Wednesday, 6 March 2013

Under Pressure

Well apparently, I can put up some big numbers. Unfortunately it's in a category where no one wants to have high numbers. I went back to work after my hysteroscopy and had one of my medical assistants take my blood pressure on a few occasions. My readings were ranging from a systolic of 150-160 with a diastolic of 100-110. It has now been five days since I took my last birth control pill and my numbers are going in the wrong direction. I feel as if I've taken one step forward and two steps back. The process of fixing my uterus has created another problem. I have a new and improved uterine cavity; but I might not be able to put it to use.

I know it's a straightforward etiology. My vasculature does not like exogenous estrogen. In a strange way I feel it would be easier if I were significantly overweight and just needed to get in shape. What does this mean for my prospects of doing IVF? Birth control pills and estrogen supplements are necessary elements. I might not be able to do the IVF procedures that I've been so desperate to avoid. More so, I may not be healthy enough for pregnancy. A thought that scares me to my core. I know I've cared for pregnant women with many more complex medical issues, and although irrational, I acknowledge I hold myself to a different standard.

I did a medline search for oral contraceptive and blood pressure. Less than five percent of women on birth control pills develop overt hypertension and rarely malignant hypertension can occur. It can take 2-12 months for blood pressure to return to normal. That was enough to propel me past the Denial and Anger Kuber-Ross stages and into Acceptance. I had a patient who had significant hypertension during her first pregnancy and required three medications at maximum doses to control her blood pressure and she needed to be delivered at 35 weeks. Her primary care doctor recommended that she get her blood pressure under control before attempting another pregnancy. Her response was to stop all her meds and go ahead and get pregnant. At her first visit her blood pressure was 188/124 and she was sent to urgent care for immediate blood pressure lowering and to evaluate for end organ damage. I asked my colleague the rhetorical question, "Why do people make such stupid decisions?" I would not be that person. I will be a good girl and take my medicine.

I went for a visit with my primary care doctor, who started me on an anti-hypertensive. I've gone from one pill to another. I had to POAS to check for protein in my urine, which was negative and I'm sure will seem funny at some point in time, but now feels too depressing. I downloaded a BP app for my iphone and I've been recording my readings. I've been avoiding salt at all costs and have stopped eating any pre-packaged foods. I feel as if my age is catching up with me and I'm falling apart.

Damn you birth control pills! I've spent my professional career championing your cause. Have I not been a good soldier in your army? I've defended your data, promoted your non-contraceptive benefits and you fuck me over like this? Deep sigh. Time to get over myself and move forward. As Rizzo says in Grease, "there are worse things..."



  1. Oh man I am sorry you are dealing with this! I can't imagine how frustrating this is since you are in such good shape! I know how you feel about the BCP hatred! HELLO BCP! I am your biggest ally! I teach young girls about you every day! How dare you keep the secret of my POF from me for ?10? years?! What did I never do to you!?

    1. I know it's the ultimate betrayal! I know you'll also relate, I'm so gutted as this means I probably won't be able to take hormone replacement when I do get to menopause :(

  2. That's terrible, I just can't believe someone in such good shape is having this problem! We are raised to think that if we treat our bodies well then we can avoid stuff like this. It's just one more kick in the pants to discover you can't in your case. I hope they can find some workarounds for you and you can have everything you want.

  3. Wow, that is not good. Is the new medication at least helping? Do you think your RE will have any options for you? You would know more about this than me, but are there any pills that work using hormones other than estrogen?

    I can totally relate to how must be feeling (btw, glad you avoided the medication that could give you cankles!). I have a comical visit with my PCP every year because I'm always wanting to switch up the medication for one reason or another and she always has to pull out her little brown book of prescription meds because she's not used to seeing young(-ish) healthy, active women with blood pressure problems.

    Also, when you have a chance, would love to hear what you're eating to go low-sodium.... I've always wanted to try, but couldn't figure out how to do it since everything, especially bread, has so much sodium! :(

  4. I'm in the same boat as you in terms of having high blood pressure, despite being thin and in shape (well, I could stand a bit more exercise, but still). It's so weird that the estrogen raises your BP, though -- I thought it was supposed to lower it; that's what my doctor said, at least. And it's proven true in my case; at 7 weeks, mine has gone down to 120/80. The hilarious thing, too, is that if you ever end up with OHSS, you have to go on this high-sodium diet to help get rid of it. After avoiding salt for years, I was suddenly like, "GIMME ALL THE POTATO CHIPS!" 'cause I had this "medical" excuse. :)

    Anyway, I do believe you can find some way to get around this... hang in there!

  5. I am hoping you are able to get your bp under control. I'm so sorry you've had to deal with it going up. Ugg. Are you taking bp meds to get it back under control? Will those meds work with IVF? I'm hoping for the best for you!