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    Hi Again Dr. Hohner. When to call my ob/gyn or doctor concerning BCP's
    Sabine48 posted:
    It's been a while and recently I've had new concerns. I hope I can be as brief as possible in explaining my concerns.

    Been on BCP for close to 35 years, no real problems until this past year when I had very heavy, irregular bleeding. Went to a wonderful ob/gyn that I waited a long time to get in with, had some polyps removed that did not show up on abdominal ultrasound, thankfully she found them and they were non cancerous. Put me on a higher dose of BCP, currently still taking Ogestrel 0.5/50, 28 day regimen. Prior to that I took Lo Ovral for several years and did fine until I had the heavy bleeding and anemia from the blood loss.

    Things seemed to be getting under control with the higher dose BCP but since late September if memory serves me I have had slight calf pain in my left upper calf that has not gone away. It's a mild pain, kind of like a muscle ache, no burning or swelling or any other symptoms, just that slight sometimes muscle spasm like pain. I dismissed it until reading some of the cautionary notes on my pill insert. I think a call to my dr. or ob/gyn is in order. Should I be concerned? How soon shouldl I try to get in? Should I go to my GP first or to the ob/gyn who is up on my situation? My next appt. for my annual exam is in February 2012, should I wait?

    I seem to be prone to dull kidney pain on my right side as well and I'm thinking maybe some hip joint pain on that same side that has caused me problems in the past. I have some discharge yellow in color, no odor that I can tell. I know these are things I need to report to my dr. or ob/gyn and plan to. I'm 49 and worried for having taken BCP's so long.

    Our insurance provider has changed due to my husband getting a new job after a lay off. It appears my favorite and most trusted ob/gyn might no longer be an option which really upsets me. I'm hoping to see her at least once more to get some direction as to what I should do or a referral but I will really miss her take charge mannerisms which is why I sought her in the first place. I know that's nothing you can do anything about I just thought i would mention it.

    Any advice once again would be very much appreciated. My plan is to quit the BCP altogether, I was hoping with this ob/gyn I would be able to decide my next step and to get things taken care of. I am considering tubal ligation or my spouse getting a vasectomy, I'm worried about the changes that might take place since I had so much trouble with heavy bleeding this year.

    Hope to hear from you as you are able. Sorry it got so long! Thanks!
    Sabine48 responded:
    Next a.m. - pain seems to subside at rest or sitting. Woke up this a.m. with severe hip pain on my right side that included the thigh area and fron lower shin area with a little pain in upper foot area, this seems to be when I am weight bearing, i.e. standing or walking that it seems at it's worse, at least until I am up and about for 5 or more minutes then I believe it is lessening in pain but still there. When I sit though it seems to help and I do a LOT of sitting. Thank you!
    Jane Harrison Hohner, RN, RNP responded:
    Dear Sabine: With that kind of severe right leg/hip pain that should be evaluated by a primary care MD. It would be less likely that such a pain was linked to your birth control pills (BCPs).

    I was concerned reading about the left calf pain as you are taking an older, higher dose (50 microgams of estrogen) type BCP. There is an increased risk of a blood clot (deep vein thrombosis or DVT) in the leg/arm/lung. Our risks for a DVT rise with age, obesity, and immobility--and the pro-clot quality of estrogen. So please let your primary care MD know about the calf pain so it can be checked as well.

    Your being on lower dose BCPs such as LoOvral should not have an impact at your age if you are a non-smoker. I can understand your concern about a return of the dysfunctional bleeding if you go off BCPs for a vasectomy or tubal ligation. Hopefully the removal of the uterine polyps will help, but there is no way to know except for stopping the BCPs and seeing what happens. Some women with tubal ligations do end up going back on BCPs during perimenopause because dysfunctional bleeding problems.

    Hope your current GYN can refer you to someone like her. Be sure to bring in your new "approved provider list" for the insurance company so she can circle some suggested names.

    Sabine48 replied to Jane Harrison Hohner, RN, RNP's response:
    Thank you for your helpful reply Dr. Hohner,

    I'm thinking I have a pinched nerve which would answer for the leg/hip pain. I will see a dr. if it lasts too long. Thank you for your suggestion.

    I had read about clots being a possible side effect of BCPs. The pain is recurrent in the same spot, not extremely painful but a dull cramp or tightening is the best I can describe it. My appointment is in February and I'm not sure of the urgency but I will be calling my ob/gyn this week to see what they think I should do or watch for before then. I will hit the big 50 next year and I guess age and immobility are two real possibilities given my lifestyle. I am pretty sedentary at home and work reminding myself to get up and move about once an hour if I remember! I will put a call in to my primary dr. as well, thank you.

    Thank you for suggesting an approved provider list to bring to my gyn with me. I sorely dislike the thought of losing her, she is the first doctor I really felt a lot of trust with.

    Your help and advice are always appreciated.

    Kind regards.
    Sabine48 replied to Sabine48's response:

    Dr. Hohner,

    Hello again! Went to my primary dr. this week. She thinks I have sciatic nerve pain that would explain the problems on my right side. I also told her about the left leg mild cramping and that I've had it more than 2 months. She set me up for an ultrasound tomorrow for which it will likely be a few days to get results. We want to make sure it isn't a clot, scary thought. I just had a friend have a stroke at 53 because of taking a higher dose of hormones (I never get which, estrogen or progestin) because she was bleeding so heavily. Thankfully she was found and air flighted to the hospital in time, she is daily working to get back to where she was before the problems. She is extremely overweight and sedentary, I'm not necessarily overweight at 5'6" & 140 (at least I'm guessing I'm not) but my lifestyle IS sedentary because of my job and when I come home I like to take it easy.

