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jenko

To females going on accutane

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Hi ladies.

My doctor wants to put me on accutane, and he has told me that I need to be on 2 different forms of contraceptives. I showed that I was hesitant about it, and he said that before I start accutane he advises me to try to get a pap smear and start birthcontrol. I went to planned parenthood and got all of this done, which is such a pain the ass, because im celibate. And for religious reasons.

So I got the gyno to give me 6 months of ortho tri cyclen, and I am going to see the derm tomorrow to register for ipledge. I was wondering during the course, I would say that I am on the birth control but not take it. I am celibate for religious reasons.

But my question is, is there a way that the doctor would detect that I am not taking the birth control through my blood work tests? The reason why I do not want to take BCP is because I have tried it before for my acne, and it made me feel horrible. I was gaining weight, pissy all the time, and I was constantly dizzy and nauseous.

So if I say to the doctor that I am taking the BCP but I am actually not but wont get pregnant anyway is there a way that the doctor would pull the plug because he knows im lying analyzing my estrogen level or such through the bloodwork?

thank you.

i love acne.org.

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Your doctor should have been able to set your primary form of BC as "abstinence" and secondary as "none". This is how mine was done. How can you have a secondary, or barrier, form of birth control if you are not having sex?

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thanks for your replies... I just came back from the derm right now. I told him that I will not get pregnant because I am celibate for personal reasons, and he says that the only way he feels ok with giving me accutane is if i am on BCP. He would not take abstinence as a form of contraception. And he goes on to say that if he feels that I have been inconsistent with the drug, he will take me off the medication right away. BEcause this is a process mandated by the government.

So pretty much I have to put down in writing that I will be on the BCP but I guess he wouldn't know the difference from the blood results.

It makes me feel scared, because I wonder if he can tell that I am lying through the bloodwork.

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I haven't posted on acne.org in a long time, and I've just been a lurker for the past few months (since I went on accutane), but I just had to log in to reply to your post.

I'm sure your doctor just wants to protect his butt from lawsuits, but his attitude is paternalistic and disgusting.

Getting a pap smear has absolutely NOTHING to do with birth control or accutane, especially since you aren't having sex. There is no logical connection between going on birth control, and having an abnormal pap smear, though places like Planned Parenthood usually want you to get paps before they give out bc, simply so they know you are getting them done. Your doctor could easily have just prescribed you the birth control, especially since you aren't sexually active. We don't require men to get prostate exams in order to be prescribed Viagra, but when it comes to women's health, even the dermatologist has a say!

On top of that, I would be incredibly uncomfortable with a dermatologist who thought it was his job to investigate your sexual life, and to try to tell if you are not being reliable using your birth control. That's just creepy and disrespectful. You have a valid medical reason to not go on birth control, and a valid reason to be abstinent (religious belief).

My doctor was perfectly fine with me choosing abstinence as far as reporting bc to ipledge, even though she knew I was on the mini-pill (not acceptable hormonal birth control according to ipledge). I couldn't go on normal hormonal birth control because of migraines, so I just used the mini-pill. She simply did not delve into my sexual life other than the mandatory monthly question, "you're still choosing abstinence for your official birth control method, right?" (My husband and I were not completely abstinent, but we ended up using about 3 or 4 forms of birth control when we had sex.)

If it isn't easy for you to get a new derm who will prescribe accutane, I say just continue to go to your derm, but do not feel bad at ALL about lying. I would call a pharmacist to ask about whether the birth control would show up in blood tests. I would also try to get some Plan B to have on hand if I were you, even if you don't go on accutane. That way, if you did end up having unplanned sex, you would still have a backup to prevent pregnancy.

*Off soapbox -- end rant -- best of luck*

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The doctor has to do that. Do you know how many girls just say "oh yeah sure I won't have sex..." and then do? I'm guessing a lot and then their babies come out mishapen and the derm takes the blame when it all could have been prevented. I am not saying that you would do this but Doctors would rather be safe than sorry. Honestly, I would just take the birth control.

