RSSThe Pill or Mirena
October 18, 2008
Women have written to me suggesting that I live in a delusional rosy bubble. Their lives are difficult, everyone’s life is difficult, aging is not easy, and why am I presenting such an unrealistic view of the world?? “Like, if we could really do something about it, we would have already”, is the implication.
I receive other letters where women share their reasons for reading this site. Most often, I hear the words “relevant” and “feel better about myself”. Now that’s pretty encouraging since it’s exactly what I’m trying to do. There are many excellent health and beauty blogs, many. But they’re not about us once we’re over 40 or so.
I very much live in the real world. I have no beef with celebrity, except that they’re not real. They are at best a diversion whose earning status greatly exceeds their contribution to society. Their chateaux, their surgeons and dentists, their nannies, their divorces, whatever. Got nothing to do with anyone I know. They’re bugs in bottles. Yet, they’re the standard I’m supposed to measure myself against. Spare me. I’ve given birth 3 times and breastfed 3 children. Let’s calm down and honor the right things.
Bleeding
So, this is what’s been going on with me. With no irregularity exceeding 4 days before this episode, the period that was due September 11 was 5 days late. Bill had a vasectomy 10 years ago, but I still get freaked out. Pregnancy test was negative so I really didn’t care if it ever started. Once it began, it was heavier than usual for 5 days, but not more than anything I’d ever had. It tried to stop for a day or two, then started up again in huge volumes with no sign of stopping for days.
I figured it was pre-menopausal and would stop eventually, but it just got heavier. I felt fine but I finally dragged myself to the doctor because it’s hard to see appointments with blood clots pouring out of you and blood running down your leg. Hey, this is real life, right? I have an aversion to pretense. And I would challenge any male to tell me that having his blood dripping out the end of his penis would not cause him to be a little distracted at the office.
MD (a wonderful woman our age) sends me packing to Emerg. where I spent an afternoon that alternated between hours of sheer boredom and moments of near terror, or at least intense discomfort – not unlike performing anesthesia, for any of you who have done it.
The diagnoses
What are the possibilities?
1) Fibroid tumour > not likely with a normal ultrasound (I only had a moderately thickened uterine lining which could be normal during a period)
2) Polyp > also unlikely with normal ultrasound
3) Cancer > not common but possible; we come back to this one.
4) Pre-menopause > very likely. I’m 48.
Stopping the blood
Job 1 is get the bleeding to stop because my Hemoglobin is 20 points less than it should be. Not transfusion-worthy, but enough to tire you. This is accomplished with high doses of Estrogen (Es). Remember the old style Birth Control Pills (BCP) we took 20 years ago? We took 1 a day. I was to take 2 every 8 hours. Within 2 doses, I’m vomiting like a chemo patient (it was so strange – I could feel that it was the drug making this happen), but the gushing blood and clots dried to up to NOTHING!!! Now this is fascinating when it’s not happening to your body. Anyhow, I tapered off the high dose estrogen and was at 1 per day within 7 days, and doing well. Was I disturbed to be taking these doses of estrogen Es and progesterone (Pr)? Shit, yes, but my choice was hemorrhage. This pill is called Ovral.
Well, what do you do when you’re sick these days? You sit home with your blankie (as an adult your blankie equates to a Do Not Disturb sign) and read about yourself on the net. Then you take all your new-found, context-less knowledge to your doctor and tell him what’s wrong with you. You can tell he’s heard this before, but he’s open-minded and will go around once or twice if his waiting room isn’t packed.
I now try to go off high dose estrogen/progesterone, after 10 dry days. Along comes a spider, because 2 days later, the blood has started up again, but light. The plan was to try an extremely low dose BCP called Alesse. Ya, well, it didn’t gush but it was getting heavier by the day. Off the the GYN I go.
Here’s a great guy. For 25 years, this man has spent his nights elbow-deep in placenta and his days listening to women who won’t stop bleeding, and still loves his job, respects his patients, and cares about women’s bodies. A find, this guy is, and delightfully no nonsense. Vets don’t have the luxury of doing a thousand medical tests and we relate better to doctors who cut to the chase.
