I can’t believe the letter I’ve just had from my doctor’s surgery, I am furious. I have suffered from severe migraines for years, and have had one stroke already. (people who get migraines are 3x more likely than the general population to have a stroke.) I’m at risk of another stroke. I’ve been prescribed a drug called topiramate for a while now, to reduce the frequency and severity of the migraines.
I’ve just received a letter from the doctor’s surgery saying that, due to new guidance, as topiramate can cause birth defects, all women of childbearing age who take it MUST be put on birth control, regardless of whether they are sexually active. Which, as I’m sure you can tell from my username, I am not. I don’t want to be pressured and bullied into taking contraceptives. Hormonal contraceptives have a lot of side effects, including increased risk of stroke. Apparently the wellbeing of a foetus who will never be conceived is more important than the wellbeing of a woman who actually exists! Even non-hormonal contraception is something I don’t want, most of it involves embarrassing and painful procedures that I do not want to be subjected to. And quite frankly, it’s the principle of the thing.
So I am going to have to stop taking this migraine med, which will be awful for me, because all the other migraine meds either don’t work for me, or are unsuitable for stroke patients. I’ve even had nerve-blocking injections in my head from the neurologist which only worked for a couple of weeks, then my migraines came back with a vengeance. But no, a hypothetical foetus matters more. Is this not blatant sexual discrimination? I am so angry.
EDIT: You know what is extra infuriating? The letter didn’t even offer the option to choose to come off the topiramate, or keep it and take the contraception. The letter just demanded that I go on contraception immediately. No “if you’d like to keep taking the topiramate please make an appointment to get contraception,” just a very rude and authoritative demand that I make an appointment to be put on contraception immediately.
EDIT2: I’ve just read the letter more thoroughly. It says the problem with topiramate is that the babies of women who take it while pregnant are at a higher risk of ADHD and autism. Just think about what they’re saying. They’re saying ADHD and autistic people are so unwanted by society that it’s better to force women to go without medication they need, or force them to take meds they don’t want and that could have detrimental side effects for them, than let more autistic/ADHD people come into this world.
You’re welcome. If it helps, these are the key bits with all the faff deleted.
From the gov.uk guidance:
The pregnancy prevention plan[PDF] says:
If I’ve read your comments right, your compelling reason is your sexual orientation.
You can probably ignore much of the rest of what I wrote as you’re unlikely to need it. If the doctor doesn’t listen to you, you can think about letter-writing. I can give some pointers. Remember, I’m not an expert, but that shouldn’t be an issue because it shouldn’t get that far.
You can be confident in your appointment. The letter you received sounds like it is a bit inaccurate. The guidance is on your side because it clearly states that you do not have to take contraption with topiramate if you understand the risks and have a good reason as to why you’re unlikely to get pregnant.
I hope you can get this sorted easily!
Thanks so much. I’m going to use this to compile a letter and send it. It’s really difficult getting an actual appointment these days.
Here is the letter I’ve written to the doctor:
**Dear Dr R,
I have received a latter stating that as I am a woman of childbearing age taking topiramate, I must be put on birth control unless there is a compelling reason why pregnancy is not possible. I have not been sexually active for 18 years, have no intention of being so again, and I started going through the menopause almost a year ago.
As a stroke patient, hormonal contraceptives put me at higher risk of stroke, and for my own reasons I am not willing to accept any kind of contraceptives. I consider my reasons for not needing contraceptives to be compelling and I would like to continue to receive topiramate.**
The reason I put “for my own reasons” is because I don’t want to sound threatening right from the start if I can get it sorted out amicably and also it leaves it open for me to think about what to write later if I need to fight. I was thinking I might have three angles to argue this is discriminatory if it comes to that:
Insisting someone needs to take a drug only because they’re female is gender discrimination. I could bring my asexuality into it. Although I’m not religious, as a young child I was brought up extremely catholic. They catholic church teaches that contraception is unacceptable. I could pretend I’ve returned to my childhood religion and argue discrimination on religious grounds. What do you think?
That’s clear and to the point. I agree that it sets a good tone – it’s not threatening.
One small change needed, from ‘latter’ to ‘letter’ in the first sentence.
I have one optional suggestion that would signal that you know about the guidance. You could mention that you are happy to sign a risk assessment form as part of the pregnancy prevention plan to confirm that you are fully aware of the risks and satisfied that you will not get pregnant. I do think you already cover this, though; maybe it’s something to add in a follow-up if they were a bit stubborn.
All-in, this looks like a good letter and I hope it goes well for you. (I completely understand if you don’t want to, but otherwise, please let me know how it goes as I’m rooting for you.)
That’s a good idea, thanks. I dropped the letter off this morning but if they give me any bother I will mention the risk assessment form. I’ll definitely let you know what they say.