My thoughts on the pill

 

Diary entry in March 2021:

I went in a run this morning. At about 2km in I am very sweaty, much sweatier than usual and feeling uneasy and anxious. I am beginning to get a dull pain in my abdomen. I stop and sit down for a while, Mum comes to walk me back, I drink water and walk back feeling better.

I start work, feeling a bit sore especially in my lower back and abdomen. My abdomen feels like it’s being pressed with a heavy weight and also feeling oddly hungry. I drink lots of water but feel dry mouthed.

It gets worse at lunch time. I feel tired, I need to poo, I sweat a lot and it’s cold sweat now. The pain is bad. Lying down helps a little but not much, then not at all. My face feels slack. I’m sweating so much. I’m turning to try to ease the pain. My legs hurt. I want to faint to be out of here. My breathing sounds like this: “Hannah, hnhhh, hnhhhh.” I feel like I’m slipping away, but I also feel so much pain. I try to sleep to escape, eventually I do. 

I feel better when I wake and the pain has passed but left me weak. I sleep again and wake up feeling weak but no longer crampy. I eat some bread.

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It's been over a year now since I started taking the oral contraceptive pill to manage period pain. I wanted to write about my positive experience with the oral contraceptive pill to add balance to the conversation, because sometimes it is the most extreme and negative responses are the ones that get magnified. These are legitimate experiences: the pill is a hormonal medication that will create change, which could be positive, or it could be negative. But it is worth a try, and if the pill has negative effects it is possible to stop and see an end to the effect of the pill. For anyone thinking about the pill, I recommend watching this video. I’ve learnt that the pill benefits anyone suffering with endometriosis for the following reasons:

- It reduces pain.

- It directly addresses the problem, reducing the growth of endometrial tissue and therefore reducing inflammation and the development of scar tissue because of cycles of growth and shedding.

- Prolonged use of the pill increases rather than decreases the chance of being pregnant.

- After stopping the pill you usually get your period back in 32 days.

- There are multiple sorts of pills, and a doctor can advise on the best one. If one doesn’t work, there might be another option out there that will.

I started experiencing pain connected to my period to the extent that I was unable to function in 2020. It would typically come on the first day of my period, usually without warning. I wrote a list of what the pain was like for a visit to a gynaecologist:

- I sweat a lot

- Cramping in my abdomen, which comes in waves

- Pain radiating down my legs

- My vision goes blurry and I feel like I'm going to faint

- I feel weak and dizzy

- Sometimes the sounds around me go muffled, like I'm underwater

- Sometimes I vomit because of the pain

- Usually the pain lasts for a couple of hours, and I fall asleep.

I first went to the doctor for my period pain out of necessity rather than choice, after almost passing out on a bus, getting off, and then literally crawling on the floor to the steps of a hotel where staff then called an ambulance. The nearest hospital was SGH, which is where I went and they monitored me until my blood pressure got back to normal levels and the pain stopped. They gave me some strong painkillers (Mefenamic acid) and another pill to line my stomach before I took the strong painkillers, and a follow up appointment.

The follow up appointment was with a business-like looking woman who told me that this was a normal woman thing. I asked for a blood test to check on my iron levels or nutrition, and she assured me it was not necessary (but I didn't feel very assured - I just felt trapped and frustrated). I left, and tried the painkillers, which didn't work.

The second visit was with a young man who looked fresh out of med school. I explained the pain I was experiencing. He said it was menstrual pain (I mean, duh) and that I could take the contraceptive pill or get a contraceptive implant. I asked if he could explain what was causing the pain before I considered hormonal medication. He said it was my period (yes, but why is it so painful, when it hadn't been before?) and asked me if I'd heard of prostaglandins (I wanted to ask him if he'd heard of google; of course I'd heard of prostaglandins. I'd been reading everything I could about period pain ever since I'd had the first bad one). I started to cry. He looked stricken, and a nurse passed me a tissue box. I left and cancelled all future appointments.

