Getting Examined to Get the Pill

From the WebMD Archives

May 1, 2001 -- Most women who use birth control pills expect to get a breast exam and pelvic exam each year when they see their doctor to refill the prescription. It's a familiar routine, and it allows the doctor to check for signs of sexually transmitted diseases and other harmful conditions.

For many women, this annual visit to a gynecologist is their most reliable, familiar form of health care. But many experts argue that when pelvic and breast exams are linked to the birth control pill, it reinforces the mistaken idea that the pill increases health risks. Some are concerned that requiring a pelvic exam reduces access to this highly effective contraceptive, especially in at-risk groups like teenagers.

And, there's no scientific reason to link these exams together with the contraceptive prescription, experts say. If a woman wants to obtain a contraceptive today, and postpone the pelvic exam, she should be able to do so.

For more information about contraceptives, check out WebMD's Women's Health board moderated by Jane Harrison-Hohner, RN, RNP.

In fact, in recent years several policy-setting organizations have come out in support of this new approach to contraception. The American College of Obstetricians and Gynecologists says a first visit for oral contraceptives doesn't have to include a pelvic exam if the patient wants to postpone it. Planned Parenthood says a pelvic exam may be postponed for up to 13 months after starting birth control pills.

Felicia H. Stewart, MD, of the Center for Reproductive Health Research and Policy at the University of California, San Francisco, and colleagues, have published a study in the May 2 issue of TheJournal of the American Medical Association that reviews the medical literature on this issue and offers some valuable information for women:

  • When you get your prescription refilled, it is only necessary to have your blood pressure taken and your complete medical history reviewed, unless you fall into a high-risk group.
  • You don't have to have a pelvic exam during the same visit when you get your prescription. However, pelvic exams are important, and should be done at a convenient time.
  • You don't have to have a breast exam during this visit. However, the breast exam is an important way to check for breast cancer, so do get one at a convenient time.
  • Another important test is the Pap test. While not necessary to renew your pill, it is an important screening test for cervical cancer, and you should see that you get it done.

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"This paper offers important information and hopefully will allay some of women's anxieties about prescription hormones," says Holly Thacker, MD. "Almost half of all pregnancies are unintended, and this occurs not just in teenage women, but also in women over age 40." Thacker is the head of women's health at the Cleveland Clinic Foundation, and assistant professor of medicine at Ohio State Medical School in Columbus.

Jonathan S. Berek, MD, believes doctors don't need to do a physical exam in order to prescribe oral contraceptives "particularly for young, healthy, nonsmoking women. The risks associated with unwanted pregnancy are considerably higher than any of the exceedingly rare complications of hormonal contraception in that group of women." Berek is professor and chair of the College of Applied Anatomy at the UCLA School of Medicine and chief of the Division of Gynecologic Oncology.

However, there are people who disagree.

Janet Pregler, MD, believes while it may not be scientifically necessary to have a pelvic exam on the same day you get your prescription for birth control pills refilled, there are very good reasons for doing so. "It's in your interest to have these exams done. From a convenience standpoint, most women want to get as much done in one visit as possible, so I don't see any reason to separate these two things." Pregler is the director of the Iris Cantor-UCLA Women's Health Center and center director for the UCLA National Center of Excellence in Women's Health.

One important part of the pelvic exam is the Pap test, which Pregler calls "the most effective cancer screening test we have, because we actually sample cells on the cervix. This form of cancer grows slowly, so we can essentially guarantee a women if she gets this test done regularly, she won't die of that form of cancer."

Those who support the new approach to contraception are concerned about the substantial number of teenage unplanned pregnancies.

"It is difficult for some young, sexually active women to come to terms with this issue and deal with it in a mature way," Thacker says. "Hopefully this new approach will make hormonal contraception more available."

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Support for prescribing birth control pills without a physical exam is part of an ongoing effort to eventually make them available over the counter, Berek says. "Ultimately it will lead to sales without any prescription, which in my opinion would be appropriate, based on the evidence."

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