Boom Shake the Womb!

March 16, 2017March 17, 2017 / Endo Lady UK / 10 Comments

A guest post by @LizzieBennett_ for endometriosis awareness month.

Life Lesson by Don Raye
The fierce wind rages
And I see how trees survive
They have learned to bend

Before

I’m 13 and I’m being prescribed the pill for irregular, painful bleeding. Apparently my cycle just needs to settle down.

I’m 14 and I’m being rushed into hospital to have my appendix removed. Only when it comes out it looks like it isn’t the culprit after all.

I’m 15 and I’m put on the contraceptive injection because I’m still bleeding for two weeks at a time and being physically sick from the pain.

I’m 17 and I’m asleep on my mum’s bathroom floor for the second night in a row, because the cold floor is the only thing that will ease the pain in my lower back and I may as well be somewhere that I can vomit.

I’m 18 and I finally see a consultant. I’m too young to have endometriosis she assures me, but after pressure from my mum she agrees to do the operation to rule it out so that we can focus on the other ‘much more likely’ causes. She gives me surgery for a bet.

I’m 18 and she pulls back the curtain after my surgery to inform me without kindness that they did find endometriosis on the back of my womb. It is now removed and she’ll see me for a follow up. She never did and I did not receive the slightest advice on how to manage an incurable chronic condition. Everything I ever learnt is from charity websites and women’s magazines. I have never underestimated Marie Claire.

I’m 20 and I’m back to bleeding for weeks at a time. I’m informed that further surgery should be a last resort and I need to find hormonal alternatives. They give me the implant.

I’m 22 and the implant has to be swapped because it’s not longer effective. Surgery is not an option.

I’m 24 and the implant has to be swapped because it’s not longer effective. Surgery is not an option.

I’m 27 and I bleed for eight weeks over Christmas and New Year. I’m extremely bloated, and uncomfortable. I have a constant bearing down sensation in my back and cramps in my legs. I often cannot get out of foetal position because of the pain. I’m exhausted and I find it difficult to open my eyes in the morning; I worry that I am becoming depressed. My anxiety is through the roof, but who can blame me when my whole body feels like it’s against me?

I’m 27 and I’m seeing a private consultant. I’ve been unable to move from my bed and have been experiencing labour pains when I bleed. The pain is now also present when I don’t bleed. I’m asked to rate the quality of my life. I circle ‘0’.

I’m 27 and the consultant shows me pictures of my womb. She’s removed endometriosis covering the left side of my womb and the pouch of Douglas. My womb collapses when it is touched, the muscles have deteriorated. She suspects adenomyosis. As my mum is crying next to me all I can think is ‘Thank God someone believes me, thank god it’s not all in my head’.

I’m 28. It’s the day before my best friend’s wedding and I can’t stand up straight because of the pain. I’m so tired from not sleeping that my vision has started to blur. I manage the pain with tramadol, codeine, and jäger bombs, but I know I was close to not being able to be there. I consider how much more I am willing to miss for this disease.

I’m 28 and I’ve decided to have a hysterectomy. I’m on a drug that has shut down my pituitary gland. I am so sick I honestly feel like I am dying. Someone asks me what I do all day now that I can’t work and I’ve had to take a leave of absence from my PhD. I survive, I tell them, every ounce of my energy from the second I wake up to the second I go to sleep goes into surviving. I google my first consultant for my PALS report and it transpires she is writing a book on cultivating ‘compassion’ in the NHS. Yep. Compassion.

I’m 28 and I’m doing the compulsory pregnancy test before my hysterectomy. The fact that I haven’t had sex with anyone for two years apparently doesn’t mean I can skip it. I’m at peace with having family in whatever way it comes, but I can’t help but remember the daydream I’ve said since I was a teenager of waiting for my partner to come home and greeting him with the test in my hand and hugging each other with mad joy. Tears fall silently down my face in the starkly lit toilet, whilst I pee on a stick. No hope of a positive test. No partner.

After

One of things that I did not expect after my operation were the irrational feelings occasioned by the trauma of my muscles inside. I had read that sometimes your other organs go into shock at the removal of the womb, but I hadn’t been prepared for my body literally feeling like I had given birth. In semi-lucid moments in those first couple of weeks I would wake up reaching my arms out and wanting my baby. It was, even for someone not naturally broody, pretty horrific.

For the next few months after the operation I would quite often have to leave nights out, or lunch dates, early to cry. I wondered if this was a delayed grief, but in retrospect I think it was a combination of extreme tiredness and sheer, abject relief. Relief that I had made it through those long months, relief to be past the fear of the operating room, and relief to finally have my body back on my side after 15 years.

