In one of my last check-ups, my neurologist mentioned that despite being on my current anticonvulsants for the better part of a year, I kept having break through seizures. She studied my e-chart and tapped her chin. “I wonder if it’s not an interaction with your other medications,” she said.
I swung my legs and raised my eyebrows. “But I’m on the lowest dosage of that antidepressant,” I protested.
She shook her head. “No, not that.”
“But I’m not on any other…” I blinked when I realized what she was talking about. “Oh.”
She smiled. “Would you consider getting that removed?” she asked. “It’s the only other factor.”
I blushed and rubbed my stomach, because even though she’s a medical professional this is still strangely embarrassing. “Um,” I stammer. “Yeah, I can talk to my gynecologist. I could make an appointment to talk to her.”
“Think she could take it out soon? Before your next appointment?”
Jesus. She was being pretty pushy this time. “I…can try to get in to see her before the new year,” I said.
“Great! We’ll see if that helps by the next time you come in!” Then we did our typical neurological tests and I got out of there.
As I left, a melancholy chilled my bones. Soon I’d have to say goodbye to a very dependable friend.
I recall having an accidental Puberty Talk with my mom when I was about 10 as I watched her load a box of sanitary napkins (never, ever call them “maxi pads” in my presence thankyouveddymuch) into the cupboard under the bathroom sink. Curious, I asked what they were.
“Women need them because they bleed once a month,” she explained. “And in a couple of years, you’ll need them too.”
“Wait, why?” I asked. “Do all women bleed?”
“Don’t worry,” she assured me. “It just means that your body is ready to have a baby. And yes, all women do.”
She didn’t come out and explicitly tell me that once you start bleeding, you’ll be a woman, I just concluded it. Naturally, I became excited at the prospect! Being a woman meant maturity and responsibility! It meant new adventures and opportunities! And once I became a woman, I’d be taller, prettier, smarter, and all around better than I currently was, right? Because already, I was so young and didn’t realize I hated everything about myself and didn’t realize it and wished womanhood would change it, as if puberty were some magical switch to stop hating yourself.
Ugh. Ten-years-old is too young for such low self-esteem, but I had managed to perfect it.
So enthralled by the idea of becoming a woman, I would wake up and look for any evidence that I had transitioned out of the clutches of childhood and into the sweet embrace of femininity. I did this, seemingly, every day, for months. Then years. When my girlfriends talked about their periods at sleepovers or at school (always in hushed tones so the boys didn’t overhear and shout “ERICA IS ON THE RAG!”), I couldn’t participate. Or I would lament my lack of involvement in this modern ritual.
“Don’t worry,” one girl told me, bitterness evident in her voice. “You don’t want this.”
Surprised, I (now twelve), asked, “Why?”
“It’s awful. It hurts all the time.”
“Wait — what?”
She didn’t elaborate.
I turned around in my desk, now shook. Why was I just now hearing about this?
“Mama,” I demanded, dropping my backpack on the living room floor. “Does getting your period hurt?”
She raised her eyes from her Stephen King novel. Her expression of incredulousness and amusement shocked me even more than that afternoon’s revelation. “Sweetie,” she said. “Of course it does. Didn’t I tell you that?”
I froze. “No!” I cried. “You never said anything about it hurting! You just said there was blood and all women get it!”
“Honey.” She put her book down. “Periods come with cramps. Some women have it worse than others.” To my horror, she added, “That’s why I’m in bed all the time when I’m not at work.”
“What? I thought your back was hurting!”
“Yes, that’s part of it.” She nodded. Why the fuck was she being so calm about this? “Your grandmother had it worse. She had a hysterectomy because of endometriosis— that’s when the uterine lining grows all over the place. And sometimes your flow is really heavy and you’ll soak right through your sanitary napkin.”
I paled. What was a hysterectomy? Why didn’t she tell me any of this when I was 10, and wanting so desperately to be grown up and have all this happen to me?
“But sweetie, don’t worry about all this right now. I didn’t get my first period until I was 14. You probably won’t either. You’ve got a few more years yet. Enjoy yourself.” She smiled and picked up her book. “And you probably won’t have any of the problems me, your grandmother, and her mother had. Plus, things are different now for girls.”
Of course, I was too terrified to listen. Plus, it seemed like my mother was having too much fun telling me this torturous side of menstruation.
I called S, who confirmed but downplayed my fears about this Menarche Malarkey.
