Unpacking My New Relationship to My Body as it Gets Smaller

When people ask me what I've been up to since I graduated, my first response is always "living". College was a rough time for me (like almost everyone I know), and the months since have allowed me to take steps to become the person I want to be. My mental health has improved, my skin has cleared up, and most obviously, I've lost a lot of weight. 

Being fat my whole life means that I grew up hyperaware of my body in a way that smaller people didn't. As I got older, it became increasingly obvious that the world had disdain towards me for being fat. Fatphobia is more than just fat-shaming, and has real consequences in the lives of fat people. I remember when I had my first panic attack after my grandmother died when I was 16. My doctor acknowledged that I might have an anxiety disorder but didn't want to consider medication because "most of those medications make you gain weight and that's the last thing a 16 year old girl would want". Maybe I wanted better control over my health, but sure, let's keep me from getting fatter. At 18, I was told that I would probably be infertile because of my PCOS and having excess weight would make it even harder to conceive. 

I've noticed my body changing over the months, but it's a side effect of having the time and money to go grocery shopping as well as having a partner who pays for my gym membership and a job that affords me the time to go 4-5 days a week. I can say from experience it's not just as simple as "buy and cook healthy food". There's classism inherent in our societal conversations around fatness but no one really wants to hear that. I was in college and pretty well off for 4 years, and I still didn't have time to buy food, cook, and eat anything other than garbage most of the time because of everything I had to do in a day.

The conversation around weight loss is still one I'm not sure how to step into, or one I should step into at all. Even at my biggest, I was still considered a smaller fat. I've always occupied a relative amount of privilege. Now, depending on who you ask, I'm not even fat anymore. I'm technically average, which is mind boggling as a person who wore a size 16 in middle school.

In this body, trying to speak about fat positivity and body acceptance seems disingenuous at best, privileged and space occupying at worst. Knowing that this is the case doesn't make it any easier to cope with, but I've genuinely lost a community and that's heartbreaking for anyone to deal with. 

People who wouldn't believe me about the way I experienced the world in a bigger body would be more inclined to listen to me in my smaller one, but those aren't my experiences anymore so it seems weird to talk about at all. I would've preferred to live my life and not have anyone acknowledge that i look different, because most of the time I feel like I look the same as I did a year ago. The physical adjustments were relatively easy to handle, but nothing can really prepare you for the mental aspects of becoming a new person. 

The way I move in the world now is different from anything I've ever experienced before and I'm not sure how to feel about it or where I can even process my feelings, but it's a very unique space that I occupy. Trying to explain that I feel just as visible but only because I'm perceived as more attractive and less of a social burden makes me sound like I'm seeking validation. Fat people don't care because they don't have to, and thin people don't deal with the social impacts of living in a fat body so it's irrelevant to them.

Walking around in a more privileged body carrying the knowledge of what it was like to have less privilege just a short time ago feels like being really good at random trivia but never having any opportunities to show what you know because your knowledge is so specific. I don't resent anyone for not caring about my "skinny tears". I just hope that I'm able to find a space where I'm able to use my privilege and experiences to advocate and amplify the voices of others who aren't given the same opportunity.

When Birth Control Doesn't Make You Feel Liberated Part 2: New Beginnings

This post is part 2 in a series about my experiences with birth control. Part 1 is here.

Note: about halfway down the page, there is an image of a rash I had for educational purposes. There is no blood or other body fluids present in the image.

The first few weeks with my Nexplanon were fine, and I was excited to have birth control I wouldn't have to worry about for a few years. I dealt with the side effects as they came: cramping, bleeding, skin changes, weight gain, and mood swings, because they initially subsided. They all came back eventually, but I'll get to that in a second. The worst of them all was this lingering arm pain where the implant was inserted, like it was rubbing against (and tearing) my bicep muscle. It was a sharp pain, and I'd only feel it when I extended my arm a certain way or someone grabbed that area, about 3 inches above my left elbow. I thought it would go away once I got the implant out, but it's still there about 8 months later even though I only feel it when I extend my arm.

The final straw for me, however, came in October of 2016, about 8 months after I had gotten the implant. I started spotting, which was normal for a few days each month since I didn't have an actual period. But the flow got heavier and didn't stop for MONTHS. It didn't stop until well after New Years. I know part of the risk of hormonal birth control is that it'll throw your body out of whack but that was ridiculous.