GYN does an in-office biopsy, minor deal. That’s to see if it’s cancer. If it is, you’re off for a hysterectomy. And may I say that if I have cancer, with the amount of green tea and turmeric that goes through me, I will never eat broccoli again.
Cycles without ovulations
If it’s not, it seems the most likely is what are called “anovulatory cycles”. It’ s complicated.
Normally, in the first 14 days of your cycle, a follicle is getting ready to ovulate, so Estrogen is climbing, growing a uterine lining. Now your ovary release the egg. In the second 14 days, Progesterone is climbing to keep the uterine lining healthy. Pr is also the PMS culprit. Then your period starts and the lining is shed. As the next follicle grows, Estrogen climbs again, it stops your bleeding and the next cycle begins.
Having occasional cycles with no actual follicle or ovulation is just part of early menopause in all women. In me, the problem appears to be that on this cycle, there’s not enough Estrogen to stop the bleeding. There’s more to it of course, but this is why feeding me Estrogen got the blood to stop pouring out. Well, that was the easy part. Now what?
A choice among evils
BCP come in different strengths. Ovral is 50 times your body’s natural Es and Pr ; some BCP are 6 times; Alesse is 2 times your physiologic levels. If I understand my two choices, the first is Alesse which will probably bring the cycles back under control but it may be 3 months of bleeding before that happens. Remember that this is not the same as Hormone Replacement Therapy (HRT), where you’re given supplemental Es for the symptoms of menopause. That’s a whole ‘nother kettle of fish.
The other choice is a Mirena IUD. It releases micro doses of Pr in the uterus.
Pros for Mirena:
1) no Es at all – this is the hormone associated with stroke and blood clots, so this is a huge plus, particularly if you smoke or have a tendency to clot
2) tiny dose Pr – so minimal side effects, minimal PMS-iness
3) 30% of women have no period at all
4) can be removed in 5 years by which time I should be done menopause completely !!!! think of it – potentially no period ever again! not that its’ a big thing when they’re normal, just a messy inconvenience. Torrential, however, is a big inconvenience.
5) usually good control of excessive bleeding
Cons for Mirena:
1) pain and cramping for 24hrs when inserted, though less in women who have had children and are beyond using it for birth control
2) still some exposure to synthetic hormone
3) sometimes uncomfortable – but can always be removed
4) only been on the market 5 years, so not much long term experience
What about a D&C? Works for 2-3 months. Even aggressively done, only 40% or so of the lining can be removed, leaving plenty of abnormal tissue in there.
Endometrial ablation ? Here, the uterine lining is scarred down, so no periods in some women, mild in others. Sounds great. BUT, if ever you develop anything that could be cancer, you can’t biopsy an ablated uterus. You have a hysterectomy whether you have cancer or not, because they can’t tell by biopsy. So some women get hysterectomies who didn’t really need them.
Natural progesterones as creams or nasal sprays or pills like Prometrium? We’d all pick this one. Some women I know swear their cycles go better when they use them in the last 14 days. Others find no effect or PMS effects, presumably because they have enough Pr of their own. The snag is that I have to get the bleeding to stop before I can think about these. I asked both my MD and GYN and they admitted to not being very familiar with them, and having concerns about controlling the hormone levels in the body where absorption varied between women.
Sugar. Lots of it.
I am aware that there are worse things out there than what I’ m going through. But I know what worn down and discouraged feels like too. If ever I come across as glib and synthetic, it’s not my intention or my reality. The hard times are hard. Everyone’s a nice guy when things are going the right way. What kind of guy am I when things are going awry? Not such a great one. Supper last night was French Fries and Oreos.
I haven’t had a fry in about 12 years. It was kind of strange. Makes me wonder what the fuss is about, but I guess I’ve outgrown it. I do happen to be in possession of one of my favorite substances on earth, that being a can of pure Quebec Amber maple syrup, and I may wind up doing myself some harm with it. Or at least find the juice to get through next week. I’m already wondering what the gifts- to- self will be.
The absolute best maple syrup.
