Tenure-Track Uterus: My (mis)adventures with birth control

This is a post about my uterus*. It is not a love letter.

This post is not for the squeamish, but I hope you read it anyway. This post won’t apply to some of you, but I hope you read it anyway. You may think this post is TMI — too much information. I disagree, and I hope you read it anyway. This post may have some of you thinking, “Why the hell is she writing a post about reproduction and birth control on a blog about women in academia?” Read on. 

My reproductive system and I have always had a love-hate relationship. It started with that first period that left me debilitated on my 12th birthday (the messy, painful reality was so much less romantic than the readings I’d devoured. Becoming a “woman” was not what the rose-colored pamphlets promised, in addition to being biologically essentialist). For the first year, I spent a lot of time wearing jackets tied around my waist when yet another overnight-sized maxi-pad let me down. By high school, I’d settled into a comfortable routine of regular-ish, heavy periods. By the time I was 18, I was on hormonal birth control (Ortho Tri-Cyclen Lo). The few times I’d go off The Pill (more often related to access than choice), it would take months for me to have a natural period, and the cramps would be so debilitating that I’d miss work or school for a couple days. The Pill kept everything under check: regular, light, predictable, seemingly no side effects except fantastic skin. Perfect!

During one of those off-times, a catastrophic condom failure led to what was a very bad abortion experience (again related to access rather than choice). The clinic was fantastic, but the runaround with insurance, state officials who lied to my face about Medicaid access for an abortion, and a deliberately obtuse nurse who pretended she didn’t know why I was getting the ultrasound (“it’s a girl! And she looks perfectly healthy!”) meant that I never wanted to go through that again if I could help it. I was in an emotionally abusive relationship, and I didn’t want a baby. I was still in college. I knew that for me, having a child meant not being able to pursue my dreams. I was a first-generation college student from a working class background, and I couldn’t go to my family for help. I had the abortion, in Canada, in my 2nd trimester. I don’t regret having it, though I am still angry about the how and the why.

I went back on The Pill as soon as I could. When I hit my late twenties, however, my love affair with oral contraceptives hit a rut. I found myself irritable, lacking physical affection for my then-boyfriend, dizzy with hunger by 5 pm, and getting migraines more and more often. When another access-related snafu hit during grad school, I ended up going off birth control for a few months. The transformation was incredible– I felt like my old self again; less anxious, less irritable, physically affectionate. I knew right away that I couldn’t go back on The Pill, but I absolutely did not want another abortion if I could help it. My gynecologist was sympathetic, but wanted me to stay on some form of hormones because of concerns that my not ovulating regularly put me at a higher risk of ovarian and uterine cancer. So I tried the NuvaRing. I didn’t react well to it physically — too much discharge. I tried the Mirena, and expelled it within days (ouch!). At a loss, I tried a mono-phasic birth control pill and some B vitamins, hoping that not having swings in hormones would reduce the moodiness and migraines. I found that I felt even worse, and more troubling, I kept forgetting to take the damn things (despite having had no previous issues with remembering).

I finished grad school, and moved away from my then-boyfriend-now-husband. I went off birth control entirely for a year, relying on condoms for the few times we were together. I felt great, except when I had a period, which was so heavy I became anemic. Still concerned about cancer, my new gynecologist prescribed monthly progsterone pills to trigger a period. After one pill turned me into The Incredible Hulk for 24 hours, I swore to myself that I would never take another.  I remember sitting at my desk, actually shaking with anger in overreaction to some small thing, my heart racing. When a small voice said, “this isn’t normal,” I googled “progesterone angry.” To my relief, it wasn’t just me.

And now, here I am, just starting a faculty position. My husband and I are still a part-time long-distance couple, at least for two more years. We’re still relying on condoms. We want to start trying to get pregnant in a couple years. We know we might get pregnant sooner than that, or that hormones might delay that start date even further. We’re also aware that I’m reaching an age (early thirties) where it may be more difficult to get pregnant at all. In the meantime, I live in perpetual dread of having a period, where between the debilitating cramps and losing an ounce of blood every four hours (I have a Diva Cup**; I checked) means a full stop to productivity or travel of any kind. I also dread not having them, and take regular pregnancy tests. I feel, in a word, hijacked.

