Women's Wellness Obstacles: Period Problems (Part 1)

Needless to say...don’t read this if period talk or personal stories bother you! 

“You can do this!” I say as I take two more ibuprofen.    I sort through my leggings and find the black pair that has some, but not too much, compression.  My belly feels large and heavy as I pull the waist band up and over.   Now that my oversized sweats have been replaced with uncomfortable fitted leggings, I search for a loose shirt.   Being a group fitness instructor means class must go on!  I can’t cancel classes monthly so…I take a deep breath and hope that the ibuprofen works well enough to keep me from feeling like my insides are being ripped out. Don’t get me wrong, I LOVE what I do…I just wish my body was more cooperative!

I’m far from the only woman who dreads each month.

• One in ten women have endometriosis, a condition in which tissue similar to the endometrium (uterine lining) grows in places outside of the uterus.  The growths can occur anywhere in the body and are most commonly found around the uterus, ovaries, fallopian tubes, bladder or bowel.  The growths cause inflammation, scarring, and often, intense pain.  Symptoms vary and may include pain, bloating, digestive problems, ovarian cysts, and infertility.
•  Adenomyosis is increasingly diagnosed in women over 35. Similar to endometriosis, adenomyosis involves growth of endometrium in the uterine muscle.  This condition often causes uterine enlargement.  Symptoms can include abdominal distension, severe cramping, and heavy periods.  The symptoms tend to worsen with age until menopause.  I had never heard of this until I was told I may have it.
• Fibroids are noncancerous tumors within the uterine muscle and can lead to heavy, painful periods, anemia, backache, urinary frequency and bowel problems.  These growths can become quite large. Fibroids are a common reason for hysterectomy. 
• Even without specific conditions, menstruation can be difficult to manage, particularly in the teen years and during perimenopause.   

Women's reproductive health and associated conditions are getting more attention these days, thankfully.  We can hope in the years to come they will be more widely recognized and more easily diagnosed and treated.  These conditions are generally considered benign, as in, they won’t kill us.  But that doesn’t mean they're harmless.  Problem periods DEFINITELY add to the challenge of meeting fitness and wellness goals.  For some, daily activities of living are also negatively impacted.

We don't talk about periods very often yet so many of us suffer each month.   I am interested in other women's experiences.  Maybe you are too.  Continue reading for mine.

Elated.  That’s how I felt Memorial Day weekend the summer I was 12 years old.  I got my period.  I was growing up.  It’s a milestone!  That elation quickly morphed to horror as each month brought with it not only the inconvenience of heavy bleeding but excruciating pain.  As if being in junior high isn’t hard enough already, throw in bleeding, cramping, and feeling nauseated every single month.  I assumed it was this way for all my friends because we never discussed it.   I vividly recall sitting on the floor in Home Ec with my back against the counter, knees to chest, trying not to cry.  I remember curling up on my bedroom floor, flipping through a YM magazine to distract myself until the ibuprofen took the edge off, tears streaming down my face onto the pages.  I believed this was normal.

At my first visit to the gynecologist, I was given birth control and a prescription for a higher dose of ibuprofen to ease my period symptoms. I was 18.  The possibility of underlying conditions was never mentioned.  I took the pills.  They helped; the bad months weren’t as frequent.   About a decade later, due to unexplained, sudden high blood pressure and other odd medical symptoms, I had to go off of the birth control pill.   Throughout my 30s, cramps, bloating, frequent trips to the bathroom, headaches, fatigue, and other pelvic pain became increasingly worse.   Sometimes pain would radiate down my legs.  Sometimes I’d feel like I was about to vomit.   Unsure of what else to do, and still thinking it was a normal experience for most women, I kept taking ibuprofen, unbuttoning my pants due to the bloat, using heating pads, deep breathing methods, and dealing with it.  

During my annual doctor’s visits, I would bring up the pain and other symptoms but I downplayed what I was experiencing.  I don’t know why…probably because periods equal pain, everyone knows that!  In recent years, I have had to temporarily go on iron supplements due to mild anemia and I tried birth control again without success.

