One Year

Marriage is a roller coaster. When you're engaged and people assure you that the first year of marriage is always the hardest, you quietly chuckle to yourself and think "How could this be true? We're so excited, we'll be newlyweds, everything will be perfect!" But once you've lived it, you may begin to see a little pearl of truth in that statement.

Everyone's first-year-of-marriage challenges will be different, but regardless of life circumstances, marriage is an adjustment. For one thing, your money suddenly isn't YOUR money anymore, and your spending suddenly affects someone else. There's this expectation of equity and fairness in how "extra" money is spent. It needn't be a huge bone of contention, but no matter how you slice it the first year of marriage inevitably brings up countless situations that force you to forge a new strategy, bit by bit, for handling finances between the two of you.

Then there is the melding of two families, and the priorities of each spouse when it comes to family time. When the holidays come around, there are double the people to make time to visit, and holiday traditions to be respected. Throughout the rest of the year, your weekends become a four-way struggle between "us" time, "friends" time, "his family" time and "her family" time. If you come from tight families and you live relatively close to them, and you're trying hard not to neglect your friends (no one wants to be "the boring married couple"), it becomes easy to let "us" time take a back seat. Not only is that unhealthy over the long run, but it can be downright exhausting at times! It's a tough balance, and it will take some time to figure out what sort of pattern you'll settle in to.

Marriage will teach you just how much you need God in your life, too. Your capacity for forgiveness, tolerance of another's values, and patience will all be tested beyond what you once believed were their limits. There are things that your spouse will want to buy or do that don't seem "worth" the expenditure to you (whether it be of time, money or both). There are hobbies that your spouse will pick up that seem trivial to you. There are days when your spouse will be caught up in his or her own troubles and stresses and you will feel ignored or unappreciated. Your spouse will even say and do things that just outright hurt you on occasion, because the more time you spend together, the more opportunities there will be for that sort of thing to happen. These same things will inevitably also apply to you from your spouse's perspective, whether you see it or not. The bottom line is that you will both choose to act out your promise and commitment of love every day. You will always forgive, you will always forget, you will always be patient, and you will always value the things that make your spouse happy whether you understand them or not. Because that's what you promised, and because the other 98% of the time gives you every reason in the world to feel the same way you felt back when you made that promise.

We often put on our happy faces for the world even when our home life isn't ideal - when we're going through "rough patches". I know I have. It's just what you have to do. But the first year of marriage really DOES have the potential to be the hardest, and it WILL surprise you and throw you for a loop now and again. It won't always be a bed of newlywed roses, despite what we "newlyweds" will tell you ;] Marriage is a challenge because it is meant to be - God uses marriage to propel each spouse ever closer to the image of Christ, as we learn the virtues of Christ in our daily interactions. There is no more effective way to learn and internalize these virtues than to commit your life to serving another human being in marriage, day in and day out. It's important for newlyweds to realize this fact when it does get hard... it doesn't mean that you married the wrong person, it just means that it's working. Change doesn't always feel good in the moment, but you are being molded into the man or woman that God wants you to be.

All that said... after a year of marriage, I find myself a SUPREMELY happy newlywed :] We really have been through a lot this year - more than most people know - and it has been anything but a walk in the park. But through the challenges, our bond has been solidified on such a deep level. We grew more this year as individuals and as a couple than any other year in the (nearly) 10 that we've been together. We are more in love now than we have ever been, because God used those challenges to yield an incredibly fruitful first year of marriage. When I look at my husband, I don't see the hard times. I see the hard-working provider who, despite his supreme distaste for mornings, gets up at 4am to work overtime when it's available. I see the selfless giver who scrubs the bathroom, mops the kitchen floor, does the dishes (every night) and vacuums because I'm studying for an exam and it needs to be done. I see a tired, stressed out guy after work who gets down on his hands and knees and cleans the litter box every day as soon as he gets in the door, because he doesn't want me to do it. I see the guy who won't let me get out of bed to get something I forgot once I'm there - he'll get it. I see the guy who won't let me carry one bag out of Target - he's got it. I see the comedian who leaves everyone in the room in stitches wherever he goes - the "life of the party" who, when he calls to say he can't make it, inspires other people to think twice about whether they even want to go anymore (that always makes me laugh, and I'm not kidding either!). I see the warm, funny, outgoing, confident, giving, loving, caring guy who inspires so much respect and love in me that my measly body can barely contain it all. The guy who brought me these, the day BEFORE our anniversary :]

Marriage to a guy like that will give you a short memory for the "rough patches", because the other 98% of the time, he's all you ever dreamed of. Happy Anniversary babe <3

A Tough Pill to Swallow: COCs and Infertility

One of my greatest fears in life has always been infertility. I feel so strongly called to motherhood, and I am so excited to experience the gifts of pregnancy and child bearing – the mere thought of being unable to bear my own children is nearly (no pun intended) unbearable. I suspect that I am not alone in this fear, though I also suspect that many young women have forced the subject to the proverbial “back burner” for the time being, just as I did. Of course I have always wondered whether I would have difficulty conceiving, and lamented the fact that I supposed I’d just have to wait until the time came to find out.  Little did I know, that’s not entirely true. Little did I know, there are lots of potential obstacles to fertility that can be revealed and addressed well in advance through fertility awareness. More importantly, little did I know that the Pill itself could be masking fertility issues or even creating them.

There are a variety of ways in which combined oral contraceptive (COC) use can affect fertility, some more dramatically than others, but all worth discussing. Some are difficult to quantify by their nature, so this post won’t be full of shocking statistics – it is meant to provide some “food for thought” and to bring to light some of the barriers to future fertility that COCs often present.

