Exams Are Birth Control Obstacles

Women who want to use hormone-based contraception such as birth control pills do not need to undergo a breast or pelvic exam, researchers conclude.

Their recommendation contradicts current guidelines, which suggest that gynecologists perform a breast exam and a Pap smear before writing a prescription for these types of contraception.

But according to Dr. Felicia H. Stewart of the University of California at San Francisco and associates, reviewing a woman’s medical history and checking her blood pressure can provide enough information to determine whether a woman should not use hormonal contraception.

“We now know which medical conditions make using hormonal methods unwise. The steps necessary to identify the medical conditions involved are medical history review and blood pressure measurement,” Stewart told Reuters Health.

These conditions include high blood pressure, certain heart and liver disorders, stroke, migraine headaches and breast cancer, among others.

Stewart explained that when birth control pills were introduced about 40 years ago, doctors did not know the potential risks. A “thorough exam” that included a pelvic and breast exam seemed like the best way to monitor a woman’s health, she said.

Today, requiring women to undergo these exams may perpetuate fears that hormonal contraception is not safe, and create unnecessary obstacles to obtaining birth control, which can result in unintended pregnancies.

The report, based on a review of medical studies and medical position statements, is published in the May 2nd issue of the Journal of the American Medical Association.

“Eliminating unnecessary requirements can give clinicians more flexibility in providing contraceptive services,” Stewart said.

The recommendation does not apply to intrauterine devices that release hormones, since a pelvic exam is part of the insertion process.

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