Lies in Women’s Health
The important details of a woman’s menstrual cycle and the effects of the medication given to control it are often obfuscated by doctors and hidden from patients. For Cynthia, this had dangerous consequences.
Illustration by Cynthia (@PTElephant).
I had always suffered from heavy, incredibly painful periods. Along with the bleeding, chunks of tissue would be released, and I would often bleed through my clothes at school. It looked like I’d been sitting in paint. I missed school for days during my periods and my doctors continually wrote it off as, “normal”, but were kind enough to write excusal notes for my absences, though this didn’t make up for the days of education I missed.
Finally, when I was 17, I was referred to my first gynecologist and was given birth control as a means of “easing my periods”. This only really seemed to shorten the days I was bleeding, rather than easing the intensity. That was relief enough for me at the time, and I didn’t know if there was anything more that could be done, so I continued on that dose.
After moving to a new state a year later, I was switched to a different brand of birth control by my new gynecologist and assured it was the same formula as the previous one, but this one had the spiffy added benefit of a B vitamin! This switching to a different brand that was allegedly the same formula happened a few times. Each time I spoke with the doctors about my period still being very heavy and painful, they never once mentioned that what I was having on the birth control was not actually a period.
In fact, every gynecologist I saw from the ages of 17-30 at multiple practices told me the lie that I was having a period on birth control and never once mentioned what it actually was – withdrawal bleeding. This is, in my opinion, a major failing on the part of these and many other gynecologists who have and continue to spread this myth. This not only misinforms the patient about what the menstrual cycle is, its role in fertility, and why you can’t have one while you’re stopping your cycle on the pill, but it also erodes informed consent.
In short, withdrawal bleeding is caused because of the sudden drop in hormones while taking the “inactive pills” in hormonal birth control pill packs. In that way, it is similar to a period, but it’s not really a period, because it’s not caused by the normal cycle and the uterine lining does not fully develop before shedding. This is also why withdrawal bleeding is supposed to be lighter than what is experienced during an actual period. It is not considered medically necessary to induce withdrawal bleeding, but some consider it to be an indicator of health, as it does show that the body is able to respond to the change in hormone levels and can be a sign that a woman isn’t pregnant.
If I were really having a period on birth control, that would have been an indicator I was fertile and that the birth control was not working. This brings me to the next glaring issue I experienced with the gynecologists while I was on the pill. After having been on the pills for a few years, I started getting this intense pain every so often in my abdomen that was so strong, it would wake me up out of a dead sleep and made me feel like I couldn’t move without rupturing something.
By the third time this happened, my ex decided to take me to the ER. I got in the car in my pajamas, he started to head to the hospital, and then it suddenly stopped. Not wanting to incur a hospital bill over something that had seemed to have blown over, we drove back home. But then, it happened a fourth time and it lasted all the way to the ER. I waddled in, had a very invasive series of exams and a catheter inserted because I’d been unfortunate enough to be too shy to pee in time. I then learned I was experiencing something called “Mittelschmerz”.
Again, I was politely misinformed by a doctor and the subsequent printouts they gave me that Mittelschmerz was nothing more than “mid cycle pain” that can just happen. No reason given for it, no more explanation. Having had such horrible cycles and misery between periods before birth control, I just accepted this as a continuation of that. However, this was not the case, and knowing what I know now, I see that this misinformation could’ve had drastic consequences.
Ovulating on Birth Control
Mittelschmerz is not merely “mid cycle pain”. It’s ovulation pain. I had apparently been ovulating on my birth control, which is most likely why my periods were still so intense at the time. However, no one explained this to me. The doctors at the ER and my various gynecologists had all heard of and were familiar with the condition, but all waved it away as unimportant and just something harmless that women experienced. But it was not harmless for me at the time. I was sexually active on birth control, with no intention or desire to become pregnant. And yet, here I was ovulating, under the belief I couldn’t get pregnant, and they did nothing to inform me about what was happening or acknowledge the risk.
At the time, I never fully understood how someone could become pregnant on birth control, but if more medical professionals are this irresponsible and negligent, I can understand how that happens. Clearly, my birth control was subpar – something wasn’t as effective as it should’ve been. But, instead of being taken seriously, I was waved away, assured that everything was normal, and that I should just take Tylenol. It was starting to feel like all gynecologists had scripts similar to telemarketers at this point.
To an extent, they were right – I was clearly responding to the hormones, I was still “healthy” and “normal” by that measure. However, they were wrong to dismiss my symptoms. What I was experiencing was not “normal” on birth control. I shouldn’t have been having a normal cycle. I shouldn’t have been ovulating and having a window of fertility. I was also experiencing other ovulation symptoms that I didn’t know were part of ovulation because no one ever told me about them. My cervical mucus changed at the time of ovulation, and I was having changes in energy level and mood typical of an unimpaired cycle.