If I have an aversion to pretense, I have a bigger aversion to indecision so I have to pick one. In my head, Mirena makes the most sense by far. If it works well, it could potentially be the very best option, even if it only stays in 2 years. I’ve read a thousand horrid experiences with it. Without diminishing each woman’s suffering, were you told a thousand nightmares about delivery when you got pregnant and none came true? Your encounter with it is very much your own. I must look at this the same way. Do any of you have any familiarity? I’m so hoping to hear many good things about Mirena.
A sincere thank you to Michelle M., whose e-mail on this Saturday made my whole week better. 
We are all so connected and have so much of our incredible strength to share with one another. Women are and will be each other’s salvation. We help our sisters cope when no one else can.
Comments
11 Responses to “The Pill or Mirena”
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I don’t have any experience with the options you have – just hope that one of them works and you’re back to normal soon!
Chris I hope you are feeling better soon! Odd to get the details on your blog. For those of your readers who think you live in a bubble, keep writing as they obviously don’t know you yet.
http://www.socialmedia404.com/?p=675
Christine,
You have my prayers.
I can share with you my experience of 10+ years of IUD use. I haven’t had the ‘brand’ you are considering and I had mine for birth control.
The insertion is a bit uncomfortable and I had cramping on the way home and the same for the removal. Nothing that a few Ibuprophen didn’t handle.
I had a few months with spotting, very light, only in the beginning. My periods were normal for me. Nothing as heavy as you’ve described nor for more than 5 days. I loved the freedom it gave me. I no longer have an IUD because I no longer have a uterus..I had a lvl 3 prolapse and other complications that required removal in the spring of ’04.
I hope you find the right method for you.
Julie,
Thanks for the good wishes. It’ ll sort itself, I’m sure. I’ve learned a lot about it in the last 2 weeks. It’s such a big topic and affects every single woman alive, and yet you hear nothing about it till it’s happening to you. Odd.
Patrick,
Maybe I’ve been writing the wrong things.
I could tell everyone about how I can pick maggots out of an eye socket and eat lunch with the other hand. But no, that skill is common among all veterinarians. That’s why we have such good stories at parties!
Donna,
That’s exactly what I was hoping to hear. Surely they insert thousands of these things. You always only hear the bad things, no matter what the topic. I figured there must be some women out there who do well with these IUD’s. It certainly sounds like a very good solution if it works.
Chris:
Have you considered a hysterectomy? I am 56 yrs. old. I finally got one 3 years ago, after going thru years of agony .
My last period was at age 42, and I was immediately put on HRT. I was grateful for the respite, and I continue HRT to this day. When my Gyn discovered (benign) fibroid tumors growing on the outside of my uterus, he suggested a full hysterectomy. His kindly intended comment was “Why would you want to keep it?”
Should have done it years ago. I am still the woman I have always been, just freer, with less pain, embarassment and aggravation.
Hi Christine,
For many years i took BCPs and lived 3days of every month completely at the mercy of my period. I thought it was normal. Two years ago i switched to the Mirena. I am so glad i did. I am relieved (at 44) to have significantly decreased the hormone intake. But most significantly i have those 3 days a month back. The bleeding is greatly reduced (but i am glad i still have some or i would be spending a fortune on pregnancy tests!). I continue to experience what i describe as a heaviness for a couple days a month but nothing like the pain and cramping pre-mirena. I hope the option that you choose works as well for you as the Mirena did for me.
C
Linda,
It seems that hysterectomies are postponed till no other option exists. They sure don’t rush into them, at least here in Ontario.
Having said that, I’m not one bit averse to the idea. In fact, if last week’s biopsy turns out to be cancer (report back in 2 days), then that’s exactly what will happen.
The thing is, I have no discomfort. Never have.
I don’t understand why you were automatically put on HRT after your periods ended? Is it because you were so young? Or did you have hot flashes, or other signs where estrogen supplementation might help?
Interestingly, as I wrote in a comment on the “What’s a Mirena IUD? ” post, I noticed 2 groups of women who talked about the IUD side effects. Bad news in the young, much better in older women.
I noticed another trend – that women who took HRT loved, and wished they’d stayed on it once it was discontinued. When you look at actual statistics ( I’ll post the site when I find it again) for side effects, it’s not really very high. These hormone fears are just trends in medications, not without justification. It’s different now from 5 years ago, and will change again.
