control. period.

A tough thing to come to terms with as an adult is how little control we have over life.  Growing up we can’t wait to be in charge of our lives.  Then you become an adult and realize that there is very little you can control.  Today’s blog is about taking control back from your uterus…and your ovaries for that matter.   Hang on kids, this one’s not for the faint of heart.

I have control issues.  The more things I think I’m in charge of the better I feel.  Seriously.  I blame my parents.  (Just kidding mom and dad!)  I’ve been this way since I was small.  Trying to be in control of what I wore, what my older brother did, where we went when…sounds amazingly wonderful for my parents right?  This is why I was the LAST child.  Well one of my favorite things about my job is giving women control over their lives and their bodies.  If you haven’t heard the news ladies, your reproductive system is working hard most of your life just to do that…reproduce.  And that means a wonderfully complex rollercoaster of hormonal shifts resulting in either pregnancy or a menstrual bleed.  Really?  These are my options.  Awesome.

Humans have been trying to prevent pregnancy since at least the 1500’s.  I won’t drag you through the remote history of attempts at contraception but just know that it involves the use of alligator dung, fish bladders, mercury ingestion and more.  The first commercially available oral contraceptive was available around 1960.  In the 50 years since it has become illegal to advertise or have any public information distributed regarding contraception.   It was available to married couples only.  In fact, it wasn’t until 1972 that birth control became legal for everyone in the US.  Contraception as we know it, with many safe and reliable choices, is a reality that only came into existence in the 1980’s.  To recount all this is fascinating to me.  I have a dozen handouts and booklets on contraceptive options for my patients.  It is difficult if not impossible for me to imagine a reality where I wouldn’t have a choice in, if and when I wanted to become pregnant.  Not to mention no control over my own menstrual cycle or the multiple medical conditions that hormonal contraception is used to control and improve.  A world without hormonal contraceptive options for me is like a world without the internet on a handheld device for the pastor.  Disastrous.

When the pill first became publicly available most women requested it for menstrual regularity.  In fact, many packages had a warning label about the medications “contraceptive side effects.”  But a woman could go to her doctor and ask for the pill for these reasons and then use the medication to safely and appropriately space her family.  Using a hormonal contraceptive for a non-contraceptive indication is quite common these days.  In other words, a lot of my patients come wanting relief from their pain or anemia associated with monthly menses, improvement in their skin from excess androgens and relief from symptoms of things like endometriosis, polycystic ovarian syndrome and others.  Do some of these women use hormonal contraception to prevent pregnancy?  Yes. But some simply use it for these other reasons.  To take control away from their uterus and back into their own hands so to speak.

What most people don’t realize is that you can use the birth control pill and other hormonal methods to completely suppress their period.  No seriously, you can.  And guess what?  It’s safe to do so.  If you ask a room full of female gynecologists who aren’t actively trying to get pregnant if any of them are having regular cycles know what you’ll get?  Crickets.  We avoid periods like the plague.  Why?  Because they are disruptive.  And annoying.  And messy.  Do hormonal contraceptives have risks?  Yes, but these are small compared to the risks of having a baby.  Is hormonal contraception right for everyone? No.  But multiple studies and multiple systematic reviews of those studies have shown extended use of contraception to suppress the menstrual cycle to be no more risky than the usual use of the pill.  Oh yes, and they found that patients were happier not having their period come every month.  Shocking, I know.  When the pill was created it was supposed to mimic a regular cycle so that no one would know you were on the pill.  Sneaky, huh?  Well now every magazine you pick up contains some advertisement for birth control or tampons or something associated with your reproductive organs.  And while we still live in a culture where we raise a fuss about who is having sex with whom (well except for our own kids who would never do such a thing), we have come to terms a bit more with discussing issues surrounding reproduction.  We still have to fight battles for access to affordable and reliable contraception in a country where almost half of pregnancies are unintended.  Sex education in our culture is informal and erroneous at best which propigates most of those unintended pregnancies in both the young and the not so young. But thanks to those who have gone before and paved the way for us to make choices about our own body.  Seriously people.  Someone had to protest for me to gain control over my reproductive organs.  This is the world we live in.

So there you have it.  There are lots of things you can’t control.  What time the baby will deliver.  If your kids will behave in the restaurant.  My work schedule.  How many people will need to talk with Pastor Jason after church.  But fear not.  The menstrual cycle can be controlled.  Don’t want to have a period?   Don’t have to.  Don’t want another baby?  Don’t have to.  Don’t want to be bothered by anovulation or cramps or worsening of some other problem…don’t have to.  You can control at least one part of your life.  period.