Have you tried the ortho tri cyclen lo? I am on that right now because the strong stuff always made me really sick and I would get migranes and throw up all night. But with this stuff I don't think I have gotten sick even once.

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Hi jenko,

Honestly, I don't think you should even have to lie. Abstinence is an acceptable and legal option to choose if you want to take Accutane. You do NOT have to take birth control if you do not want to.

That comment above mine is quite upsetting. You know your body and you are responsible for all the choices you make with it. The doctor is only there to guide you, not decide for you.

If you want to go on Accutane and this doctor will not prescribe it without you taking BCP, then I think it best to find a doctor who doesn't want to control you so much :hand:

Regardless of why this derm insists you take BCP, whether its to "cover his ass" or because he is a sexist bigot, whatever. The choice is yours and you should keep it that way.

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Guest tofupup

Yeah, I had this problem too with my derm. The nurse asked me for my 2 forms of birth control and I said, "abstinence and nothing," (because the first precludes the second). I remember her getting all flustered and insisting I had to say another one.

I asked, "How about if I just say I got my tubes tied," and she said I'd have to show her the proof. Then I said, "What if I were in early menopause," and the dr. insisted as long as I was under the age of 50, they still needed me to state 2 forms.

We argued for a while and I think I eventually said abstinence + condom, or she finally accepted my statement of just abstinence, but either way--- there is no way I would let them force BCP on me. It's totally f*cked up and condescendinig to think women can't control their own damn sex lives.

If this one won't accept "abstinence," I would get a new dermatologist. You can't let yourself be controlled and condescended to like that.

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I think you people are blowing this totally out of proportion. Its Birth Control for goodness sakes. Not the devil. Take it for 6 months and get off of it. And to say that my comment is "upsetting" is a tad rediculous. There are worse things to consider when deciding whether acutane is right for you. Birth control should be the least of your worries.

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Hey

You do not have to take the BCP this is a load of crap from your doctor, they only do it to protect their ass. I am from Australia and they asked me if i take the pill i said no, they asked me if i was sexually active and said yes. they advise me i cannot under any circumstance get pregnant but they cannot force you to go on to the pill. tell them you will not take it and ask them if they want a statutory declaration from you stating you will not get pregnant whilst taking the meds. they cannot force you and do not feel like you have to do this. i said no, and they never pushed me too. :)

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"I think you people are blowing this totally out of proportion. Its Birth Control for goodness sakes. Not the devil. Take it for 6 months and get off of it. And to say that my comment is "upsetting" is a tad rediculous. There are worse things to consider when deciding whether acutane is right for you. Birth control should be the least of your worries."

The issue here is that the doctor is trying to force her to do something she does not want to do, and it is not necessary. Just because it's "only birth control" to you, it's not for everyone. That needs to be respected.

Abstinence is an option to choose as birth control, that is the one she chose. Part of the reason iPledge is in place is so doctors won't be held liable if someone gets pregnant while taking Accutane. iPledge is there as a warning. If Jenko doesn't heed the warning and is lying and gets pregnant, then that is her fault, as unfortunate as that would be.

Jenko says she is celibate. It is NOT the doctor's business to decide whether she will be or not. The doctor is there to warn you of the serious risks of getting pregnant, and to inform you that in order to write your prescription you must have two forms of birth control, or abstinence.

It's by no means acceptable for a medical professional to force you to take a medicine you don't want to, WHEN IT'S NOT NECESSARY.

The reason I found your comment upsetting is because of the ignorant comment about misshapen babies and because you don't seem to think that Jenko, or any women for that matter, should have a say in their health care. Do you really want some doctor telling you "screw your beliefs you slut, you're taking birth control pills"?