At that point I thought I'd just endure things, but it kept getting worse, so I made an appointment with the polyclinic, who referred me for an ultrasound and then a follow up at Ng Teng Fong hospital. I went there at the end of 2022, with Mum coming along for moral support. We saw a male doctor who had a foldable bike under his desk, who gently explained that there was nothing unusual about my ultrasound, which meant I (thankfully) didn't have fibroids. He then suggested that while we can't be sure, the cause of the period pain seemed to be traceable to the first day when the uterine lining sheds. The intensity of the pain suggested that either I was experiencing heavy bleeding or endometriosis. He then drew a squiggly picture of a uterus and explained that endometriosis is a condition where the lining that’s meant to grow in your uterus somehow also grows elsewhere. Doctors and scientists don’t quite know why this happens, but when your period arrives and all these linings shed it can cause a great deal of pain. 

He then suggested taking the pill, which introduces “fake hormones” that mimic estrogen and progesterone into my body. This signals to my body not to produce so much of the real stuff, and as a result I don’t ovulate, my uterine lining grows much less each month, and when I have my period between pill cycles, there is less shedding and less pain.

It made such a difference to have someone take the time to explain how things worked, and to answer questions I had about the pill which I was anxious to take in case it affected future fertility, or had negative side effects on physical or mental health. I left the appointment sufficiently assured and with a bag of pills to take. 

After I begin taking the pill I saw an immediate positive change in my periods. They were far lighter and les painful. Initially I would still get cramps,  but cramps that were manageable with pain medication, and which didn’t stop me from moving or working. It has only improved; these days I can go for a run on my the first day with no consequences or fears. I rarely experience any pain, fever low grade pain. 

An unexpected benefit of taking the pill was also in regulating my moods. I'm not clear as to whether it was due to hormones, or the apprehension of pain, but previously I’d get very anxious near my period, and I’d experience what we’d come to call an ‘emotional breakdown day’ at some point which involved lots of crying. Not to mention the feeling that my body was betraying me, and the self-gaslighting of my own body and experiences, exacerbated by doctor's visits in which I was told this was 'normal', where I doubted that the pain I experienced was legitimate. The physical relief provided by the pill also offered mental and emotional relief. After taking the pill I was calmer around my period.

When I was doing my own research about the pill I came across so many terrible stories about its side effects and inefficacy. This combined with the tendency for women's health issues to be downplayed societally and even in medical circles means that it can be hard to take the step of taking hormonal medication for period pain out of fear of the effects of the pill, and doubts that one actually 'needs' it. What I experienced was pain that was abnormal, but I made it seem normal, and kept going until I was shown a way out. The thing is, if pain is stopping you from pursuing normal activities you need relief. If pain is causing you mental and emotional distress, you need relief. It was only when I could step out of the cycle of pain that I fully realised how unnecessary it was to experience it every month, how much it impacted my life, and that help was out there, I just needed the courage and assurance to try.

Little moments of joy

 

- Playing League of lexicon

- Big shell pasta

- A good design meeting

- Running to work

- Seeing an owl as we walked home from my parents house, perched on a branch and backlit by the lights of a basketball court, before it swooped away silently

- Pancake day pancakes slathered with tahini and honey, and chocolate hazelnut spread and banana

- A big bunch of lilies from my love

- A prune (called, on it's packet, a 'plump') and toasted almonds after a Chinese New Year day three walk

- Playing "Six second scribbles" and seeing my auntie double up in laughter over a stick man drawing in response to the prompt "nipple".

- Jungle gold chocolate

Looking back on 2023

 

At the start of this year, I drew myself in vibrant colours. In the picture my arms were outstretched and words surrounded me, words like: 

"Open" 

                     "Embrace"

  "Adventure" 

                                                  "Fun"

              "Joy"

 

I wanted 2023, after the wintering year of 2022, to be my spring: a year where my life opened up again to possibility, joy and adventure. It meant less stability and more flux, experimentation and journeying.

