Welcome to part 4 of this blog’s longest-running series: Pill-o-talk. The series in which I stopped taking the pill (nl), got a copper IUD (nl), had it removed again almost immediately, went back on the pill, and eventually had my fallopian tubes removed. All’s well that ends well? Well, you’re reading part 4, so… no.

Some foreshadowing can already be found in part 3. During my surgery, the doctor discovered endometriosis and removed it. I was actually kind of annoyed about that at the time, because it had been done without my consent. Not that endometriosis is exactly fun to have, but removing it can in turn lead to scar tissue, adhesions, and other complications.

But let me start with the good news: after my surgery and the removal of the endometriosis, my bowel problems improved significantly. For several years, I had been dealing with mysterious cramps that would sometimes send me running to the bathroom. Because of this, I often felt anxious and preferred not to go too far from home – or rather, too far from a toilet. Long bus rides, being stuck in traffic, or other places without (comfortable) bathroom access would make me panic. Of course, everyone and their mother told me these symptoms were psychological, that they were mainly caused by stress. It’s true that stress made things worse, but it turned out that my anxiety was actually justified.

Now for the bad news: almost immediately after the surgery, I couldn’t pee comfortably anymore. It felt… different. As if there was no clear end to it. As if the last drop was always left behind. I assumed this was caused by the catheter they had inserted during the operation. That probably hadn’t been done very gently, so it likely just needed time to heal. But then came urinary tract infection number one, urinary tract infection number two, urinary tract infection number three… Suddenly, I was taking more antibiotics than I ever had before.

But it wasn’t just the urinary tract infections. The whole area felt off. The closer I got to my period, the worse it felt. As if the full weight of my uterus was pressing down on my bladder and bowels.

When Charlotte came to stay last October, I felt so awful that I went to the hospital. They promptly sent me away, after which I found an English-speaking clinic. The gynecologist there had mixed reviews. Some people liked her because you could always get an appointment quickly and be back out the door with your medication within five minutes. Others thought she was terrible because you’re back out the door with your medication within five minutes. And I have to admit, she doesn’t exactly dig very deep. I had a urinary tract infection, so I got antibiotics. Fine, great, I needed those – but what was the actual problem?

By now, I’ve developed a working theory, and it goes something like this: in the years after my surgery, when I wasn’t using any hormones and my cycle was wonderfully stable, the endometriosis gradually returned. There’s probably also some damage, scar tissue, or whatever around my bowels. All of this caused everything inside to press against everything else, especially as my cycle progressed, my uterus became heavier, and settled into a lower position. That pressure also made it difficult for me to empty my bladder properly, which meant I was going to the bathroom all the time, which in turn wasn’t doing my bladder any favors. I also started unconsciously holding tension in the area.

I went back to the gynecologist, essentially to ask for a referral for more advanced scans. After all, her ultrasounds weren’t showing anything unusual. But instead of referring me, she said, “Do you want to stop your periods? I can prescribe a pill for that. Let’s first see if that helps.”

There are several ways to treat endometriosis: you can have the tissue removed every so often through laparoscopic surgery, have your uterus removed, or use medication to stop your cycle. The first two options are fairly drastic. And what if they only make things worse? Medication is a way to keep the problem somewhat manageable until it eventually becomes impossible to ignore and surgery turns out to be necessary after all. So even though I had pretty much sworn never to go back on the pill or anything similar, I agreed. I was prescribed Dienogest.

The first few months were rough. I kept bleeding a tiny little bit all the time. That was normal and would go away, the doctor said. Fortunately, she was right about that. After a few months, it stopped, and I started noticing the effects of the medication. The pain is much less now! (At the same time I started taking the medication, I also began eating more fibre and stopped eating and drinking things that irritate my bladder, such as green tea and chocolate.)

I still don’t love the fact that I’m taking hormones again. I actually quite liked my natural cycle, in terms of sex drive, emotions, and everything else – okay, okay, except for those few days around ovulation when 1) I was in pain, and 2) I’d end up crying because I felt like nobody truly cared about me or understood what was going on inside my head. Other than that, I find it rather annoying that I have to take my medication twice a day and therefore have to set alarms for it. And that I have to visit the doctor regularly just to pick up a repeat prescription. Whenever I’m there, they always want me to measure my blood pressure and fill out an entire questionnaire. And last week they even wanted to draw blood, do a pap smear, and schedule me for a mammogram. Just like other hormonal medications, this pill comes with a slightly increased cancer risk, which is why.

Anyway. How does this story continue? No idea. For now, I’ll keep taking my medication in the hope of postponing any future surgery for as long as possible. Hooray for being a woman.