I am gloriously, blissfully Mirena-free. Here’s how it all went down:
As I was driving past the hospital, on my way to work this morning, I saw, unmistakably, the building my appointment was in. “How did I not notice this before?” I asked myself and, later, my pregnant coworker, who had already assured me the place would be easy to find.
The waiting room was, as I’d predicted, full of pregnant women. But I only found one of them to be particularly aggravating: a heavily pregnant girl who was maybe in her early 20s, wearing way too much makeup, and pouting/grumbling the entire time she waited – despite her boyfriend’s repeated efforts to make her smile. Otherwise, they were pretty inoffensive. After all, I should be able to allow them to exist in their natural habitat. (Not like that one time, the Father’s Day after our loss, when I took Doug to a brewery, and there was a pregnant chick on the tour with us. She wasn’t drinking, which made me feel even more like she was rubbing her pregnancy in my face, and I came this close to cornering her and asking hysterically, “Is there nowhere I can go to get away from you people?!” But I resisted.)
When the assistant called me in, she mispronounced my name, calling me Mary, and at first I didn’t get up. Then I decided to play nice, by which I mean I corrected her in front of the entire waiting room. “I just wanted to make sure there wasn’t really a Mary you were calling,” I explained when she apologized.
She took me to the exam room, looked at the file, and asked, “So you’re here to talk about birth control options?”
Dammit. “I’m here to have my IUD taken out, and then talk about non-hormonal options, yeah.”
Suddenly, I had more paperwork to fill out – the sort of paperwork they should have given me in the lobby, regardless of what my appointment was for: no, I don’t smoke; yes, I wear my seat belt; no, I don’t have high blood pressure or cancer or AIDS; yes, I’ve been medicated for depression; no, I’m not allergic to any medications; yes, I have a diabetic brother. (Oh, and um, I checked the “single” box again.)
“Ok,” the assistant said after I was done, “I’m going to go ask Lisa if she has time to remove your IUD today.”
“Wait. That’s the whole reason I’m here. I called the number three times to make sure they had it right in the notes for my appointment.” The assistant started to look at her file again, but I just kept talking. “The last woman I talked to said she was writing it in there. I want the IUD out, it’s making me sick, it has to come out today.”
The assistant sort of smiled at me. I’m sure I’m not the most hysterical, hormonal woman she’s ever seen in that exam room. “Okay,” she said, and walked out the door.
A few minutes later, she came back to tell me that Lisa, the nurse practitioner, would indeed take the Mirena out for me today, and that I should undress from the waist down. No offense to Doug, but I hadn’t been so excited to take my pants off in months.
Lisa knocked a few minutes later. She’s a middle-aged woman with a wavy gray bob and an infectious smile. She asked what I had and hadn’t liked about my IUD, and I told her everything.
“It’s not true that women with PCOS need hormonal birth control to preserve their fertility,” she said. “The reason we would put someone with PCOS on hormonal birth control is that we don’t want too much uterine lining building up and not being shed [due to sporadic or non-ovulation], because we’ve found connections between thick lining and pre-cancerous cells. So whether we put them on something like the pill, which will force a cycle so the lining is shed regularly, or an IUD, which keeps the lining really thin, hormonal birth control is one way of preventing that from happening. But it’s not the only way. If you ever go 90 days without a period, come see me, and I’ll give you a pregnancy test and then a 10-day prescription for a drug that will basically induce a period. Problem solved.”
I asked about getting an ultrasound, or whatever other test, to confirm or deny PCOS, and she convinced me – in a way I feel good about – that that wasn’t necessary either. “If we did an ultrasound, and we saw what looks like a little string of pearls all around the outline of your ovary, we would be able to confirm PCOS. But if we didn’t see that, that doesn’t mean we could necessarily rule it out. PCOS is a process-of-elimination syndrome: we rule out thyroid disease [and some other stuff I forgot], and if we have no other diagnosis for certain symptoms, then we say it’s most likely PCOS. But it’s not something we really have to do anything about – except what I said about making sure you shed lining – until you want to get pregnant. As long as you’re getting your cholesterol and your blood sugar checked fairly regularly – because even in slim PCOS women like yourself, we find cases of high cholesterol and diabetes… But you may not ever have to worry about those either; we know they all travel together, but we still don’t know who’s driving.”
Which is to say, they don’t know whether PCOS causes high cholesterol and diabetes, or whether high cholesterol and/or diabetes cause PCOS, or what. And while I enjoyed a few high cholesterol moments in college, my last few screenings have been in the ideal range. And thanks to my brother, and my family’s involvement in various ADA functions, my diabetes awareness and blood-sugar-testing opportunities are high.
She gave me two websites to visit: one that, although meant for high school/college-aged girls, she recommends to a lot of women, because of how clearly and concisely it explains PCOS. The other… Well, the name says it all: Condomania.
“It’s a really fun site,” she explained. “You don’t have to buy from them, although they are pretty cheap, but at the very least you can go on there and read about the different condoms so you don’t wind up standing in the drugstore comparing packages. Or you can get sampler packs from them, to see what you like. When my sons were living at home, I had this pickle jar – which I thought was kind of appropriate – full of condoms that I kept in the laundry room, for them and their friends to take. And whenever I’d see the level in the jar getting low, I’d tell them I was going on condomania to order more, and was there anything in particular they liked form the last batch that they wanted more of. It embarrassed them – especially my sons’ friends, I think – but I just told them I’d rather not have them getting anyone pregnant or coming home with a disease.”
I asked her if there was anything I needed to do now, with regards to my PCOS or my life, to get ready for babies in a year and a half or so. She said to just be aware of my cycles, which, before my pregnancy, were pretty regular if six weeks long, so by the time we get there, we can try to pinpoint the best days for conception. And to start taking a prenatal as soon as I like, or at least a folic acid supplement (the latter of which I have, but forget to take more often than not). And that’s it.
Before I let her go, I had to ask – although not in so many words – whether she thought I was crazy.
“Do you get people in here very often who say their hormonal birth control affects them so horribly? Because a lot of people I’ve talked to love their IUDs, or they have the ring and they love that…”
“I don’t see it that often,” she admitted. “But there have been a few. Different medications and hormones affect people differently. The way I see it, pills are like shoes. I wear a size 8 shoe, so most size 8 shoes should fit me. And most pills should work the same way for most people; that’s why the FDA approves them. But if you say the hormones are affecting you a certain way, I believe you. Some people are more sensitive. Some people can take one Benadryl and hardly be able to walk. So I don’t think it’s silly for you to believe you’re especially sensitive to hormonal birth control, if that’s what your body is telling you.”
So, despite a few initial inconveniences, I left feeling informed, prepared, and decidedly not crazy.
Oh, and somewhere in the midst of all that talking, Lisa told me to take a deep breath, and she pulled out my IUD. Once she left the room, I looked at the culprit, lying on the tray in a plastic bag. It’s hard to believe that something that small was causing me so many problems. And I took a picture of it, because I wanted the proof that it really had been in and that it really was out.* Like, here’s another chapter over with. Now we can move on.
*I still regret not getting a printout of my ultrasound pictures – the ones showing the empty sacs and no baby. Why should I feel like my experience was any less worth documenting than those of women with successful pregnancies? But no one offered me a printed photo, and at the time, I had too much on my mind to even think to ask.