Amenorrhea – the absence of menstruation – represents one such barrier and affects many women upon discontinuation of COCs. Amenorrhea implies anovulation (the absence of ovulation), which obviously presents an insurmountable obstacle to conception for as long as it persists. No ovulation, no egg, no conception. While it may only continue for a few cycles, in rare cases post-pill amenorrhea can plague women for years, and younger women are no exception. Anovulation can also go undiagnosed for a time, as anovulatory bleeding is not uncommon when transitioning off of COCs.

Allow me to explain. Normal menstrual bleeding is triggered by a decline in progesterone when pregnancy does not occur in a given cycle. Progesterone, the hormone responsible for maintaining the uterine lining in preparation for the implantation of a fertilized egg, is secreted by the corpus luteum (CL; the remnants of the ruptured ovarian follicle from which the egg was ovulated that cycle). The CL can only survive for a short time without support from the hormone hCG, which is only secreted by a successfully implanted embryo. Consequently, in the absence of pregnancy, the CL eventually dies away and progesterone levels decline with it. Without the support of progesterone the uterine lining begins to shed and recede, giving rise to progesterone withdrawal bleeding or menses.

But of course, in an anovulatory cycle there is no CL and therefore no progesterone rise or withdrawal. This is where estrogen comes into play – it is responsible for preparing and maintaining the uterine lining prior to ovulation, and for triggering ovulation itself. Without sufficient estrogen not only will ovulation be unlikely, but the uterine lining will also remain unstable and may shed at unpredictable times throughout the cycle. For a woman who is discontinuing COC use this bleeding can look like irregular menses, which seems plausibly normal for a transitional time, and so many women waste months waiting for their cycles to regulate – or worse – go on believing that they are ovulating (since they are bleeding) and spend months trying unsuccessfully to conceive. Not only can amenorrhea and anovulation present a serious obstacle to conception, they can also be deceptive and cause much undue stress and anxiety as a couple struggles to conceive. They are treatable conditions in most cases, but treatment can be expensive and may take weeks or months to be effective.

What saddens me the most about these potential complications is that many women are unaware of the possibilities. For example, my plan was always to “come off the Pill” about 3 months before we were ready to try to conceive (on the advice of my GYN provider). Given my educational timeline as a medical student, future intern/resident and future physician, my husband and I will be trying very hard to time any conceptions carefully. Of course there are many variables and it is often impossible to plan “down to the minute”, but the possibility that ovulation could be delayed by 3, 6, 9 months, even a year…? That would have been a HUGE unexpected obstacle that could have cost us a window of opportunity. Of course I always fall back on the knowledge that God will provide, and that His timing is truly all that matters at the end of the day, but what a heartbreaking turn of events that could have been.

The idea that the Pill has the potential to cause infertility issues is scary enough, but what is even more common is the masking of existing problems. One common setback, for example, is a short luteal phase – the time between ovulation and the onset of menstrual bleeding. As we discussed, progesterone secreted by the CL maintains the uterine lining in preparation for the implantation of a fertilized embryo. It is easy to imagine that, if the CL dies off prematurely and progesterone levels decline too quickly, a fertilized egg would not have time to successfully implant prior to the onset of menstrual bleeding and the conception would be lost without the woman’s knowledge that it had ever occurred. On the other hand, some women may have infertile cervical fluid, which significantly reduces the lifespan of sperm in the female reproductive tract and may hinder its passage into the cervix altogether, presenting another obstacle to conception. Another common “fertility problem” (which isn’t really a problem at all) in women who do not use ovulation predictor kits is late ovulation. There is a very common misconception out there that ovulation always occurs at mid-cycle, around day 14, which for many women simply isn’t the case. If you don’t ovulate until day 20 (which is completely normal for some women), having sex 14 times on day 14 does nothing to improve your chances of conceiving, and so many couples spend months of heartache trying unsuccessfully to conceive simply because they are unacquainted with the woman’s cycle.

The punch line here is that all of these conditions are masked while a woman is taking COCs. There is no luteal phase without ovulation, there is clearly no late ovulation without ovulation, and the quality of cervical fluid is dramatically altered by the progesterone component of COCs. These are all issues that a couple may encounter in their attempts to conceive, and they are all issues that can be uncovered and addressed through natural means (or medicinal means if necessary) far in advance, greatly reducing the time, effort, and stress associated with trying to conceive.

Another potentially serious medical condition often masked by COC use is primary ovarian ineffectiveness or POI, which is often the culprit behind the prescription of COCs for menstrual regulation. Women with particularly heavy or irregular flows or more severe menstrual symptoms (painful cramping, for example) are often prescribed COCs to correct the imbalance of hormones that causes these symptoms. POI can cause particularly heavy, light and/or irregular flows, and while COCs often do restore the proper hormone balance necessary to alleviate symptoms, the underlying ovarian insufficiency remains. When these women discontinue COCs, their ovarian hormones (estrogen and progesterone) will most likely still be insufficient to properly regulate their cycles (with the caveat that POI can come and go in some cases). Though not all women who experience heavy or irregular periods have POI, the disorder affects an estimated 1 in 100 women by the age of 40 – not terribly uncommon. The most disturbing fact is that POI, when left undiagnosed and improperly treated, can result in long-term infertility according to Dr. Lawrence Nelson of the National Institutes of Health. Dr. Nelson also notes that POI can trigger premature menopause in women as young as 30. Women on COCs with underlying POI can go through menopause without realizing it due to the masking effects of the Pill, and upon discontinuation discover that they are no longer able to bear children.

As POI is masked (and often improperly “treated”) by COC use, it is not uncommon for the disorder to cause unnecessary and devastating infertility problems in unsuspecting women. If you have been prescribed COCs for the kinds of cycle irregularities discussed here, I would encourage you to ask your doctor for a simple blood test that can screen for POI by evaluating your FSH levels (follicle stimulating hormone, which is secreted by the pituitary and is responsible for follicle maturation prior to ovulation).