“Yeah,” she said. “Like, it’s weird. I get crampy and stuff. But I take ibuprofen and I’m ok.”
I sighed. “That’s good.” Maybe that was a relief, or maybe that was a delusion. Either way, I felt better.
“My boobs hurt sometimes,” she supplied.
I waved that off. “Eh, I don’t have them yet, and probably never will. So that won’t matter.” (For the record, I’m delighted to report that twelve-year-old me was very wrong about that. Thankyouveddymuch.) “What about…uh…soaking through stuff?”
“No,” she said. “That doesn’t happen at all. It’s pretty, uh, normal? I guess?”
“That’s good, too.”
“Yeah, plus I use tampons. Only moms use sanitary napkins.”
Either my mother was indeed a good predictor of my bodily functions or Mother Nature wanted me to stay within the confines of childhood for as long as possible (perhaps a blessing, in retrospect), because my first cycle started at age 14.
I recall the first pains of menstruation, because its a pain that stays with me today. It begins first as a dull band of aching that stretches from one hip bone to the other. Then suddenly, a thousand sharp, stabbing pains come flying all at once — like your uterus is full of shurikens. I don’t remember where I was when I first felt it, but I know it was around December because I thought I know what this is and then how wonderful that it’s an early Christmas gift.
The next day, I got my period.
Despite the aching, that preteen excitement and hope came back. Wasn’t I a woman now? Was I going to be pretty, popular, interesting, and lovable now? Were people going to listen to what I had to say? Was I going to have anything to say?
I think back to my girlfriends who had long since started their cycles. Were any of them women at age 11? 12? Was I truly the last of them to start mine at age 14? What about the other late bloomers out there — were they any less of a woman than me? What about girls who didn’t care about identifying as women at all? What about the girls who were born in the wrong bodies and would never menstruate? This is stuff I think about now with the lens of retrospect and empathy. I was deeply anxious, insecure, and sad and wanted so desperately to be pretty and popular that I thought something as simple as a natural bodily function would grant this to me. On the contrary, it didn’t; just like it didn’t for anyone else who started a menstrual cycle.
What it did do is bring me a world of absolute misery well into my adult life.
I learned to hate menstruation before I turned 15.
A girl’s first cycle can trick her. It’s sound and fury that first month and then silence for another month or so while her body adjusts to the new hormones. The ovaries are flexing, the fallopian tubes are stretching, and the uterus is doing a few turns. Since I wasn’t a sex-haver, I didn’t worry about this break in between cycles. In fact, during this time I asked my mother if she would buy me a box of tampons.
She agreed, albeit reluctantly. I never asked why, though I’m sure it had something to do with not wanting her daughter to put something in her vagina at that age. Likely, she thought I would be irresponsible, leave them in too long, and develop Toxic Shock Syndrome. Or, maybe she still hung onto old-school Puritanical beliefs about virginity and thought I wouldn’t be “pure” if used them. But after her initial hesitance, she let me get a box of teen-centric tampons, which are so advertised because they’re “silky,” “light,” and “narrow.” I’m guessing that’s supposed to let your teen daughter do all the stuff she normally does (sports, homework, watch tv, worry about her social life), while alleviate your grown-up concerns (IS HER VAGINA STILL SMALL AND INTACT AND NOT AT ALL READY FOR A PENIS) at the same time.
While a period didn’t make me feel any more womanly, a box of tampons sure did! My mom never used them, so I had a box of gold tucked under my arm. In our only bathroom one bloody Sunday (my apologies to Northern Ireland), I opened up the box of — what the fuck are these things? Individually wrapped syringes stuffed with cotton? — and tried to figure out the instructions.
Ok, if you don’t menstruate, figuring out how to use a tampon for the first time when you’re 14 and don’t really know what your body does is confusing at best and unpleasant at worst. Other words I’d use include: messy, frustrating, absurd, and painful. Even today, I don’t exactly have a good process for it and I am much more comfortable and familiar with my body than I was twenty years ago. Though the instructions in a box of teen tampons are friendly and approachable, the first step is always 1. RELAX. Suddenly, that made me very, very nervous. Why do I need to relax all of a sudden, tampon? What are you going to do to me?
It took about fifteen minutes of painful poking and prodding with that first tampon before I ultimately threw it away in disgust. I was decidedly not relaxed and it wound up half-dislodged from its applicator, sitting like a pathetic, beached and bloodied whale after a fight with a shark. But not one to be discouraged from my goal of Tampon-hood, I fished another out from the box and went at it again.