Adventures took lots of different forms. Our family went on our first trip together in February, up to Desaru on the east coast of Malaysia. Desaru has been a holiday place for my family before I was born: we grew up going to the same seaside resort, and saw it change hands three times. The people working in the hotel would recognise us every year and comment on how tall we'd grown, and at the end of the holiday we'd return to Singapore with our skin brown, our hair big with salt and the memory of being rocked by waves still held in our bodies. This visit was the first time we had been back after the pandemic. The sea was bloated and high from the monsoon storms and waves towered over us. There was no choice but to dive into them, or under them, and feel them push and pull you like a muscle. Dad no longer rolled in the breaking waves with us, but he did slowly (stick and all), step into the swimming pool. The cold water stiffened his muscles, but he kept going, walking a lap around the pool before retiring to a deck chair with sunglasses on. An old place, a new form of family; we still had a lot of fun.

The most surreal happening was in April, when for one glorious weekend I flew to the UK for Lucy and Dom's wedding. International flight is befuddling at the best of times, but the sheer magic and strangeness of stepping on a metal airborne cylinder in tropical Singapore and twelve hours later stepping off into the cold air of England was especially obvious when it happened for such a compressed amount of time. I remember the days in a series of  delightful vignettes: being lifted off the ground by a hug from Naomi, sipping hot tea in the kitchen surrounded by excited, loving people, a grateful nap in Lucy and Dom's new apartment, blowing balloons in a room full of balloons, laughing over photographs of young Lucy and Dom with Rachel. Rolling fiddly curlers in Lucy's hair the morning of the wedding, singing 'The blessing' and meaning every word and wishing with all my heart for happiness forever for these two lovely people, dancing and dancing and dancing... I did worry about such a short trip: it was a big expense and a lot of carbon from the flying. But when I was studying in London, an artist once told me that life is short and whenever you have a choice, choose the option that loves people; in this case the answer was obvious. I was so glad I went.

In May we celebrated two years of marriage and I prepared for the opening of my first big exhibition. Both collided on the 22nd of May (our anniversary date). We met on the top of Mt Faber hill, beloved because it has a beautiful view of the port and the sea, and crucially is usually empty of other people. We each brought surprise bits for a picnic, and Jacob chose things that brought back memories of past dates or moments. I felt truly, blissfully happy. When we got home, I received a call from the museum about something in the exhibition that was changing which I thought should not be changed. It was gut wrenching and after the stressful, intense days of installation prior to it. When I talked about it with my boss subsequently, he reminded me that in this job, one must strike a balance between caring for the work and not caring too much. I’m learning to find that balance at work, but the scales don't add up in marriage. In marriage the best thing is to care, and then to care more and more and more and more (but not care about things like an unmade bed or full rubbish bin). 

Jacob's parents visited in June (his Dad and sister) and September (his Mum). By the second visit both had moved into separate houses, and things were different. I read somewhere that divorce doesn't mean your family is broken, but that your family is reorganised. That was a really helpful perspective shift, and meant that when I asked Jacob who he considers his family it made sense when foremost, he maintained that he still sees his Dad, Mum and sister as one of his families, mine as another and our church small group as another. "What about me?" I asked. "You're part of all of them." At the end of the year we went back there to see them, and celebrated Christmas in two different homes. That wasn't easy: each home had it's own emotional energy and ways of being, but also had it's delights. I loved the red kites above Catherine's home and the long walks which required a certain skill of navigation. We walked them with friends too, which felt important. I loved how close Mark's home is to the river that he loves, and how the kitchen is full of his pottery projects (including some plates he considers 'failed', which Jacob and I now happily use for all our toast adventures). In a way, I am learning that there is more of family to explore and discover in this separation, rather than less.

This year my intention is to seek clarity. I imagine clarity as a clear path found through inner stillness, but with the intention to move forward (or backwards, or sideways, or wherever the path is taking you). I hope it will bring better balance between work and life (last year sort of felt like my teenage years at work, with big feelings and frustrations). I hope it will also bring more trust, as Jacob and I make bigger plans for our future. 