Infertility is one of those subjects that really hits home for many women – particularly young women who have yet to begin or complete their families. I do not wish to employ fear tactics to scare women off of the Pill, but these are real concerns worth discussing openly. Most young, healthy women will never be touched by the heartbreak of infertility, thank the good Lord, but the gift of child bearing is one worth protecting through careful consideration of the risks. If you are interested in discontinuing COCs and becoming acquainted with your cycle prior to trying to conceive, I highly recommend charting (see Taking Charge of Your Fertility in Books I Recommend, or click here to learn more about Natural Family Planning online). It's worth taking a few extra months to sort out your cycle, look for any irregularities or potential challenges, and have a thorough understanding of your own cycle - and if all is well, charting is still worth its weight in gold as it will give you all the tools you need to conceive whenever you're ready!

If you're just joining us in this series and would like to read more, see the sidebar for links to previous posts, or start here at the intro. And stay tuned for the next post in the series (yeah, there's more!)...

Resources:

http://www.independent.co.uk/life-style/health-and-families/new-fertility-fear-fueled-by-the-pill-1964647.html

Taking Charge of Your Fertility by Toni Weschler, MPH (see Books I Recommend) 

The Dusty Little Box

When I began using the Pill, my fertility was little more than a nuisance in my life. Like a gnat at a barbeque it always seemed to pop up and ruin the moment, and just wouldn’t be shooed away. The constant worry (particularly as that time of the month approached), month after month after month, was driving us both insane. Well, I just wasn’t going to stand for that kind of oppression at the hands of my own biology – I found a way to stick it to those pesky ovaries. I’d shut them up. The Pill freed me from the chains of fertility, and for me, that made the Pill just about the greatest thing since sliced bread. It allowed me to drop my fertility into a tiny box, seal it up and pack it away. I knew I’d use it again someday, but for now I didn’t care where it ended up. I just pitched it under the bed, left it to collect dust bunnies and went about my business.

Fast forward seven years. I find myself a married, twentysomething woman with a deep, agonizing ache in the pit of my soul. Some call it “the baby itch”, which makes me laugh. Some man must have coined that phrase, because “itch” just doesn’t even begin to cover it. An itch, I could scratch. An itch would go away. An itch is a minor irritation that might distract one for a brief moment. This ache of which I speak is utterly unmanageable, unremitting, and all-consuming. Day and night, regardless of other distractions, it is perched on my shoulder whispering sweet baby sighs and projecting images of tiny wrinkly toes and adoring toothless grins. Yes friends, I’ve got it bad.

But even despite all that, the light bulb still hadn’t flicked on in my mind. I still hadn’t reached the realization that my chemicalized body was completely incapable of giving me what I so desperately desired. Well, I knew it intuitively, but I failed to recognize what it truly meant to me. I had taken it all so lightly for so long. “When we’re ready, I’ll just go off the Pill and we’ll get pregnant” …I hope. “I’m young, so my cycles will bounce right back” …I hope. Those lingering fears, coupled to my concurrent discovery of the myriad health risks associated with oral contraceptive use, set off an entirely novel train of thought, and triggered an unexpected uprising of emotion that I’ll never forget.

Tears welled up in my eyes as I figuratively reached under the bed and fumbled around for that dusty little box. It was different than I remembered it – it was nearly bursting with its contents and the seal was barely holding it closed. What I had stuffed into that box so many years ago had been growing and multiplying, but had gone unnoticed for all this time – it was out of sight and out of mind. That tiny little box could barely contain the significance that my fertility had taken on, though it fit so nicely when I packed it away. I held that little box in my quivering hands as I contemplated our future, my longing for children, the past transgressions that the Pill had allowed me to perpetrate without a second thought. The tears were flowing down my cheeks by now. How could this weighty box ever have felt so light? How could the matter of my own fertility ever have meant so little to me?

And then, it really hit me. There I sat, in the prime of my biological child-bearing years, a virtual desert of infertility. I felt like a stripped down version of myself. On the outside I was all woman, complete with eclectic accessories, expensive handbags and a closet full of shoes. I wore feminine clothes and feminine scents, embraced my role as a wife, loved to cook… all the pieces were there. There was just that one minor detail that was missing – an internal detail that sustained my biological role as “woman” – and I had given it away. That precious gift that so many women would almost kill for… I had it, and had run from it like a house on fire, thanking my lucky stars that I had escaped unharmed.

Of all the things that I fear in this world, the inability to have children just might be #1 – yet I had willingly rendered myself infertile. It suddenly seemed so unnatural that my body had not been allowed to cycle in years, and that I knew nothing of my reproductive health. I suppose I was planning on waiting until we were ready to conceive to find out where we stood as far as my fertility was concerned. Great plan. This giant question mark was far more worrisome than the prospect of leaving the Pill behind, particularly in light of the highly effective natural methods of birth control that I was learning so much about. I wanted to know myself. I wanted to reclaim control over this pivotal aspect of my world – a subject that meant so much to me yet had been so casually and carelessly ignored.

Knowledge is power, and the female body is a wealth of it – harvesting that information just requires a little extra attention and a thermometer. That vital information can be used to postpone pregnancy, to achieve pregnancy, to troubleshoot fertility difficulties… all without ever stepping foot in a pharmacy or a doctor’s office, and most importantly, without harming a woman’s health or future reproductive capacity. No chemicals, no regret. Just your body doing what it was made to do, naturally and effortlessly. That, my friends, sounds like a great plan for me.

A few months ago, I was more empty inside than I realized. The growing weight of my fertility was blindingly apparent in some ways, yet I had failed to notice that the dusty little box that contained it was ready to burst. I understood all too well the significance of the gift of child-bearing, and how exceedingly important that was to me, yet I had stripped myself of it and taken my body for granted. I can forgive myself for the decision that I made all those years ago – young girls simply cannot understand the profound magnitude of their fertility – but I’m having a hard time wrapping my head around what took me so long to put two and two together.