Had I known what to look out for, had gynecologists addressed the Mittelschmerz and heavy bleeding, had they told me what the cycle was, my doctors and I would’ve been able to more adequately address the issues at hand and drastically decreased the risk of an unwanted pregnancy. Thankfully, I managed to get lucky and not become pregnant while all this was going on.
Abandoning Informed Consent
Shortly after, I switched to a new gynecologist, and they gave me a new prescription. This time, the birth control seemed to work as intended. What I believed to be my periods were much shorter – only about 3-5 days, my mood and energy level were relatively stable throughout, and no more Mittelschmerz. I was switched to “different” but “identical” formulas again a few times, but thankfully, things stayed consistent. What I didn’t know, however, was that the pills they gave me were to treat what they suspected was endometriosis and that they were lowering my estrogen. Again, informed consent had been abandoned.
Not only did I not know that my estrogen was being lowered, but I had no idea the effects of lowering my estrogen would have on my body – especially for a prolonged amount of time. This was never explained to me. My doctors never took the time to explain what the side effects would be beforehand, and when those side effects started kicking in, I was assured that it couldn’t possibly be the birth control and that I should stay on it.
The strongest of the effects was my vaginal lining thinning to the point where my nerves were starting to be exposed. It got so bad, sex was nearly impossible and always painful. Even sitting still, it felt like my insides were lined with crushed glass. Eventually, I complained enough that they decided to do something. Unfortunately, that something was “pelvic floor training”, which consisted of me buying dilators and going to an appointment once a week where I was to be vaginally penetrated and have my vagina pulled open in different directions. I told them repeatedly I didn’t think this was the issue and that the skin itself is what hurt – not the penetration or expansion. However, I was ignored and assured that the pelvic floor training would work.
At each appointment for the “training”, I cried. I spent the entirety of the 30 minutes tearing up uncontrollably and sweating profusely from the pain. I could barely use the smallest of the dilators at home. I was to use them every day and increase the size over time. I was unable to do this. I was going to set up an appointment to tell my doctor that I wasn’t going back and ask to try something else, but I moved to out of state again and ended up with a new set of doctors.
This is when I finally started hearing the truth about everything. My new doctors informed me what Mittelschmerz was, that the birth control I’d been on had been lowering my estrogen, and that no, my issue was not going to be fixed by dilating or through pelvic floor training. They also explained that no, the different formulas were not “identical”. This explained why I would sometimes have to go from pill to pill every three months, as the side effects were maddening on some but not others. Furthermore, you’re often made to wait three months to make sure you’re “adjusted” before they’ll let you switch again.
Monitoring Fertility without the Pill
My new doctors finally took me off birth control pills, realizing they had eroded my body in a myriad of ways and there was no way to counter the effects with other medications. I was able to keep from getting pregnant with successfully monitoring fertility, and I highly recommend that for those who don’t want to fiddle with their hormones. Unfortunately, after having stopped taking birth control, my periods returned to their heavy, painful norm and I started having severe urinary issues. They suspected that the endometriosis spread to my urinary tract and started the process of diagnosing that. During this time, I made the decision to get pregnant and see if I could have “normal” periods the natural way, being that pregnancy seems to have an 80% chance of “curing” endometriosis. So, just before my cystoscopy appointment, I found out the good news and am expecting a baby in June!
Looking back on all of this, with the exception of the baby, I feel incredibly violated and betrayed. The doctors who should’ve been paying attention, weren’t or didn’t care. Information that should’ve been shared with me wasn’t – either because they didn’t think it was necessary, or because it was deemed “medically irrelevant”, as it turns out a concerning amount of women’s anatomy seems to be to professionals.
How many more women are misled and put their faith in doctors who don’t take them seriously? How many more women are misinformed about their bodies and their reproductive health? We’re so often waved away and told to go home and take Tylenol that it’s practically become a meme. Ads are made that make menstruation sound like nothing more than a curse that has no benefit to health and should be eliminated. The cycle itself is practically erased from the collective consciousness unless you’re trying to find information on how to get pregnant, rather than avoid it.
Perhaps, it’s the cultural attitude in the West of trying to avoid pregnancy and medicalize oneself out of the “inconvenience” of a menstrual cycle that led us to this point. Whatever it was, it has poorly served us. Instead, it’s led to rampant misinformation and obfuscation of health information that can and seems to already harm women and girls.
Hormonal birth control is too readily prescribed not only under the attitude that the natural process of the menstrual cycle is a nuisance, but also for things as mundane as acne reduction. As opposed to this, we would be better served by learning how to best manage symptoms and learn what the effects and changes of the cycle are, so we can have a better understanding of our health. After all, lies and obfuscation never helped anyone.
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