A normal, pill-free ovulation cycle involves a chain reaction of four hormones: progesterone, estrogen, luteinizing hormone (LH) or follicle stimulatinghormone (FSH) to prepare the body for possible pregnancy and equips the body to maintain the pregnancy. The ovaries grow eggs, the uterine lining thickens, and the body undergoes ovulation, or the releasing of the egg for potential conception. Oral contraceptives act in opposition by suppressing the brain from making FSH, preventing the potential egg from growing and delaying ovulation. Even when people bleed while taking oral contraceptives, it is not a “real” menstrual period, it is a result of withdrawal bleeding due to the swift drop in hormones that are synthetically introduced during the time a woman should be menstruating. Oral contraceptives act as a road block so that ovulation can’t take place.
We had a patient came to Turning Point (now True Choice) for a pregnancy test and ultrasound. She had an abortion the previous year using the RU486 abortion pill. She had been taking oral contraceptives but when she decided to have an abortion, was not educated on the effects RU486 has on reproductive health in addition to the negative impact oral contraceptives would have on future fertility. The client decided to go off of the oral contraceptive one year later because she and her partner felt ready to have a baby.
Two weeks later, she began menstruation. Later in the month, she began to bleed again. During this time, she began to have symptoms of pregnancy including fatigue, moodiness, breast tenderness, headaches, and frequent urination. She took a home pregnancy test and found out she was pregnant. Prior to coming into our clinic, the client reported 2 weeks of active spotting, dizziness and increased pain. Because of her history of a recent abortion with RU496, oral contraceptive use and active bleeding, we were unable to perform the ultrasound. We discharged our patient and gave her miscarriage precautions and advised her to go to urgent care or her Ob/gyn.
The patient did not understand how the RU486 abortion pill and concurrent use of oral contraceptives impacted her fertility. Her understanding was that she could just get pregnant at any time. Our team helped educate her on the long-term consequences of both the RU486 abortion pill and oral contraceptives. We discussed that our hormones facilitate the entire cycle to ovulate, prolife rate the uterus and maintain the lining of the uterus to support a full-term pregnancy. If hormones are imbalanced or insufficient, the uterine lining cannot be supported and miscarriage is likely. The patient was given emotional support upon receiving this education.
When we followed up with the patient, she told us she went to urgent care and miscarriage was confirmed with medical team. The team at TCMC expressed condolences on her loss, and she said she was very grateful for both the education and support we provided for her. She said she could now move forward and plan for the future having gained more insight into her personal health.
Could this outcome have been prevented if the patient had been more educated about the potential long-term consequences of her short-term, uninformed decisions? At TCMC, our medical staff are trained to teach women to understand their bodies, recognize hormonal and other vital signs of health. We believe women have the right to be informed participants of their healthcare. We empower women to gain a better understanding of their biology through accurate, complete, comprehensible information to make informed choices about their healthcare. Through evidence-based education, we enable women to take control of their personal health record and help them better manage their fertility.