But today, I stand before you a new woman. It is as though a sizable chunk of my soul has found its way home. I suppose it was in that dusty little box all along, alongside a little slice of my heart. These missing pieces were so small in the beginning, I thought I’d barely notice them. Oh how they grew, but it was such a long, gradual process that it fooled me for a very long time. Now that they’re back where they belong, I feel full again in a way that I never anticipated. I never knew what it all meant to me until I had it back. One thing is for sure – I’ll never let it go again. I know that there is little I could say to convince most young women that they’d feel the same way if they allowed themselves to unpack that dusty little box, but I hope that my story will at the very least give you a moment of pause to contemplate what your fertility means to you.

For the full story of my journey from the Pill to Natural Family Planning, catch my Guest Post on Planted & Blooming. 

You KNOW You Want One...

I simply couldn't resist taking a moment to promote Lisa's blossoming bow business! You KNOW you're just dying to snap that bad boy into your little cherub's wispy ponytail! The cuteness is darn-near unbearable!
Check out Pretty Ditty Hair Bows 

to snatch up a few unique hair bows for your special little one.
Viva La Dainty-little-girl!

A Tough Pill to Swallow: Contraindications to COC Use

The following is a reference list of underlying medical conditions that, if present, may increase a woman's risk of experiencing medical complications as a result of combined oral contraceptive (COC) use. This list was gleaned from the Merck Manual, a common reference that can be found in any doctor's office or hospital unit in the country.

Contraindications to Combination Oral Contraceptive Use
Degree	Condition
Absolute	·      Abnormal uterine bleeding with an undiagnosed cause ·      Diabetes mellitus (or other disorders) with vascular complications ·      History of estrogen-dependent cancer, coronary artery disease, hepatic adenoma, idiopathic recurrent jaundice of pregnancy, stroke, thromboembolism, deep venous thrombosis, MI, or active SLE (because risk of cardiovascular sequelae is increased) ·      Hypertension if uncontrolled ·      Immobilization of a lower extremity if prolonged ·      Liver disorders if active ·      Major surgery for 1 month after (and 1 month before if elective) ·      Pregnancy ·      Renal insufficiency ·      Smoking after age 35 ·      Triglyceride levels > 250 mg/dL
Relative	·      Amenorrhea with an undiagnosed cause ·      Cigarette smoking if heavy in women < 35 ·      Depression ·      Diabetes (treated) ·      Family history of blood clots ·      Fibroids ·      History of liver disorders with recovery ·      Hypertension (treated) ·      Migraines with neurologic symptoms ·      Obesity ·      Precancerous cervical lesions (treated) ·      Premenstrual syndrome ·      Seizure disorder (drug-treated) ·      Varicose veins

Allow me to take a moment to define some terms and abbreviations. First of all, the categories absolute and relative essentially refer to the level of caution a provider ought to observe when prescribing COCs to a patient. Any of the medical conditions in the absolute list are absolute contraindications - patients with these conditions should not take the Pill. Medical conditions in the relative list are relative contraindications, meaning that patients with these conditions may have an increased risk for complications relative to the general population and should consider other alternatives, though use of the Pill is ultimately permissible. As for some of the terms and abbreviations within the list...

• Diabetes mellitus is type II diabetes (usually adult on-set)
• Hepatic adenomas are benign liver tumors
• MI is myocardial infarction (a fancy clinical term for heart attack)
• Thromboembolism and Deep venous thrombosis are blood clots
• SLE is systemic lupus erythematosus (commonly known as Lupus)
• Hypertension is chronic high blood pressure
• Renal insufficiency is chronic kidney failure
• Amenhorrea is the chronic absence of menstrual bleeding

Please feel free to leave a comment should you have any other questions or concerns about this list. I'd be happy to clarify any other terms or abbreviations, though medical questions concerning your relative risks and decisions about your medications should be directed to your physician, since I am not (yet), in fact, a doctor ;] 

It is absolutely critical, when evaluating the relative risk you assume in taking COCs, that you be made aware of the underlying medical conditions that may augment that risk. The statistics that I've offered in other posts in this series refer to the baseline, general population risk - having any of the contraindicated conditions (relative or absolute) immediately puts a patient at a higher risk for complications. 

Stay tuned for the next topic in this series on the health risks associated with oral contraceptive use, and if you're just joining us, catch up on previous posts:

• Introduction
• Vascular Complications
• The Pill as an Abortifacient (not part of this series, but a relevant read)

***UPDATE: Catch the next post in this series on Infertility

Books I Recommend

So, apparently I couldn't stay away. Or I'm a professional procrastinator. Or both. You be the judge.

Just wanted to call attention to a new page I created, aptly named "Books I Recommend". You can also find it (for future reference) in the pages bar just below my blog header. It contains a few suggestions for great reads on Love & Marriage (and sex, too... can't forget sex!), Science & Faith, and Family Planning & Fertility... for now. Check back every so often for additions... after my exam. Because this really is the last you'll hear from me until Thursday afternoon. I hope.

I'll Be Back Soon...

Well, it's been a long year. Really it hasn't - it has flown by - but it's been an incredibly tough year. I never thought I'd survive. I suppose that technically speaking, I still may not survive, but the end is so close I can smell it! Yesterday was my last day of class, and Thursday is my final exam in Neurobiology. That marks the end of my first year of medical school, and almost more importantly, the end of NEUROBIOLOGY! I'll be 25% doctor. And more importantly, I'll be half-way through this horrendous basic-science-lecture-laden first two years before clinical rotations! HALF-WAY THERE! That's progress.

I'm really just writing to apologize for the blogging hiatus, and to reassure you that I'll be back at it again as soon as I get through this last exam. My next post will be a continuation of the Pill series, so stay tuned. In the meantime, I'll be in my study bubble, study cave, whatever you wanna call it. Just means I'll be on my couch in my pajamas staring at my laptop for two days straight. Faaaaaaabulous. Catch ya on the flip side!