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I do believe that she said she doesn't want to go on birth control because it makes her sick. And my comment is ignorant? I do believe that is what happens if you have you get pregnant on accutane. Therefore, it is not ignorant, it is the truth. I went on birth control a few years ago because I had a messed up menstral cycle. Just because someone is taking Birth control does not make them a slut and I do not beleive that the doctor believes so.

Also, it is the doctor's duty to make sure that the patient is following the iPlege program. If a patient tells the doctor they are and they really are not following it, I am pretty sure it still comes back to the doctor.

I did not comment on this blog to start a fight and that's why I said everyone is blowing this out of proportion. I merely commented to explain that I used to get sick on the regular type of birth control, just like the original poster, and I am now taking a lower version that doesn't make me sick.

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She said she is celibate for religious reasons, and birth control made her sick in the past.

Taking birth control does not make you a slut. A doctor telling her he doesn't trust that she will stay abstinent for six months, is like saying she can't keep her legs closed despite the fact that she probably understands how serious Accutane is. It's very unprofessional and judgmental on the part of the doctor.

The reason I said your comment about misshapen babies was ignorant is because you did not cite any legit statistics and also because I think most women would choose to have an abortion in that situation. Actually, according to this study of women who got pregnant while taking Accutane, 84% terminated it.

I don't want to argue either, and I understand your point. Accutane is serious medication that almost certainly causes birth defects. No one wants to go through that. But in the end, it is up to the patient to understand that. The doctor is there to educate you, not choose for you.

I don't think anyone, man or woman, adolescent or adult, should be told what to do with their body.

Edited by skylyre

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wow this is pretty ridiculous.

it clearly says on the paperwork that you have to choose 2 forms. its not the doctor trying to push anything on anyone or judge them. everyones taking this too far and being a bit too sensitive about it. they legally have to follow the iPledge or they will lose their lisence. whats the big freaking deal. she can choose abstinence and a CONDOM. she doesnt have to take bc. but there is nothing wrong with taking it. so many people say they wont/dont have sex. but things change, things happen. and they dont cover their asses because they are judging. its because it is the LAW. and they dont wantt o lose their career because someone wasn't being hoenst or careful.

there are MANY forms of bc. not one is perfect for everyone so you have to shop around basically to find which one is best for you. but before you get super offended and freak out, talk to your derm about abstinence and a condom as choices. becuse thats clearly one of them on the list. dont get all offended and high horsed because you are a virgin due to religion. so was my whole high school- and 31 graduated with babies. so he's just trying to cover his ass and yours. following the law. he isnt trying to get all in your business.

and the babies arnt just misshapen. most of them dont make it to term and/or are vegetables. they dont even form right in the beginning. and yes i have done my research. but i wont cite it becuse i think this whole thing is blown out of proportion. you saw the papers, you signed the papers, thats your choice.

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kimmie, az and everyone else: I don't see how this is ridiculous at all. What IS ridiculous is how uninformed everyone is about iPledge and your rights as a patient.

"it clearly says on the paperwork that you have to choose 2 forms"

It also says you can choose abstinence. You do not need two forms if you are abstaining from sex.

I do not know Jenko (the OP) or her doctor, so I'm trying to make a general statement about what iPledge is and what is acceptable, or legal, to be compliant with the program.

Taken from the iPledge website:

WHAT IS THE iPLEDGE PROGRAM?

The iPLEDGE program is a set of steps all patients, doctors, and pharmacists

must follow. The main goal is preventing pregnancy and birth defects, but both

male patients and female patients must follow the iPLEDGE program.

To get isotretinoin, all patients must:

• Sign the Patient Information/Informed Consent form(s)

• Be able to keep appointments

• Agree to follow the iPLEDGE program steps

iPledge was put in place because both doctors and patients were not listening to the dangers of Accutane and pregnancy. Women were becoming pregnant too often on the drug and this caused many people to want it to be taken off the market. The reason iPledge is such a pain is to get people to realize how serious it is.

