Four Ibuprofen

Some advice for when “take four ibuprofen” is the standard of care.

So last week I talked about the recent rush for abortion bills, and since then, things have gotten worse. Like, way worse. But I think that I don’t have very much new to say on that front, besides “Fuuuuuuck.” I could talk about Alyssa Milano’s ill-advised call for a sex strike, but it honestly just makes me tired. So instead I’m going to expand on something that I briefly mentioned in my last post—IUDs. More specifically, the way that medical professionals and common discourse seem to ignore the pain and complications around IUDs.

I know that anecdotes are not evidence, but I’m egotistical enough to think that my own experience serves as a good foreground to this topic. Content warning for graphic depictions of pain and blood. Skip to the paragraph that starts with “This story is” if you don’t want to be squicked.

When I got my IUD, I had no chance of getting pregnant (unless I happened to be sexually assaulted, the fear of which was admittedly a component in my decision). I wasn’t sexually active, and “terrifying stories you hear in high school” aside, it’s not super probable to get pregnant from a toilet seat. What I did have was debilitating periods that caused extreme blood loss and a sudden, instinctive fear that at some point my access to the birth control pills that kept them somewhat at bay would be taken away—you see, I got my IUD at the end of November, 2016. I had called to make an appointment within days of the election.

I did my research—I looked up the differences between copper and hormonal implants, I looked at different brands, and I talked to many friends who’d already had an IUD put in. As with almost any medical procedure, I got a range of opinions, because my friends had a range of experiences. Some of them had terrible reactions to the IUD and got them removed. Some had a remarkably easy insertion process and raved about it. The majority of opinions, however, followed a consistent narrative: it’s going to hurt like hell, but you’re going to be glad you did it.

I was really worried about that pain. For some (possibly TMI) background, I’ve basically never had a non-traumatic OBGYN experience. My yearly exams are always painful, and I seriously considered having an endometrial ablation when I was 22 because I knew I didn’t want children and it would decrease the number of reasons I’d need an exam. (The doctor refused to perform the procedure at that point because “I might change my mind,” and that is a rant for another day.) So the stories of painful insertion procedures made me very nervous. But friends told me that there were a lot of options available to help mitigate that—things like cervical softeners and higher intensity pain medication for before or after the procedure.

So when I called to make the appointment, I asked about the pain, and the pain mitigating options, multiple times. Over and over, I was told that the best thing to do would be to take four ibuprofen before the procedure. I expressed doubt that this would be enough—for scale, four ibuprofen is what I take for a headache. My body doesn’t respond to low-dose medication in basically any form. I asked about the cervical softeners, I asked about the higher intensity pain medication—four ibuprofen. Four ibuprofen. Four ibuprofen.

I took the four ibuprofen as suggested, but I asked about other options again at the appointment itself. The nurse asked if I’d taken the four ibuprofen, and I said I had. The nurse told me I’d be fine. When the doctor came in,  I asked him about it as well. Four ibuprofen. He suggested that I should take my phone out and read an article or play a game, as a lot of his patients found that a good distraction from the minor pain of the insertion.

What followed was some of the worst pain of my life. For scale, again, I’ve slammed my thumb in a 2-inch thick door, burst an eardrum, and had spinal surgery. When I talk about pain, I have a pretty big scale. And this was at the high end of the scale.

My hands were clenched, white-knuckled, around my phone. Tears were blurring my eyes. My legs were trembling as I fought the urge to clench and make things worse. The doctor seemed surprised that we were having such trouble. “When was the last time you were sexually active?” he asked. I thought back to my chart, the one he supposedly read, where I put a big zero next to the question about how many sexual partners I’d had. “I’ve never been sexually active.” I’m pretty sure it’s the only thing I’ve ever said in a voice that could be legitimately called a “growl.”

Eventually it was done. He sat back with a cheery smile. “Whew! For a while there I thought we were going to maybe have to do this surgically.” I thought about all of the interim steps between “incredible pain” and “surgery,” steps that I had specifically asked about and been denied, and said nothing. The nurse showed me where there was a supply of pads, talked about the cramping and spotting I’d likely have for the next few days, and they left. When I stood up, I found out that they had left behind the large paper pad that had been resting underneath my groin and upper thighs for the procedure. It was soaked with blood. I carefully folded it and threw it in the biohazard bin, then got dressed, put on the pad, and went to call my friend for a ride home.

I got off pretty lightly in terms of after-procedure effects, with a day spent on the couch with my dog while I watched Netflix and felt achy with cramps before feeling fine the next day.

