Patient wants an IUD so we discuss the risks as part of informed consent including: IUDs are >99% effective in preventing pregnancy, but those who do get pregnant are more likely to have an ectopic pregnancy.
"What happens if I get an ectopic, are docs able to take care of me?"
Patients should not have to ask this question. They should not have to wonder if someone will save their life. Ectopic pregnancies can be a life-threatening emergency and are never viable.
Regardless of how many vague and not-based-in-scientific-evidence laws are drafted, we will continue to take care of patients. But physicians should not have to be in that position to wonder if doing what is best for a patient is against the law.
Go out and vote this weekend or on Tuesday. Don't let our country move backwards. Keep politicians out of our hospitals and clinics. #GoVote#ReproductiveRights
Also, IUDs do not increase the risk of an ectopic pregnancy, but if you have an IUD and have a positive pregnancy test, let your physician know immediately!
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Parent: She can't go to school on her period.
Me: 👀
"The school locks the girls bathroom and girls are only allowed 15 bathroom passes per semester."
"Are the boys bathrooms locked?"
"No"
Here's a stack of school notes for the whole class. #MedTwitter#obgyntwitter#MedEd
No one should be regularly missing school (or work) for their period. Heavy periods, painful periods, unpredictable periods, annoying periods, premenstrual symptoms, just hate having periods. There are so many options to make menstrual cycles less daunting.
NSAIDs (ibuprofen, naproxen) are the best for cramping. Most people aren't taking enough to be therapeutic. Start 1-2 days before each period (if able) and take around the clock (every 6-12 hours depending on the med). Catching up on pain is much harder than staying ahead of it.
”She's moody, probably because she's a teenage girl, but could it be the #BirthControl?”
"She's acting so hormonal."
"Her moods are crazy, she's PMSing all the time."
Moods have nothing to do with #gender and sex hormones! These #stereotypes only perpetuate #bias. 🧵 #MedTwitter
Let's start with #hormones. Hormones are chemicals released by certain organs that carry messages to other organs. Everyone has hormones. Changes in hormone levels can affect our moods but having hormones does not make someone moody.
The reproductive (and other) organs produce the sex hormones (#progesterone, #estrogen, and #testosterone) in all people, just in different quantities. These levels can vary throughout the day and over time.
Parent: Is it true birth control pills are made to have monthly periods just to appease the church?
Me (having just read Malcolm Gladwell's book about this): It seems so, yes. There's no reason your child needs to have periods.
Parent: 😡 Why didn't anyone tell me that sooner! 🧵
John Rock, a devout Catholic, was one of the inventors of the Pill, which was FDA-approved in 1960. The Catholic church bans any methods other than the rhythm method as 'mortal sin,' so the only acceptable way to avoid pregnancy is to not have sex during the fertile window.
Most hormonal birth control works by maintaining a thin uterine lining and preventing the cyclic changes of the hormones that trigger ovulation.
Myth: "My periods are so painful that I miss a couple days of school each month. Sometimes I think about calling 911 because of the pain. My doctor said this was normal and I'd grow out of them." 😱😱😱
THIS IS NOT NORMAL. 🧵 #MedTwitter#obgyntwitter#tweetorial
Severe period cramps are common but they are absolutely not normal. If someone is missing school or activities because of cramping or heavy bleeding, this is not normal. There are so many options to make periods better and no one needs to have a period if they don't want to.
It's reasonable to treat the painful periods first and see if things get better. Not everyone needs an ultrasound to evaluate heavy, irregular, or painful periods. If cramping remains persistent or progressive, a pelvic ultrasound can check for an obstruction.
There's actually nothing special about Sunday. It doesn't matter what day your period starts and you don't have to start your #BirthControl the Sunday after your period starts. 🧵 #MedTwitter#tweetorial#obgyntwitter
Usually I tell people to start the first day of the period or as soon as they pick up the prescription. Starting during the period decreases risk of breakthrough bleeding and starting immediately gets them protected against pregnancy asap (and often makes next period lighter).
Pill packs come with these handy stickers so it's easy to change the labels to remember what day they're on.
There are many reasons someone might not have periods. I usually divide them into sections to make them easier to rule out:
- hormonal: either repro hormones not cycling normally and/or abnormal levels of other hormones
- structural: could be a blockage or underdeveloped organs
Things to think about:
- any evidence of puberty (breasts, pubic/axillary hair, growth spurt)?
- could she be pregnant?
- any other symptoms (acne, facial hair, breast discharge, hot flashes, night sweats)?
- any (cyclic/monthly) abdominal pain?
- exercise and eating habits?