Attempt number two was marginally more successful, but not without a helping of “Ow! Shit! Ow! Ow ow ow ow!” to follow. It would be a two-fold anatomy lesson for me that day in that 1. I’d learn how to better angle things, especially if I wanted to sit down on anything harder than a bean bag chair and 2. Holy crap, I wouldn’t have to take this out to pee after all!
I told you I was naive.
The next hurdle with tampons would be taking those fuckers out. If it was uncomfortable going it, it was goddamn misery the first time I tried pulling it out. Again, I wasn’t relaxed — and by now, you should know that relaxed is a euphemism for having your Kegel muscles relaxed, not just taking a deep breath and slumping your shoulders like I thought. So when I pulled the string, every muscle in my body clenched and —
You get the point.
Another good lesson in my own body functions was the used tampon itself. I had seen my mother’s balled up and used sanitary napkins stuffed into the bottom of the bathroom trash before. I had seen my own used sanitary napkins, as well. But I had never seen a used tampon — shriveled and brown, like a dead animal — before.
At that moment, something changed in me — this was real now. This wasn’t some fantasy come to life. Now I had a chore I had to maintain for the rest of my life. It came with pain and balled up cotton and — humorlessly — fine red floss on my nether region. Great, I thought. More red hair. As if I needed another goddamn reason to be unattractive.
Growing up requires a blood sacrifice.
It wasn’t until I was 16 that the external parts of my body finally caught up to my internals: waist, hips, chest, all that ridiculous stuff that I prayed to have years prior but didn’t get until long after my friends got them and no one cared about now. Again, the gift of retrospect tells me that there was absolutely nothing wrong with my body and everything worked as it was supposed to. I wasn’t really a late bloomer per se, I just grew at the speed my body needed to grow. But you couldn’t have told me that back then. I wouldn’t have believed you. I just knew if I looked pretty, all of my problems with boys, girls, and self-loathing, would go away and that would mean I could work on my problems at home with less stress.
And that was another thing about hormones that my mother didn’t tell me about: Depression. While I battled near crippling waves of pain that would sometimes knock me out of school for two days a month, I didn’t realize that the mental illness would come sneaking up behind it. I was always an anxious child, but depression was new. And it would haunt me for twenty years before I finally took medication for it.
But depression and physical pain love to spit roast you. First the physical pain knocks you out with it’s uterine shurikens and then the depression phases in from the dark corners and says, “Why are you going through this? It’s not like a man is ever going to have sex with you. I mean, have you looked at yourself in the mirror lately?” And then boom-boom! You’re on the floor, crying, clutching your stomach and calling for your mom, who genuinely is the only person in the whole fucking house that understands what you’re going through and you wish you hadn’t rolled your eyes so many times when she said she didn’t feel like taking you to Claire’s to get a clear purse. And sometimes this happened twice a month, just because your body wanted to fuck with you. Maybe all that praying to Mother Nature when your were 10 paid off more than you thought it would.
One morning I woke up to go to school and saw a Quentin Tarantino movie on my pajama pants and bed sheets and screamed, “Mama!” I thought I was dying. I had heard her use the word hemorrhage before, and I wondered if it was happening to me, too. She pressed my head against her chest while I sobbed and said, “Poor baby, it’s ok. I know it looks bad, but it’s ok.”
I stayed home from school again. Mom had me run a hot bath and then she gave me one of her pills — something that rhymes with “schmopioid” because it knocked me right the fuck out. Menstrual cramps be goddamned, because I didn’t feel anything for about 6 hours.
Somewhere in that haze, I thought, this can’t be the rest of my life, can it?
When I turned eighteen, I scared the shit out of my mother when I approached her and said, “Mom, I want to go on birth control.”
She sat down her Stephen King book and cleared her throat. After a very long pause, she asked, “Ok, can I ask why?”
I looked her directly in the eye. “You know why.”
I would never in a million years describe my mother as progressive, feminist, or liberal. However, she has made some very interesting parenting choices for my brother and me that were accidentally forward-thinking. One of those choices included fighting to let my brother have my old dollhouse, which he kept and used as a Batcave, a Power Rangers command center, and a house for tired wrestlers. “He’ll use his imagination,” she told the nay-sayers. “And if he wants to play with dolls, he can play with dolls! He’s not hurting anything! Let him play!”
The second choice she made was not freaking out when her barely adult daughter just admitted to her that she was (finally!) sexually active and wanted to get birth control.
