March 29, 2014

Progesterone, Progestogen, Progestin, Oh My

There is a stark power differential in the medical profession, one which I am acutely aware of as a social worker. Patients, and particularly patients who often find themselves under-represented in and stigmatized by the medical community, can find it difficult to advocate for themselves within a power dynamic that casts them as the passive receptacle of medical wisdom. As someone who strives to help those populations advocate for themselves and equalize power within the doctor's office, it's enlightening to watch that differential shift throughout a conversation, to see my own power deflate from the grip of stereotypes.
"Hrrrrggggrrrllllppfft," my stomach stated emphatically across the near-empty waiting room.
"Shit," said my brain, as I scanned for knowing looks and near-by restrooms. A child seated across from me glanced up from her book before nestling into her mother's side, and I became suddenly consumed with identifying all of the fish in the large aquarium at my side.

"It's a fish of some sort," I thought. "The yellow kind." I pressed my hand against the cool glass, envisioning myself in some cold, disembodied space of mottled light and crackling water.

My histamine reactions have recently ramped up, and my face is a red patchwork of hives. Inside, I imagine welts rolling across the surface of my intestines as my stomach clenches and re-clenches in pain. "There's nowhere to retreat, dear stomach. We're in this together." The nurse calls my name and I arrange my face into a semblance of a smile and walk with her down the hall to the scale.

Momentarily, I consider kicking off my shoes -- marbled, forest green flats that I had lucked upon at Goodwill's MLK Day Sale -- then chastise myself and step onto the scale. The number soars up in seconds as my heart lurches down into my knotted stomach. "Sweet merciful shit," I try not to say out loud, sensitive to the presence of the much-heavier nurse just behind me. I have been struggling to accept and love my body as it is, but the number in front of me was one that I had only seen once, ever, in my life, a time of heavy drinking and emotionally abusive relationships, a time when running was no more than a memory of a part-time, long-lost friend.


As a writer, I couldn't shake the symbolism; as a feminist, I was frustrated at the failings of my philosophy, my railing against unfair portrayals of feminine perfection while striving to attain them myself. "Stop beating yourself up," I whispered, my mantra for the week, repeated in notes tucked into pockets and notebooks to remind me.

When my doctor walked in, I was ready for solutions. "I want my hormone levels tested." I assumed my most Graduate School, Educated Woman demeanor. I explained my research, my histamine intolerance, my food reactions, not getting a period in over 4 years. He nodded, he questioned, and he seemed genuinely curious, up until I mentioned my Depo.

"Generally we don't test for hormone levels right away. Given your age, your weight, I think we should start with a course of progesterone. That should help shed your endometrial lining and start your period. When progestins enter your body..."

"Whoa, whoa, sorry, wait, progestin or progesterone?"

"Well, they're the same thing."

"Um, well, except they have a different receptor, right? I mean, that's what Depo is, a progestin. I can't... I don't want that again, that's what put me in this mess in the first place." I felt my Educated Woman demeanor begin to falter. (C'mon, Cass, you know this stuff.) "I mean, it's not my period that concerns me, it's my pituitary. It's not producing it's own progesterone. Will taking progesterone give it a little kick in the nads and get it going?"

"Like I said, progestins-"


"I'm not sure what you mean..." His usually kind face tightened, lips pressed together. "They are the same thing. Progesterone will help stimulate the shedding of your endometrial lining and you should have a period within 10 days. If you don't, we can look into hormonal testing. Or maybe you're really active?" I could sense my hista-meanies starting to flare up. (Down, Girls, wait this out.) I stammered out my exercise routine and qualified it with a comparison to where I had been before beginning birth control, my face flushing with histamine and embarrassment.

"You can lose your period due to intense exercise and weight loss." He turned and started typing into his computer.

"Yeah, that's, that's not it." I looked down at my legs and shifted toward the front of the examination table, then tugged at my dress. "When I got my last shot, you know, in August, there were times where I couldn't even eat between the hours of 9 to 5. My reactions were so bad!" I stared at him, hoping he would turn and see the eager pleading in my face.

"That's not good." He continued to type as I picked at a fingernail.

"I'm sorry, I just... I was just weighed, and I am the heaviest I have ever been in my life, and I feel like there's nothing I can do about it and it has completely thrown me for a loop." It is a last desperate strategy, this self-blame, and suddenly Feminist, College Educated Cassie deflated, and there I was, uncovered, insecure, overweight--the patient, the receptacle for clinical knowledge, and I burned with shame and large thighs and Goodwill shoes and government healthcare (I'm losing my private insurance at the end of the month) and internet research and a mere Master's degree.

"Okay, let's try the progesterone. That sounds good. Sure. Let's do it." There was a small tear on the heel of my flats, and I lifted my foot to try and press it back in to place.

He typed out the prescription and left the room. "Hashtag: Awkward," I muttered, and showed myself out.

In the lobby, a group of teenage women were waiting for TB tests. "Oh my God let's go run in the rain!" one shouted as the others punched her in the arm and laughed. I struggled with the heavy wooden door and stepped outside, gripping the side of my dress against the wind. "HrgggrrRRrr!" shouted my stomach to a woman scurrying by, a tiny white dog tucked into the chest of her jean jacket, its curls matted with rain, and I wished for some small, warm being, pressed tightly against my heart.

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