And that’s why this matters to me as a woman and an academic:

It matters because lack of access to birth control and reproductive healthcare nearly kept me out of graduate school. I know it’s possible to have a kid as a college or graduate student, but it wouldn’t have worked out for me at the time.

It matters because my periods can completely destroy my productivity: I can’t work, I can’t attend talks at a conference, I can’t go into the field. I only have a period every 3-4 months; I know women that are having periods like that on a monthly basis.

It matters because I already feel like the tenure clock and my biological clock are having a Royal Rumble in my uterus. If we do get pregnant now, living apart, the timing would be terrible for us. But what if it’s our only shot? Would my husband have to quit his program?

It matters because I don’t want to get cancer. I kind of like being here to do science.

It matters because I feel like this has been the single most tangible expression of work-life-balance in my life. When I was on The Pill, I was miserable at home. Just before I got off of it, my then-boyfriend and I were having discussions about whether we were working out. As soon as I got off it, it was like a completely different relationship. I don’t blame this entirely on The Pill, but I think it made a real difference.

It matters because women are constantly judged as inferior because of our biology. We’re written off as emotional, irrational, bitchy, or “on the rag” for asserting ourselves, or even just for existing. The fact that I attribute strong emotional side effects to my contraceptives is deeply troubling to me as a feminist, because it feels like I’m buying into that culture that dismisses women’s emotions because of our biology.

If we want to help women at home and in the workplace, we need to think about access to reproductive healthcare options. We need to validate women who express dissatisfaction with a given method– I once changed gynecologists three times in a row because of dismissive, condescending attitudes about my physiological responses! We need to provide safe alternatives to hormonal birth control. New options for male birth control need to be on the table. We need to rethink a tenure clock system that is out of sync with our reproductive biology (male and female!) and provide flexible plans, childcare, and parent-friendly workplaces.

I don’t have answers for managing my own uterus right now, let alone the collective uteri of women in academia (and beyond!). I do hope we have these conversations, because I don’t think they’re TMI. If anything, we have TMS — Too Much Silence about women’s health, and not enough information. Not by a long shot.

So, folks, here’s your TMI-safe spot to kvetch. Share your frustrations, experiences, advice, and questions in the comments. Leave the sexism and evo-psych bull honky at the door, please. Comments will be monitored heavily.

*I am a cis-gendered woman. I have a uterus. Not all women do. Throughout this post, my intention is not to suggest that this is a problem that only women deal with (some folks who identify as men have uteruses), or that women automatically deal with, or that you have to have a uterus to be a woman.

** I highly recommend menstrual cups. I wish someone had given me one when I was 12; I’d never have needed those jackets around my waist. Bonus points for being reusable (no waste!), non-irritating, high-volume, and graduated, so you can see how heavy your periods are if you’re a nerd like me. I recommend getting two to swap out at work, with a little dry bag like the ones they use for cloth diapers (check Etsy). On heavy days, I use PUL-lined cloth pads as a backup, which I love.

30 thoughts on “Tenure-Track Uterus: My (mis)adventures with birth control

  1. I once had a family doctor who told me that he wouldn’t sign prescriptions for birth control because he was “very catholic” (this is his own description, and it shouldn’t be interpreted as a statement of very religious catholics). He did assure me that if I needed a prescription he would get one of his colleagues to sign it for him. Of course, forget about discussing methods and such… (I live in Canada, in a place where you must have a family doctor first in order to reach a specialist, where finding a good family doctor is very hard, and where there are wonderful benefits such as universal health care and real maternity leave, so, you know, good and bad.)

  2. I am a cis-gendered female in my early 30s, and my uterus-related experiences overlap some of yours.

    My teen years were also filled with sweatshirts ’round the waist because standard protection was insufficient for a morning of classes. I couldn’t make it 4 hours with both a tampon and a pad some days. I left for university and my periods stopped suddenly, which my doctor attributed to stress. After 8 months of no period whatsoever, and several very uncomfortable conversations with my parents and doctor, swearing there was no way I could be pregnant, I was put on The Pill (also, Ortho-Tricyclen, they sure loved that particular pill in the late 90s early 2000s). My acne disappeared, my breasts grew a cup size, and my periods were suddenly short and regularly scheduled. 18 year old me was thrilled.

