Women's Health Matters: Period.

Sit tight: this post is a doozy.

I'm a Vagina Warrior.

I realize this is quite a startling way to begin my post, but being a Vagina Warrior drives me, it shapes the way I look at the world, and fuels my passion for women's health advocacy. What exactly is a Vagina Warrior? Well, it stems Eve Ensler's The Vagina Monologues; I performed in five productions of the show throughout college and two years after I graduated at the first college where I worked. The mission of the V-Day movement is near and dear to my heart, and a Vagina Warrior is someone who fights for women, women's rights both home and abroad, and for the safety and health of women and girls everywhere. My work in health advocacy, particularly around infertility, is how I assign my Warrior status (and when I say Warrior, think dorky Xena sporting Old Navy rather than leather-plated skirt).

So I've got three things my inner Vagina Warrior wants to cover in this post, all related to our periods: Tampons. The Red Tent. Project Vital Sign. Sound interesting? Read on.

So I was thrilled when I saw the new Kotex U commercials:

I am in no way being compensated for this. This was too damn awesome not to share.

Thank you, Kotex, for keepin' it real. I haven't had a "real" period in months, technically years if you count that fact that while on birth control, it's not an actual period as a result of ovulation, rather, it's withdrawal bleeding from a drop in hormones. I'm still experiencing breakthrough bleeding on my HRT (the pill), and I had to use a tampon for the first time in over a year last month. I stared at it like, "You want that to go where?" amazed at how quickly I had forgotten all about this strange feminine product. So when I saw this commercial I appreciated that it wasn't trying to sell me this flowered up idea but was like, "Hey. Hey you, you with the XX chromosomes. You're of menstruating age and you need a practical solution to your monthly biological phenomenon. Here, have a tampon." 

I appreciate Kotex's candor, because women don't like to talk about our periods. It's something society doesn't talk about... like infertility. (Funny how women's problems are marginalized into silence.) Which brings me to my next Vagina Warrior subject: the Red Tent Temple Movement and the forthcoming documentary: Things We Don't Talk About. 

 Anita Diamant's The Red Tent is an inspiring fictional retelling of the story of Dinah, Jacob's only named daughter in the Bible. The Red Tent was where the women of Jacob's tribe gathered for their monthly cycles, for births, miscarriages, and shared sisterhood. (If you haven't read it, go do that this summer. And keep a box of tissues handy when you do.) 

ALisa Starkweather has taken the fundamental ideas of The Red Tent and translated them into a movement of women gathering in sacred spaces to share in each other's sisterhood. Our temples are bedecked in red fabrics and welcome to women of all ages, menstruating or otherwise; the Red Tent Temple Movement is about restoring women's dialogue and celebrating the feminine life experience. The Red Tent Temple has allowed me to restore what I felt was lost- my sense of monthly cycles. While I may not bleed every month, I gather with my friends, my sisters near each new moon at the Salem RTT, and that sense of womanly rhythm has returned to my life. Isadora Leidenfrost will be exploring this movement in her forthcoming film, Things We Don't Talk About: Healing Narratives from the Red Tent. I get the sense that this is going to be an important film, and wanted to put this on folks' radars.

Still with me as I talk about all these "woman" problems? You are? Great. Because my biggest problem is calling Aunt Flo a problem. She should be a welcome guest, not a nuisance! CNN recently published an  article online about women's attitudes toward their periods. The article is (fairly) balanced, but the thing that got me was the general tone that "Ewww! Periods are icky and gross and cumbersome." (Yes, I know for some women, they dread their period: heavy flows, debilitating cramps, nausea, and worse.) It was the title that got me: Periods - who needs them anyway?

Who needs periods? Every woman does, that's who! This leads me to my third and final soapbox moment of this post: Project Vital Sign. Sponsored by Rachel's Well, a non-profit women's health organization, Project Vital Sign is working to create a national movement for educators and health professionals to recognize menstruation is just as much of a vital sign as heart rate, blood pressure, or temperature.

