T O P I C R E V I E W
Member # 79774
posted 10-04-2012 07:25 PM
Unsurprisingly, I seem to have found another area of sexual health/contraception that's under-investigated and under-informed.
Mostly because I'd been given conflicting information and suspected most of it was wrong and was slightly annoyed, but also out of interest, I did a bit of research myself around the net on sites and academic papers for medics and by medical academics. What I read is hardly comprehensive, but it was interesting. The overwhelming message, from nearly every source, was that a) there's been very little good study of contraceptives among people with heart conditions, and b) there's considerable and common misinformation being given out by medics even contrary to known WHO and country-specific guidelines. My overall take-away information is that doctors and nurses are quite commonly over-cautious about contraception with people with heart conditions, even where the person clearly fits into WHO guidelines of "this method should be fine for someone with this condition". This is especially bad when it happens with people for whom pregnancy would be risky - they're advised not to become pregnant, but wrongly not given access to the most reliable/easy-to-use contraceptive methods when those methods would be fine for them, or when those methods are low-risk but much better medically than pregnancy. On the flip side, a considerable percentage of people for whom pregnancy would be inadvisable say they've never been told that; and a fair percentage of people who would be ok or very-likely-ok in pregnancy had been advised at least once that they shouldn't get pregnant. It just seems... not good enough. Which is what some of the paper authors said. The explanation mostly given is that people with heart conditions are living into adulthood far more than previously because of better treatment, and thoughts about adult concerns just haven't caught up yet... but I suspect that isn't the whole story. I would think it also has to do with the general neglect and overlooking of women's (and/or people with uteri) health issues. The papers I read said that women with heart conditions should be given full information about their situation regarding possible pregnancy in their teens, regardless of their current life situation or future plans. I think that would be an excellent thing. I was just told "come to see us if/when you plan on starting a family". I would feel weird making an appointment to say "I have no plans, don't know if I ever want to, but I'd just really like to know!" Because that information might affect my choices and plans. I'd rather know Before making any plans or starting to want anything. I really think that medics generally should be better informed about contraceptive and pregnancy information; for probably close to half their patients, it's going to be relevant and important, so it seems like they're not properly serving a huge number of their patients! And of course one person can't know everything, so they should be able to say that they don't know, and have easy access to a source that Does know. Or at least knows as much as the insufficient research can say.
Member # 96230
posted 10-04-2012 11:58 PM
A large part of the problem is likely that they are afraid of possible malpractice charges if anything does go wrong, which can be a pretty big thing.
Member # 3
posted 10-05-2012 10:34 AM
Just FYI, what you're describing here hasn't been my experience working in and with clinical practices.
Instead, what I've experienced are doctors and clinicians asking patients (or having those of us working with them), ask for specifics about their heart condition, in detail, and then figuring out what methods, with their specific condition, may or may not pose increased health risks. That's not to say every doctor and clinician does things that way, and I'd certainly be curious about what paper or paper you were reading -- especially to see where we're talking about, what kind of doctors, etc. -- but I'd be wary of drawing conclusions that doctors, in general, do poorly around this and also poorly when it comes to talking with teens about pregnancy and contraception (particularly pediatric GYNs and even a lot of GPs).
Member # 79774
posted 10-05-2012 02:19 PM
First, I apologise if what I wrote is misleading to anyone - I ran my internet searches in the UK, so my results were UK-leaning, and of course may very well not be at all applicable world-wide.
I'm inclined to stand by what I said for the UK, though. I can't find quickly a lot of the stuff I read before, as I used a variety of search terms and scanned through a lot of results lists very quickly. What I have right now is yet another different piece, one of the first results that came up for articles and that says many of the things I was saying just in the introduction/extract that's freely available. http://heart.bmj.com/content/92/10/1520.short Also, I'm not a medic or an expert, so I'm totally open to the possibility that the people and places writing and publishing this aren't any good and I just wouldn't know that. I know that not every study or article published is worth the paper it's written on. I have found a good number of sources saying roughly the same thing, so unless they're all based on the same duff information, I think there's likely some truth to it.
Member # 3
posted 10-05-2012 02:30 PM
Thanks for that link, Redskies. Interested to take a look at it.
Member # 3
posted 10-05-2012 02:33 PM
(So far, in reading, seeing more "may" with how this works out -- or might -- in practice -- than statements it IS what happens, but need to give it a full read. Will probably not have a change until next week, but again, thanks for it, and interested to dig in.)
Member # 35643
posted 10-06-2012 06:44 AM
Hi Redskies, interesting to read your perspective, hope it's ok for me to offer my 2 cents also In my (basic) understanding, there are some reasonable UK guidelines around contraceptive use for people with heart conditions. The UK resources which I usually use come from fsrh.org, like this one: http://www.fsrh.org/pdfs/UKMEC2009.pdf Of course, I don't know which heart conditions you are referring to or about the quality of studies that these guidelines are based on, but they are endorsed by UK college of O&G. For example,if you're referring to complicated congenital or valvular heart disease, the above guidelines state that "benefits usually outweigh risks" for every reversible contraceptive method apart from the combined pill. For specifics, you'd need to discuss with your doctor- my feeling is that a cardiologist or O&G would be more likely to know, rather than your GP, although they can certainly ask a specialist if needed. quote: Originally posted by Redskies: The papers I read said that women with heart conditions should be given full information about their situation regarding possible pregnancy in their teens, regardless of their current life situation or future plans. I think that would be an excellent thing. I was just told "come to see us if/when you plan on starting a family". I would feel weird making an appointment to say "I have no plans, don't know if I ever want to, but I'd just really like to know!" Because that information might affect my choices and plans. I'd rather know Before making any plans or starting to want anything. I agree with your first point. It would be excellent if all young women with chronic conditions were given info and support around this, way before they're considering pregnancy. At the same time, I don't think anyone needs to feel uncomfortable or weird to approach their physician to discuss their options as early as they want to. I would hazard a guess that the doctor would feel pleased to have such an organised resourceful patient who is invested in caring for their own health. Same deal if you want to show them a paper/guideline you've found or bring up a point you disagree with them on. It's part of their job to reach a compromise with you. After all, it's your body and your heart