    It took me until early grad school to recognize that the intense food cravings and mood swings I was experiencing weren’t really normal. My reactions to things mystified me sometimes, and there were nights the week before my period when I could eat a horse. Like you, I felt as if my body had been high-jacked. It took me much too long to make that connection, and the only reason I did was because my new primary care physician was incredibly intuitive. I didn’t want to try patches, injections, or rings unless they were the only option, but a hormonal birth control was the only way to regulate my periods. My doctor worked with me, and after reviewing my options we also decided that a single-dose pill might help keep me level. I had to try 4 different pills (and 4 different negative reactions) over 2 years before we settled on one that works for me. It’s been a decade now and I am still on the same prescription.

    Compared to many of my female friends and relative I have had it relatively easy. I haven’t been debilitated by cramps and I have been fortunate to have always had access to, and been able to afford, to maintain my birth control of choice. I am lucky to have found a prescription that does not make me unhinged or leave me bleeding all month long (for a while it seemed like I would have to choose one or the other). Even given that, however, determining my best option required a lot of trial an error, at the expense of my emotional and physical stability. Since leaving grad school I’ve been diagnosed with hypothyroidism, and that has been a whole other barrel of hormone-related fun. The fact that women are written off because of their biology, as you say, makes all of this even more challenging because I know that I, at least, felt compelled to hide my struggles for fear of seeming weak.

  3. Spermicidal foams work – if they are still available, it is many years since I needed them – as long as you remember to use them each time – but this aspect is no different from using condoms. I only had pregnancies when I wanted them (three plus a very early natural miscarriage), and i had a pregnancy each time I wanted one; and except for a year or so after each birth and when my husband was writing up his PhD, times when i wanted to be extra sure, I never used the Pill. I am surprised these foams are not discussed more often. I liked them – more comfortable than condoms, can be inserted a little while beforehand if you choose, and I was the one totally in control. Some of them are reported to be antiviral to some extent, too, don’t know if this is true.

    • Good point about non-condom alternatives (or supplements)! I haven’t explored many of those very much. Sadly, it still leaves me in a bind about ovulation and menstruation.

    • I hate to say it, but spermicidals are absolutely NOT antiviral, that’s a very persistent myth that’s probably killed people. They kill viruses in a test tube, but in vivo they increase the risk of viral transmission.

      Some women also get severe irritation from them. Others tolerate them fine, though.

  4. Thank you for this post! My experience has been very similar to you and to the commenter Gibbs. I wanted to add that I have found academia to be better in relation to these problems than other environments, because when I am debilitated by cramps and bleeding I can somewhat easily work from home. Ditto when I am anemic. And I’m rarely in a situation where I can’t change a pad & tampon (gotta wear both) every hour. But it has made my career a challenge, having these health distractions

  5. … and then after all those ‘young adult’ problems are over, you get hot flushes….. (sorry, didn’t want to spoil the party)….

  6. I’m a college student, and I dread my periods. Even with pain meds, the cramps are debilitating, and it’s getting worse. Everything from fatigue to headaches to mood swings, odd food cravings. My life is taken over by hormones 1-2 days every I have no idea how often. It ranges between 4-8 weeks, I think. I hate not being able to predict it, and the days I spend on the sofa, (or in lab/class wishing I was on a sofa) useless.

    • I’m so sorry! I did find that hormonal birth control helped so much with my periods. If you can find one that works for you, it might be worth a shot. Good luck!

  7. Heavy periods + fieldwork in areas with no trees to nip behind = a particular challenge. And it’s not always possible to reschedule, even for those lucky women with totally regular cycles, because there are often multiple people involved and external constraints on trip timings.

    Ah, the joys of being female ;-)

  8. Woo Diva Cup!

    Mainly wanted to respond to the dismissive doctors. It takes a lot to stand up to someone who’s giving you a pelvic exam. You’re not in control, you’re literally exposed, and you’re not considered the authority in the room.

    I had one doctor lie to me, cite urban legends instead of actual literature, and dismiss my concerns about my medicine. On that last point, I’d like to note there is now a class-action lawsuit for my medicine for the concerns that I had!