As long as your doctor and the pharmacy where you get your scrip from are compliant with the program, they cannot be held responsible. You are the one making the pledge - whether it is to use two forms of birth control or to be abstinent. Your doctor has pledged to inform you of all the risks before you take it. The pharmacy has pledged to not give anyone a scrip who has not been compliant with iPledge. The only way your doctor is going to be in trouble is if they do not comply with iPledge...but then you wouldn't be able to pick up your scrip.

For the patient - iPledge is still nothing more than the honor system. You say you will take birth control, use condoms, be abstinent - whatever. iPledge is here to protect you and to inform you.

Now your doctor has every right to say they will not prescribe you Accutane unless you are using birth control. If that is the only way they feel comfortable prescribing it then they should clearly state that to you and it should be that way for EVERY patient, no exceptions. Then, if you still want to take Accutane and wish to choose abstinence as your birth control, you need to find a doctor who will accept that.

That is the only ethical way to handle this. A doctor cannot pick and choose who can be abstinent and who can't. Nor should they bully you into thinking that you are not able to abstain from sex for six months to take a serious medication. Some people would have no problem not having sex, everyone is different.

That was my original statement to Jenko. That she shouldn't have to lie or take something she doesn't want or have to. If she chooses to stay with that doctor, then yes, it looks like she will have to take a BCP. The point is if she doesn't want to, she needs to find a new doctor.

I do not see what is ridiculous about defending one's right to choose their own health care.

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Being abstinent is great. Good for you. But what if, GOD FORBID, something happen against your will? It's called rape. No condom. No birth control. I'm assuming you would not want to abort the baby. How fair is it to put a child in a position where they would have to live with birth defects that were 100% preventable? Do you have any idea how difficult it is to care for a special needs child? I would hate for that to happen to anybody but this is one of the big reasons why birth control is being pushed and is so very important. In any other circumstance I would support not taking it but this is a crazy world we live in and you don't have control over what other people do. There are some sick, sick people out there...

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Being abstinent is great. Good for you. But what if, GOD FORBID, something happen against your will? It's called rape. No condom. No birth control. I'm assuming you would not want to abort the baby. How fair is it to put a child in a position where they would have to live with birth defects that were 100% preventable? Do you have any idea how difficult it is to care for a special needs child? I would hate for that to happen to anybody but this is one of the big reasons why birth control is being pushed and is so very important. In any other circumstance I would support not taking it but this is a crazy world we live in and you don't have control over what other people do. There are some sick, sick people out there...

ok ok ok, i think maybe we are thinking too much about this, yes rape could happen but it is unlikely...dont scare the girl!

i also did not want to go back on the pill, i had been on it for many years and came off to start a family, i cannot beleive how much it effected me emotionally, i was a wreck for a few months at least.anyway then decided i needed t osort my acne out once and for all...so go back on the accutane.however the derm says "you gotta be using at least two methods of birth control" i made it clear that i did not want to go through the pill hassle again, to start trying for a family again in the new year, i also suffer migrains etc. so i was given a big long speech about the importance of not getting pregnant whilst on accutane, then they said use condoms and spermacide. done and dusted no problem. i started my treatment monday! whoop!!!

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I'm glad I found this post... I don't want to go on birth control either. It was the one thing holding me back from Accutane. I couldn't imagine being on any more meds! My husband is in the Army and isn't even in this state right now... Why the hell would I need birth control?? I don't want the risks that come with BC on top of the risks of Accutane. Also I'm on Solodyn right now and thats prolly taking a toll on my body too! Hopefully my derm doesn't give me any problems! I go at the end of June and I'm gonna ask to be put on it.

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If your doctor is still being a douche:

1.) Get prescription for Birth Control

2.) Fill it out

3.) Dump it down the sink when you get home

It's that simple!

Really, it doesn't show up on any blood tests or anything, so they'll never know.