Mom nodded and said, “I’ll make an appointment for you next week.”
I have been on some form of birth control my entire adult life, which accounts for half of my life now. I went on it for two reasons: so I could have monogamous, unprotected sex with a man without getting pregnant and so I could regulate my cycle and not be in bloody, miserable pain. I had 100% success with the former, I had middling success with the latter until 8 years ago.
All of the following reflects my own experiences. Your mileage may vary. Please talk to your own healthcare provider before deciding on a birth control option that is right for you.
My first experience with birth control was Depo-Provera, the 4 times a year shot. I started taking that at age 18. The only trouble with the shot was that I got it in Michigan, but immediately moved to Alabama, and had to schedule my shots around driving home. At first this was fine – we’d drive home on Spring and Fall break and during the Summer and I’d see my family. But eventually, my family moved away from my hometown and I aged off their insurance, and we didn’t have a reliable car to make the drive anyway. And while it’s good for keeping the babies away, Depo did nothing for regulating my cycle. I still woke up, crying, begging for death or OTC pain killers.
For a little while after the Depo ended, we just used condoms. While not a chemical form of birth control, if used correctly they’re 85% effective. But all it takes is one time of Wait…did that..? Did you…? Did it?! And then hoping to God everything’s ok and then you suddenly want that horrible blood and pain again. But there would be no more panics again, because I’d go back to real birth control almost immediately after. Plus I was getting sick of rolling around in smears of blood, soaking through tampons and into sheets or my nice underwear (the ones I wore for sexytime or just the ones I didn’t want ruined) and pretending I wasn’t in absolute misery once — or twice — a month.
When I switched birth control again, I asked my then-gynecologist, “Is there something wrong with me?”
“All your tests come back fine,” she told me. “No polyps, no cysts, no legions, no bad cells. You just have really heavy cycles. You could have endometriosis, but we’d have to do some exploring for that.”
“What do I do?”
“How about skipping them entirely?”
“What?” I sat up from the table. “I can do that?”
“Sure can. I’ll put you on the Pill, and you can just skip the placebo week.”
Oh. My. God.
No, no one told me you can do this, that you can just skip your period entirely. I almost cried for joy when she wrote me the prescription. So for the next couple of years, I went on the Pill (or Pills, the brand changed a few times). A combination estrogen and progestin pill that, once I got to the placebo week, I just tossed those pesky little pills away and could live my life period-free!
But no good deed goes unpunished. Unfortunately, the hormones in birth control pills do a number on my skin. Having good skin before I went on the Pill, I had shitty skin afterward. I broke out in cystic acne around my chin and cheeks. I looked like a 13-year-old boy in some pictures. I had to take the Pill at the same time every day, which was an absolute pain in the ass. Today, I’ve got anticonvulsants and antidepressants that I take twice a day at the same times like it’s no big deal, but when you’re in college and in the middle of hanging out with friends — or, even better, in the middle of having sex — it’s inconvenient.
I then switched to the Nuvaring, which would be practice for what was to come. The acne died down and it was great not having to have a daily reminder to take a pill. In fact, that was working up until October 2011, when I found out we’d be going to Northern Virginia for six months. I wouldn’t be able to easily refill my Ring prescription.
My gynecologist said, “Have you thought about an IUD?”
I said, “Well, I considered it. But don’t you only give those to women who’ve had babies?”
She replied, “I’ve put IUDs in women as young as 17.”
“Oh,” I asked, intrigued. “I’ve heard of Mirena. Could I possibly not have a period?”
“That’s possible in some women. Are you interested?”
I smiled slowly. “Only most of my life.”
Every person with a uterus reacts differently when they get an IUD inserted. The gynecologist who inserted my first Mirena was not gentle, even though I liked her as my health care provider. I think about it like inserting that tampon for the first time, only farther back and with more shurikens.
The process is like this: like a regular gynecological exam, you strip from the waist down. You put your feet into the stirrups and stare at the slender metal tools on the counter. There’s a model of a uterus with an IUD on the counter, you should probably look at that.
You’ll likely already have given a urine sample, so don’t worry about peeing on the gyno — who is actually an NP, by the way. When she walks into the room, she’s joined by another woman who is a student but wants to observe and asks your permission. You say yes because why the fuck not — invite the whole class to look up your vagina. Not every day they get to see a red one, you’ll bet. Your gyno walks the nursing student through the process so you are hearing everything in real time.
