Women across America complain of going to their OB-GYN with a cycle-related problem just to have their doctor prescribe hormonal birth control as the fix-all solution for acne, anorexia, anemia, endometriosis, and more. Current health insurance structures incentivize it.
Kaitlyn Conner’s dermatologist told her to take birth control for her acne, and her OB-GYN recommended it for her irregular cycle. Conner claimed they didn’t even try to diagnose her and just treated her symptoms. It took having a facial done to realize, via her facialist, that she may have had polycystic ovary syndrome. Only after Conner and her mom brought up the possibility to her doctor did they diagnose her.
Rebecca Phillips’ mom brought her to the doctor at 15. She had anorexia, an eating disorder which had temporarily ended her periods. Her doctor recommended birth control.
One woman who wished to remain anonymous said she struggled with anemia for years. Three out of four of her doctors recommended she take birth control, saying that since she didn’t have gastrointestinal issues, then based on her age, her problem had to be related to her menstrual cycle.
“They’re just kind of like, ‘Oh, we have birth control. We can give it to you for free. Why wouldn’t you accept it if it’s going to help your problems?’” she said.
The Structures Incentivizing Birth Control
Several incentives prevent women from getting proper diagnoses.
Heritage Foundation senior policy analyst Emma Waters explained that health insurance companies prioritize treating symptoms above diagnostic care.
Insurance structures motivate doctors to spend less time with patients for more money overall. A doctor can make more money by seeing multiple patients requiring a “moderate” decision-making level, such as those requiring a prescription for birth control, compared to fewer, lengthier, “high level” decision-making appointments.
Prior authorization can create another barrier between women and diagnostic care. Insurance companies often require prior authorization for laparoscopies, the surgery to diagnose and treat endometriosis, a condition where tissue that is similar to the lining of the uterus grows in other places where it doesn’t belong. It can cause pelvic pain and heavy periods, as well as fertility issues. Prior authorization structures can require that women try first-line drugs and treatments such as birth control before getting surgery, delaying diagnosis.
Finally, the Affordable Care Act, or Obamacare, requires most insurance providers to provide birth control completely free with no out-of-pocket costs or cost sharing, creating an incentive for doctors and patients to prioritize birth control over spending money on diagnostics.
Many point to the lack of funding for women’s health studies as another reason women find it difficult to get diagnoses.
How Birth Control Affects Women
While hormonal birth control can certainly make life easier for women struggling with gynecological issues, it often cannot fix the underlying problems and masks the symptoms, leading to a further delay in diagnosis, according to Efrat Lamandre, a family nurse practitioner with a Ph.D. in integrative medicine.
“[W]hen symptoms are suppressed with hormones, the real drivers — insulin resistance, inflammation, cortisol imbalance, or low thyroid function — continue unchecked,” Lamandre wrote on Substack.
Hormonal birth control can mask symptoms because it can makes a woman’s period regular, when her natural cycle may be irregular, indicating underlying problems.
Many women struggling with gynecological problems wish they could find affordable alternatives to birth control, and they feel like their doctors are ignoring underlying issues.
Faith Mangrobang, diagnosed with endometriosis, described the problem as like a running car with the parking brake on. “Putting on the parking brake is going to hold it there,” Faith said. “If you take it off, what happens? … is it going to just get infinitely worse?”
Growing Frustration with the System
Glory Grace Haye said that after years of fighting suspected endometriosis, she canceled her insurance plan and began going to a more holistic doctor.
Another woman who wished to remain anonymous said she also switched to a more holistic doctor who did not take health insurance after her OB-GYN tried to prescribe her birth control.
A spokesperson for America’s Health Insurance Plans (AHIP), when reached for comment, said many preventive services are available to patients with no cost share. “Health plans have been proactive in advancing value-based contracts that address whole-person, including in gynecological care. … [they] provide coverage and support for diagnostics and treatments for these conditions,” according to the spokesperson.
But women leaving their OB-GYNs are showing that they are skeptical.