    Admittedly I've yo-yo'd through the years going up and down about 35-40 pounds, wish it were easy to keep it off permanently! But.. I take a day at a time and have done WW twice with good success.

    Anyway, I had another question, my dr. mentioned getting an IUD with a little progestrin as a form of birth control if I have to get off the pill. I've never used that method and it sounds too easy. I don't much like the thought of having to 'check for the string' periodically but she said it is 99% effective and proving very good as a birth control method. What are your thoughts? She figured I could use the 5 year low progestin one, I will be talking with my gyn about it too. We also plan for my husband to have a vasectomy to double the protection if it will help!

    I also told her about the migranes I have gotten every month for the past 3-4 years having started it seems just before my cycle in the beginning to mid way through it to recently, towards the end. She said it was likely the estrogen? I'd not heard of that. She said the progestin would likely help with that and my periods with the IUD. What are your thoughts?

    I will let you know what the results of my ultrasound are if you like. Not sure exactly where to go from there until I know more about whether or not it is actually a clot. I suppose the first thing would be to get off the pill. I am worried about bleeding again! It's always something at this age or so it seems and I'm told with each year it's something else! Ugh. Thanks for your time!

    Merry Christmas to you and your's!
    Sabine48 replied to Sabine48's response:
    Utrasound I was informed by the wonderful woman technician was negative for showing any blockage. I hate to sound like a hypochondriac (if that's the right word) because that's what I felt like but I hope that the test was completely accurate. I'm supposing it can see deep into the veins. So, on to the next step of trying to find out what it is that might be causing my cramping. Thankfully it appears it is not a blockage.

    Thank you for your support. I'm not sure what other board to seek, I'm wondering if it is a lack of something my body needs, Vitamin D - calcium, magnesium, or other minerals. Is there a test to find that out? I know I don't get enough of any of those as I don't take any supplements and am pretty strict on my diet which I'm pretty sure doesn't offer all the necessary supplements either.

    Thank you so much!
    Jane Harrison Hohner, RN, RNP replied to Sabine48's response:
    Dear Sabine: Yes, let's hope no clot within a blood vessel is present! It's good that your primary care MD is taking the leg pain seriously and ruling out a clot before setting on a sciatica diagnosis. While your lifestyle may be more sedentary than you would like, you are not overweight AND clots tend to form in prolonged immobility (eg wheelchair bound, bed bound).

    The Mirena IUD contains just enough synthetic progesterone ("progestin") to keep the lining of the uterus very thin, but not enough to cause generalized symptoms often seen on DepoProvera. Thus it works really well in perimenopause when too thick linings cause the familiar bleeding problems. It is also a very effective contraceptive.

    I could not find any data on the effect of Mirena on menstrual migraines (which tend to be induced by a normal fall in estrogen levels prior to menstruation).The Mirena may not suppress ovulations, so in theory you could still have some hormonal fluctuations. You can ask your GYN what their clinical experience has been since there's no published data.

    Sabine48 replied to Jane Harrison Hohner, RN, RNP's response:
    Hi Dr. Hohner,

    Appreciate your reply, am a little concerned about your comment, " ... let's hope no clot within a blood vessel is present!" Do you mean there could still be that likelihood even if an ultrasound doesn't show it? Should I press for more tests or can I be confident that since the ultrasound didn't see anything I should be okay? Dr. wants me to come in for bloodwork, I'm due so maybe it can give a clue as to whether or not I'm lacking in something. Not sure what that might be that would cause tightness & slight cramping in the left calf though. It feels like I've had a workout on the treadmill but I haven't, I have been walking on it a lot lately. Should I still be concerned about a clot?

    I'm sorry for the confusion as to the sciatic pain, it is in the opposite leg from the upper buttock to the foot, getting better slowly.

    Thank you about the info. on the IUD. I wish there were easy answers. I will ask my GYN more about it and try to find out more on my own as possible.

    Kind regards,
    Jane Harrison Hohner, RN, RNP replied to Sabine48's response:
    Dear Sabine: My apologies. No, a doppler or ultrasound flow test should be able to identify a clot of clinical significance. If your primary care MD was currently concerned about a deep venous thrombosis (DVT) you would be under treatment by now.

    I can understand your concern for personal experience. After doing a marathon at age 42 I tore the IT band in my right thigh. I was sure I had thrown a clot because I was using birth control pills and was still smoking two cigarettes a day. I promised "I will quit smoking forever if this will not be a clot!" I did quit for good--and it wasn't a clot. But you know, it still hurts after a long run or skiing all day. Moreover, the older one gets the more musculo-skeletal things seem to happen. Often one has no idea what's causing those new aches and pains. It really is frustrating.

    Sabine48 replied to Jane Harrison Hohner, RN, RNP's response:
    Hello Dr. Hohner,

    No apologies necessary, I just wanted to make sure I was understanding correctly. Thank you for taking the time! The technician told me just after the test that she could see no evidence of any blockage, the results were sent to my primary dr. and they called Friday afternoon to let me know the same. I'll go in for some bloodwork this week if I decide on a day to fast long enough! Maybe I need to think about my diet or lack of and find out what if anything I should be taking since I don't.

    Sure don't look forward to these kinds of things but I hear they can and do happen as we get older. Good for you to have quit smoking for whatever reasons!

    As always I truly appreciate you and the time you give to so many including myself!

    Merry Christmas!

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