don't have accidents from pills/patches." That is incrediblly patronising and paternalistic. China is a place where women are forced to have IUDs, I hope we are not heading there.
But anyway in my situation I am a happily married woman who would not care if I got pregnant again. (Not that I've ever found it hard to remember to take a pill.) And it does not make sense that my doctor would get angry at me because I don't want a Mirena unless there is something in it for him.
Tell me Sleeplessinderbyshire: Why do some doctors refuse to remove them? I have heard of many women have to ask repeatedly to have their IUD removed. One woman rang her doctor's office to have it removed and the receptionist claimed that none of the doctors know how. I beg your pardon, but if they had training to put in in they had training to take it out.
I find it interesting that you say the gynecological world considers it safer when there is the possibility that it can perforate the uterus and cause ectopic pregnancies!

[pumpkins34]

I'd like to add that the pill has been around for 50 years. It has been used by millions and millions of women. I think its safety record is well and truly proven. And I heard one doctor say it is safer than aspirin. On the other hand, the Mirena has only been around since 2000 and already there are class actions being talked about. And lets not forget the Dalkon Shield. Please explain how the Mirena is considered safer?

[OnTheBen10DaysofChristmas]

Having spoken to the practice nurse and the nurse at the FPC when I had my implant removed I don't think that my comment is patronising.

There is a huge problem where I live of teenage pregnancy. I live in a deprived area and one in 20 girls between 15-17 become pregnant which is an unbelievable statistic. The NHS are really trying hard to stop this to help the girls to not become pregnant before they wish to and therefore encourage the implant for these girls as well as providing condoms in lots of easily accessible clinics.

[pumpkins34]

You know the countries with the lowest teenage pregnancy rates in the world are the countries where the pill is available OTC. So it maybe it's not the fault of the teenagers but the system. In the United States where getting the pill is virtually impossible without doctors requiring a pap smear, pelvic exam and breast exam, which by the way are not requirements for the pill but merely a medical history and blood pressure test, the teenage pregnancy rate is the highest in the world. Therefore doctors and the health system are creating barriers to the pill for these women, it is not that they don't know how to use them.
And BTW I still don't believe that doctors do not receive an incentive payment from Bayer, because too many doctors are pushing this particular IUD over any other.
I had an online argument once with a doctor here in Australia that denied, denied and denied that doctors got incentive payments for performing pap smears- until I proved it by providing a link to the Australian government website which clearly stated that they pay an incentive if doctors screen 65% of their female patients. Then this doctor said "Oh but I don't get the payments, the practice does".
So I know how doctors try to split hairs when they deny stuff.

[south345]

I noticed on my records it said they'd given me stoping smoking advice in July but I stopped 7 years ago!

[peggyblackett]

Sorry to hijack, but for those of you using the Mirena what are the benefits? I have horribly heavy periods and would love for them to be lighter. Plus, I'm scared that I would get the same mood swings as I do on the pill - has anyone experienced this?

I know my GP would immediately say that there are minimal side effects, but continuing to have heavy periods, or it destabilising my mood, would really put me off.

[haddock1976]

For me with endo and PCOS the Mirena has proven invaluable and without it, I would not be pregnant. which sounds totally arse about face but makes sense really

Long story but very simply put (with lots of detail missed out) having had 4 ops to remove cysts and a build up of endo tissue the Mirena prevented my periods and stopped the growth of more cysts on my ovaries/build up of endo tissue. My wonderful surgeon in London said that in his opinion I had 12 months after Mirena removal in which to conceive naturally before my body got clogged up again.

Two consultants prior to this one had told me that in the unlikely event I did actually conceive I wouldn't be able to carry full term.

9 months after removing the Mirena I fell pregnant and I'm 39+2 and really looking forward to meeting my daughter.

It isn't for everyone but it was for me.

[Hollyfoot]

Just to reiterate, the Mirena has made a huge difference to me. I'd been struggling with really heavy periods since they started. They affected my whole life and I've had anaemia as a result of them.

After a few months of irregular bleeding on the Mirena, they stopped completely. Havent had a period for 4 1/2 years now and I've had no side effects. for me, its been wonderful. People do seem to have bad experiences if you trawl the internet but I suspect the happy majority are pretty silent. All the best whatever you choose.

[haddock1976]

Sorry OP, a totally irrelevant post in relation to you might be of some use to others.

[peggyblackett]

Aaah haddock that is a lovely ending. Hope you get to meet your babe soon.

Hollyfoot, thanks for the info. I have had awful periods all of my life - so switching to light/no bleeding would be wonderful. I've only realised how much blood I lose since having a mooncup. It's quite a lot :(.

[Emmac50]

I've been fitted with one of those and love it and everyone I know absolutely loves it. Needless to say I was in your situation as they kept forcing anti depressants and all sorts even though my thyroid levels went well above they should have in blood tests anyway. Doctors get extra money for promoting these more permanent type contraceptions and anti depressants. Stick by your guns and don't give a dam what they say. It's getting more and more privatised and less about what the patient feelings and issues are. Stand your ground!!

[FrozenNorthPole]

QOF payments are not the same as kickbacks, and definitely not the same as privatisation . QOF payments are used by the DoH to make GPs emphasise particular areas of priority in their consultations e.g. stop smoking, weight loss etc. which they judge to be of population-level epidemiological benefit. By definition, being population-level, they will not be of use to many individuals and, believe me, in many cases irritate the heck out of many doctors. They are paid to the practice to enable service provision i.e. the nurses, doctors, equipment and premises. So if you're angry at what you're being advised to do, my advice would be to request that a note be put on your file explicitly stating that you do not wish to receive advice on this matter again. I ended up doing this with a particularly pernicious health visitor. The doctor will still probably want to try to give you advice that he/she believes to be in the best interests of your health, but it at least saves you having the argument with every GP reg newbie that you come across: just point them in the direction of your note.