    The next doctor I had was obviously surprised at how candid I was regarding my personal health. We got along quite well, but I’m still unsure how to interpret his, “Are you sure it’s the medicine?” when I told him LoEstrin was making me act insane. He asked, I said, “it’s the only thing that’s changed this year,” and he switched me to a new pill.

    I never thought I would need empowerment the exam room. I was even chastised by my mother when I told her (raged to her) about the first doctor. She asked, “But he’s a doctor, don’t you think he knows this stuff?” Be reminded that the exam room is no place for bullying!

    • I’m starting to think self-advocacy in the doctor’s office is one of the most important, yet least-discussed aspects of reproductive health care. This is such a big deal! I once went to a clinic and the male GP had NO idea how The Pill worked. “You’re still ovulating on the Pill, right?” And I had a nurse tell me that the Nuva-Ring discharge couldn’t have been “that bad,” or that there’s no way I could be bleeding as much as I said, until I told her about the Diva Cup.

      I’ve just moved to start a new position and I’m so stressed about having to go through all this again to find another gynecologist.

  9. As a practicing Catholic working visiting positions, I was in constant terror of what a pregnancy would do to my career when I had no job security. NFP worked well enough for us in grad school, but I knew that if I got pregnant, I’d have support and job security for the time I needed off to deliver. Then I was in the one-year market. When would I be able to deliver a child? During the Fall, when I was just starting a one-year? In the winter, when I had to fly to my convention for tenure-track interviews? During the Spring, when campus visits were happening? Or the summer, while moving and switching health insurance? Assuming I got a job the next year at all. My institution never laid out what options I might have, and I was afraid to ask in case my employer assumed I was planning a pregnancy, rather than reassuring myself that if I got pregnant, I’d not lose my whole career.

    It was clear to me that the uncertainty was stressing me out and playing havoc with my marriage. So I began to examine my options. Hormonal BC and my severe migraines wouldn’t have worked, and I have ethical objections to medicating a healthy organ (Again, I don’t judge others’ choices to use it – it’s just not right for me and the way I experience my body). The barrier methods I had been using (while feeling a crisis of faith over it) had an unacceptable margin of error and made sex uncomfortable. Now I’ve got a copper IUD and it’s a good solution, though it took some painful adjustment and one very uncomfortable expulsion. Extensive research into how the IUD functions and the chance of risk if I do become pregnant left me comfortable *enough* to choose it, but I would prefer to have left my uterus in its natural, functional state and had a few children with my husband *without* giving up my life’s work. I don’t feel like I had the freedom to make the choice I wanted to make, and if I were a man, this wouldn’t even be an issue, even if my wife had children.

    So basically, I had to choose between my religion and the career I love, and it was a difficult time for me. My husband was supportive and wonderful, to be clear, but the structure of academia was in direct conflict with the beliefs I adopted on my conversion. Again, I have no problem with other women’s choices – this was about my ability to choose to practice my religion, hold to the way I prefer to relate to my gender, sex, and body, AND continue to compete for tenure-track jobs in a down market.

    I’m at peace with my choice (such as it was), but I now avoid Mass and Confession for fear of having my priest judge me and not be able to understand the rationale that allowed me to feel morally and spiritually OK about this. I resent the structure of academia for supporting me as a woman – but only if I’m a woman who doesn’t reproduce. And I feel particularly lost because when I try to explain this to other academic women, they’re often hostile to my religion’s policy on birth control (Which, ok, I get) rather than to academia’s respect for my choice to be both a professor and devout.

    I know some women have children in one-years and still do well. It’s not that academia “told” me to go turn off my fertility… but. Every single structure assumes that I will be physically fit and available to jump through hoops in pursuit of my career. These hoops happen on a schedule, no matter if I’m due that week or not. Such rigid structures are particularly discriminatory to women whose health and beliefs complicate their use of birth control, and I think such voices have a right to be heard and represented.

    • Thank you for sharing this story — it adds a completely different twist (religion), but it’s one I think many people will be find valuable. I can’t imagine navigating all of this with an additional consideration. You’re so right that there seem to be very rigid lines around what is and is not acceptable, or what we’re willing to do institutionally to support women. It seems often that institutions just don’t want to have to try very hard.

