Trust Your Gut: The Mirena IUD Story

I debated for weeks on posting something about this or not.  Warning: some people might find it to be TMI, but it's something that needs to be discussed.  Something that unfortunately there isn't a ton of research on, but maybe that will change in the coming years.  Something that friends and training partners have urged me to post about, because let's be real, I'm probably not the only person who's dealt with this.

Let's start back at the beginning...November 2015.  I had just had a pretty awesome year of training and racing.  I was excited to go into my off season, take an awesome trip to Taiwan (Hi Rory and Kara!), rest up and then start the process all over again for 2016.  My primary care physician had recommended thinking about an IUD and presenting all the benefits.  A major selling point of the Mirena...no periods!  That sounds great to an endurance athlete, no pregnancy, do daily pill or

anything to remember and it's good for 5 years.  Little to no side effects since the hormone is delivered in a very small amount directly in the uterus.  I thought about it some and decided to go for it.  For me, this was going from no hormonal type of birth control since I was a college athlete and at that time everyone (docs and athletic trainers) thought it was best I be on BC since I wasn't having a cycle at all.  I stopped taking the pill probably in less than year because I didn't like the way it made me 'feel'.  I didn't have any objective #s or information at that point but I knew it wasn't agreeing with my body.  My hope and thought was that Mirena would be different, lower hormones, no estrogen, and plenty of my friends and training partners had them and didn't note any changes.

In mid-December, amidst off season galore I had the Mirena inserted.  A bit of discomfort for a few hours, but nothing so great I couldn't swim that evening or carry on with work that day (I did take a decent amount of Aleve, but I've had cramps when I was younger that were much much worse).   I knew to expect some discomfort for a few days and light spotting for up to 2-3 months.  I bled for about 2 months straight (annoying, yes) but was confident once it stopped all would be well and I wouldn't have to ever deal with a period during training or racing for the next 5 years or so.

January rolled around and training started back up.  The first few weeks went well, just bringing the legs back and getting back to the zones.  My first testing week came and went.  Aside from a scary moment where I may have blacked out for a second after an 8 minute all out test on the bike all seemed to go decently well.  I attributed it to pushing myself to my limit and really giving it

everything I had.  The following weeks when I'd expected to see some form of progress I saw declines in pace and in power.  Steady incremental declines week to week.  My perceived exertion was very low for a given heart rate zone.  Thankfully the swimming continued to improve (we don't use a HR monitor in the pool).  Coach wasn't too worried and encouraged me to just stick with it and not watch the numbers.  We were early enough in the season and far enough out from the A race that there was no reason to ditch the HR zones and train by RPE quite yet.

I kept at it and we started seeing some small improvements in February.  RPE continued to stay very low and heart rate just seemed out of control.  Try explaining that to people, most people either think you're just out of shape or legit crazy.  I had a doctor's appointment in mid-February and rattled off a list of weird things that were going on, but I didn't want to blame the Mirena, and thought it might just be coincidental.  Extremely dry skin (my eyelids were practically falling off), dizziness/lightheadedness (enough that any change of position at work as enough to make me almost fall over), constipation, headaches (I'm not a headache person), decreased sweat rate, high heart rate compared to RPE, and a general increase in anxiety.  Biking and running were things I used to thoroughly enjoy and they were becoming a huge source of stress and anxiety.  The doctor suggested it sounded like I might be iron deficient so she took some blood and we decided to wait another month or so and see how things went with the IUD.  Iron deficiency sounded very plausible, I had just bled for the 2 months leading up to that point and I am an endurance athlete, and I rarely eat red meat.  I promptly went to the grocery, got some steak and proceeded to have red meat with my next 6 meals (breakfast, lunch and dinner).  I had a great run and felt much more like myself the day before a 1/2 marathon at the end of the week.  At the 1/2 marathon things presumably went 'fine' I won my age group, ascended my HR throughout, and the time was hard to compare as it was a 'trail' 1/2.  I'd be lying if I said I felt great or even good, I felt dizzy and light headed by the end.  I had taken sports nutrition and liquids throughout the run and it wasn't hot out, it was actually quite perfect.

My 2nd testing week came and went and there was progress that had been made.  Despite my perceived low effort levels it was great to see that the progress was there.  I also got the news that my dream bike (more on that later) could possibly, actually be mine!  Things were looking up and seemed to be heading in the right direction.  I was curious though, I wanted to know the effects of Mirena or progestin on the female endurance athlete.  I searched pubMed and Google quite extensively.  I found one good study noting that it's a difficult area of physiology to study but most of the cardiovascular benefits come from estrogen, and progestins (synthetic progesterone) are actually an antagonist.  I wasn't thrilled, but figured the dosage was so low and delivered locally so I wouldn't get those effects.  I found some anecdotal information in blogs and forums but no great research.  I started keeping extensive notes and jounaling - ruling out everything we could with the help of my coach and doctor.  Iron, Ferritin, TIBC, etc was great (had 2 blood draws for this), thyroid was good, weather wasn't seemingly making a difference, washed and changed the battery on the heart rate monitor.  We reviewed nutrition to make sure I was getting enough calories and carbs, I changed up inhalers to make sure it wasn't a bad inhaler.  I tried recreating exactly what I did the couple days leading up the the 1/2 marathon and nothing seemed to get me back to a congruent HR and RPE.

