I’m currently on day 4 of seven days of Pro.vera. Not to bring on a period for any upcoming clinic trips- I’ll be taking birth control pills in August for that one- but solely to end this cycle and to hopefully (oh please) help out my poor face.
Yep. I am breakout city these days.
It’s kind of crept up on me, but I’ve finally had to realize in the last month or so that my face is as bad as it was when I was a teenager. Before I went on birth control pills. Before I had a PCOS diagnosis. This was close to fifteen years ago now. Since then I’ve been on birth control, more or less continuously, for nine years. I occasionally took a break from it, but never for more than a few months. My skin was fine. I never thought about it, except to be a little bit smug when we lived in a sun-burnt country and I had AMAZING skin for my age because I didn’t grow up there, and lots of women would comment on it.
I chucked out the pills for good back in August 2007 after Q. and I got married. Since then I’ve occasionally taken them for a month to line things up for a cycle at the clinic. And every time we were at the clinic, I would be pumping myself full of hormones to counteract the PCOS so we could get pregnant. My skin throughout was fine. I never thought about it, except to occasionally note I was developing some fine lines, partly from aging, and partly from stressing about infertility.
Then I did get pregnant. And then I had E. and was nursing. And all of these things balanced my body out perfectly and my skin looked fantastic.
And then, a year ago now, I weaned E.
And I waited.
I had hoped (hoped so very much) that getting pregnant and breastfeeding for a year would help reset my body. I knew people to whom this had happened. So many things had changed since I first went on birth control when I was nineteen. I was thin now, for one thing. My diet was much healthier. I exercised regularly. In short, I was taking much better care of myself. I knew from the various tests various doctors had run that I had no signs of insulin resistance, that I was an atypical PCOS case.
I wanted my body to fix itself. I wanted it to start over.
In October I started to notice a little bit of acne- just in one spot, near my nose. It was annoying because I couldn’t clear it up, but it wasn’t too unsightly.
In late November I went to see my GP. When I told her I still hadn’t had a period, close to six months after fully weaning E., she sent me off with some Pro.vera to bring on a period.
In January, five weeks after that period, I had another one. On my own. I must have ovulated.
This stupidly raised my hopes again. If it had happened once before, it could maybe happen again! Maybe my body just needed the one artificial bleed brought on through Pro.vera to sort itself out!
So I started waiting again.
And I waited.
In April I went to see my endocrinologist before I left for the U.K. By that stage my acne was getting worse- it was on my chin, around my mouth. They were never huge breakouts, but there was always something. I kept trying different creams. It was worse on the side I slept on, so I kept changing my pillow case every day to see if that would help. I sternly reminded myself not to poke at my face, or to touch it unconsciously while working (which is a bad habit).
I was already in the U.K. when the endocrinologist called with my blood results. Everything to do with my thyroid was fine. But since I am a puzzle, and he likes puzzles, he always tests a whole slew of other things too.
“Tell her the acne is caused by the PCOS” he told Q., “and get her to take progesterone to end the cycle. That should help.”
I had never mentioned the acne to him. He noticed it himself. He only sees me every six months or so now, so it was bad enough that it made an impression.
I felt like a moron when Q. told me what the endocrinologist had said. It honestly hadn’t occurred to me that my PCOS could be causing the breakouts, given it had been so long since I’d had to think about my skin. I had assumed, since the acne had appeared after I weaned E., that getting pregnant and nursing had fundamentally changed something about my skin- made it more oily, or more sensitive, or something. Again, I knew women to whom this had happened.
My PCOS had been dormant- controlled by birth control, or by medications while at the clinic, or by pregnancy and nursing, for fifteen years.
Now, my endocrinologist reminded me that it was still there, and that it needed to be managed.
I should have taken Pro.vera as soon as Q. told me this. I have a supply- given to me by my GP, who had said I should take them every three months if I didn’t have a period on my own (after getting a blood test to make sure I wasn’t miraculously pregnant- ha ha). But I’d been ignoring this advice, because I was still hoping that my body would do what it did in January, and I didn’t want to confuse it if it was trying to sort itself out.
And then Q. and E. got here, and we got busy, and then we were going to be away, and well, there never seemed to be a good time to schedule in a week of hormonal roller coasters and mess and lots of pain (thank you, endo). Really- can you blame me? If you could avoid having a period, wouldn’t that seem like a good option?
And then I finally realized that my acne was still getting worse and now most of my forehead was breaking out as well. I was starting to get self-conscious about it. I felt it was the first thing people saw when they looked at me. I felt, to be honest, like a teenager again, and felt ridiculous that this was the case when I was thirty-three, closing in fast on thirty-four.
So I broke out the Pro.vera on the weekend. And I’ll cope with the hormones and the mess. And the pain, which has been better since having E., so maybe giving birth really did help on some level, at least with the endo. And the insomnia, because apparently I am the only person in the world for whom progesterone does NOT produce extreme levels of exhaustion, but rather the opposite. It’s been taking me two or more hours to fall asleep at night since I started the Pro.vera, and I now realize that this must have been what caused the first trimester insomnia problems I had while pregnant with E. I’d orginally thought they were related to anxiety, as they went away (largely) once we had our good nuchal fold scan. But that was when I eased off the progesterone as well. And I never got the first trimester fatigue everyone talks about, even after I weaned off the prednisone (which was a steroid). So I think I just react in the exact opposite way to the norm to progesterone, just as I do not lose weight on met.formin like most people do, and I do not gain weight on pred.nisone like most people do (but lose it, and lose it quickly). Which is all very weird.
Anyway, hopefully this will help sort out my face.
If it doesn’t, we’re back at the clinic in the fall, and I know that will clear things up.
But this whole issue has made me realize that once Q. and I are done trying to add to our family- whether that means we do get to make E. a big brother, or we remain a one-child family- once we are absolutely done with the clinic, I need to think about how I’m going to manage my PCOS.
I don’t want to go back on birth control until I hit menopause (do PCOSers go through menopause the same way? I’ve never even thought about this). I don’t want something so artificial controlling my body, and birth control pills affect my thyroid pills, and we’re only just now finally settled on a dose that really works well for me.
At the same time, the last few months have made it clear that I can’t just ignore my body either and keep on keeping on with a period-free lifestyle.
I guess I’m finally realizing that I need to work harder at managing my PCOS, that it wasn’t fixed by having E., that it’s not something I can ignore for the rest of my life.
I’m starting to wonder whether I should be talking to my GP about Met.formin again, since it is meant to have good results at managing the symptoms of PCOS, even for those who are thin with no insulin resistance. I wouldn’t care if it couldn’t help me ovulate if it could keep my skin clear(ish).
I’m starting to wonder whether I should use some of Q’s crash-hot health insurance to go see a naturopath to talk about alternative forms of treatment/management.
I don’t need to think about it all right now. Right now I’m looking ahead- to the clinic and the FET(s) in the fall. But at some point in the next couple of years this question is going to arise again. And I need to think about before my face makes me feel like I’m back in high school.