A Tough Pill to Swallow: Vascular Complications

The decision to use or discontinue combined oral contraceptives (COCs) is a very personal one, as we’ve discussed already. Particularly for women who do not have any ethical or religious conflicts with contraception, an emphasis must be placed on weighing the benefits against the risks for a given set of circumstances. The purpose of this mini-series is to provide scientifically grounded information to women seeking to better understand the health risks associated with oral contraceptive use in order to make informed personal health decisions – it’s not about making judgments or defining right and wrong. Only you can determine the best course of action for you, given your particular circumstances and future reproductive intentions.

Left Hemisphere Stroke, via Google Images 
http://www.theuniversityhospital.com/stroke/inhospital.htm

The Pill & Vascular Health

The risk of “blood clots” seems to be the most widely recognized of the many COC-related health risks, so we’ll start there (though you’re probably already inferring from my use of quotation marks that there’s a lot more to the story). Blood clots (also known as thromboses) are serious business, as they can break free (or embolize) and travel to any number of vital organs, blocking blood flow and causing ischemia (inadequate blood supply resulting in prolonged oxygen shortage and tissue death). When this happens in the brain, we call it a stroke. When it happens in the heart, we call it a heart attack. We all know that stroke and heart attack are life-threatening and life-altering events. But ischemic events can cause damage to the liver, lungs, eyes, kidneys… any organ that receives blood flow (and if you have a pulse, that should include ALL of them!).


Deep vein thromboses (DVT), or blood clots of the deep veins (usually in the legs) can also form in the extremities and cause pain and swelling, and are often the culprit underlying pulmonary embolism (PE). Blood from the lower extremities returns directly to the right side of the heart and is immediately pumped out to the lungs to pick up fresh oxygen, at which point the oxygenated blood returns to the left side of the heart to be pumped out to the rest of the body. The arrangement of this circuit provides a convenient, direct pathway through which an existing DVT can send a chunk of clot up to the lungs where it lodges and forms a PE. The presence of a PE prevents blood from reaching certain areas of the lung by blocking blood vessels, creating “dead space” in the lung where no blood is arriving to pick up the fresh oxygen, which means that less oxygen is transferred from the lung to the blood with each breath. This oxygenation difficulty can quickly lead to labored breathing, rapid heart rate, cardiac arrhythmia and sudden death.

The causal relationship between COCs and these vascular health risks is complex. Oral contraceptives essentially mimic pregnancy by providing the balance of hormones that a pregnant woman’s body would produce, which leads to cessation of the normal cyclical hormone fluctuations that cause ovulation and menstruation. (The “menstruation” that women experience on the Pill really isn’t true menstruation, but rather “withdrawal bleeding” that is triggered by the withdrawal of progesterone during the “sugar pill” [or very low-dose] week of the Pill pack.) This particular balance of hormones is known to produce elevated levels of various clotting factors in the blood and to increase platelet aggregation both in the pregnant state and (to a slightly lesser degree) during COC use⁴. There are also studies that have implicated COC use in the genesis of hypertension^1,2 (known more commonly as chronic high blood pressure), and still others that have demonstrated elevated serum cholesterol levels in COC users relative to non-users² – factors that have yet to be causally linked to COC-related thrombosis and heart attack, but that certainly may play a role.

And now for the nuts and bolts^3,5:

•  The risk of venous thrombosis increases 3 to 6-fold in oral contraceptive users relative to non-users.
•   That risk is doubled again for the “third generation” (read: newest) combined oral contraceptives containing desogestrel or gestodene.
• Stroke and heart attack risk is elevated 2 to 5-fold relative to non-users.
• Risk does increase with age, as well as risk factors such as high cholesterol, high blood pressure, diabetes and smoking.
• What about “low-dose” pills? Are they safer? Unfortunately, most studies say no – these risk statistics hold for the newer low-dose pills as well (though there are a few studies that report a modest decrease in heart attack risk).
• What if I only used the Pill for a year or two? These risks are independent of the duration of use, so whether you used the Pill for a few months or a decade, your risk is the same.

Most young women on the Pill stand a good chance of never experiencing any of these health issues, especially if they don’t smoke and live out an overall healthy lifestyle. What is disturbing is that rather than put this information out there so that women can make their own informed decisions, many practitioners choose to disregard the information altogether. They have decided on their own that the benefits outweigh the risks, and so the decision has been made for the patient, and without the patient’s knowledge. Many women don’t even realize that there are serious potential consequences to be weighed. I hope that this knowledge will empower you to take a second look at your reproductive health and make an informed, conscious decision.

Stay tuned for further exploration of the health risks associated with oral contraceptive use. I plan to tackle cancer, bone loss, infertility, and permanent loss of libido among many other intriguing topics in women’s health.

***UPDATE: Catch the next post in this series, Contraindications to COC Use


References
1. Basile, J. and M. Bloch. Identifying and managing factors that interfere with or worsen blood pressure     control. Postgraduate Medicine. 2010 Mar; 122(2):35-48.

2. Bressler, R. and J. Durand. Oral contraceptive risks: a realistic appraisal. Drug Therapy. 1979 Oct; 9(10):81-95.

3. Martinez, F. and A. Avecilla. Combined hormonal contraception and venous thromboembolism. European Journal of Contraception & Reproductive Health Care. 2007 Jun; 12(2):97-106.

4. Poller, L. Relation between oral contraceptive hormones and blood clotting. Journal of Clinical Pathology. 1969; 3: 67–74.

5. Tanis, B. and F. Rosendaal. Venous and arterial thrombosis during oral contraceptive use: risks and risk factors. Seminars in Vascular Medicine. 2003 Feb; 3(1):69-84.