Smaller adventures from the year (but still big on joy):  

1. After much deliberation, I joined a choir again and sang in a concert in March. There was also one point where I looked out over the audience and saw Dad struggling to contain what would have been an almighty sneeze and had to stifle a giggle. And after the concert we asked a woman to take a photograph of us, and she cheerfully took one that had all of us in it except our heads. 

2. After the exhibition had been open for a while, Hannah and I took a weekend trip up to Kluang to hike Gunung Lambak. It was a tricky climb, and I was trying my best to keep up with two guys: one of whom was an ex-marine and the other was a canoeist and marathon runner. I just about managed, puffing and panting all the way!

3. In November we joined Emily and Wesley at the 39th Singapore bird race. There were mistakes made: I didn't bring a pair of binoculars and I was wearing bright pink shorts (no camouflage here). We saw over 30 different kinds of birds, including the otherworldly milk stork, endangered strawheaded bulbul and a lineated barbet, which I consider my personal friend since there's often one outside our window. I am looking forward to the 40th bird race!

4. Towards the end of the year some of our friends from small group started weekly badminton sessions. I am very rusty (although have I ever been sharp? That is the question...) and have a bad tendency to squeal when the shuttlecock approaches me at speed, but it is so much fun. 

Bali June 2023

 

After opening my first exhibition in May, Jacob and I took a break in June to fly to Bali with Jacob’s Dad and sister. During the flight I noticed a tiny black speck in the corner of my vision: a floater, like the dot of an ‘i’. It was only visible when I looked at the flat expanse of the great blue sky, and I wondered how long I’d missed it, staring at screens and in dark galleries? I forgot about it soon enough, when the cloud cover below the plane was broken by the tip of a mountain, and as the clouds cleared another appeared, and another.

We’d gone to Bali primarily for Mark, Izzy and Jacob to achieve their open water scuba diving qualification and for me to use mine in the clear waters off Amed (north-east Bali). The sun set about an hour earlier in Bali, and by the time we got to the dive centre it was dark and we were tired after a day of travel. We walked up the stairs to the communal garden where we were offered cold lime juice and water and we knew we were in good hands. The days that followed started with a cooked breakfast, more juice, beautiful dives in the morning and languid afternoons reading and lying down. I loved the regular rhythm and simplicity of it. 

Since I hadn't dived for over six months (when I qualified for open water diving), I took a refresher course with Nyoman where I went through a few basic theory classes with Jacob, Izzy and Mark and then some skills in the calm and shallow waters off Jemeluk beach. Unlike my diving course in Tioman, which frontloaded the theory and then had a few intense days of actual diving, the course Jacob, Izzy and Mark did with Adventure Divers interspersed theory and diving. On that first day we took a slow, wobbly dive around Jemeluk bay and saw lion fish, stone fish, goat fish, shoals of bright blue damselfish, angelfish, and in the far distance a small turtle, like a ghost. 

When you're underwater everything is silent, and you don't have the normal soundtrack of life shadowing each experience. No music through headphones creating an emotional tint, no traffic or city bustle drowning out your thoughts, just the white-noise roar of the sea drawing breath. That is what I love - so much peace.

On our second day I dived with Coco, a marine biologist from Sicily who was doing a course on coral conservation. This was my first boat dive, and we set off in a jukung (a thin, indonesian fishing boat) across calm waters under blue skies. Before we dived you could see the bright colour of coral through the surface of the water - it was so clear! 

We dived around Jemuluk West, passing coral that looked like large goblets or meadows or small antlers which fish darted in and out of. Diving is slow business; you fin along to keep yourself buoyant, not to move faster. To move fast would be to miss the world around you, and sometimes I would try to stop at one place, so I could observe a dancing family of clownfish or the lattice of a sea fan. 

My heart's wish had been to see a turtle, and I was happy on the first day to see the silvery image of one in the distance, but I was not prepared for the abundance of turtles on this diving day. We saw turtle after (hawksbill) turtle, close enough to see the algae growing on their shells and the wrinkles around their dark eyes. 