Allow me this divergence... I'm still reconciling my feelings on hormonal birth control pills. On one hand, it kept my ovarian cysts at bay all throughout college, after I had already lost an ovary to a torsioned cyst. On the other, it masked my POI for what could have been years. Now they replace the hormones my body cannot produce naturally. I've had this weird give-take relationship with hormonal birth control, so I'm still not sure where my allegiance lies. The point of this brief divergence is to say that eliminating our periods or masking them is a dangerous game, as we lose a basic sign of our reproductive health. My personal thoughts on birth control aside...

Our periods give us a clear picture of our reproductive health and even our overall health. The fact that the media and society paint our periods as nuisance, gross or insignificant is infuriating: it sends the message that we should do away with them entirely, reinforcing broader social constructs of shame, embarrassment, and silence surrounding women's health issues. I know I'm not going to change society, but I'll be damned if I don't try. And look, don't take my word for it (cue Reading Rainbow music) - Dr. Lawrence Nelson at the NIH/NICHD agrees in a recent piece on NPR:

"There's this disconnect," says Nelson. "The menstrual cycle is just seen more as a nuisance by many women. But actually, [when periods are regular] it's the sign that the ovaries and the whole endocrine system related to reproduction is working the way it should."

My points, after this whole long, ranting post?

Love your period. 

Celebrate your womanhood. 

Advocate for women's health issues.

Because women's health matters. Period.

ICLW May Be Over, But NIAW is in Full Swing!

I did it. 170 blogs (3 went down since the list went up). 170 comments in 7 days. I made my first Iron Commenter! I have found so many new blogs to follow- check my right sidebar to who I've added. I've found a ton of adoption blogs- check out my left sidebar just to see all the adoption bloggers I'm following. But most of all, I've met and made connections with so many people. The experience of making these connections is just amazing. Iron Commenter is indeed not for the faint of heart, but it is worth it, so worth it.

Like the post title says, ICLW may be over at midnight tonight, but that doesn't mean the comments have to stop. This has definitely kicked my butt into being a better active partipant in the ALI blogosphere. The sheer value in the connections I've made will only last if I keep up my end: reading, commenting, sharing stories.

Just because ICLW is over doesn't mean that NIAW is even close to being done! There's a lot happening on Capitol Hill right now. Melissa Ford of Stirrup Queens has posted her remarks she gave this morning at the infertility briefing on the Hill. They are powerful and inspiring. They remind me of why it is that I'm out and outspoken about my IF: because we need the government to act! She's there today with the executive leadership of RESOLVE. I hope they're making waves.

What else can you do to raise awareness? You can tweet about it, Facebook it, blog about it... make sure you Stumbleupon and Kirtsy and Digg and Reddit your links too! You can be out and outspoken about your infertility. Like Iron Commenter, it's not for the faint of heart, but damn if it doesn't feel good. "But what IF I'm too nervous about outing myself?" you ask? Well, here, let me do it for you. Use me as your stand-in, and share my What IF? A Portrait of Infertility video. Just spread it with words like "Because 1 in 8 is someone you know. This video is about a very important cause." And then leave it at that. *wipes hands* See? Infertility activism and advocacy is easy.

Other ways to raise awareness? Check out all of the blogs participating in #ProjectIF. Retweet @resolveorg or follow them on Twitter. Use hashtag #infertility in your tweets. Link to other bloggers on your blog, or even better yet- on your Facebook.

There's still 4 days left, including today, to raise awareness for National Infertility Awareness Week. Take just a few minutes each day and keep the awareness going!

A sea of questions about adoption.

It's Patriot's Day here in Massachusetts, quite possibly my favorite random statewide holiday (aka, freebie day off). Happy start of the American Revolution! It's also the running of the Boston Marathon. I can totally see a relevant metaphor between marathons and adoption, but seeing as I know next to nothing about running culture, I'll just let that metaphor pass me by...

Anywho, we've dived deep into adoption literature and websites, talking more with our families this weekend. Ari needed an eye checkup (his father is an eye doctor), so we spent the weekend with our families; I had the chance to do some serious baby shower shopping for my sister. Our parents are so excited for us. It's wonderful to have their support, and I feel constantly blessed with the amount of support we have in our lives. And I wasn't a blubbering mess picking out shower decorations- in fact, I am freakin' PUMPED to be an aunt in just a couple of months. I think now that since we're solid on our decision to adopt, so much of the uncertainty and doubt about having kids has been washed away. I've moved from pain to excitement.

