Burdens we were never meant to carry

(Note: if you didn’t read last week’s post on the good, the bad, and the ugly of NFP, you might want to start there.)

A couple years ago, I asked my Ob/Gyn about antidepressants that would not screw up my cycles, because perimenopause was already causing enough havoc. He said, “We could try X or X, but first we should look at hormone levels, because that’s the most likely culprit.”

Now, I’ve been taking bio-identical progesterone for over twenty years (10 days a month starting on Peak + 3, a classic Napro technology treatment.) I began it alongside metformin as part of infertility treatment in the early 2000s.

But my new (non-NFP) practice wanted me to take it all the time, not just post-ovulation.

I said, “No thanks.” In sympto-thermal NFP we look for a sustained temperature rise to confirm post-ovulation infertility, and progesterone is what causes that rise. So if I were to take progesterone all the time, how would I ever know what was really happening? Perimenopause is hard enough as it is.

Besides, in online NFP forums, people are constantly warning that taking progesterone around the cycle is the same as taking birth control, because it can suppress ovulation.

So I kept on keeping on… until things really went bonkers.

There came a cycle where I had no signs at all, and I never was able to start taking post-peak progesterone.

During the month that followed, my mental health was BAD. There came a day when I was as low, emotionally, as I have been since I was twelve years old and thought everyone would be better off if I just died.

(Hint: the fact that mental health was so far off the cultural radar that 12-year-old me had no idea that thought was a sign of needing help? That’s something that has profoundly shaped my own approach to parenting. We believe in therapy and medication in our household, and we DON’T believe there’s anything embarrassing about seeking it.)

I was in a bad, bad place: resenting everyone and everything. Husband, kids, professional connections. I looked at the world and saw no cause for hope at all.

And I thought, “I have to ask for help RIGHT NOW.”

But as I was getting ready to pick up the phone, I remembered where I was in my cycle, and the fact that I had gone a month without progesterone supplementation for the first time in twenty-plus years, and (probably not coincidentally) now I was on another cycle where the temperatures were lagging. I’d had one day of temperature rise; I needed two more to start my progesterone regimen.

I thought, “This may be hormonal. I’m going to wait and see what happens when I start progesterone.”

Two days later, the chart finally gave me the go-ahead. I took the caplet at bedtime, and when I woke up in the morning, the whole world felt different. All the same realities, but I was just so much better able to grapple with them.

I thought of my doctor saying that the first line of defense for mental health at my age is hormone replacement therapy, not antidepressants.

I thought of the community of NFPers crying out against using hormones this way because it could suppress ovulation and that would be a sin.

The next month, I had an unbelievably long cycle. In the middle of it, I had an ultrasound done. The doctor pointed to a shadow on the screen and said, “That right there is evidence of an ovulation, but it’s at least two months old. At LEAST.”

All these things came together, and I thought, “What the heck? I’m not even ovulating anyway most of the time, even without progesterone support. Why on earth am I freaking out about suppressing ovulation? We are specifically talking about using this as a treatment for a medical condition—depression/anxiety—that is causing harm to me and my family. AND I’M PROBABLY NOT OVULATING ANYWAY!!!!”

The upshot was that shortly thereafter, I started taking a low dose of progesterone every day and a high dose post-peak. Since then, I’ve tracked temperatures throughout the cycle (intermittently, but enough to see the pattern). Would you like to know what impact round-the-cycle progesterone has on the temperatures that guide my husband’s and my fertility discernments?

None.

If anything, over the past year, my temperatures have stabilized into a more readable pattern.

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At the same time all this was unfolding, RFK Jr. gave that press conference trying to convince everyone that taking Tylenol in pregnancy causes autism. ACOG, organizations of mental health professionals, and well, everyone who actually knows anything about medicine, said, “The science does not back up what RFK is saying. There is no connection here.”

But that hardly matters these days, when a certain swath of the population is willing to accept absolutely anything from the mouths of their demagogues as Gospel truth, no matter how many times it’s proven false.

All this got me to thinking about the burdens we place upon people.

Jesus absolutely excoriated the religious authorities of his day for tying up heavy burdens, hard to carry, and not lifting a finger to help carry them.

It strikes me that scrupulosity around avoiding hormone replacement therapy during perimenopause out of a fear of it acting as a contraceptive, even though we’re likely hardly ovulating at all already, equals tying up heavy burdens, hard to carry, and not lifting a finger to help carry them.

Likewise, it seems clear to me that taking away the ONLY painkiller available to women in pregnancy is a huge burden being placed without good reason (i.e. solid science). It is particularly unconscionable from people who want to encourage women to be open to life. Instead of doing what public policy can do to make pregnancy less burdensome, this adds more.

And to this, I’ll add one more example.

If you’d asked me ten years ago, I would have said I didn’t believe there is a situation where hormonal birth control is really necessary. Birth control is a Bandaid that gets slapped on everything without addressing the underlying cause of whatever is causing a doctor to prescribe it. This causes unnecessary heartache for many women whose cycles are telling them there is a medical problem long before they start trying to have kids and can’t.

It is better medicine—more respectful of human dignity—to dig down and figure out what’s going on with the body and fix it than it is to slap the Bandaid of birth control on top and hope things magically resolve in the background. (Magical thinking, anyone?)

Likewise, nobody has ANY FREAKING IDEA what to do about perimenopause, because it’s so profoundly under-researched. There was no reason to study it, because women have been using birth control for sixty-odd years now. Why bother?

BUT.

Shepherding a young woman with intellectual disability through adolescence and into adulthood has been eye-opening for me. Self-care around menstruation is no small thing for anyone, let alone someone with a cognitive disability. And when you add baffling cyclic problems—near-constant bleeding, two days on, three days off, ten days on, four days off—it quickly becomes a huge, huge burden on everyone.

There’s got to be a cause, and of course we’d rather figure out what that cause is and fix it. And yes, NFP is the single best tool to figure out what that cause is.

But the care, consistency, and nuance required to make NFP observations and report them is beyond some girls and women. After five (six?) years of trying to find answers and a solution without hormonal birth control, I finally realized God was patting me on the head and saying, “Honey, it’s okay. You can lay down this burden. I never asked you to bear it.”

Yes, the world would be easier if we could just say “birth control is always wrong.” If it was that black and white. But it’s not.

Discernment is the work of discipleship.

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