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 overScreen Shot 2016-08-25 at 10.08.42 PM 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.

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get over it. period.

If you know me, you know that I am full of opinions and strong feelings.  Some of them are about “important things” like atonement theories, HPV vaccination, standing up for victims of abuse.  Most of them are about the “not important” things like what crust you should get on your pizza, naming your baby something that you know how to spell, wearing appropriate shoes for your outfit.  I buy clothes fairly swiftly because I know exactly what I like.  If you ask me to pick something for dinner I might not know what I want, but I will certainly tell you what I absolutely don’t want to eat.  When I picked out furniture for my home a few years ago I told the guy what he had picked that was atrocious and what was fine and he went from there.  I’ve been this way since I was small; my mother spent her mornings struggling to get me into a dress that was “too itchy” “too tight in the neck” or “just didn’t feel right.”  I would eat rice for dinner because nothing else was acceptable.  When my youngest tells me she knows best and I should stop helping her or telling her what to do my mother just smiles and I know that this is exactly what she went through.  I think many of us have stuff we feel strongly about.  One of my practice partners hates all white condiments, grammar errors, giant baby hair bows and spray tans. (love me some spray tan for my ultra-whiteness).

When does my “stop helping me, I know best” voice come through the strongest?  When I’m tired, when I’m stressed, when I’m hungry.  Oh, and when I was pregnant.  Ask any of my work friends about the day prior and the day I went into labor with each of my daughters.  I was full of opinions and strong feelings.  Most of them involved making a plan to fatally injure who I felt were the most annoying among my co-workers.  Yes, that’s right.  My friends knew I was going into labor because I threatened to kill people.  For one of my besties, it’s when she’s about to start her period.  Yes, that’s right.  PMS.  Three letters that strike fear in the hearts of husbands everywhere.  It’s what teenage boys use to blame girls for having any strong opinions.  “She told me I was out of line.  She must have PMS.”  Premenstrual Syndrome is like the government.  Everyone thinks they know how the country should be run but they have no idea how government works.  So with PMS.  They think they know what it is and what we should “do to fix it” but in reality for most it is a mystery.

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Does PMS exist? Why of course.  You see, your brain is a wonderfully strange organ.  Besides keeping you alive everyday by making sure you can breathe and swallow and move in an organized fashion, your brain is your regulatory system for your emotions, your thoughts and even your hormones.  Oh we’d like to blame our ovaries for everything, but it’s the brain that drives your body to work in the way it does.  For women, our brain is constantly “talking” to our reproductive organs, sending pulses of hormones trying to get them to spit out hormones in the hopes of getting us pregnant (no thank you).  That results in a lot of peaks and valleys throughout the menstrual cycle.  I like to tell my patients that for some women it’s like a horrible roller coaster and no one will let those bars up so you can get off the ride!  Some women have such bad symptoms that they are classified with premenstrual dysphoric disorder (PMDD) based on what poor quality of life they have during this time in their cycle.  Ouch!

So what is my response when usually well meaning spouses and significant others ask me to “fix” my patients PMS?  Usually I start with (surprise) my strong feelings about understanding what it means to be the sex that was created to carry and deliver another human being.  Give us a break.  They also give us the ability to bond with tiny humans that scream at us the moment they are born, they give us the ability to feed that tiny screaming human from our own body if we choose to do so.  Those same hormones are probably a big reason my bestie tolerates her husband who inspired this blog post with his eye rolling PMS commentary!  The truth is there aren’t a lot of options for treatment of PMS, especially if symptoms are severe.  While there is a lot of money to be made fixing erectile dysfunction, curing premenstrual syndrome just isn’t a sexy sell.  Fortunately for many women starting on a birth control pill, taking scheduled NSAID medications or even using medications to treat other disorders like depression and anxiety can help with PMS.

In the mean time, get over it. period.  Stop using PMS as an excuse for anybody like me who has lots of opinions and strong feelings.  I would never accuse Pastor Jason of having something like PMS if KD leaves OKC and he spends hours sobbing uncontrollably.  I choose not to buy into the belief that opinions and strong feelings are all bad.  Strong feelings get things done.  I hope my passion for the “important things” will be the reason we eliminate cervical cancer or domestic violence or sexual assault.  I’m sure my passion for the “not important” things keeps the church girls entertained on a daily basis.

So ladies, keep your strong feelings.  Make time for self care, even if you don’t have PMS.  Husbands, boyfriends, friends, significant others, partners, give grace to those around you.  It might be PMS.  It might be lack of food, lack of sleep, a looming deadline or some other stressor.  If you have terrible PMS talk to a physician you trust.  Hopefully you can find relief.  But most of all, give yourself some grace.  I won’t say that I have never regretted sharing my opinions or having strong feelings about something.  I am certain that a lot of my opinions are probably not correct or based on anything sound.  My opinions on lots of things have changed over time and are probably just as strong in the opposite direction of what I once thought.  And I probably won’t ever stop with the “don’t help me, I know best, here are my strong feelings” during those times of mental fatigue.  And maybe neither will you.  No apology needed.  I’m over it.  Period.

 

 

a voice in the wilderness.

It has been quite a week.  Pastor Jason was involved in all the church Sacrements last weekend.  A funeral, a wedding, a baptism, a dedication and communion.  Which means it was a very. busy. weekend.  So I didn’t get my blog post done on Sunday.  I was a bit disappointed in myself but I just didn’t have peace about the final version.  Well, it got scrapped so here I am with version number 2.  Same title, different content direction.