You may have noticed the large new column of adoption-themed blogs to the left. Thanks to everyone and their suggestions in my last post: I found so many great resources and stories out there. With this influx of information, Ari and I are trying to stay afloat, treading uncertain and overwhelming waters. We have so many questions. Just when we think we have an answer... more questions! It's a lot to digest at once. We've been doing so much of our own soul searching, asking questions of each other and having conversations we never thought we'd have.

Here's just a small snippet of what's running through our heads:

• Race. Wow, this has been an amazing, confusing, refreshing conversation at any given point. It gets interesting because I'm half-Japanese, half-Irish(ish), so I have perhaps a more open attitude toward race. At the end of the day, our preferences are our business, but it's a mind-blowing conversation to be having just the same.
• Religion. Not knocking any Christian organizations out there, but there's a TON of support for Christian couples... haven't seen so much for Jewish couples. Obviously, we'd need to disclose our religion and in what faith our adopted child would be raised. I worry that this is actually going to limit the kind of reception we'll get from birthparents. 
• Cost. Sweet jiminy crickets. Since IF treatment is mandated in Massachusetts, the cost of treating our infertility was a lot more doable than the cost of coping with childlessness (an important distinction). Thankfully, Ari's new job is allowing us to save for the first time in a year, but we still have a lot more to go. I've been researching grants, and sadly, neither of our employers provide any adoption assistance benefits. I've also been toying with the idea of setting up an Etsy shop for some of my crafts, and of course, monetizing this blog. Our parents have also volunteered to help... I wonder is it tacky to ask our friends and family fundraiser-style? Is a PayPal "Donate Here" button on this blog too far? This arena of etiquette is completely foreign to me.
• How open? "Open" adoption can mean a lot of things. Are we a "Come over for lunch on Tuesdays" kind of family or pictures every birthday or are we just "please let us know about any medical issues as they arise for you and your family" when it comes to openness? How open is too open? How will this limit our chances to be picked by birthparents?
• Blogging. Don't worry, I'm not planning on closing this blog any time soon, but as I've browsed other adoption blogs, there are pictures of the adoptive couple, full names, contact information, detailed personal profiles with sidebar badges like "Considering adoption? Consider us!" I wonder if I'm ready to do that when the time comes, or perhaps I just create a separate blog entirely. Do I really want to share all of this with our future agency, birthparents, or even future child? I also wonder if a sidebar request like that isn't also in violation of Massachusetts law (no private advertising may be done by the couple, as independent adoptions are illegal in the state). 
• Stuff. Um, do adoptive parents get baby showers? Do we need to buy a crib before we have a home study? How does one- better yet, WHEN does one get the future child all the stuff they need?
• Cost. Did I mention we're still scrambling to figure out how we're going to afford this?

We're trying not to get too overwhelmed, but all these questions just keep coming. I'm hoping to tread water just long enough to get us to the RESOLVE of the Bay State's Adoption Conference in June. Until then, anyone have some answers or thoughts to our questions?

Let me show you my No Face.

I was hoping to eventually title a post "Let me show my my O face" but sadly, looks like I didn't ovulate. Blood tests and u/s seem to indicate a big fat nothin is happening up in my lady bits. Dr. G put it so nicely in an email to me on Thursday:

"The lab tests look no different from your old ones. In other words that "follicle" is not producing any hormones like a follicle does. It sounds as if it is an inert cyst. That does not explain all your symptoms except for the supposition that the cyst is shrinking and would have been bigger and more active hormonally if we had looked at this earlier. I would suggest we recheck your blood work in a week."

POF, FTW.

Also, what the hell is an inert cyst? Part of me is like, well, let's get the second round of bloodwork and an u/s done. The other part of me is tired of getting some seriously passive aggressive behavior from my boss at work who's getting a little tired of me having near montly trips to the doctor that eat up a half day (b/c of the location of my doc and the places he sends me to for diagnostics, it's all quite scattered far from where I work). I'm also tired of feeling like a fucking lab rat, poked and probed and prodded.