Probably one of the hardest things about my illness as young women has been painful sex, and bleeding during or after it. On top of which, the irregularity of my periods has always meant that I could come on at any time. So on a date when the glasses are being cleared from the table, and they’ve inched their chair over, and I’m laughing and playing with my hair, and they say do you fancy coming back to mine for a drink? My first thought has never been ‘get in’, or ‘I thought you’d never ask’, but ‘have I got sanitary stuff with me?’ Or ‘what if I bleed in the middle or it, or in the night if I stay?’ And if this doesn’t put me off entirely, it means that I look like I got incontinence issues, because I constantly go to the loo to check that I haven’t started gushing blood at various stages of what should be that amazing/awkward/disappointing first hook up.

No one wants Jaws the movie on their first date.

Then, let’s say it goes all right, and you find someone brilliant and understanding. Those things don’t just go away. It’s never going to be fun for someone to feel like they are hurting you when you are being intimate. Sex becomes bound up with worry. I have found that this means that I hold something of myself back during the moment. People sense when they are not getting all of you, and it has implications.

I am now one of the lucky ones. However, there are still consequences for the rest of my life. All of the literature for post-hysterectomy sex is geared towards intercourse with your ‘loving husband’. I’m 28. It could very likely be an intoxicated encounter with a tinder date. Even once I’m passed the initial terror of being naked with someone again, at what date do I casually slip in that I can’t have children the conventional way? Admittedly I was ambivalent beforehand, but ambivalence is a topic that can wait. None of this means that it was the wrong decision; I feel extraordinarily well and happy and optimistic about the future. However, the right decisions are still hard decisions.

So, why am I writing this? Because one of the most important things anyone can do to raise awareness is to tell their story, and for others to share the stories that women tell. It legitimates the experience of women with endometriosis. It sends a message to young girls to trust their bodies. And, hopefully, it may give them the strength to persist with getting a diagnosis when they are told that it’s just ‘normal period pains’.

I can assure you – nothing about my young life with this disease was normal.

As well as difficulties I have faced, I have been lucky enough to also receive fantastic care and wonderful acts of kindness. From the nurse who took my blood and told me we have to make decisions that are right for us at the time, to the porter who held my hand as he wheeled the trolley in to the operating theatre, and the physiotherapist who spent an hour with me before my operation and made everything about those bruising, brutal first two weeks of recovery a bit more bearable.

I have seen great changes in the last ten years in the way that endometriosis is spoken about and treated, and I look forward to the seeing what is achieved next ten years. However, I am aware that for some women it is already too late. These women have met the loss of hopes, dreams, jobs, and relationships with bravery and grace. This piece is written for them.

For further information or for anyone who would like to support or donate to a charity during endometriosis awareness month:

https://www.endometriosis-uk.org/

http://www.adenomyosisadviceassociation.org/

http://www.hystersisters.com/

Elizabeth Bennett is a folk singing, footpath walking, gin drinking PhD student. Having been diagnosed with endometriosis at 18 after 5 years of G.P. appointments, she took the decision to have her uterus, cervix, and fallopian tubes removed at 28, in order to regain her health and restore a sense of self. With her brilliant friends and family she had a stitch and bitch hysterectomy party ‘Boom Shake the Womb’. She has not met Mr Darcy yet, but she has a sneaking suspicion he may arrive in the form of a Sussex Spaniel.

You can tweet Elizabeth at @LizzieBennett_

Have a story to share? Email me at endomyworld@gmail.com

Adenomyosis: A one way ticket to hysterectomy?

April 14, 2016April 14, 2016 / Endo Lady UK / 48 Comments

Did you know that April is Adenomyosis awareness month?

I was diagnosed with this disease in August 2014, on the same day that I was also diagnosed with endometriosis. It really wasn’t my greatest day- but it did explain rather a lot. Like many people I had never even heard of adenomyosis before, so I was very taken aback to find out that I have it. Adeno-what?! When I wanted to learn more about this mystery illness that had been wrecking havoc on my insides, a quick internet search revealed (rather depressingly) that adenomyosis a) is the lesser understood evil cousin of endometriosis (and that is certainly saying something!), and b) is a leading cause of hysterectomy.

This hysterectomy factoid really bothered me from the start. It may be some form of Stockholm Syndrome, but I am really attached to all my lady parts and am not keen to loose them. However, reading about the experiences of other women with the disease on internet forums made me feel like having a hysterectomy is an inevitable part of my future. They describe the disease growing stronger until it takes over your life. Now don’t get me wrong, I want all women to feel empowered to make the choices that are right for them, and if a hysterectomy is going to relieve suffering then that’s great. But for a long time I lived in a state of panic, like my uterus is a ticking time-bomb waiting to explode. I tell myself that those joining support forums or having hysterectomies are those who have been worse affected by the disease, and may not be representative of the majority of women with adenomyosis.

