First a warning. This blog post discusses female reproductive organs. This makes some people squeamish and is too much information for others. If you are one of those people, you may not want to continue reading. You’ve been warned.
With that said, as part of my treatment for PCOS, my reproductive endocrinologist recommended that I get a Mirena Inter Uterine Device (“IUD”). The Mirena contains a low dose of slow-release artificial progesterone that the device delivers right to the uterus. The reason for the IUD was two fold, first the local release of hormones would like help to correct some of my cyclical hormone imbalances and the use of a Mirena IUD also may help reduce the risk of uterine lining cancers in women with PCOS. The doctor also suggested it may help with weight loss. I was scheduled for an insertion at 7:30 a.m. on Friday morning with my gynecologist and was given a prescription for misoprostol to use two hours before the procedure. I was also encouraged to take ibuprofen to help with pain.
I arrived at my gynecologist’s office a little nervous but I knew I had a high pain tolerance so I wasn’t really worried. I was wrong. Very, very, very wrong. In order to insert the IUD the doctor must manually open the cervix using a cervical clamp. The doctor then measures the uterus and inserts the IUD through the cervical clamp. Its as painful as it sounds. Maybe more so. I tried my hardest to be okay but I couldn’t help squeaking out in pain on several occasions. After the IUD was inserted, I was nauseous, dizzy and felt like my insides were being wrung out. It was a horrible feeling. I could not even sit up. It was a monumental task to eventually get up, get in my car and drive to work for a 10 a.m. client meeting. I had no idea it would be this bad. I made it through my meeting, dragged myself home and curled up on the couch in pain for the rest of the day.
I was also in a bit of shock. When I had arthroscopic knee surgery (two weeks before the IUD insertion) I was given general anesthesia for the surgery, received IV pain medications in the recovery room and was given a prescription for thirty Vicodin for post op pain. How many Vicodin did I actually need — none. The surgery was essentially painless. Yet with the IUD insertion, I was given nothing for pain and I was experiencing significantly more pain that I had felt with knee surgery.
On Friday night, frustrated with how horrible I felt I sent out a tweet — “Lesson of the day – having an IUD inserted is more painful than a Brazilian wax. #tmi.”
I didn’t really expect any response to my tweet and I was surprised when a flurry of replies came in from several women and, in particular, women who were endurance athletes. The response was two fold: first that yes, IUD insertion is ridiculously painful and second why don’t we talk more about how female specific issues such as hormones, birth control and menstruation effect us as athletes? Several of the responses to my tweet dealt with the fact that women chose to use an IUD because oral birth control made them feel awful; other responses centered on the fact that dealing with the cyclical nature of female hormones had an impact on training and racing (not the least of which is getting your period the morning of a big race). Many of us spend thousands (and even tens of thousands) of dollars on race entry fees, coaches, nutritionists, gear and clothing but we don’t even think about how the fact that we’re female impacts our performance (for me hormones have had a huge negative impact on my body composition). In fact many medical studies still ignore females.
This isn’t a plea for women to be given special treatment, but rather a question — we’re at a point in time when there are aerodynamic studies about the best placement of a water bottle on a bike yet its is almost impossible to find good resources (and discussions and support) concerning how female specific hormones and menstruation impact training and racing — shouldn’t this be a topic more of us are talking about publicly? And should talking about being female really require the warning I wrote at the top of this post?