I'm bummed, big time. I'm frustrated, and I'm angry, and I'm tired of holding out false hope. Did I mention that Ari's other really awesome job lead fell through? That would have been amazing but alas, it's not to be. Got that news followed by that email from my doctor within just a few days of each other. (He's still had 1 interview this past week with Company A, another one Monday at Company B, a 2nd interview for Company A on Tuesday, and a formal offer from Company C on Wednesday. I'm excited for this week for him.)

I'm just really angry and tired of all of this. What I thought was excellent news this time last week was once again, just a fleeting anomoly - just light and shadows and nothing of substance to hold onto. I was so excited to have actual TTC babymakin' sex and then I got that email and basically didn't want to be touched. I could be channeling this energy into looking for a donor or finding an adoption agency instead of holding out this false hope that I'm actually going to conceive with my own eggs.

I fucking hate this. I fucking hate that infertility has become my life. I fucking hate that I feel like my life is on hold, when I can so clearly see the end result that I want, but I can't do a goddamned thing b/c something else pops up in front of me, pulling my attentions elsewhere.

I fucking hate waiting... and waiting, and waiting, and waiting- for blood tests, for ovulation, for emails back from my doctor, for finances, for things to just settle the fuck down already... I am stuck in a goddamned existential waiting room, flipping through magazines I don't really care about and tapping my toe impatiently.

I may need to go into hibernation for a bit.

Bingo cards and holding out hope.

A cryptic blog post, yes. Allow me to explain...

Ari got a call from a close friend of ours from grad school about some theatre related things, as these boys love to talk about. Surprise surprise, in the middle of the conversation, we found out they're due in April, first baby for them. We are of course, super excited and wonderfully happy for them. And like all happy announcements, it's only logical that I stand in the shower crying.

You know how it is to be infertile.

It's like a Pavlovian response: pg/birth announcement ding! I'm crying in a corner somewhere. Drives me nuts. Not the announcement, but my reaction. I will of course put on a happy face, b/c, well, I am happy for them. But if I'm at home and reading it on FB or getting a phone call, inevitably, 5 minutes later, I'm a mess for a good 15 minutes and then my mood is killed for the day. Case in point, yesterday.

So why the bingo card? I teased with Ari last night we should make a bingo card of all our coupled friends and stamp them as ppl announce they're pregnant. I have no idea what the prize would be, but that's kind of what it feels like. I'm totally in that mostly married late 20's group where everyone's poppin' out babies. It's both awesome and awful. B/c, I love me some babies. It's that whole leading up to baby where all of the attention is on said couple that's the hard part. That sounds profoundly selfish when I type it, but it is what it is and I own those emotions. It's just that unspoken reminder of failure. Of loss. Of emptiness, barrenness, of holy shit I never knew I could be this jealous a woman-ness.

That random announcement definitely messed with my mood, compounding with some continued bizarre PMS-like weirdness. I've felt PMS-y since mid-January - bloating, cramps coming and going, tender boobs, and being generally crazy emotionally. I noted that my estradiol was elevated somewhat in my last round of blood work, so it seemed natural. But today is day 5 of random and persistent ovarian pain, around my right (and remaining) ovary. At first it just felt like regular cramps, but for the last 4 days it's been hovering in the 3-4 range on a pain scale of 1 to 10, and yesterday moved into the 4-5 range. It is highly likely I've got a cyst.

And that would be fucking AWESOME.

Why? Why would I be happy about a cyst?

B/c it means my ovary tried to pop out an egg! On its own! Nevermind that it got fucked up and might have made a cyst, but it maybe made an egg! This is like a freakin' miracle for a woman with POF.

Worst case scenario: it's a tumor. Why do I jump to that? That's what happened to my left ovary. (In fact, that's how I lost my left ovary.) Other worst case scenario: ectopic pregnancy. Highly unlikely though, given my gradual symptoms, and no other symptoms of early pregnancy. Best case: I'm knocked up. (Ha! Fool's hope.) What's most likely: ovarian cyst of some kind.

Either way, I hope I'll know more by this afternoon- I was able to get an urgent appointment with my GYN today at 2:30. Fingers crossed it's a cyst.