A Tough Pill to Swallow: An Introduction to the Health Risks Associated with Oral Contraceptive Use

Have you ever wished that someone would just sift through the mountain of scientific data out there regarding the risks and benefits of oral contraceptive use and just give you the bottom line? HA! Yeah, me too. While I have yet to find the time to pull off that monumental task, I am attempting to use my knowledge base and resources to do some digging and bring you the highlights (or lowlights, as it were).

The story is a complex one, full of controversy and heated debate. As is true of nearly any heavily researched topic in the sciences, you will find a variety of studies that often yield wildly different conclusions. It’s no wonder that young women are confused. It’s no wonder that, faced with a towering heap of conflicting data, most women take the word of their healthcare providers at face value and assume that the benefits outweigh the risks.

As a physician-in-training, I have become aware of an entirely new perspective on healthcare – that of the medical “establishment”. As valiantly as healthcare providers may struggle to keep the best interest of each individual patient in mind, we cannot know each of our patients as well as we’d like to, particularly when it comes to making highly personal decisions concerning such issues as reproductive health. This disparity often leads providers to make general recommendations from a broader public health standpoint, and that is an important point for the patient to understand.

When evaluating the evidence for contraceptive-associated health risks, the “establishment” weighs the relatively small risks to women’s health against the broader socio-economic impact of unwanted pregnancy. The economic burden on society grows with every free abortion and every pregnant teen loaded onto the public assistance payroll. The outcomes for teen pregnancies are just dismal, for both the young woman and her child. In third world countries where it is not uncommon for women to die in childbirth, the public health impact of oral contraceptives is of tremendous consequence. These are the kinds of issues that play into the perspective of healthcare providers when it comes to contraceptives. The percentage of women experiencing adverse side effects would have to be quite substantial to trump these benefits from a public health standpoint. Given this perspective, and the decades over which it has become engrained, it is easy to see how the risks have become a finely printed footnote in the pages of real-world medical practice.

You, on the other hand, know yourself intimately. You know your individual circumstances and reproductive intentions. None of these public health considerations are of any consequence to you when considering risks to your own health, but without receiving any explicit warnings from your physician you may never find cause to question the safety of any medication you’ve been prescribed. Hopefully your doctor will (at the very least) screen you for risk factors prior to writing a prescription, but after a blood pressure check and a brief family health history questionnaire most physicians are eager to hand out contraceptives, particularly to young women. Unfortunately, ladies, we bear the burden of digging up the information necessary to make our own personal health decisions.  And when it comes to contraceptives, the decision is certainly a very personal one.

With regard to contraception, the burden has always fallen on women (despite the fact that men are fertile every day of the year, while women have only a few fertile days per month to control). Along with that burden comes a choice – a choice to follow the crowd, allowing artificial hormones to sterilize that which makes us life-giving creations of God, or to seek out other means of “protection”. Being the self-sacrificing lot that we are, women often choose the route of least resistance and opt to pop a little pill once a day and forget all about our fertility. We are told time and again that it’s no big deal – that we don’t need that part of ourselves until we’re ready to have children anyway. But what if that very Pill made it impossible for a woman to conceive when that long-awaited time came? What if, after leaving the Pill behind and conceiving several beautiful children, that very Pill still had the potential to ravage a woman’s body (and that beautiful family that she has built) through a devastating battle with cancer?

It is easy to put off the consequences of contraception because we don’t feel them today. Ironically, we won’t experience those consequences until it comes time to take back what we so willingly gave away in the first place – our fertility, our ability to create life, our desire for children and family.

For me, those things are a rather HUGE deal. I’d bet a paycheck that most women feel similarly. Perhaps the until-recently-highly-male-dominated medical establishment didn’t quite “get” the profound gravity of a woman’s fertility. Perhaps women have been kept in the dark for selfish reasons (the mainstream alternatives to the Pill being abstinence or condoms, neither of which are particularly pleasant). In any case, it is time to close the gap between the information (or lack thereof) disseminated in birth control clinics and GYN offices and the reality of oral contraceptive use. Not only because women deserve to know, but because they may need a kick in the pants to acknowledge the significance of their own future health and fertility.

Stay tuned… the information you’ve been missing is on its way. I haven’t quite decided how to present it – perhaps in “mini-series” form to keep the posts at a manageable length. In any case, I hope that at the very least you’ll find it eye-opening… and maybe even life-changing.


*UPDATE*: Catch the next post in this series here! Topic: The Pill and Vascular Health

The National Day of Prayer: What are The Non-Theists Really Afraid of?

Warnings:

1. This post is quite long. Pee first, maybe get something to eat.

2. This post is an opinion piece, and may ebb a little more progressive than you're used to (because I'm just not your typical Conservative Christian) but I hope you'll hang with me 'til the end before formulating a scathing new opinion of me and my kooky politics ;]

US District Court Judge Barbara Crabb recently handed down a ruling stating that government sponsored prayer, ie. The National Day of Prayer, violates the Constitution. On the surface, I am as appalled as anyone, mainly because that’s simply not true. But I believe that this entire upheaval speaks to a deeper issue in this country that is worth addressing.

For now, let’s start with the basics. Why should anyone be upset about a government-endorsed National Day of Prayer? There’s no good reason, really.

First of all, acknowledging a National Day of Prayer does not endorse any one particular religion. We’re all welcome to pray to whomever we choose – it’s the not the “National Day of Prayer to the God of the Judeo-Christian Tradition”. Perhaps they’re abstractly promoting “spirituality” or “faith” in a general sense by encouraging prayer, but it’s quite a stretch to call that a Constitutional violation, and it certainly is not discriminatory against non-theists.

