Ask The Doctor

Do you have a topic you would like information about? Send your question to specialists_for_women@yahoo.com. The Specialists for Women providers will alternate presenting information about specific obstetrical and gynecological topics.

We have had several good questions recently. The first question Dr. Reed will answer is "Can a 17 year old obtain contraception without her parents' consent or knowledge?"

The short answer is "No". According to the Texas Family Code, a minor (under the age of 18) can legally consent to medical therapy without parents' consent under the following conditions:

*A minor on active duty with the Armed Forces of the United States can consent to any medical therapy.

*A minor who is 16 years or older, resides apart from his or her parents, and manages his or her own finances, regardless of the source of income, can consent to any medical therapy.

*A minor can consent to diagnosis and treatment of any infectious, contagious or communicable disease which is reportable to the Texas Dept. of Health.

*A minor who is unmarried and pregnant can consent to the treatment of pregnancy, but not abortion.

*A minor can consent to treatment for addiction, dependency, or any other condition directly related to drug or chemical use.

*A minor can consent to counseling for suicide prevention, chemical addiction or dependency, or for sexual, emotional, or physical abuse.

Specialists for Women providers encourage adolescents to confide in their parents regarding sexual activity, need for contraception and prevention of pregnancy and sexually transmitted diseases. Abstinence is the only failproof method to prevent STDs and unwanted pregnancy, but recent studies show that 2/3 of all teenagers have had sex by their senior year in high school. Studies have also shown that access to contraception does not increase or decrease the likelihood that an adolescent will become sexually active, but it does decrease the chance of unwanted teen pregnancies and decreases the risk of pelvic inflammatory disease. A minor can come to the office for evaluation of sexually transmitted diseases legally; we can then legally provide counselling on prevention of pregnancy and STDs.

The following is a link to the Texas Family Code rules on minor health care:

Texas Family Code rules on minor health care

The next question I will answer is: "What are my options for the treatment of fibroids if I desire pregnancy?" The American College of Obstetrics and Gynecology has a link for patients; the following is a link to the patient information pamphlet on fibroids:

www.acog.org/publications/patient_ education/bp074.cfm

The next address provides links to many other sources of information about fibroids:

www.fibroidfacts.com/understanding/links/

The final question concerned getting pregnant after using DepoProvera for several years, and OCPs (oral contraceptive pills) for several years without having periods.

The use of OCPs has actually been shown to protect a woman's fertility. The pill decreases the risk of developing endometriosis, which is a very common cause of infertility, and DepoProvera has been used to treat endometriosis much longer than it has been used for contraception. OCPs also decrease the risk of PID (pelvic inflammatory disease) which can scar the tubes and cause infertility.

As for the part about whether not having a period for many years is a cause for concern, it is not as long as DepoProvera or low dose OCPs were the reason for not having a period. It is not medically necessary to have a period while on OCPs or DepoProvera; in fact, decreasing or preventing menstrual bleeding is one of the health benefits of these medications. It is a misconception that a woman needs to have a period monthly while on the pill or DepoProvera in order to shed the lining of the uterus. It is not unhealthy to not have a period while on the pill or DepoProvera. The reason there is no period is that these medications do not cause the lining of the uterus to grow and thicken like it does during a normal cycle. On the other hand, if periods stop spontaneously even though the patient is not using the pill or DepoProvera, and is not pregnant or menopausal, then evaluation by a gynecologist is recommended.

If periods are regular and normal after stopping OCPs or DepoProvera, ovulation is probably occuring. This can be proven by checking a serum progesterone level about 21-22 days after the first day of the period. If pregnancy does not occur within 12 months (6 months if 35 or older), then evaluation by a gynecologist or reproductive endocrinologist is recommended.