This is me, holding out hope for a cyst.

Women and Falling Fertility: ABC News Article

Women and Falling Fertility: Women Lose 90 Percent of Eggs by Age 30 - ABC News

Saw this lined at Fark.com, of all places. The article is interesting. The comment thread, like any comment thread on Fark, is a disaster. Still, premature ovarian failure is a fairly uncommon diagnosis... but it makes sense why some women, if not born with enough eggs, would run out much faster. Average age of Dx for POF is 27. Go fig.

"That's a nice looking ovary you have there."

Thank you?

I had my ultrasound this morning. I haven't had one since after I had a cyst rupture in 2000, and this morning was actually a pleasant experience.

[Funny side-story: When Dr. Gross asked me my scheduling preferences for my u/s, I told him anytime was fine. I asked him if I needed to arrive with a full bladder or do anything to prep, and he just laughed. "Not since the Reagan administration." Apparently, u/s technology has evolved in the last 10 years.]

I took an hour-long T-ride this morning to the Longwood Medical Area; driving in would have taken just as long, if not longer, in morning rush hour, and parking would have cost a fortune. I haven't had to do the morning T-commute in a long time, so it was nice to spend the time reading Sarah Gruen's Water for Elephants. (Sidebar: excellent read so far. Can't wait for my friend's upcoming Book Club about it.) If I wax a bit descriptive non-fiction in this post, it's b/c of the book.

I arrive at the office, to be greeted with poster reproductions of Chagall and Kandinsky, and vaguely tribal variations of Madonna women and children. There is a friendly receptionist, a little bit of paperwork, and plenty of hand sanitizer and signs instructing people how to cough into the crooks of their arms. I take a seat on the most comfortable waiting room chair ever, and I quickly realize why they're so comfy as a bulbous pregnant woman wrapped neck to calf in breathable stretch cotton comes waddling in with a pair of neon purple Croc clogs on her feet. She is perfectly proportionate save for her swollen belly, like a comic caricature of pregnancy. She is older, as is her husband. I peg them at just past 40, maybe a hard ridden 37 or 38. There is a younger Asian couple- much younger, early 20's by the looks of it. No belly, just lots of smiles and private exchanges. There's another woman, mid-30's easily, with a petite bump poking out just slightly from her blazer. If she hasn't announced to coworkers, she'll have to soon.

I wait my turn and am called up the stairs after waiting a short while. It's like some mystical medicine man at the top of a mountain, being hailed up the stairs as all the women of the waiting room crane their necks to see who will be next chosen. I felt like Moses at Mt. Sinai.

I am greeted by Kim, the u/s tech. I was prepared for the "scooch over," the unzipping and half-lowering of the pants, the slight tickling as the probe glides over my skin. What I was not prepared for, was her first question to me: "So, what brings you in here today?" The question literally left me flabbergasted for a second, like they'd found me out, like I was sneaking into a sacred coven of pregnant women of which I had no business being there.

I explained it simply. "I was just diagnosed with premature ovarian failure and we're going to try treatments in a few months, so my OB wants to get a good look at everything to make sure there's no uterine abnormalities." As soon as I said OB, I felt like an idiot. Until I've got a baby up in there, he's just my GYN. I explained my history of PCOS, and my ooverectomy. She said she was very sorry to hear of the diagnosis, and her words hung there, awkwardly, in the air as she fired up the machine. Thankfully, the tension was broken as warm jelly was squeezed onto me. "You warm it up for patients?" My abs were clenched in preparation for the sensation of cold, and I was pleasantly surprised by its lukewarm temp.

"Of course!" she chuckled, and began. Kidneys? Check. Got two of 'em. Left ovary gone? Check. Uterus? Check. Right ovary? Check. "I'd like to do a transvaginal ultrasound, if you don't mind. We can get a better picture." Ah yes, the dreaded "dildo cam." Once I had undressed, I totally understood why it got that acronym- it really looks like a dildo. The most awkward part? Kim says, "I'm going to have you insert it; it's just easier and more comfortable for you that way."