Second of all, the government’s endorsement of a holiday does not mandate any individual’s participation in said holiday. Every citizen maintains his or her freedom to completely disregard ANY holiday they choose, on any given day of the year. We are all free to choose NOT to pray at all on the National Day of Prayer! The government endorses a lot of holidays, and a lot of people for whom those holidays don’t mean much SIMPLY IGNORE THEM. If Presidents’ Day means nothing to you, you don’t even have to acknowledge it except to enjoy your paid day off of work if you’re on a government holiday schedule. Simple as that. If it irritates you, pretend it didn’t even happen. The bottom line is, no one is grabbing your hand and thrusting you into a prayer circle – just go about your business, people!

You know, I’ve never met a Jewish person who was personally offended at the government’s recognition of Christmas as a holiday. Perhaps you have met such an individual, but have you ever seen a coalition of Jewish people file a lawsuit and spark a media frenzy over it? NO! Do you know why? Because they just choose not to celebrate Christmas. And I’d venture to say that that Christmas is a much larger inconvenience to Jews than the National Day of Prayer is to non-theists, what with the mall traffic, school closings, and all that Christmas music playing everywhere you go for three months. Of course I don’t mean to be cheeky about Christmas itself, but practically speaking, am I right or am I right?

The main point of contention for the non-theists, as best I can tell, is based in the apparent “evolution” of our country toward a far more secular state of affairs than ever before in its history. Given this secularization, they apparently perceive such “official” acknowledgements of prayer and spirituality along a continuum from simply antiquated to outright discriminatory. It seems that they would prefer it if our government failed to recognize or address religion at all in any official capacity, as if we should just let the religious roots of our history slowly fall by the wayside until they’ve been long forgotten. Somehow “progress” should be gradually pushing religion “out of vogue”.

I disagree with them for two reasons; (1) religion is and always will be a majority sentiment – it’s not going anywhere anytime soon; and (2) Our history is important and it has already been written – it is what it is – and simply recognizing the religious component of that history should never be considered “unconstitutional”. That’s just baloney.

That said, I think that there’s more to this story and that there is a valid broader message to be gleaned from this upheaval amongst non-theists. This is the part where I start losing friends along the other end of the political spectrum and am left with… well, no friends. But I hope you’ll hear me out. While I certainly believe that the government’s promotion of “spirituality” and recognition of the Christian roots of our country’s founding are entirely defensible, there is a larger movement out there that seeks to broaden the influence of those “Christian roots” in government. And that, my friends, is where the non-theists have a point.

I believe that it is our Constitutional freedoms that set America apart and make us who we are as a nation, and that includes Freedom of Religion.  I will never refer to America as a “Christian Nation” because I believe that that statement undermines those very freedoms that give me such pride in my country. The fact that our founding fathers were of Judeo-Christian faith themselves does not make us an intrinsically “Christian Nation”, in my humble opinion. In fact, I’ll even venture to say that the founding fathers just might agree with me, given the literal blood, sweat and tears that they poured into securing that very Freedom (of Religion) that we enjoy today. The American Revolution wasn’t about establishing a “Christian Nation”, it was about establishing a nation in which any religion (or lack thereof) could be practiced freely without threat of imprisonment or worse – where all citizens would be afforded “certain unalienable rights” without discrimination.

I certainly won’t deny that the God of the Constitution was intended as the Judeo-Christian God, but I simply don’t accept the idea that this fact somehow trumps the clear intent of the founding fathers to ensure equality of all religions under the law. I believe that this is where Conservative politics have steered our country wrong.  The non-theists do not necessarily feel threatened by the National Day of Prayer itself, but rather the larger “Christianization” of our nation that it represents to them. Their response to this specific issue is a backlash against the larger Conservative agenda. The National Day of Prayer has never been a problem (on this scale) in the past. It has become a problem because non-Christians in our country are beginning to feel that their way of life is being threatened.

Let’s be a little more concrete about this. I am all for the criminalization of abortion, for example, but I am not “for” any law that is based purely on Biblical teachings. Yes, I’m serious. I am a Christian (and so I choose to live my life by Biblical teachings) but I live in a country that does not legislate based purely on religious principles, because our forefathers fought and died to ensure that our freedom to practice any religion that we choose would be upheld. Sure, many laws happen to coincide with a variety of religious teachings which is just fine and dandy, but legislation based purely on the teachings of any religion is unconstitutional in my book. I am for the legal criminalization of abortion because I believe that abortion constitutes infanticide, which is already a crime in this country. I believe that, scientifically, the definition of “life” (and in turn the spectrum of what constitutes murder) as beginning at any point other than conception is a bogus and arbitrary definition, and I believe that any legislation concerning abortion should be based in that reality – not on Biblical teachings, dear as those may be to my own heart.

But it’s not about what’s dear to my heart – that’s not how America works. The beauty of how America does work, so long as the Constitution is upheld, is that no matter what the religious majority may become in the future, the rest of us will never be forced to live our lives by its teachings. Just as we Christians would be appalled if Muslims became the majority and forced us to stop and pray toward Mecca on a daily basis, Muslim Americans (or Hindu Americans, or Buddhist Americans, or Non-theist Americans) should be appalled at the prospect of any purely “Christian” teaching being forced upon them as law. An American citizen is an American citizen, like it or not, and being a Judeo-Christian Anglo-Saxon white person doesn’t afford me any extra right to legislate my personal religious beliefs – I don’t get to claim any more “ownership” of this country than anyone else, because we are a country of immigrants. That’s just our reality (again, like it or not).

The point that I’m trying to make is this: Just as many Conservatives are in a state of backlash and upheaval over what they perceive as a new set of ideals being forced upon them by a new administration of which they do not approve, non-theists feel similarly toward the Conservative Christian movement. They feel that their Constitutional right to live their lives outside the scope of religious influence (as far as the law is concerned) is being threatened, not by the National Day of Prayer itself, but by the larger movement that it represents.