A very different sort of encounter occurred later on in the first dive. During the dive we finned near an unusual looking starfish. Coco pointed it out, and we stopped and stared as was the etiquette for when we saw something unusual or beautiful. This starfish was the orange of a highlighter, and had vicious looking spikes sticking out all over its body. After looking at it for a short while, our dive instructor took out the metal stick he used to point at objects and drove it through the fleshy middle of the starfish! I was shocked - Coco later said she saw my eyes go wide - and for the rest of the dive the starfish hung, impaled on the metal stick which the dive instructor held gingerly away from him. 

When we surfaced, Coco and the dive instructor explained that the starfish was a Crown of Thorns sea star - a carnivorous predator that feeds on coral. They aren't bad in and of themselves, but because many of their predators (larger carnivorous fish) had been overfished by humans, there are too many of them and they feed on coral. The dive instructor had impaled it - which wouldn't kill it, as these starfish are remarkably hardy and can regenerate when injured - to prevent it from further feeding on the coral. He also took pains to avoid touching it because they are highly venomous; they told me the story of someone who'd buried a crown of thorns star beneath a tree, and came back to discover that the tree had died! We left it in a sunny spot to dry out and die. 

On our last day we dived the Tulamben wreck. There were more divers here and visibility wasn't as good but it was an exciting day because it was the day Jacob, Izzy and Mark would complete the last of the three open water dives necessary to get their license! Swimming through the wreck was slightly discombobulating; things appear closer and larger in the water and so it would seem like the gaps in the ships hull that Nyoman swam through were impossibly small until we followed suit and wove through the wreck with no problem. 

The next leg of our journey was to Ubud, the apparent 'cultural centre' of Bali. In all honesty, I did not love Ubud and don't wish to return. It was crowded with tourists, so much so that when you walked the streets the few local faces you saw were shop owners, touts, or drivers, and this made me feel like I was part of a problematic part of tourism where a place becomes a contained for tourists and a home for its own people. What I did enjoy were the little things, like seeing the offerings placed on the ground each morning, filled with flowers, incense, and sometimes little biscuits or cigarettes. I think I was also feeling the after effects of the intensity of the past few months, and I felt teary and fragile on that day in Ubud.

 

So it was a relief to escape to Munduk the following day. Munduk is in the North of Bali, and we were hiking a mountain there. We met our guide, Nalom, who used to be a journalist and was inspired to set up his own travel company to provide a more authentic experience of Bali. He partnered with Komang, a village chief in Munduk, whose home we stopped by for breakfast (also where we met the sweetest little kittens.)

We were hiking Mt Lesung, which requires a local guide and so halfway through our drive there we stopped to pick up Putu, a pint-sized woman who we later found out was agile as a cat and could out pace us all on the steep and slippery slopes of the mountain. She pointed out coffee plants, avocado trees and all manner of plants as we walked. At one point, where I was clinging on to my hiking stick for dear life as we trod on loose soil and slippery leaves, Putu calmly stripped a single palm leaf off a tree, and after about five minutes of folding and weaving, had turned it into a hat! What a legend.

After descending the mountain we kayaked across Tambligan lake while the clouds threatened to pour above us, and had lunch under the shelter of a seven hundred year old tree. Before we kayaked, Putu explained the Balinese naming system to me. In Balinese families the first born child is usually called Putu, or Wayan, the second born child Made or Kadek, the third child is named Nyoman or Komang, and the final child is usually named Ketut. If more than four children are born in a family then the names just repeat in the cycle! This way, you'd know the birth order of a person just from their name. So our diving instructor was the third born child of a family, and Putu was the oldest child among her siblings.

The final stop before our long ride back to Ubud was by the entrance to a waterfall. We walked many steps down and got changed into our swimsuits and approached the water. "Is it cold?" I'd asked Nalom. "It's...fresh." he replied. I dipped my toes in and it was cold, but there was nothing for it but to wade in. Jacob took a few steps and dove in, whole body, emerging with the biggest grin on his face and his arms out wide. I took swam, frog style, for a little while, gasping with the cold. We took turns standing under the thundering weight of the waterfall, letting it pummel our shoulders and backs. Then we walked out, humbled and feeling, like Nalom said, fresh.