  10. A while ago, I read an interview with Martha Stewart. She said that her biggest regret was not having more children. Given that she’s been convicted of a crime and spent time in prison, I found her answer both surprising and quite poignant. It also resonates with me because that is my biggest regret as well. After I took maternity leave, I was told that I’d lose my job if I had another baby. (Yes, I know that’s illegal, but the maximum damages available under the Pregnacy Discrimination Act are $300,000, and that’s not enough if I’ve made myself unemployable and still need a job and health insurance for a family.) Anyway, I was a coward and waited until I was in my late 30′s and settled into a new job before we tried to have a second child, and by then it was too late. Having been through three IVF embryo transfers (one fresh and two frozen if you really want to know), I’m making peace with the fact that we missed our opportunity, but I would like to encourage ambitious young women who want children to talk with their partners and to make hard decisions about what their priorities are. Of course you want tenure and a family, but please be careful about thinking you can have children once your career ambitions are fulfilled. Decide which of those (career or children) is more important to you so that you’re consciously identifying your highest priority.

    Further, even once you have decided what your priorities are, living in accordance with them doesn’t become suddenly easy. I don’t pretend to be good at this, but I can sincerely say that I regret the choice we made/ defaulted into not to have another child. I wish I had been braver. I also wonder why work seemed that important when it really wasn’t in my case.

    Finally, I suspect your initial reaction is to argue that having to choose between career and family is not fair, that men don’t have to do this, that there should be a way to have both. I’m not suggesting that this is fair because it isn’t. The biological reality is that women do not have the same amount of time as men in which they can have children, and for many of us, there is less time than we thought. I have been in the reproductive endocrinologist’s waiting room. There are a lot of professionally successful, intelligent and highly respected and accomplished women there. However, there are not a lot of happy women there.

    • Thanks for your thoughts. I’m very lucky in that I’ve got a partner who would be happy being a stay-at-home dad, but we’d like to get him through his program (just two more years). From what I know of myself, I think I’d more likely regret not pursuing my career goals than family ones (I’ve occasionally thought I’d be okay without kids), but I’d still like to not have to think of it in terms of a choice.

    • I’m not really sure exactly what you’re driving at, brinkmanship — though it looks rather like biological essentialism to me, and I really don’t hold with that.. However, I’m just going to point out that lots of people regret lots of things. My grandmother vehemently (and vocally, as in most holiday meals) regrets having seven children.

  11. I can relate – I came off the pill a couple of years ago, due to similar emotional side-effects. Since then, my periods have gotten increasingly bad, and there are times that it makes work (especially lab work, standing up for long periods of time) very difficult. I spoke to my GP about it and am on medication to make the period itself easier to live with – strong anti-inflammatories to deal with the cramping, and tranexamic acid to reduce the blood flow. It helps, and although my doctor initially wanted to push me towards more hormonal birth control, after I insisted I didn’t want to go there, she helped me find a better solution. I still find that I am off my game for at least one week out of every four, though.

    And now coming to the end of a three-year post doc and getting married at the same time, issues of when to start a family are weighing heavily on my mind. A permanent job is a long way off, and I refuse to prioritise my career at the expense of starting a family. But I’m not sure where that will leave me career-wise – I can see how easily taking a maternity-related career break could leave me out of the loop and unable to return. Thanks for the article – we need to be talking about these things more.

    • I’m sorry to hear about your situation! I’m glad you’ve had receptive doctors, at least.

      I’m in the opposite boat regarding kids, in that I’d put my career first, but I still want them. I wish this wasn’t such a marginalized issue.

  12. It’s nice to know I’m not the only one who has debilitating, gut wrenching cramps. I keep the cramps in check with Advil Liquagels (whoever invented them is a godsend, they take effect in about 10-15 minutes, unlike the 45 mins-1 hour of the regular ibuprofen pills), but I can still feel the cramps behind the ibuprofen barrier trying to break through. However, I can be functional and not curled up in the fetal position on my bed screaming bloody murder feeling like my insides are being ripped apart. I also start mild cramping 1-2 weeks before my period starts which drives me crazy because they are fast, sudden and I never know when they will hit. The pill has helped regulate my period, but has done diddly squat for the cramps. Apparently my mother was the same way. The solution to her cramps from hell? She had a baby and the cramps went away forever.

