Birth control pills and period issues? Please help

[PrincessLuLu]

I am a 22 year old female. I've been taking combination birth control pills since I was 17. I initially started taking them because of menstrual issues. I would go months at a time without a period and when I had one it would last up to 10 days, be very heavy, unbearable (and I mean unbearable) cramps, nausea & diarrhea. I would miss school it was that bad. The normal remedies for period stuff did nothing. Anyways I was given this and for most part it's been good. I've been on my current brand trisprintec since I was about 18 or 19. My periods are shorter (never more than 6 days but usually 5, 4 if lucky), very regular and generally less heavy (1 medium then 1 heavy day that tapers off). Anyways, I've noticed in the past year or so that my pills are not helping as much with this anymore. My cramps are getting serious to the level of what they were before (I feel like it's worse every new month) & I am very nauseated/dizzy like before too. I am really unsure what to do. I want to continue some form of birth control (either another brand of pills or another method that can help with menstrual issues). So my questions are:
1. What is my best course of action?
2. If I do want to consider switching can I just talk to my gynecologist at annual exam or do I have to do it separately? I need to know because it is difficult to get in to see them. Or could I talk with another person (there's a free clinic in hometown area) then go there later once I have a decision?
Any and all input would be immensely appreciated?

[Heather]

Did your healthcare provider ever do a thorough investigation into the cause of the menstrual pain you were having? If not, it sounds like it's time for that. Hormonal contraceptives can help with some causes of menstrual pain, but won't do much or even anything for others, and you do want to know what is going on here in the event that you need a special kind of care or treatment for your overall health.

So, I'd ask for that investigation, letting them know what you've let us know here, and, if you want to switch BC methods just because you don't like using the pill -- again, whether or not any pill will help with your menstrual pain at this point is a question mark until they find out WHY you are having that pain -- you can mention that, too.

Who you see for this care and when you see them is up to you, but staying in pain when you might not have to be having pain and other symptoms at this level strikes me as something you don't want to do unless you have no other way to get seen sooner. But given how severe it all sounds, I'd suggest seeing some kind of reproductive health provider, specifically, rather than someone more general, since you want -- again, if you can -- to go with someone who has the most education and experience with this kind of issue.

[PrincessLuLu]

I also forgot to mention I need hormonal birth control to prevent pregnancy as well

[PrincessLuLu]

And the person I saw diagnosed me with dysmenorrhea

[Heather]

That's just the medical term for "painful menstruation." So, if you told a doctor you had bad cramps all the time, that's something they'd note with that term, just like if you told them you had bad sinus headaches, they'd write "sinus congestion with headache on left side," or some such, or if you said you were having pain with sex, they might note, "dyspareunia" instead, since that's the medical term for that.

That you have dysmenorrhea doesn't tell us what the issue is or why, it just tells us you're having painful abdominal cramps with your period. Make sense?

And yep, whatever method you want to use as contraception, you can ask for that method, whatever it is you want there. If you like your pill and want to stay on it, it just isn't helping with your menstrual issues, there's no reason to go off of it or switch to something else unless a doctor thoughts your pill was making your cramps worse, or keeping them bad.