At age 39, during my annual appointment in October I was more open and explained that some of the symptoms were no longer isolated to one week per month.  I received an OB/GYN referral.  In November,  I noticed my belly button looked different.  I suspected an umbilical hernia but ignored it because I had no symptoms.  In December, I started to experience increasingly severe and strange abdominal pain, discomfort, and bloating. It was unlike anything I had experienced before.  I wasn’t on my period so naturally, I attributed it to the hernia.   I made an appointment because, honestly, I was scared.  The CT confirmed the hernia (it’s very small and no need to urgently repair).   Meanwhile, the OB/GYN appointment found evidence of a painful uterus.  A few weeks later an ultrasound revealed an enlarged uterus, thickened endometrial lining, free fluid, and a ruptured cyst on my right ovary.   I was a bit surprised.  My pain had been telling me something but I didn’t suspect I had so much going on in there.   In retrospect, I think I felt so awful for weeks due to the ruptured cyst, not the hernia.  I don't know if there is a link between developing a hernia and all of this other stuff going on in my abdomen.

On March 15th, a diagnostic laparoscopy and hysteroscopy with D&C was scheduled for 7:15 am. This was my first experience having a ‘real’ operation. Thirsty and anxious, I wanted it done.   Check-in and pre-surgery went well. I was given LOTS of anti-nausea meds.  As I was wheeled into the OR I could hear rock music; the nurses were friendly and fairly jovial for the early hour.  Next thing I know, I’m awake in a recovery area, shivering and disoriented.  I thought it was all a dream…did I even have surgery? 

Endometriosis was discovered and removed from both uterosacral ligaments and my right ovary. The tissue removed from my uterus was normal.  Adenomyosis is still a possibility; accurate diagnosis typically involves hysterectomy.  Recovery went well.  Pain was not severe; the worst of it was the day after surgery due to inability to fully empty my bladder and gas pain from the CO2 used during surgery.  I did not need any pain medication beyond a few ibuprofen.  A rash developed on my torso a couple of days after surgery (which was more annoying than anything!)  Fatigue was high for the first few days but then I was ready to get moving again.  The hardest part was taking it easy and allowing my body to recover before returning to normal levels of physical activity.  I was back to teaching a few Jazzercise classes (low impact) 10 days later and had full return to my schedule a bit over two weeks after surgery. 

The post-op appointment six weeks later confirmed that I was healing well but that my uterus may continue to be a problem: it’s still painful. Four months post-surgery, the removal of the endometriosis hasn't made much difference and my right side is still hurting. The option of hysterectomy has been discussed due to my enlarged, painful uterus. Endometriosis is not cured by hysterectomy though. I can: -wait to see if improvements are still forthcoming -deal with this the way I have been until menopause (potentially a decade away) -try birth control or other hormonal intervention again (not likely due to previous issues) -hysterectomy -try dietary changes and supplements.

I have read books, forums, research papers, and Facebook groups.  I've talked to acquaintances.  Hysterectomy is the second most commonly performed surgery on women in the United States.  While it may be warranted in many cases, I want to be sure I don’t jump to surgery too quickly.  However, I am also not willing to continue on this way.  I’m trying a couple of supplements (after doing my due diligence in researching them) and modifying my diet. I’m keeping an open mind but also keeping the surgery option on the table.

Many women’s stories are traumatic and heart-breaking.  These women have suffered through debilitating pain, infertility, dismissal of their symptoms by medical professionals, multiple unsuccessful surgeries, and on and on.  I feel fortunate that my symptoms aren't as severe as some. I was able to receive care and had a doctor that listened (when I finally spoke up!)

 My point in sharing all of this is so you know that you aren't alone and:

1. Consistent exercise can be difficult due to period problems.   You shouldn't feel guilty about that!  When you feel truly lousy on a regular basis, it is a challenge.  The solution is figuring out when to rest and when to push through and having strategies for when you don't have a choice. Stay tuned for next week's post.
2. Speak up!  If you are doubled over in pain each month and rely heavily on ibuprofen or other pain meds to get through it, you could have an underlying condition. Apparently, periods aren’t supposed to hurt that much!  I’m almost 40 and just learned this.
3. Be your own advocate.  When your doctor suggests birth control pills or surgery, it doesn’t mean you have to immediately accept it.  Ask questions.  Read, discuss, get a second opinion.   It can be difficult to make these decisions.   Ultimately, you have to do what’s best for you.  A few online resources I have found helpful include: American College of Obstetricians and Gynecologists (ACOG), Nancy's Nook Endometriosis Education Facebook Group (must request to join) and HysterSisters Hysterectomy Support.

 
In part 2, we'll look at a few relevant issues including how your cycle can affect your training and exercise sessions and the challenges of consistent exercise when dealing with a chronic condition.  Questions or comments?  Leave one below or send me a message.

Thanks for reading!

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