Physicians probably do see more breast cancer now than in our mother’s years and the biggest social causal factor is of course the advent of the Pill, so there’s something to this. But the microdose pills will hopefully impact those numbers in a positive way for our daughters.
Cathy,
Thank you. I’m so happy to be getting so many positive reports from older women. I’m going to go with the IUD and feel much more comfortable with that decision, thanks to all the women who have spoken well of it.
It’s fascinating to me how different we are at our stage of life from 25 years ago. We respond to food and medication differently, we look better in different makeup, we identify with different advertising. We so need to find information for our age group, because we are distinct, just as teenagers are distinct from 30 year olds.
Christine—-I hope you are feeling better. I managed to delay hysterectomy for a year and a half with acupuncture——if you have access to a good one. He stimulated my kidneys—which after a while i figured out it was the adrenals and also more erythropoetin (hormone that stimulates blood cell growth) production. I did have fibroids and eventually had the hysterectomy but kept my ovaries. The treatments kept my hemoglobin up. My description of the bleeding was ” like a stuck pig” which maybe is not funny to you as a veterinarian. And the wearing black pants all the time—-trying not to be messy.
Taji,
I think that your experiences will one day be my own. I have a whole new sensitivity to the “stuck pig” description, believe me. And black pants, definitely (Value Village is coming in very handy here). And checking the chair behind you when you get up. So far it’s just been a huge messy headache.
I’m extremely grateful that I’m not in any pain…though that may all change once this IUD is in ( in 3 weeks. Turns out I don’t have cancer).
Of the many aspects of menopause that you hear about, cycles without ovulations was a new one for me, and yet, it’s probably the most common problem of all. Maybe that’s what was happening to all those women who complained of extremely heavy bleeding some months but not others. I wonder what they did in the old days – probably put leeches on them and bled them some more!
Honestly how did I miss this!!! I am pathetic..good grief!
Tried the pill when ‘no one else’ stepped up and felt as you did… nauseated and inguinal pain, not sure where that came from, so stopped that and said, “Well I’m done here, your turn!” And time went on until last year when this all happened and the flood began.
Where to start…yes …I had an IUD after Alex was born ..had it for about hmmmm 3 years I think. No problems with insertion did not even feel it going in. Course I had had two children. Periods I was told would be heavy with major cramping. I had the reverse. Best periods I ever experienced in flow and duration with no cramping. It was removed as painlessly and I did not have another inserted. Think I was assuming that as far as birth control was concerned (and that was the reason I had it inserted) perhaps someone else should be doing something.
Just finished another period that was my regular 4 to 5 days of heavy and light combo. Have them about every 14-19 days until like I said in the other comment had nothing since September 9.
There are times when I almost consider iron supplements but the only time I did succumb to those was during pregnancy and they wreak such havoc on my intestines that it is just intolerable. More spinach, pate and whatever else I can eat and I manage. They did tell me though the last time I gave blood that I needed to watch it or I would not be able to give again.
The IUD was never suggested to me. My estrogen level was taken as my GP wanted a benchmark to go from. My GYN, who, by the way, did my pelvic exam while I was bleeding and here I was under the impression that PAP smears could not be done while on your period, said everything was normal on exam but followed up with the ultrasound where he identified polyps. Gee who knew. I have lumps everywhere as I am fibrocystic as well. Enough mammograms and ultrasounds there to go round.
So I am most interested in this Mirena. God no period how wonderful that would be. I remember this past February driving to Fredericton and feeling this warmth and had to wrap an extra coat around me as I ran into a washroom at the first gas station I found. Completely soaked underwear, jeans , jacket and the car seat. Luvly. This with a pad and a tampon in just changed an hour earlier. Ahh yes menopause. But as my mother tells me what doesn’t kill ya makes ya stronger.
Have had friends who have had the hysterectomy as I mentioned and say it was the absolute best thing that ever happened to them and wondered why they waited so long. Mom also says what do you need it for anyway. It will shrivel up eventually …let them suck it out of you now. Have to smile at her as she is 87 and has absolutely no filter but then she actually never did
We must chat you and I.