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.
