In January 2019, nearly one year after my diagnosis, I was finally feeling like I could enjoy the fruits of my labor. I was engaged to the man I loved. My freelance career was finally coming together—I had steady work and was making almost as much as I had before leaving my job. And my self-soothing techniques were paying off. Most of the time, I felt more gratitude than doubt. People around me seemed so much nicer: I got a free scone from my café! People chatted me up on the subway! It took some time to realize why—I was moving through the world with less fear. I was smiling, trusting, open.
I was going to start this brand-new year with a bang by heading to the Sundance Film Festival in Utah, where I was scheduled to do a live performance of one of my radio stories. While I was there, I was going to meet up with my childhood best friend, Kathy, and we were going to enjoy some nature—hot springs, skiing maybe. I hoped that this trip would be representative of the coming year: full of adventure instead of fear, friendship instead of isolation, success instead of self-loathing.
I hustled through the Delta terminal to catch my flight, when all of a sudden, I felt a deep, stabbing pain so abrupt and shocking that I stopped in my tracks, my rolling suitcase skidding ahead of me. I was on my period, but this wasn’t a menstrual cramp. It was something sharper, as if someone had stuck a fishhook inside me and was tugging with every step.
The pain flicked on and off during my trip. Walking aggravated it, but the muddy hot springs soothed it away. I saw a gynecologist when I returned. She ordered several tests—blood tests, an ultrasound, an unpleasant scan of my uterus that involved sticking a camera up there and wiggling it around a lot. And then she sat me down and told me matter-of-factly, “Well, it seems like you probably have endometriosis.”
“What? What is that?”
“Well, it’s basically when the lining of your uterus starts growing outside of your uterus. Around your fallopian tubes, around your whole pelvic area, sometimes around your intestines or the muscles of your lower back. There’s no way to really prove that you have it without opening you up for surgery. And there’s no cure. There’s just pain management, maybe putting you on hormones to try to keep it from growing aggressively. Eventually, if it gets really bad, we might open you up and try to cut some of the lining back, but we’ll try to avoid that.”
The first thing I thought, and subsequently blurted out, was, “I have complex PTSD. Did that cause this?”
“Endometriosis affects about one in ten women. It’s really common, nothing odd there. And tell your psychiatrist about your mental health stuff. Don’t tell me.”
I flinched at her directness, even though I’ve been told some version of that sentence before: “Tell your psychiatrist. Your brain has nothing to do with your physical health.” Even though I knew that was completely wrong, I felt self-conscious using my precious few minutes with the doctor to give her a lecture on how trauma affects brain/body systems.
The doctor told me that my periods would become increasingly painful as the endometriosis progressed. My period had already been difficult, but it was mostly psychological. For years I had aggressive premenstrual dysphoric disorder, which resulted in deep anger and depression the week before my period. Now it was going to feel as if I was getting emotionally and physically stabbed? Well, at least the doctor said she wanted to stop my period entirely to slow the progression.
“How can we stop my period?”
“We’ll put you on the pill.” The doctor typed into her computer without looking at me.
“Wait—I’m allergic to the pill. I’ve been on a few, and they all make me break out into a full-body rash that’s so bad it leaves scars,” I countered.
“What about IUDs? Says here you have a copper one. How about Mirena?”
“Mirena made me so depressed, I felt suicidal for the two months I was on it,” I said quietly. “Should you take out my IUD? Will that help? I mean, it makes periods worse, right?”
“No need. Copper has no hormones, so it won’t change anything. Hmm. Okay—then I guess we’ll have to force you into an early menopause. I’ll give you Lupron—it’ll give you hot flashes, mood swings, that kind of thing—but it’ll stop your period.”
Her bedside manner was infuriating. As if this was no big deal. “Wait!” I said, racking my brain. I’d tried damn near every form of birth control, and everything had made me depressed. But becoming menopausal two decades before my time didn’t seem great for my mental health, either. This decision felt impossible: Should I prioritize my physical health or my mental health? But I knew that my physical health and mental health were deeply intertwined. If my mental health suffered, my physical health would suffer, too. Should I refrain from taking medication and endure the pain, which would probably affect my mental health? Or take medication that would improve my physical health but wreck my mental health?
“Do I have a choice here? Do I have to go on anything? There isn’t anything else?”
“If you don’t go on any medication, your pain will probably steadily increase until it is excruciating. Trust me on this one,” she said and laughed. “I have plenty of patients who can’t think about anything but their pain. That’ll make you miserable, too.”
“Okay then.” I gave in. “I’ve been on the NuvaRing once before, years ago. It also made me really depressed, but it was the least terrible hormonal option I’ve had. If that’s the only thing I can do…”
“It is. Great! I’ll write you a prescription for it.”
“I don’t know if you understand. It’s not great. I’m going to be really sad now,” I said, squirming under my paper gown in her cold, gray room.
“If it makes you depressed, I’ll just write you up a prescription for Zoloft. That should cover it,” the doctor returned brightly and then waltzed out of the room to her next patient.
My legs were wobbly with this life-changing news, so I indulged in a taxi ride home and googled “endometriosis.” One study showed that women who have suffered from childhood trauma were 80 percent more likely to develop painful endometriosis.
Of course.
* * *
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It is a great, sexist irony that in our society, PTSD is generally considered a male condition. It is the warrior’s disease, a blight of the mind that must be earned by time in battle, in some dangerous overseas desert or jungle.
But the real statistics suggest the opposite: Women are more than twice as likely to have PTSD than men. Ten percent of women are expected to suffer from PTSD in their lifetimes, as opposed to just 4 percent of men. But even after #MeToo, a global movement to recognize the legitimacy of women’s trauma, treatment for this trauma remains a half-assed endeavor, an afterthought in the shadow of the glory of war. And it has always been this way.