In a comment on my most recent post, Comfortably Numb asked for more information about ovarian cysts, and because that was my first post dealing with that topic, this post is my attempt at providing her with more information. This is much more personal than I ever envisioned being on my blog, but I think women should be as informed as possible about their reproductive health.
My Personal History of Reproductive UNhealth
My struggles with reproductive health have existed since I was 11 years old. To give you some perspective, my “first” period was waking up with severe abdominal pain while being covered/soaked in so much blood that my mom thought I’d been stabbed. I’ve always had pain and been irregular (e.g., three months straight of menstruating to the point of anemia from that initial experience). I also had considerable weight gain and hormonal imbalance. At 11 years old, my doctor put me on Premarin (a hormone treatment for menopausal women) to shock my system with hormone therapy, and that was disastrous after only three days on the drug. My only other option at 11 years old was a surgery that could have potentially left me sterile, and my parents left it up to me to make the decision on whether to go through with it or not. I chose to take my chances with the pain and did not have the surgery. Since then, I’ve been on more birth control pills than I can remember, changing each time to address my body’s changing hormones. I’ve missed school and work because I’ve been crippled with painful menstrual cycles. I’ve had to spend entire summer breaks mostly confined to bed or limited movement also due to the pain. I lived like this for 17 years. Inescapable pain is a prison.
When I started having digestive issues a few years ago, I kept complaining of either sharp, stabbing pain or dull, soreness in my lower right abdomen. Thinking it was related to the digestive issues because of the unbelievable nausea that accompanied it, I went to expensive extremes to resolve it. Some of my nausea and stomach pain actually was related to digestive stuff, but my doctor referred me to a reproductive specialist in my city, and she found a string of cysts, some of them measuring 3.5 cm in diameter around my right ovary with an ultrasound.
In my case, the cysts dissolve on their own, though it may take several weeks. I have noticed reduced frequency of cyst-related pain since I started practicing yoga & added running, and because I now eat foods that are less processed with less sugars. I actually started taking yoga in October 2010 as an alternative to the physical therapy my doctor prescribed to me for the cyst pain, and it’s been the catalyst for the lifestyle overhaul I’m living in right now. However, even with reduced frequency, the pain level hasn’t changed when I do get them. It’s severe, and it wipes me out.
Because repeated, multiple cysts are typically linked to a hormone or insulin-related imbalance, it is treated as a precursor to diabetes, and many doctors prescribe medicine like Metformin, (which is traditionally used for Type II diabetics) to help cyst sufferers lose weight and manage cyst formation. I have NOT been prescribed Metformin because my cysts do eventually dissolve on their own and because I have been losing weight with diet and exercise, though it’s an unbelievably slow and arduous process. I have, however, had to change birth control several times to address the hormonal aspect of my condition.
Symptoms & Dangers of Ovarian Cysts
Symptoms that are red flags for me are (in the order they tend to appear): bloating and more density in my lower abdomen especially, soreness (like cramps), and severe sharp pain (like being stabbed) with nausea. For me it either happens the week before or after my cycle, and sometimes it can make my cycle much worse, even considering that I’m on birth control. Additional complications of ovarian cysts include urinary incontinence and frequent urinary tract infections as well as pain during sex or even during sexual arousal.
Dangers of repeated and multiple ovarian cysts include: cyst rupture, which can cause the ovary to rupture along with it, consequently resulting in internal bleeding and a necessary trip to the ER; twisting the ovary, which can essentially “kill” your ovary; and infertility (because the eggs that are released are too hormonally imbalanced to be fertilized).
When to See the Doctor & What to Bring
If you are experiencing frequent, sharp lower abdominal pain, usually (but not exclusively) limited to one side, I’d start making a log of it, especially in relation to your cycle. I’d also include in this log what you’re eating and drinking. Be specific: Does the pain interfere with your daily life? If so, how long does it last? Do your cycles change (get heavier or lighter, skip or last longer)?
Take the log to your reproductive health doctor and discuss it. He or she will most likely conduct a pelvic exam and a trans-vaginal ultrasound, both of which can be painful with ovarian cysts present, but these exams are necessary because a regular abdominal ultrasound doesn’t always pick them up clearly. If ovarian cysts are present, your doctor will then determine what kind they are and make a plan accordingly. Some people require laparoscopic surgery to burn the cysts off and clean up any scar tissue that may have developed on the ovaries or fallopian tubes; others in danger of becoming diabetic may need to take Metformin; or people like me need to switch up their birth control to manage the hormone imbalances.
Fertility & Ovarian Cysts
Issues like this have made trying to conceive quite challenging. If I have to stay on birth control just to manage my hormonal imbalances, then what happens when I go off it to conceive? Well, I personally have a three-month window off birth control before my symptoms get too severe for daily life. If I can’t conceive within three months, then I have to go back on my pills to prevent cyst/hormone overload on my ovaries. This back-and-forth with hormonal birth control is enough to make me think I’ve lost my mind, and it kills my husband to watch me go through this without being able to do anything about it.
With hormonal imbalances, unavoidable and hard-to-lose weight, crippling pain, and embarrassing facial hair, issues of infertility seem (to me) to be icing on top of the torture cake. While I have suffered beyond measure for almost two decades, I have to face my culture’s pressure to have children (which I absolutely want), and I have to see all my friends and family members fill up mini-vans and SUVs with their ever-expanding families. I have to face questions about why we continue to wait as we are, as well as horror stories of waiting too late to have children. At one point I had 14 friends on Facebook who were simultaneously pregnant and sharing their “baby trackers” online, and I had to unfriend them because I just couldn’t take the frequent updates without feeling sorry for myself. These issues are usually silent struggles shared between couples behind closed doors and in exam rooms, and I would typically say a person’s health issues (reproductive or otherwise) shouldn’t be a matter for such public conversation as this. But clearly people don’t feel they are crossing a line when they repeatedly ask me these questions in public; so I’ve been quite (embarrassingly) forthcoming with this post.
Aside from birth control, laparoscopic surgery is also an option for me (though an unaffordable one right now thanks to the medical debt from troubleshooting these issues). Within three months of having laparoscopic surgery, I’ve been told I’ll be a “fertile Myrtle” very much able to conceive, but the danger then lies in increased complications with pregnancy and increased likelihood of miscarriage. Because being off birth control is obviously necessary while pregnant, the cysts can return while pregnant and cause complications. Pregnant women who are prone to repeated and multiple ovarian cysts are also likely to develop gestational diabetes and preeclampsia.
We’ve also considered adoption, and you wouldn’t believe the expensive hoops we have to jump through just to be qualified. It’s as expensive as IVF, and as heartbreaking if surrogate parents decide to change their minds or if adoption boards don’t approve of any number of things on our adoption application.
I’m doing everything in my power to make my body both fit and strong enough to handle the ovarian cysts and to get & stay pregnant. Every ounce of my energy is going into working (to pay off medical debt and pay for preventative healthcare), exercising to lose weight, and observing a healthy diet to help regulate my hormones all so we can have children, whether biologically, with medical help, or through adoption. I’m well aware that I am approaching 30 and still childless. I do not need public reminders or questions of why we’re still choosing to wait. And I do my best to share in the happiness of my friends and family members who are having kids, but I have to admit it is a bittersweet joy.
For More Information:
Ovarian Cysts on Wikipedia
Ovarian Cysts Fact Sheet
Polycystic Ovary Syndrome Fact Sheet
MayoClinic’s Information on Ovarian Cysts