Taking out the Mirena was going to be the last resort.  "They" say it doesn't cause many side effects and the discomfort of the insertion was enough to give the thing a fighting chance.  By mid-March my moods were not great, the frustrations of training had become too much and despite being elated with my new bike I wasn't enjoying biking or running much at all.  There was more than one mental breakdown after a training session and the passing thought of throwing in the towel for the season.  I talked to multiple people and my coach asked other coaches.  We went over sleep, nutrition, stress
level, etc.  All of which were great compared to where they've been at other times (my fitness tracker even congratulated me on averaging 9 hours of sleep for one week!). I stopped Googling and thought about who know's my body best - ME!  My gut was telling me that it was the Mirena causing all these issues and my mind was so wrapped around it that I knew I needed it out, if for at least nothing else the mental release.  Decision made Thursday evening,  Mirena removed Friday afternoon, already feeling more like myself by Sunday!  I'm enjoying training again and I can't wait to see what the next 4-6 weeks and beyond bring!

There are bound to be peaks and valleys during training and maybe some plateaus, but the inconsistency became too much.  Especially the inconsistency between HR and perceived exertion.  It's hard for other people to understand the frustration and disappointment when training isn't going well, but I'm so thankful for the support system I have in place.  At times they were probably sick of the tears, flurry of emails of frustration, and complaining on 2 wheels but thank you for the encouragement,  listening, and validating my feelings.  Everyone reacts differently to hormones and I know plenty of athletes that love their IUD, it just wasn't the right thing for me!  I hope that we see more research studies come out on the physiological effects of synthetic hormones in the near future.

To accomplish great things we must not only act, but also dream, not only dream, but also believe.

Dahlgren Trail 1/2 Marathon Race Report

Leading up to this season opener has not been a smooth, easily traveled path.  My training started off great in January.  I was running better and biking better than I would have expected coming out of off season and I was excited to get going and tackle some big goals for 2016.  Enter my birthday, during the 3rd week of January.  Now, no it wasn't my birthday itself but it was around that time that a performance decline started.  A gradual steady decline, despite constant and consistent work, a clean diet, proper recovery, etc.

I had no clue what was going on or what to expect going into this race.  I made some adjustments on the Wednesday prior to the race and saw some pretty huge benefits.  That helped pick my head up a bit and go into the race with some level of confidence.  This race was described to me as a 'flat and fast' trail.  I assumed a nice crushed gravel path similar to Paint Creek Trail (for the Michiganders) or the nice park I ran in while driving through Pennsylvania lost fall.  I can assure you, it wasn't fast, and mostly not flat.  Not it was an old railroad bed so the grades were very gentle, but they were there.

Pre-Race
Dahlgren is only about an 80-90 minute drive from DC so we hitched a ride with friends on Saturday morning and head straight to the race site.  We of course had to stop for cheap gas and coffee for our Sherpa on the way down.  Parking was easy along the rural roads by the race site and rack check-in was fast and efficient.  T-shirt is optional at this race, which is a nice added bonus for someone with far to many race shirts already.

Once we were checked in we heaed towards the bonfire to start delayering and head off on a warm up/hit the bathroom run.  Unfortunately there were only 3 port a potties and a ridiculously long line for them.  The weather was quite gorgeous for a mid-February day so I needed to make some wardrobe decisions prior to race start.  I warmed up in my jacket and long sleeve top, stopped in the woods for a quick break, and then headed back to the start line.  I knew the weather would only warm up from that point so I stripped down to a shirt, running capris and gloves.

Race Start
Since the race takes place on an old railroad bed the trail is not super wide.  The race director chooses to start the race in wave format to open up the trail a bit more.   After a few of waves of men started it was finally time for the females 29 and under to line up.  I much prefer to have people in front of me to pick off along the way rather than starting in the front and only getting passed the entire time.  The starting lady warned us that there would be a horse on the course, to pass the men, and have fun.  As the time clock hit 8 minutes it was a rather calm and anticlimactic "go" and we were off.

Race
Miles 1-4: I had a race plan but I also knew it was early season, the trail conditions were very unlike road conditions and my body had been a bit unpredictable the past few weeks.  I started off with a controlled and steady pace and starting picking off the men 1 by 1 within the first mile.  The trail was peaceful, the air was clean and the weather was pretty much perfect.

Miles 5-9:  I started to push it a bit around mile 5 and really tried to pick it up once I hit the turn around at mile 6.5ish.   My heart rate was a bit higher than I expected and I was a little nervous that I might crash and burn before mile 13.1. Knowing that there weren't any consequences for this run and some of my goals involved driving my HR up throughout the race I wanted to go for it and see what would happen.

