Cycling for change (& not the way you think)

"When was the first day of your last menstrual period?"  Every woman who has gone to the doctor for any reason can relate to this.  Upon your first interaction with the nurse or medical assistant, you're asked a series of questions, usually while they take your blood pressure, and they ask about your LMP (last menstrual period) in a monotone way.  If you hesitate, they hand you a mini-calendar.

The answer usually goes something like this: "Ummm... I guess it was the last day that I was on vacation in Mexico, and I think I got back the day after Memorial Day weekend.... so, that means it was probably... May 31st?"  They respond: "So, it was May 31st?"  You respond, "Yeah... I guess."  It's dutifully noted in your chart without additional commentary or question.

What about all the other info that's relevant?  I encourage providers to ask about more than the date, but to ask about the context.  Here's a few suggestions:

  • Was it on time? Does it typically come regularly?
  • Is your {insert current birth control method here} still working out for you?
  • Have your period symptoms changed at all in terms of pain, fatigue, or anything else?
  • How long did it last? How heavy was it?
  • For the 3 weeks each month that you don't have your period, what's going on with your cycle (ie: do you get ovulation pain, frequent infections, have other pain, etc.)?

Questions should be open-ended prompts that encourage the patient to share.  They should be in a friendly, conversational tone that conveys actual interest in the patient's responses.  These symptoms and dates are relevant to the woman's overall health and sense of wellness, as it often explains otherwise anomalous MSK pain, migraines, fatigue, or pain with sex.  It allows you to monitor her contraceptive prescriptions to be sure she doesn't unexpectedly run out, putting her at risk of unintended pregnancy.  Plus, it allows you to learn other details about her life that assist you in caring for her -- like if she's trying to get pregnant.

So, fellow women-with-pelvises (actual plural is pelves, but pretty sure that would've just been confusing)... what can you do to get the most out of these visits?

  • Overshare. Overshare as if you're chatting with your girlfriend with whom you're most comfortable.  Details about the painful sex you've been having, the way things have been bulging since you gave birth two years ago, and the fact that you've used the morning-after pill twice this winter because your insurance changed and your pill didn't get filled, and you just haven't had a free second to call your doctor about it.  
  • Share without concern for judgment.  If you're judged, speak up.  You don't need to do it in the office, you can write a letter to your provider later, request a new provider for next time, or excuse yourself and make a new appointment for the following day.  You deserve to be treated with respect and without judgment or shame.  When you're at a medical practice, you are their customer.  If you're incredibly uncomfortable, then excuse yourself to use the restroom and walk out the front door.  No one can or should make you feel vulnerable, shamed, or fearful during a medical appointment -- including your provider.  Deal with the "consequences" later, while your dignity and self-worth are intact.
  • Indicate that you are there to have an actual conversation.  Ever been at your annual exam, asked a question about birth control, and been told something vague about there being "lots of options out there" or handed a brochure?  Say something like, "I would like your input on the various contraceptive options, as I know there are some new options on the market. After I'm dressed, can you bring me up to speed on those and help me make a decision?"  That allows the provider to either agree or instruct you to make a follow-up appointment, but it ensures that you won't feel rushed or not heard when you do pose the questions.

© 2016 Inspire Santé