A second D&C

Saturday (Dec 18, 2010) I had a D&C 10 days after my Mirena IUD was removed, and 7 days into heavy bleeding following that removal.

Mirena works in few ways–

Both the ParaGard and the Mirena IUDs affect the way sperm move, preventing them from joining with an egg. If sperm cannot join with an egg, pregnancy cannot happen. Both types also alter the lining of the uterus. Some people say that this keeps a fertilized egg from attaching to the lining of the uterus. But there is no proof that this actually happens.

The progestin in the Mirena IUD helps prevent pregnancy. Progestin works by keeping a woman’s ovaries from releasing eggs — ovulation. Pregnancy cannot happen if there is no egg to join with sperm. Progestin also prevents pregnancy by thickening a woman’s cervical mucus. The mucus blocks sperm and keeps it from joining with an egg.

source–planned parenthood

Progestin, in short, tricks your body into thinking you’re already pregnant.  For most women, though, this keeps their uterine lining thin/normal.  In my case, I grew a very thick uterine wall (again, this is VERY VERY VERY rare).

I posted before that I was having a frightening level of bleeding post-removal.  On Friday, I started to meet the definition of hemorraghe (I bled through a pad in an hour) and I was passing tons of very large blood clots.  I called the OB who had removed it, again (this was the second time I’d expressed concern…the first was on day three/four) expressing that I felt I was having an abnormal reaction.  His suggestion was that I come in and get a depo shot (a shot of the same hormone which I now know was causing the issues at the root of the bleeding)…I was also given a heaping helping of condescension and head patting for being a silly girl.

I got an emergency gyn appointment with a different doctor.  Who also offered the depo shot, but only if the ultrasound didn’t show any reason for the bleeding.

The ultra sound showed a very heavy lining and what could either be a very large clot or a polyp.

An urgent appointment for a D&C was scheduled for first thing the following morning (about 15 hours post-appointment).  Which is good as I was starting to suffer side effects from the blood loss, like light-headedness and weakness.

Today I had my second D&C.  My first was following the start of my miscarriage with Hope, a little over three years ago.

It’s funny how different and similar the two experiences are.  Similar in that the procedure was the same–my cervix was opened, my uterus was scraped clean, I was unconscious for the procedure.  Different because unlike then, there was no grief–I didn’t lose a baby today, I just had a gyn procedure to keep me safe.

I’ll talk more about this on the Expat Bostonians blog on Monday or Tuesday, but the worst part of my experience today was that the facilities in Singapore are not size-friendly.  Too-small facilities that hurt me during the ultrasound, too-small panties I couldn’t slide up my thighs…all were constant sources of humiliation and shame when I was already struggling to find my inner strength. Having to beg for pain killers didn’t help…I lay in the recovery room crying, practically curling into the fetal position in intense pain for I don’t know how long begging for vicodin (which they don’t have in Singapore).  They tracked down my doctor who came in and expressed her shock that I was in pain, but who finally prescribed Tramadol (similar to Percoset/Vicodin) for the pain.

Just as before, the D&C takes trying to conceive off the table for two periods.  Which I’m okay with.  I need to find a good team here, and while it all sort of worked out (and I’d be pissed if I’d found the right team and then had this happen), it was foolish to get it removed before I had a solid endocrinology team in place.  Ironically this means we’ll be starting around when we’d though the earliest we “should” try was back when I cared about my 10 year college reunion and thought I knew people in my year (it turns out I don’t)–around March (I have long menstrual cycles–35 days with ovulation around day 21/22).  March is also when we’ll find out what Ravi’s bonus will be and if I decide that giving birth here isn’t what is going to work for me (more on that Monday or Tuesday–I’m coming to some realizations that I’m struggling with) we’ll know if we can afford a pregnancy/US birth in 2011.

Some friends have asked if I’m angry that I wasn’t warned about this before getting the Mirena.  I wish someone HAD said something, but I’m unclear on exactly how rare this reaction is.  Certainly none of the reputable sources talk about it…and while Bayer/Mirena’s sites have no reason to advertise it, Planned Parenthood and other reliable sex education/contraception pages have no reason to hide it as a commonly reported problem (if it were, which I’m told it’s not).

Honestly, I loved my Mirena.  Even knowing I might need another D&C, I’d consider getting it (or switching to the non-hormonal copper IUD, Paraguard) again while I think seriously about the Essure sterilization procedure after kid #2.

I would still recommend it to anyone.  I can’t emphasize how much this is an abnormal reaction.  Most women would not have this particular issue.  But then, I’ve never been accused of being “normal.”

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