2013 July 28
At 63 Years Old
Before I begin what will likely be a rant, perhaps a little background information is in order. I have been happily menopausal/post menopausal for about nine years. That in itself will give you some indication of what this rant will encompass, so if you are offended by discourse regarding female issues, stop reading NOW!
My reproductive system has never really been user friendly. I have endured PMS, infertility, arrogant fertility specialists, and assorted surgeries, pains and discomforts over the years. Once having come to terms with all of the challenges offered up on a monthly basis by my uterus, ovaries and fallopian tubes, I settled in, and learned to "tell time" by the passing of each menstrual cycle. If nothing else worked well in that system, it was, at least, regular as clockwork. For me, a month was the length of time from the beginning of one cycle to the next.
When menopause began, I actually felt a little sad, in spite of the tempestuous relationship with my lady parts, because it required me to rethink my time passage measurement. But, as women always do, I adjusted. And I cruised along becoming comfortable with a new season of my life.
In many ways, a very pleasant season. No cramps, no mood swings, no sudden gushes during a period caused by doing something strenuous, like lifting something heavy no unexplained cravings for chocolate, no emotional outbursts - none of those unpleasant, annoying aspects of womanhood. Learning a new way, albeit "normal" way to measure time transit seemed little to take on in exchange for loosing so many annoying things.
So, in this new found freedom, I have cruised through the past nine years. Granted, my family doctor, who does my pelvic exams, would occasionally bug me about a uterine polyp with which she was concerned. Mostly, I have been able to ignore her. However, once we were in Pittsburgh for an extended period this late winter into early summer, I could ignore her no longer. (The reason I was ignoring her requests to have the polyp checked was that it required me to visit the gynecologist whom I did not like. And because I was too lazy to seek out a different gynecologist) To placate her, more than for any other reason, I scheduled an appointment with the dreaded gynecologist.
Poor Raymond. I made him go with me, even into the exam room. To my dismay, his impression was that, "he seems like a nice guy". That really isn't relevant, though. The initial exam, concurred with my PCP's concerns, and I was scheduled for a procedure, to remove the polyp and biopsy it and my uterine lining, with was "too thick for someone so far post menopausal". Suddenly the lovely period of detente between the lady parts and I was at risk.
The polyp was removed and was benign, as was the too thick uterine lining. It seems that although I am indeed post menopausal, my ovaries are producing more estrogen than is considered normal, which in turn, causes a thickened uterine lining. Both the gyne and my PCP are concerned that left to its own devices, this lining might decide to evolve into uterine cancer at some point. In order to combat that possible issue, they both thought (think) I should follow a course of treatment that would require me to take 10mg of Provera (a hormone my menopausal self no longer produces ~ progesterone) for ten days at the beginning of each month for three months. In fairness, the gynecologist wanted me to take it for June/July/August, but I didn't start it in June, as I waited until I talked to my PCP, to get her take on it. Since I trust her, and since she seemed to make a case for taking it, I acquiesced, and decided to move the treatment to July/August/September. Since my next appointment with the gynecologist isn't until late September, I figured it really didn't matter.
So, on July 1, I began my first month taking Provera. The doctor had warned me that if I had been prone to PMS symptoms, they could return with this medication. PMS would've been welcome! Instead, I became a screaming, psychopathic, irritable bitch! There is no other word for it! It was as if my evil twin had taken up residence and even though I wanted to, I could NOT evict her. I hated everything and everyone! I was critical of everything Raymond did or didn't do. I was cranky beyond measure. I cried or yelled, more or less constantly. Everything and everyone irritated me to the point that I wanted to slap them, or worse. In a word, I was UGLY! I was SO UGLY that I couldn't even stand myself! It seemed like the longest ten days of my life! I can only guess how long it felt to my poor husband.
In the midst of the early days of July on Provera, I also began a course of Medrol (a steroid - yet another hormone!) this one for the treatment of the severe arthritic changes in my cervical spine which were causing problems with a nerve root. I asked the pharmacist if this would interact with progesterone which was already recking havoc with my personality. He said that it might "intensify" things for the first few days, but somehow thought it reassured me when he told me, "it's really not a 'you' thing - it happens to everyone taking progesterone". I was not comforted!
The pharmacist was correct, though, as the steroid for the arthritic stuff didn't seem to effect me as badly as the other hormone.
Finally, day ten arrived. No more Provera. Thank you, Lord! I won't say I mellowed out immediately, but there was light at the end of that tunnel.
Remember the joke about the light at the end of the tunnel being the oncoming train? Yep, there it was three days later, as promised by the gyne, the light at the end of the tunnel that turned out to be my first period in nine, did you hear me? NINE!!!! years! While I knew this was the expected outcome resulting from dumping progesterone in my body, it still came as a general shock to my 63 three year old system!
Let me say this as simply as I can: at 63 I am too old to be standing in line buying tampons and pads! Granted the whole period was over in five days, but it sucked! I don't want to have a period at 63! especially after not having one for 9 years! The whole process, from the crazy irritable person inhabiting my body, to the shedding of excess uterine lining, to finally staring to feel human again took up more than half the month of July! I don't want to repeat that process in August and September!
Yesterday, while driving to Adams, NY, Raymond and I were discussing all of this. I said that I was leaning toward stopping the Provera. He was enthusiastic in his support. Until he questioned why I was doing it in the first place. When I explained to him that the doctors were concerned about the thickened uterine lining developing into uterine cancer, he suddenly had a change of heart, and thought I should take the remaining course of Provera, in spite of the maniac we both fear I will temporarily become.
I'm still not convinced. As I told Raymond, if I'm 63 and on a scale of 0 to 10, with 0 being no chance of cancer and 10 being cancer, I am at 1.5, and if I have been at 1.5 for at least 9 years, what are the odds that I will develop cancer? And if I do, couldn't they just yank my uterus? Raymond's response was to question whether that type of cancer would spread if it did develop.
So… here I sit, just a few days away from the beginning of the next month with no idea what I am going to do. Take it, or not, that is the question. I do not want to become a screaming mimi for for the first ten days of August. I also do not want to deal with having another period. I hate the whole process. It feels so unnatural. Yet, I certainly do not want to develop uterine cancer. But the question remains, if I have had a thickened uterine lining for the past nine years without it being positive for cancer (it has been pre-cancerous - but NEGATIVE for actual cancer cells), what are the odds that I WILL develop cancer? I don't want to tempt fate. I have been down the cancer road with my bladder and am grateful for how contained any abnormal cell growth there has been.
I'm thinking phone calls to both docs are in order tomorrow. Perhaps the severity of my reaction to Provera will decrease with each consecutive month. Perhaps it won't. I need some straight answers and NOT simply, being told this is what we generally do. In spite of the song, I am NOT every women! I am an individual and perhaps this is not the course of treatment for me. I certainly don't want to take medication that in the long run, may not really have any effect. But, on the other hand, I don't want to see my uterine lining morph into cancer. What's a 63 year old to do?
Oh! and just a little side note. When I asked the gyne if we couldn't just do a hysterectomy, back in April, his response was, "I can't in good conscience take out healthy tissue." So, if it's healthy, why am I taking Provera and scheduled for yet another biopsy in September? It all seems rather convoluted to me.
Perhaps I should've called him while I was harboring my angry twin during those early weeks in July.