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  14. I am a female graduate student field biologist. I also have been battling depression for the past three years. While taking my early grad classes and living a pretty normal life I managed ok. I talked to a therapist, I tried anti-depressants, I started mediation. It never really went away, but it was managable. I could take classes and teach and sometimes cry for hours, but I could at least hold off until I was alone. However, living on my field site for the last year brought all of the stress and sadness to a real trigger point. I’ve been lacking in confidence in my work. Somes days it was almost impossible to get out of bed which is doubly impossible when you’re on a strict experimental schedule.

    So (like any good scientist) I decided to do some research. I started mood tracking, I started food tracking, I started menstrual cycle tracking. I started reading articles and psycological literature. And no joke, it turns out that this major depression I’ve been battling and blaming on the stress: its PMDD (a particularly souped up form of PMS). The bad days are ALWAYs ovulation days, with another build up just before menstruation. My doctor agrees that this seems likely. Somehow I never noticed, though I did know I always had a rough time with PMS. I had stopped taking birth control, to give my body a break, just before grad school and all the stress started. As a first step, I tried going back on the pill (which doesn’t always work for all PMDD cases) and I felt SO. MUCH. BETTER. At this point, it could still be a placebo effect. Its only been a couple months. Totally possible. But man, I’d eat a skittle every day for the rest of my life if it helped this much. I don’t even care if I have an increased risk of breast cancer. I was dying every day this summer. Now, I feel more awake than I have in months.

    My advisor has been so incredibly supportive through the many times I’ve cried in front of him. He tells me all the time to rememeber not to stress too much, that there is time. That I should take a day off if I need it. He’s truly fantastic, but I have felt so unprofessional. I can’t tell you how many times I thought I should just quit and go back to working retail. So, now that I’m feeling so much better, I kind of want to tell him, “hey, thanks for being so supportive, I’m really not as unbalanced as I might have seemed, I’m doing better now.” We never really talked about it specifically while it was happening (I was way too embarrassed to bring it up), so it seems strange to talk about it now, when he will likely notice that I’m doing better all on his own. Do any of you have some advice for me? Is this too personal? Is an explaination helpful? Is sooner better than later?

    Thanks so much for bringing up this “TMI” topic. It really helps me to read these stories and know I”m not the only one.

  15. Thank you so much for this post. I’m one of these lucky women with regular periods that are OK. Still, I think this topic deserves way more discussion than it’s currently getting. Thanks for being so open.

  16. It is not normal to have killer cramps. And it is not “just in your head”. Many women suffer from endometriosis but it goes undiagnosed for years, usually until they find a good doctor or they decide to start a family but face fertility problems. I highly recommend you do some research on it; there are lots of resources online, especially at the Endometriosis Association web site.

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  19. You say: “We’re also aware that I’m reaching an age (early thirties) where it may be more difficult to get pregnant at all.”

    You might find this interesting:
    http://www.theatlantic.com/magazine/archive/2013/07/how-long-can-you-wait-to-have-a-baby/309374/?single_page=true

    It’s a text about how our ideas on when it’s too late to have a baby are based on unbelievably inappropriate data: French birth records from the 18th century! The gist of the long text is that it’s still very easy to get pregnant even at 40, though you’re more likely to have a miscarriage.

    Not that I’m advocating waiting (I didn’t; I reasoned that if I can’t handle a baby and science while being a graduate student, I won’t be able to handle it later either), but I believe people shouldn’t base their choices on inaccurate information. Of course, your individual situation may be different, given your relationship with your uterus.

    • Thanks for this link. I have seen a few studies that support the idea that conventional wisdom about conception is outdated, and conceiving is easier than many people think. From that data, I know it won’t be impossible, though it will be more difficult than it would have been, say, a decade ago. Anecdotally, my friends in their mid-thirties all seem to take twelve to sixteen months, and many are resorting to fertility treatments (something I’d like to avoid). I suspect there are complicating factors, like going off a lifetime of hormonal birth control, or PCOS. It certainly doesn’t help that every time I go into the doctor’s office, I get a lecture on my declining fertility!

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