In my opinion, they have a point. I see our country headed in that direction if the Conservatives regain power, and while the ensuing course of events might appease my personal Christian values in many ways, it saddens my heart as an American. Of course my Christian values come first in my own life, but those values should NOT be imposed on any non-Christian American. Selfishly invoking our majority status to impose our beliefs is not the way to win others for Christ, it’s just a way to get what we want, and what we think is best. Given the Constitutional provision against religious influence of that nature, that simply is not the Constitutional way to govern. 

See Jane Bake ...quite possibly the cutest cookies you'll ever eat

So, remember how I said that my friend Laura is multi-talented? Remember when I said "you name it, she's mastered the art"? Well, that was even before she unveiled this little treat...

It's SEE JANE BAKE 
...and it's Laura's newest venture. You can enjoy these delectable little creations in the comfort of your own home... if you can bring yourself to eat them, that is. You can visit on Facebook or Etsy! 

How adorable are these?!?! Baby showers... bridal showers... birthday parties... the possibilities are endless. I just can't get over it!

Oh Laura. You just blow my mind, girl.

Laura's Brilliant New Series, "A Life Apart"

For those of you who don't know my friend Laura, she is a gifted writer - a woman of many talents, in fact. Decorator, re-finisher, baker, adorable-little-girl-dress-maker... you name it, Laura's perfected the art. She also happens to be a tirelessly devoted wife and mother (to two of the most adorable little red heads you've ever seen!), and a faithful Catholic. She has recently begun a new blog series entitled "A Life Apart", and I think it's gonna knock your socks off. What is "A Life Apart", you ask?

"What is A Life Apart? It's freedom from the Culture of Death, and the decline of marriage and the family. It's a call to rise above the mainstream ideals of sex, love and the human condition. A Life Apart is the belief that anyone can reclaim their faith, find spectacular love and live an authentic life. Through a series of guest posts, crazy ideas and fabulous resources, we'll introduce you to a way of living that'll leave you thinking harder and making changes."


You're intrigued. Go ahead, read on. You'll be glad you did. The link will take you to an introduction to the series. You'll also find a side-bar listing of any series-related posts she has published to date, including a guest post from yours truly, chronicling my whirlwind journey from the Pill to Natural Family Planning. This series is bound to bless you in ways you never thought possible - I highly recommend it. 

"The Pill as an Abortifacient": Appendix A, on IUDs

It has come to my attention that my previous post on the Pill as an abortifacient may have been a little narrow. Certainly the Pill is the most common of the chemical contraceptives, but I would be remiss if I didn't include a section on hormonal IUDs (or Intra-Uterine Devices, like Mirena), another commonly misunderstood form of chemical contraception.


Many women are under the impression that an IUD is simply an implantable, more permanent version of the Pill. Well, semi-permanent anyway - they can usually be implanted and left for up to 5 years. The misconception there is that the chemical composition of an IUD is distinct from that of the common Pill, in that IUDs release only progestins while most common oral contraceptives contain both estrogen and a progestin (there are "progestin-only oral contraceptives", but these are usually prescribed for specific medical reasons related to gynecological health and are not the same as the estrogen-progestin oral contraceptives commonly referred to as "the Pill"). The role of progestins in contraceptive devices is two-fold as you may remember from the main post:

1. They thicken the cervical fluid to help prevent the entrance of sperm into the cervix and shorten its lifespan within the female reproductive tract, and
2. They dramatically thin the lining of the uterine wall that normally builds up and sheds cyclically in preparation for physical implantation and nutritional support of a fertilized embryo, making it very difficult for a fertilized embryo to implant successfully - it is instead "washed out" with the monthly menstrual flow. 

Unrelated to the hormonal effects of progestin, the IUD also attempts to physically interfere with entry of the sperm into the fallopian tube by its placement location (though the IUD can and will shift over time, and we're talking about microscopic sperm and eggs that would have to squeeze by... take that for what it's worth).

You may also recall from the main post on this issue that it is the estrogen component of oral contraceptives that prevents follicle maturation and ovulation from occurring monthly. Directly from the Mirena (a popular brand name IUD) website, this means that an IUD "may stop the release of your egg from your ovary, but this is not the way it works in most cases" (emphasis mine). 

What does it all mean, in practical terms, for IUD users? It means that you can assume that during most months, you will ovulate. Given the disruption of the normal cyclical patterns of progesterone circulation induced by the IUD, your normal fertility signs will also be disrupted (such as patterns in basal body temperature and cervical fluid consistency, which could normally be used to determine when ovulation is occurring). Bottom line: you have little hope of being able to determine when or if you've ovulated. At this point, all that's standing between your egg and fertilization is the thickened cervical fluid and the rather weak "physical barrier" of the IUD itself to sperm travel. 

Here in lies the main difference between the Pill and IUDs, as far as abortifacient properties are concerned: the IUD does comparatively little to prevent fertilization (relative to the Pill, which is designed to prevent ovulation altogether, however imperfectly that may work). Once a successful fertilization has occurred, you (as an IUD user) are now relying on the IUD to ensure that your body rejects that conception (as a result of the thinned uterine lining). If you happen to be a woman who is pro-life and defines life as beginning at conception, you have put yourself in a terrible position. You are using a birth control method that allows for ovulation to occur, and loosely attempts to prevent fertilization, but primarily functions to create an inhospitable uterine environment that will reject a fertilized egg. 

I won't venture to call one chemical contraception method "worse" than the other, because that really isn't the point here - that would be splitting hairs. I make this point because many IUD users may not fully understand the mechanism behind their chosen form of birth control (I've mentioned how I feel about the tragic dearth of patient education going on in OB/GYN offices these days) - they may believe, as most women on the Pill do, that they are not ovulating. Pro-life IUD users really need this information, so that they may carefully consider the facts: that they most likely are ovulating, and are therefore risking a lot of fertilization. It is precisely this risk of fertilization that lends chemical contraceptives their classification as "abortifacients".