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I'm so happy my doctor here in HK just says he "Trusts me". Because I told him I'd just do abstinence during my treatment.

I would never want to go through all of what the op went through. I'm so sorry.

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Ugh. I agree with the majority of posters here that if you don't want to take the birth control, you shouldn't take it. I can respect the dermatologist's position on this (he's just erring on the side of caution), but I'd try to find a different dermatologist who accepts abstinence as an option. If that's not feasible, lying is indeed an option (he shouldn't be able to tell), but I agree with skylyre that you shouldn't have to lie, just as you shouldn't have to take the birth control at all. I wouldn't want to stick with any doctor who forces me into that extremely uncomfortable position. But anecdotally, my friend who took Accutane last year just lied about the birth control. She was abstinent but was forced to take the birth control prescription anyway. She started taking the birth control, but it sent her body out of whack (gained weight, mood swings, generally felt terrible, etc), so she stopped it and just didn't tell her doctor. It's do-able, but again, I'd hate to be in that position.

When I went to the same place (our university health services) to get Accutane several months later, they tried to tell me they had some relatively new policy as of that year that all the female patients had to go on birth control no matter what. Then they tried to tell me what the benefits of birth control were (e.g. "it'll help your skin!" but, um...Accutane will help my skin). I made it clear that I was 100% abstinent for religious reasons, and I pretty much said if I had to go on birth control, I wasn't going through with the Accutane there at all. I told them that I knew the potential side effects of birth control, and I was not ready to deal with those on top of the Accutane side effects when there was no risk of pregnancy involved. I just wanted to clear my skin; if I had to mess with the rest of my body in the process, it wasn't even worth it to me.

They made an exception for me, and I really appreciated that. But if they hadn't, I probably would have gone elsewhere to get the Accutane because I knew that plenty of dermatologists would accept abstinence as a barrier. And it's not so cool that I had to and was able to get special permission to use abstinence when my friend was forced onto birth control. At least be consistent!

Good luck, whatever you choose to do, and don't let anyone force you to do something you're not comfortable with or something that makes you sick.

Edited by Clear-as-Day

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Accutane is such a strong medication that regardless is birth control pills make you feel sick, you should absolutely be taking the BCP and another form of protection while on the meds. The birth defects risk is so strong. Research on the March of Dimes website. If I were a dermatologist, I would not feel comfortable with a young woman claiming abstinence either, because what if, god forbid, she was raped and became pregnant, or she chose to have sex and all it takes is 1 time to get pregnant. HOnestly, its not worth the risk, or the "scared" feeling when you get your bloodwork done and lie to your doctor. While Accutane can be safe - its only safe when the guidelines are followed exactly as prescribed by your doctor - not the way that is most convenient for you.

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If I were a dermatologist, I would not feel comfortable with a young woman claiming abstinence either, because what if, god forbid, she was raped and became pregnant, or she chose to have sex and all it takes is 1 time to get pregnant.

A woman should not have to take such precautions because she might get raped, it's not on her to be prepared for such thing a to happen. Also, if a woman decides that she's going remain abstinent during accutane, I'd like to think she's responsible enough to go through with it.

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Accutane is such a strong medication that regardless is birth control pills make you feel sick, you should absolutely be taking the BCP and another form of protection while on the meds. The birth defects risk is so strong. Research on the March of Dimes website. If I were a dermatologist, I would not feel comfortable with a young woman claiming abstinence either, because what if, god forbid, she was raped and became pregnant, or she chose to have sex and all it takes is 1 time to get pregnant. HOnestly, its not worth the risk, or the "scared" feeling when you get your bloodwork done and lie to your doctor. While Accutane can be safe - its only safe when the guidelines are followed exactly as prescribed by your doctor - not the way that is most convenient for you.

Abstinence IS a perfectly valid option. Your what-ifs are far-fetched and unreasonable and also assume that young women aren't competent to understand the concept of birth defects......

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