Soon after the sonogram tech came in, Sonya? I believe was her name, as a second set of eyes. She had Kim switch on 3D mode, which was surreal. It was like an old-timey photo of my uterus, all sepia toned and grainy. All of it looked the same to me, save for the uterus, which was a clear, black void in the middle. Seeing the emptiness of my uterus left me with a short pang- of seeing friends' sonograms with their millimeter fingers and toes and noses and thinking, "I would love a little bean of my own in there." Someday, I tell myself. Gotta stay hopeful.

Sonya goes, "That's a nice looking ovary you have there." To which I reply a confused, "Thank you?" I ask if they can see any follicles, and they explain that since I haven't had a period since December, there are none to be seen since they would only be visible during a certain time during a cycle, as they gear up for ovulation. Sonya says she'll send the report over to Dr. Gross this afternoon, and that everything appears normal and healthy. No cysts, growths, or anything out of the ordinary.

They hand me a wipe and wish me luck. For the first time in this whole process, this is the first normal diagnostic I've had. It felt good to know that there shouldn't be any problems keeping something inside there, it's just getting something to put in there that's that trick. And that, despite the moment of longing I felt at seeing my empty uterus, I kept a smile to myself as I rode the T home, excited and hopeful at the chance to see a little hand, a little face in there.

Someday, I smiled to myself, the T rattling around me. We are going to make this happen.

Where do babies come from, anyway?

The ovaries are one amazing set of organs, I have learned in the few weeks following my Dx. Both reproductive and endocrine - you might call them the command center for the hormonal workings of the female body. Before you can understand anything about premature ovarian failure, you need to understand exactly how the female reproductive and endocrine systems work.

Short version
Uterus builds up endometrium (lining) in anticipation of release of egg. Ovary releases egg. If sperm is in wait, egg should fertilize. The fertilized egg travels down the fallopian tube to the uterus and implants in the endometrium. Cue: pregnancy. If there is no sperm to fertilize the egg, then the egg and endometrium are flushed out in that lovely process known as menstruation. And then the whole process starts over again.

For the visual learners

Image credit: Fertility Plus (http://www.fertilityplus.org/faq/hormonelevels.html)

A Hormonal Primer
Let's take a look at exactly what's happening hormonally during a woman's cycle. If you've ever wondered why some women might get a little "moody" during their cycle, well, we've got a LOT going on at once hormonally in our bodies :)

Follicular (Pre-Ovulatory) Phase
The pituitary gland begins releasing FSH (Follicle Stimulating Hormone). This primes the ovary to start maturing its follicles, the individual part of the ovary that releases the eggs. During this phase, several follicles actually develop at once, on both ovaries, but only one follicle will mature and release an egg in most normal circumstances. Estradiol (estrogen) is released by the ovaries during this time, and aids in the building of the endometrial lining of the uterus.

Ovulatory Phase
As estrogen levels peak, it triggers the release of LH (Lutenizing Hormone) by the pituitary gland. Of all the developing follicles, one will mature and burst, releasing the egg. It is currently unknown how the body determines which of these follicles on which ovary will release an egg. The ruptured follicle then becomes the corpus luteum (Latin for "yellow body"), and begins to release progesterone. Progesterone is a heat-releasing hormone, and causes a woman's BBT (Basal Body Temperature) to rise. It's also responsible for hot flashes. Progesterone is essential to ensuring implantation of the fertilized egg and to sustain pregnancy. If the egg is fertilized, it will take about 7-10 days to implant in the uterus. Once implanted, the fertilized egg will begin to release the hormone hGC (Human Chorionic Gonadotropin). This is the hormone that POAS HPTs (pee-on-a-stick home pregnancy tests) are designed to detect. The corpus luteum will continue to release progesterone, until the placenta develops and takes over progesterone production for the duration of the pregnancy.

Luteal Phase
If the egg is not fertilized, the corpus luteum will begin to disintergrate, and thus, decrease the amount of progesterone released. The drop in progesterone causes a second rise in estrogen, which then triggers the uterus to shed the endometrium, inducing a woman's menses. And then it starts all over again.

What does this all mean for me?
Well, my remaining ovary isn't working anymore for some presently unknown reason, so NONE of this is happening in my body right now.