no. 22: when you know, you know (and other myths)

on Big Life Decisions, and the beauty of what is.

As a person who talks about their life on the internet, one of the most common questions I’ve gotten over the past year is how I *knew* I was ready to have a child.

I wish I could tell you that I woke up one day to stunning clarity of purpose, sun shining and birds chirping, and just *knew*.

The reality is that when I was 23 I was forced to consider, at great length and in great detail, the paths that my life could take and what they would look like if it did not include children. Before we get into that, though, we need to go back a little bit further.

On my sixteenth birthday, my life changed. 

For the preceding three years, my period had been uncomfortable but uneventful. That day, however, it was like a switch flipped. In a matter of minutes, the standard discomfort morphed into a blinding, incapacitating pain that lasted for hours. Too weak to stand from cramps and violent nausea, I collapsed in the bathroom of the wrestling tournament I was staffing for the athletic training team. 

Embarrassed, and unable to articulate to the all male coaches and my classmates on the wrestling team what was happening, I scarfed down tylenol from my first aid kit and tried to keep my hands from shaking while I taped ankles and fixed bloody noses until my mom arrived to collect me. 

My monthly cycle became increasingly debilitating as I got older, stealing hours and then days of my life with sudden, unpredictable bouts of pain. I would be laid out for days with a myriad of shifting symptoms: one month it would be migraines and cramping so bad I would vomit, the next it would be lower back pain so severe it I thought it was a sports injury, and then the next could be moderate but manageable discomfort accompanied by positively horrifying mood swings that impacted every element of my life. . 

Despite sleepover grumbling and group chat camaraderie, as far as I could tell, my friends and peers were not having this experience, and so I began to timidly search out answers. I asked first at my pediatrician in high school, and then with increasing intensity at student health in college: this seems abnormal – this cannot possibly be normal?! 

I was told, repeatedly and (occasionally) enthusiastically, that it was just part of being a woman. It is what it is. 

When, dissatisfied with this answer,  I pressed instead about what could be done to manage it better I was encouraged to take hormonal birth control, which I did on two occasions: from 18- 20 and from 21-22. Both attempts reduced the severity of my monthly pain, but worsened the severity of other things including mood and anxiety fluctuations, and the frequency with which I was getting migraines with aura. While attempting to get my migraines under control, I learned from my neurologist that combined hormonal birth control may further increase the risk of stroke, especially for people who get migraines with aura (citation here and here, although some recent studies suggest risk may be lower than originally thought). At the time, I discussed it with my doctors and we determined not to risk it, and that was the end of that. I stopped, and over time the pain returned. 

After college, blessed with supportive roommates who emphasized emphatically that my experiences were decidedly not normal I made an appointment with an OBGYN to be evaluated for endometriosis. I came equipped with the power of my google research notes, prepared to argue my case until I was heard. To her credit, the OBGYN believed me and decided to run some additional tests, including bloodwork and a transvaginal ultrasound.  I’ll spare us all the play by play, but what I will say is this: 

When I was 23 years old, sitting in a cold doctors office in a thin paper gown, clutching a friend's hand, a doctor probed me with the ultrasound and rattled off life changing information like it was the weather report. In a daze, I learned that not only did I likely have endometriosis, but that I also, definitely, absolutely had polycystic ovary syndrome (PCOS).  

That appointment, and the ones that followed were a blur. It’s hard to remember specifics, but the thing I do remember is that I was told early, often, and emphatically that when it came time, it would likely be difficult for me to conceive – if it was possible at all.