Then you get pried apart with a medieval torture device called a speculum. Your NP is kind and uses a plastic one, but others are not so lucky and get an icy metal one. But you get plenty of lube which you will notice later. Then your NP tells the student (and you) that she’s “applying the numbing agent to your cervix” which may sting or tingle a bit. This part doesn’t bother you, actually. Your cervix is well behaved and well mannered.
“Now, I’ve going to use the sound to survey her uterus,” the NP tells the student,” and slides in the slender metal tube used to measure the length of your uterus.
And this part is bad. Like, real bad. This part feels like the shurikens are jumping around again, all pointy and angry, looking to break out of your reproductive area and burst through from your abdomen. You hold it together though because you’re in your late twenties, now. You clench your teeth and go, “Oooh, ow. That’s unpleasant,” because you have a tendency to make understatements
But the nursing assistant knows her bedside manner and goes, “Are you ok?”
“Yeah,” you say, because this just feels like normal cycle cramps and sadly debilitating cycle cramps are par for your course. “I’m fine.”
“And now I’m putting in the IUD…”
The shurikens pinwheel again when you feel the IUD going inside you. But it’s the same pain you’re used to. So while you hurt, you can’t say this isn’t unexpected.
And then it’s over. The NP, the nursing student, and you are now old friends, checking in on each other. You’re making jokes and smiling. “Thanks ladies,” you say, and then you have to relax on the bed for a few minutes because someone touching your cervix triggers a vasovagal reaction and makes you dizzy and you nearly pass out.
“Rest for a few minutes,” the NP says. Then she tosses a single Kleenex at you. “And clean yourself up.”
Right, you forgot. At some point, getting birth control has to make you feel like a whore somehow. Sigh.
I loved that first Mirena to death. For five years I didn’t need a single tampon, sanitary napkin, ibuprofen, tylenol. or anything stronger. During that time, I saw the creation and marketing of menstrual cups and Thinx, the underwear that you can bleed into and wash and reuse. I could plan trips without worrying about taking menstrual products with me. I didn’t wake up crying and pleading with M to reach for the water so I could take some analgesic and get back to sleep. I no longer worried about ruining nice underwear, pants, sheets, or blankets.
The amen in amenorrhea.
And also, I could have all the sex I wanted and not get pregnant. That too was good.
At then end of its run, I had a new gynecologist — an actual MD, not an NP — and asked to swap out my old one with a new. I was in my thirties by that time and though she agreed, she gave me a warning: “Did you know that birth control comes with a higher risk of stroke and blood clots for women in their thirties?”
I paused. “Well, yeah,” I said. “I mean, I take care of myself.”
She nodded. “What about the copper IUD?”
I mentioned my history of painful, irregular cycles. “Also, acne,” I added. “But at the end of this one’s life, I’d like to talk about more permanent methods of birth control.”
My gyno nodded. “Sure,” she said. “Let’s talk about that in five years.”
So I got the first Mirena swapped out for the second (and final) Mirena. This process was a lot better this time. Either I knew what to expect or she was more gentle, but I was in and out with hardly any trouble.
That was in 2017.
In 2018, I had my first set of known seizures. In the back of my mind, I knew my neurologist would always ask me to have my Mirena taken out. It’s a known variable. So when I went back in December to the same gyno who removed my first one and put this one in, I waved to it. “Goodbye, old friend,” I mourned. “You served me well.”
Now, there is nothing.
The day after it came out, my uterus threw a fucking party. It was as if it said, Holy shit, you guys — that one dude is out of here let’s tear this place apaaaart! And then it proceed to bounce the shurikens off the walls and into the floors. Eight years. Eight long years since I felt any cycle agony. I had forgotten what it was like.
But I had come prepared for it. I was now a woman of 2020, armed with sustainable tampons and sanitary napkins and my own menstrual cup! I had a cycle tracker thanks to the Health app on my iPhone. I also had a brand new jar of ibuprofen to pop whenever I felt the shurikens start to bounce around.
When I woke to the shurikens stabbing me this month, I thought back to being a nervous 14-year-old again. This is what I have to look forward to for a few more years, maybe a decade. My gyno twice mentioned menopause and mammograms to me the last time I saw her, and I’m only 35, for Christ’s sake. Now instead of worrying about weather people at school like me, I have to contemplate vaginal dryness and inevitable death.
But I can do this. I know what to expect. It’s going to hurt like hell but it’s nothing I haven’t experienced before.
I’ve got this.