I’ve gotten bored of living in fear and feeling that I have no control over what is happening to my body. I have written this post to answer some of the questions I am frequently asked about my experiences with adenomyosis, to try and figure out what may be waiting for me in the future, and to help raise awareness for this often debilitating much overlooked disease.

What is adenomyosis?

Adenomyosis is a benign chronic disease where the lining of the uterus (endometrium) grows into the muscle layer of the uterus (myometrium). This can happen diffusely throughout the uterus-appearing as little specks, or can lead to the formation of larger growths called adenomyomas.

What does adenomyosis feel like?
Having endometriosis in addition to adenomyosis, I used to find it difficult to determine precisely which symptoms were caused by each disease. Since having my endometriosis surgically excised I believe I now have a much clearer understanding of the effects that adenomyosis has on my body. It’s important to note though that each person experiences of disease is unique- how adenomyosis affects me may be completely different for somebody else.

For me, adenomyosis feels like a red hot poker is being slowly stabbed into my uterus over and over again. This used to only happen during my period, but now it strikes any time in my cycle. It’s basically uterus Armageddon. The disease also leads to a dull but intense aching sensation which radiates to my lower back and thighs. Like many women with the disease I also experience heavy periods with the presence of many clots, some of which are very large. I once had a clot the size of an egg- it was horrifying. I’ve tracked my periods since puberty and they have certainly become progressively heavier and more painful over the years.

A myriad of other symptoms have also been associated with adenomyosis. I have certainly experienced many of them to greater of lesser degrees, such as fatigue, aching joints, bloating, and a general feeling of malaise. Adenomyosis can also compromise bowel and bladder function, lead to anemia (from the prolonged heavy bleeding), and has been tentatively linked to depression. It’s effect on fertility is currently unclear as there has been little research on the subject, and the work that has been done is often confounded by the women also having a diagnosis of endometriosis. However, the general feeling appears to be that adenomyosis can negatively impact upon fertility outcomes, we just aren’t clear precisely why or how this is.

Over time adenomyosis can also cause the uterus to grow, and it can become extremely enlarged. This leads to severe abdominal swelling, making the it appear as though the woman is pregnant. I’ve had strangers ask me if I’m pregnant. It’s really upsetting, especially if you’re worrying about your fertility anyway.

Yeah..pretty much this.

Who gets adenomyosis?
If you read any published source on this disease it is likely to tell you that it primarily affects women in their late thirties and forties who have had multiple children. However, evidence is increasingly emerging that younger women can be affected by the disease, even young teenagers. Explore any online forum for adenomyosis and there are many women in their early twenties affected. I’m affected, I was diagnosed at 26 at it had clearly been going on inside me for quite a while.

It is likely that this age bias in the scientific literature stems from the fact diagnosis often relies on hysterectomy, and that women in their forties who have completed child bearing are more likely to take this option/ or be granted permission to take this option by their doctors.

My take home message here is that anybody with a uterus could have adenomyosis. If you have concerns about this based on your symptoms speak to your GP and request a referral to a gynecologist.

How is adenomyosis diagnosed?
I was initially diagnosed with adenomyosis during a laparoscopy in August 2014. After I woke from the anesthetic, my surgeon spent a long time detailing the numerous organs my endometriosis had damaged, and then ended her soliloquy with ”and you have a lumpy uterus”. No further explanation was provided and the term ‘adenomyosis’ itself was not mentioned, which really annoys me.

Fast forward six months and I am mid way through a trans-vaginal ultrasound at an endometriosis specialist center when the doctor says ”…and you have adenomyosis”. She said this so casually, like it was nothing. I’d pretty much worked this out from my own research following the whole ”lumpy uterus” comment, but it was still a huge blow and I cried my eyes out totally melodramatically for the rest of the day.

A historical reason why adenomyosis has been difficult to overlook is that is required examination of the uterus post-hysterectomy for a definitive diagnosis to be made. However, progress with scanning technologies, particularly MRI, means that adenomyosis is increasingly being diagnosed without the need for hysterectomy, and can be accurately distinguished from similar conditions such as fibroids or leiomyoma.

Obligatory stock photo of a woman with period pain.

Obligatory ridiculous stock photo of a woman with period pain. She isn’t swearing and crying?!

Is there a cure?
A hysterectomy will cure adenomyosis. Since it only affects the tissue within the uterus, removing this organ solves the problem.

It’s clearly great that we do technically have a cure, unlike endometriosis which has none. However, hysterectomy clearly isn’t ideal and a better solution is required which doesn’t take such a huge physical toll on the body or cause infertility. I am still hoping to have children soon, so ripping out my uterus really isn’t an option right now. Since I can’t use hormones (such as the pill or mirena coil) which can be used to help manage adenomyosis, I am effectively forced live with symptoms for the foreseeable future.