This story is not meant to scare anyone away from getting an IUD. In fact, as I wrote last week, I still strongly consider that anyone who can get pregnant consider getting an IUD. But I think it is important for anyone who is considering doing so to go in with eyes wide open, and to know one important thing: the doctor is probably going to be dismissive of your pain. Casey Johnston wrote a piece about the disconnect between the amount of pain IUD insertion can cause and the amount of pain relief patients are offered. (Note, I don’t totally agree with the titling of the piece, which is “If Men Had to Get IUDs, They’d Get Epidurals and a Hospital Stay,” because there are plenty of trans men who get IUDs and are also likely to get their pain discounted, but the main theme of the piece, that women and women’s pain are discounted, is spot on.) It’s honestly a bit beyond belief that a procedure with such a high propensity to cause blinding pain is not automatically performed with the option of higher dose pain medication and a local anesthetic. And this isn’t even taking into account the very serious and painful possibly side effects.

Johnston muses that one of the reasons doctors may downplay both the pain and the effects of the insertion procedure is that they don’t want to scare someone away from getting one, and I think this is likely correct to a certain extent. When the procedure is advertised as a “quick,” mostly painless event where you might just feel a “pinch,” more people are likely to look into it and sign up for it. But I honestly think that explanation covers less ground than, “medical professionals discount women’s pain.” There have been studies that show that menstrual cramps can be as painful as a heart attack, and generations of women were told to take a couple ibuprofen, put on a heating pad, and get back to work when they complained about menstrual pain. In my case, I repeatedly expressed concern over the pain to nurses and to the doctor, and was repeatedly dismissed. And in the midst of the procedure the doctor had apparently had the thought, “This is fairly difficult, should we do this surgically? Ah well, no way out but through! Tally ho!” (He may not have actually thought the words “tally ho,” but it seems an appropriate addition.)

So my advice from last week still stands—look into long-term birth control options. (Ideally, if you’re like me and you’re certain you don’t want kids, you might want to look into sterilization procedures, but you’re likely to face some of the same obstacles I did, so that one isn’t as practical of a piece of advice.) But I want to amend last week’s advice with some further advice. Sadly, this advice kind of amounts to “add obstacles to your own care in the hope that the end result will be better,” and I know that not everyone has the spoons for that. But I am deeply invested in this being as non-traumatic as possible.

1. Do your research.

There are a lot of long-term birth control options out there, including IUDs and subdermal implants. I was most interested in the former, because even more than avoiding pregnancy I wanted to avoid debilitating periods, and the subdermal implants aren’t very useful for that. While hormonal birth control in pill and ring form are also available and are viable options, the current trend towards removing contraception coverage and even trying to outlaw contraception makes me lean towards birth control options that are There To Stay for at least a few years. Find out what your different options are, find out what experiences others have had, and do your best to figure out what will be best for you.

2. Talk to the doctor personally prior to the insertion, preferably at a separate appointment.

I had never met the doctor who performed my procedure before having the procedure. This was mostly due to my brain frantically blaring at me, “DO THIS AS SOON AS POSSIBLE,” so I just signed up for the first available appointment with the first available doctor. In retrospect, this was a mistake—even though I should be able to trust any random doctor to have my best interests in mind…. Well, I can’t. If I had met the doctor prior to the insertion appointment, I either would have had the chance to discuss pertinent information and been sure that he understood it (I could find a lot of different languages in which to say “I have never had sex” until he understood) or, if I still didn’t feel confident that he was taking me or my concerns seriously, I could have asked for a different doctor. Once we were at the appointment and Doing The Thing, the mix between my own sense of urgency and my fear of “wasting people’s time” meant that I felt stuck.

3. Don’t be afraid to waste people’s time.

In the back of my mind, I had been hoping that there was a disconnect between what I had been told over the phone and what was going to happen at the appointment. I was hoping that when I was face-to-face with a nurse or with the doctor, that they would decide to take me seriously, take my concerns into account, and offer more pain mitigation options. That didn’t happen. And when that didn’t happen, I should have politely thanked everyone for their time and left. Given the reasons that I was getting an IUD, there was no reason that I had to continue the appointment once I was certain that my pain and my concerns were being discounted. It would have taken a leap of social awkwardness that I’m usually reluctant to pursue, but I should have left at that point.

4. Bring someone else that can help advocate for you if you need it.

Not everyone is good at interpersonal conflict, and I get that. So if you have a friend or loved one that feels comfortable doing so, let them know what your concerns are and bring them with you to the appointment. When they see you getting uncomfortable or not getting what you need from the doctor, they can help you navigate either leaving the appointment or advocating for you.

5. Don’t gaslight yourself.

You know your body. You know what “normal” and “abnormal” types of pain are for you. I was lying on that bed, crying from the pain, and still my brain was telling me, “it is supposed to hurt this badly.” In the modern age, nothing is supposed to hurt that badly, especially not a routine procedure. The world, and especially the medical establishment, is going to try to discount and minimize your pain. Don’t do their work for them, and don’t gaslight yourself.

So that’s my advice for navigating the medical system in search of long-term birth control. Now if all of this systematic disenfranchisement has given you a headache, take four ibuprofen—because that is what it is good for.

Signed: Feminist Fury.

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Featured image is of a bottle of ibuprofen on its side with four pills in front.

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