My first version of this post told a story about Nancy and Mac, who we sat next to at the rehearsal dinner and who were a voice in the wilderness for us.  They spoke into our lives and reminded us that what we do each day has meaning and purpose, that our hard work is not thankless and that there is hope in the future.  And then Monday happened.  Work was work and people were acting a fool.  So the blog post sat.

But today my disappointment for not being done with the blog post “on time” was wiped away by renewed inspiration to be a voice in the wilderness.  If you didn’t know, I live in Oklahoma.  Today, our state passed a bill that makes it a crime for any physician to perform an abortion in our state, except for in the case of the life of the mother.  You must be thinking as a person of faith and a pastor’s wife that I would think this is great news, right?…wrong.  Fasten your seat belts kids, this Jesus loving gynecologist is going to try to explain to you why this is a terrible idea.  It’s going to take a minute, so bear with me.

First, I don’t think we can consider ourselves “pro life” unless we are really going to work to help make a life for those around us.  That means a living wage for all people, enough food for families to eat, prison reform, quality education for all and support for those women who find themselves raising a family alone…not to mention standing up against domestic violence and sexual assault.  And to be pro-life means you support planned and appropriately spaced pregnancies so that they are more likely to have healthy babies and take care of them in the ways we would all like.  It means you believe in access to affordable and reliable contraception for everyone.   Because even if you intend to be abstinent you might find yourself among the 1 in 5 women who is a victim of sexual assault..see previous blog post…needing emergency contraception.  Which, by the way, prevents ovulation…which happens PRIOR to conception, therefore not ending pregnancies, just preventing them.  And if we as the culture, the church or the community are really going to say we are pro-life…then we need to have the guts that two of my close friends did and invite a child from the over-flowing foster care system into your home.

Second, laws like this do not deter women from getting an abortion.  Electively terminating an pregnancy in my state is not easy to do.  Women must have money, transportation, time off of work, family or community support, not to mention navigation of the multiple laws.  So I don’t think adding this one will make a huge impact.  What makes abortion rates go down?  Access to affordable and reliable contraception.  In Western Europe abortion rates are very low, even though it would be easier to have an elective termination of pregnancy there compared to most places in the US.  Why?  They have a high rate of contraception use and a low unintended pregnancy rate.  Furthermore, I disagree with the legislation of reproductive rights.   What would happen if someone made a bill that said I couldn’t have fertility treatments to have my second child? What about a law that says no one can have more or less than 3 kids?  Uh, no thanks.  We think that these laws restricting or outlawing abortion are “good” because abortion is “bad,” but legislating reproductive rights in any way is never good. You just might not see it that way until you are on the receiving end of the law and it doesn’t fit your belief system.

Lastly, physicians don’t practice good medicine when we practice in fear.  In my job and within my belief system I would only be involved in a termination of pregnancy if the life of the mother is in danger.  I make these decisions based on clinical experience, medical evidence and science and standards of care if they exist.  Except…now that I might go to jail if I make the wrong decision will I second guess just what does “exceptions for the life of the mother” mean?  Can I remove the ectopic pregnancy, and therefore terminate the pregnancy, before it ruptures and tries to kill the mother?  Do we deliver the woman with very early and very severe preeclampsia knowing her baby will almost surely die from prematurity before she has a stroke or a seizure or is her life only in danger if one of those happens.  These seem like silly questions but when providers are asked to make decisions with a law hanging over their shoulder threatening to make a criminal out of them it just might impact judgment and decisions.  And that will certainly negatively impact the lives of women in our state.

So what do we do?  Well, it is my hope and prayer that no woman would need to undergo an elective or medically necessary termination of pregnancy (i,e, abortion).  I hope that I will be around to see that world.  But it won’t happen if I don’t do my part.  My solution, for today, was to be a voice in the wilderness.  Mostly, I try not to get myself or the pastor in too much trouble with my tendency to say whatever I am thinking and ask whatever is on my mind.  I will certainly have friends in my church, my Christian community and others around me strongly disagree with this post.  But as Pastor Jon and Jason say, we must find a way to disagree Christianly.  Nancy and Mac, from the rehearsal dinner, were a voice in the wilderness for me.  They weren’t afraid to say what they thought, to listen to us and to tell us that our voices matter.  Today I am a voice in the wilderness for the women and their children in my state.  My state that has no solution for a 25% reduction in state funded healthcare that will leave thousands without access to medical care, a state where the district I live in has a 3.6 million dollar deficit to make up for in education despite having some of the lowest paid teachers in the nation and no art program.  A state where we put more women in prison that almost anywhere else, where we have significant problems with tobacco abuse, obesity, cancer prevention and other community health needs.

Isaiah is one of my favorite books of the Bible.  It is the inspiration for this blog post.   I love Isaiah 40.

Comfort, O comfort my people,
says your God.
2 Speak tenderly to Jerusalem,
and cry to her
that she has served her term,
that her penalty is paid,
that she has received from the Lord’s hand
double for all her sins.
3 A voice cries out:
“In the wilderness prepare the way of the Lord,
make straight in the desert a highway for our God.
4 Every valley shall be lifted up,
and every mountain and hill be made low;
the uneven ground shall become level,
and the rough places a plain.
5 Then the glory of the Lord shall be revealed,
and all people shall see it together,
for the mouth of the Lord has spoken.”

Be a voice in the wilderness today.  I challenge you to think about what it means to be “pro-life” to everyone around you, whether you think like them or not.  The truth is they are loved by God just like you.  Maybe, together, our voices can improve the systems we live and work in so that the valleys can be lifted up, the ground will be leveled and the glory of the Lord will be revealed to the least of these that surround us.  Thanks for enduring with me on this one.

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