Getting worse each month.
Image credit: The Wondering Womb

What other treatment options are available?
Before taking the plunge and opting for a hysterectomy, there are alternatives you can try- that’s the good news. The bad news is most have limited success rates and lack rigorous scientific evaluation. Unfortunately, these techniques are also rarely recommend for women who still wish to conceive in the future, as they risk causing damage to the uterus. I have very briefly summarized some of the most commonly used options below. For more information check out the links here and here.

Endometrial ablation: A procedure that destroys or removes the uterus lining (the endometrium). This prevents any further bleeding (or bleeding is reduced to light spotting) in the hope of preventing further progression of adenomyosis over time. This procedure is offered to women seeking to avoid hysterectomy, but is clearly not an option for women seeking to preserve their fertility.

Myometrial/ adenomyoma excision: If the location of the adenomyosis can be determined through scanning on MRI or ultrasound etc, then it is possible for the diseased tissue to be surgically cut out (excised). This technique is only possible if the adenomyosis has not spread to a high proportion of the uterus. Due to difficulties with defining the margins of the adenomyosis the success rate of this procedure is currently estimated to be less than 50%.

Myometrial electrocoagulation: This procedure has the ability to shrink adenomyosis deposits within the myometrium. It is carried out during a laparoscopic surgery, and using electrical current in the form of heat to destroy the adenomyosis deposits. However, this procedure is deemed less effective overall than excision owing to the fact that it is difficult to determine when the current has completed it’s work, risking diseased tissue being left behind.

Magenetic resonance-guided focused ultrasound: This is similar to myometrial electrocoagulation, using heat to destroy adenomyosis tissue. However, it has the additional advantage of being more greatly focused so that less damaged occurs to healthy surrounding tissue. However, this treatment approach is fairly new for use with people who have adenomyosis, and further research is required to ascertain its full impact.

What treatments have I tried?
I was taking the oral contraceptive pill for 8 of the last 10 years. It certainly helped to suppress many of my symptoms, although the disease was still spreading inside of me. I am not currently taking any medication or undergoing treatment as I am trying to conceive. As a consequence I often worry that my adenomyosis is getting worse with each period.

Why are you so annoyed about this?
On a personal level I am so and upset that I have to battle with another disease (on top on my endometriosis, chronic fatigue, and depression) to contend with. It just seems so unfair, but I know that’s how life is sometimes, so I’m trying to deal with it as best I can. As with my endometriosis, I am constantly frustrated that nobody has heard of adenomyosis- which basically means you get zero sympathy. Not that I really care about sympathy, but feeling understood and supported makes such a difference to living well with any chronic condition.

The lack of awareness has a more significant and darker impact than on just myself and is so damaging to women everywhere; it means there is limited research funding, no charity to advocate for us (at least this is so in the UK), and treatment options that come with extreme side effects and/or impact on the body. When you Google adenomyosis, speak to your GP about it, or delve into the research literature you basically get this response:

The unanswered questions about this disease are fundamental and numerous.

This simply isn’t good enough. I even had to explain to my GP what adenomyosis is! I mentioned to a fellow endo sister that I have it and she replied with the perfect and sensitive comment: ”I am so sorry.” Not ”What’s that?” or ”I think my cousins sisters aunts daughter had that!”, or a <silence, blank expression>. Her response actually took me by surprise, and I realised it’s because I have never really received any compassion since my diagnosis, nor given any to myself. Most of my family and friends can’t even pronounce adenomyosis. Seriously- if you want to support your loved ones and at least appear interested LEARN TO PRONOUNCE THEIR DISEASE please people!

We deserve so much better than this state of affairs. There are so many of us fighting adenomyosis on a daily basis in relative silence. We will continue to do so, and if I am brutally honest at times it’s pretty difficult to hope that things will be better for us any time soon. April is Adenomyosis awareness month, and I am finally ready to start speaking up. Are you?

Where can I find out more?
These resources have all proved useful to me for researching about this condition.
Review article by Taran, Stweart, & Brucker (2013)
Endopeadia
The Endo Patients Survival Guide
Adenomyosis Advice Association
Adenomyosis Fighters

So that’s my adenomyosis story. It isn’t pretty, and I’m not sure if a happy ending is on the horizon. Maybe a hysterectomy will be a part of my future, but maybe it won’t. Until then, I plan to keep fighting and making the decisions that are best for my body and mental wellbeing. I would love to hear about your experiences and thoughts on this disease. What symptoms do you have? What treatments have you tried? And, what have you accomplished in spite of this disease?

Love,
Claire
xx