Sunday, March 20, 2016

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 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.