Miles 10-13.1:  As mile 10 came I was still feeling pretty good and resisting the urge to push too hard before hitting mile 13.  Once I hit mile 11 I really tried to push, this is also the point in the race where things started to get hard!  I used some mantras, tried to hold on to heels for as long as I could, and continued driving my HR up straight to the finish line.  I finished a bit light headed and exhausted as well as 12 minutes ahead of the next athlete in my wave.

Finish line pic, Osmo Nutrition, and Mantras!

Post Race

We hung out around the bonfire, refueled with Osmo Nutrition and collected our Prize Money Giftcards.  Our group took home a trio of Age Group victories and a decent stash of gift cards to the local outdoor adventure store.  I was also able to share the trail with a few patients from Rose Physical Therapy Group and see them finish strong (as well as take home some age group awards).   Always nice to see the work we do in the clinic making a difference for people! There was a plethora of post race grub including cookies galore, hot soup, bagels, donuts and other snacks.  Once the awards were finished we headed out to downtown Fredericksburg for a nice brunch and to spend our gift cards, of course!

Scott, Paige (sherpa), me and Adam.

Post Race Wrap Up

All in all I'm happy with this performance.  The overall finish time was from from a distance PR, but it was a trail PR (well it was my first trail 1/2 marathon).  I had set some goals going into this race that were a bit more mental and all about digging in and pushing myself when things got hard.  My HR may have been sky high by the end, but I never took the foot off the gas and just kept after it the entire time.  Thankfully the soft forgiving surface of the trail has left me much less sore than anticipated and I'm feeling pretty good.  It was a great, low-key race to kick off the season and always fun to come away with a win.  I've been using Lauren Fleshman's 'Believe' Journal every day and think it really helped set some goals and reflect on my performance.  Hopefully I'll have some more answers over the next week or so for what's going on with my body and be able to dial back into my training after coming out of this recovery week.

Thank you to all my sponsors and supporters for 2016 including Snapple Triathlon Team, DC Triathlon Club, Sweatvac Performance Wear, Osmo Nutrition, Cliff Bar, District Taco, Rose Physical Therapy Group, Louis Garneau, Rudy Project, Xterra Wetsuits, Fuel Your Passion Coaching, and Rose Physical Therapy Group.

2016 Off and....Swimming?

The 2016 racing season has started, maybe a tad too soon and perhaps a bit underprepared but sometimes your just have to dive right in.  Sink or swim, quite literally.  No different than the past couple of years, starting with the base.  The ever so crucial, yet frustratingly easy, and slightly tantalizing base.  The time of year when every athlete is thinking and saying this is too easy, are you sure this is right, I can go faster.  The time of year when your mind remembers your November 1/2 marathon PR, your Ironman bike split and run PR but your body isn't in sync with your mind, yet.  Self-doubt creeps in, thoughts of everything you've worked for really being a fluke and that this could be the year that your body just wants none of it.  Then again, it's the time of year that you just put your head down, watts out, hit the HR and do the work because you know the watts will come, the pace will drop and splits will improve.

2016 Blizzard Edition

3 weeks into training and then it was time for a testing week.  Unfortunately I didn't see the gains I was working towards in the pool during my test set so what did I do!?  Sign up for the DC Tri Club Swim Meet of course the following weekend.  My first swim meet and a little trial by fire.  I'm lucky enough to have a good friend that just happens to be one of the top AG swimmers in the country.  She
gave me some basic instructions the morning of the swim meet on block starts and flip turns.  Every winter I think, this is it, I'll start doing flip turns.  Then I try it and decide, well I can do them if I have to, but it's much easier to just do an open turn and besides that aren't any walls during Ironman.  Yes flip turns help with body position, breath control and core but I was much more comfortable doing open turns and again there are no walls in the open water.   Well when it was time to race and start off the blocks I did just that.  Then when I got to the wall I threw my legs over and flipped.  Sure I missed the wall on a couple flip turns, but I didn't lose my goggles on the start and I set some new PRs in the pool.  Most importantly I enjoyed doing it and got some great feedback.

Wish Lantern in Taipei during the Off Season

The season again sees an early, slightly under prepared race with a  1/2 marathon effort on February 20th in Dahlgren, VA.  After some early season racing I'll really be focusing in on some pretty specific goals.  Goals in the water, on the bike, and on the feet.  When it it all comes together I should be able to put together a pretty great day in August.  So far the 2016 season is looking like this:

2/20/16 - Dahlgren 1/2 Marathon
5/1/16 - Rumpass in Bumpass Sprint
5/14/16 - Kinetic 1/2 Distance Tri
6/19/16 - Syracuse 70.3
8/21/16 - Ironman Mont Tremblant
Oct-Nov. - Late Season Race..TBD

I'm looking forward to another year with my awesome teammates and sponsors from Snapple/DC Tri as well as working with Kim from Fuel Your Passion for another year.  I'll also be taking on some more athletes as a Level 1 USAT Certified Coach this season (if you're interested check out the coaching tab at the top).  I'm looking forward to using all the people and talent around me to help progress and dial in everything.  It's looking like 2016 might see some upgrades in the arsenal as well, excited to get this season rolling!