Stephanie Jenkins was 18 years old when she was prescribed a hormonal contraception tablet to help her with acne.
The now-32-year-old from Kabi Kabi land on the Sunshine Coast took the same medication for a decade before she started experiencing debilitating migraines.
"They were aura migraines, so disturbances in vision, light sensitivity, I couldn't see out of my right eye properly," she says.
After having her symptoms dismissed by a GP, Stephanie saw another doctor through an online prescription renewal service.
"As soon as I told her all of the symptoms and how often it had been occurring … she just point blank said, 'you immediately need to cease [the pill you are on]'," she says.
The doctor told Stephanie the migraines were an indicator of an 'oestrogen overload', a side-effect of the pill which heightens the risk of stroke.
"I didn't even know it was because of the pill, I just thought it was related to my period.
"You just get put on it, you take it … set and forget."
Why we shouldn't 'set and forget' the pill
Dr Phoebe Holdenson Kimura says generally, GP's should conduct a yearly review for repeat prescriptions.
The lecturer at the University of Sydney's General Practice Clinical School says the key message is that taking hormonal contraception should not be "a set-and-forget process".
"Finding out when it was started, what it was started for is important," Dr Holdenson Kimura says.
"So, recognising many women take the combined contraceptive pill for contraception, but it also can be used for acne as well as for the management of heavy menstrual bleeding or painful periods.
"Then asking how do you feel it's going? Are you happy on the pill? Did you want to discuss any alternatives?"
She says doctors should also be checking risk factors with patients, including if they have had lifestyle changes or had medical issues such as migraines, deep vein thrombosis, a pulmonary embolism, high blood pressure, or have liver disease.
Dr Eveline Mu is a research fellow at Monash University's HER Centre in Naarm/Melbourne and says there needs to be greater awareness at GP-patient consultations of the risks of depressive disorders.
She has been studying the neurological impacts of hormonal contraceptive medication on women's moods.
"We've found that there are certain types of common hormone contraception that will be worse for women who are susceptible to mood disorders or who have mood disorders," Dr Mu says.
"Fluctuation or any differences in the oestrogen level can impact a lot of other neurotransmitters like serotonin or dopamine which are linked to mood and involved in emotion processing as well."
Other milestones in your life when you should check-in
Dr Pav Nanayakkara, a minimally invasive gynaecological surgeon from Jean Hailes for Women's Health, says along with a yearly consult there are other life milestones that should prompt a contraceptive medication check-in.
"Any sort of significant life change — so pregnancy, around the time of perimenopause, any diagnosed medical conditions, any lifestyle changes," she says.
"Or a big birthday, so any birthday ending in a zero or a five is a really good time to check in."
"Because lifestyle factors can change as we age, we might have different requirements, or we might develop medical conditions."
Research conducted by the Jean Hailes for Women's Health shows that just over half of the 3,537 women it surveyed last year, aged 18 to 50 years, didn't know about the full range of contraceptive medications available to them.
"This finding was even more significant in the 40-to-50-year age group," Dr Nanayakkara says.
"[These women] are then often giving advice to their daughters and may not necessarily know about all of the options."
Stephanie says her mother took the pill, so it seemed like the right thing to do at the time.
"It was the only thing that was offered to me as an acne treatment which seems wild to me because now I'm more educated," she says.
Stephanie says she now tracks her menstrual cycle and uses other contraceptive methods.
Be cautious of social media advice
Dr Holdenson Kimura says it is also important to get advice from your doctor and not social media.
"I'm having a lot more women coming in saying 'I want to talk about going off the pill' or, 'I've made the decision to go off the pill because I'm curious to know what it feels like'," she says.
"I think that's fine … but equally it is important to be having those conversations [with their GP] about what to consider.
"Especially if the pill's been managing heavy periods or painful periods and women want to come off it then we really need to look at what are the other options to help you with that."
This is general information only. For detailed personal advice, you should see a qualified medical practitioner who knows your medical history.
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