In retrospect, I'm not sure why I didn't let my doctor know what was happening. I think I convinced myself that it would end soon enough, and that at most all the doctor would do is recommend that I take it out which I didn't want to do at that time. It didn't help that my doctor was in Baton Rouge and I lived in New Orleans for school; she was always booked out for months and appointments almost never worked during the semester because I had class. 

Worst of all, I just wasn't feeling good. I felt so uncomfortable all the time because all of the side effects I was experiencing were out of my control. Acne, weight gain, 3 months of bleeding nonstop, depression, and body pain are all things I don't consider inherently bad, but knowing that there was a cause behind it all and I couldn't do anything about it frustrated me to no end because I felt powerless in my own body.

Part of my shingles rash on the left side of my torso. There was a matching rash on my other side and along my back.

Part of my shingles rash on the left side of my torso. There was a matching rash on my other side and along my back.

I'm a relatively healthy person, but I had a lot of health issues come up during my time on Nexplanon. I can't explicitly say that they were caused by the implant, but it's worth pointing out. First, I got shingles in October 2016. Shingles is caused by a reactivation of the chicken pox virus because your immune system is somehow compromised. It causes a painful rash on your body and sometimes your face. It hurt to move for the better part of a week, and the doctor didn't even diagnose it at first because shingles doesn't happen too often in young people who don't have weak immune systems. They originally thought it was an allergic reaction to detergent or something, but it didn't go away.

A few months later, I had a bronchitis induced asthma attack on Christmas Eve 2016 that landed me in the ER. Before this, I hadn't had issues with my asthma since middle school. I decided shortly after the terror of those months at the end of 2016 that this wasn't working out, and I was going to go back to my doctor to get the implant taken out. 

That leads us to the conversation in my doctor's office from Part 1 where she's trying to talk me into getting on another kind of birth control. I was completely over altering my body with hormones at that point, and she ultimately respected my decision. But the whole experience left me with a bad taste in my mouth. At this point, I don't see myself using any form of hormonal prescription birth control in the near future. I might give the copper IUD a shot if I ever feel like I need to use something long term. 

I'm willing to deal with the symptoms of my PCOS, even if it means a potential cyst rupture because I feel like the issues that come with taking birth control for the rest of my reproductive life might be worse. The medical field's lack of attention toward "female" reproductive care (especially for poor people and people of color) means that a lot of these problems may not come to light until irreversible damage has been done, despite the increased attention and changing attitudes toward birth control.

Protest sign at a 2016 demonstration for the Zubik v. Burwell case, which challenged the Supreme Court's ruling that the government would step in to cover birth control for employees of religious organizations who opted not to cover it for religious reasons.  Photo courtesy of  Elite Daily

Protest sign at a 2016 demonstration for the Zubik v. Burwell case, which challenged the Supreme Court's ruling that the government would step in to cover birth control for employees of religious organizations who opted not to cover it for religious reasons.

Photo courtesy of Elite Daily

I feel like we've been in a cultural moment with prescription contraception for at least the last few years. Thanks to the Affordable Care Act (for now), the accessibility of contraceptive options has skyrocketed since so many people can get them for free or at a significantly reduced cost. For people who aren't interested in getting pregnant, it just makes sense to take advantage of it. However, there are plenty of people, lawmakers and judges included, who oppose contraception mostly on moral/religious grounds and seek to reduce access through direct and indirect legislation. This has prompted protests and demonstrations throughout the years by those who want to protect access to contraception.

This puts people like me in a weird spot. This is slightly hyperbolic but it seems like I'm forced to pick a side. Either you're completely on board with more access to contraception, or you're a puritanical jerk who wants to control people's bodies. I think there's a middle ground that gets lost. I think it's possible to support access to birth control for people who want it or need it while acknowledging like any form of medicine, it's not above critique.

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When Birth Control Doesn't Make You Feel Liberated Part 1: The End

Note: for the purposes of this series, I will be using the terms prescription birth control and contraception interchangeably to refer to birth control options that can't be bought over the counter like condoms and emergency contraception like Plan B. Here is an amazing resource and birth control overview, complete with historical information!

"Are you sure you're not interested in anything else?"

A phrase normally reserved for pushy servers at restaurants came out my gynecologist's mouth half skeptical and half concerned. It had that kind of tone moms use when they want you to reconsider your decision because they think it's a terrible mistake but won't say that directly. 

It was late April 2017. I was less than a month away from college graduation and the terror of the unknown that would follow. We were discussing birth control, and I can understand why she wanted me to take a second look at the metaphorical menu before handing it back. She had just removed the Nexplanon arm implant I'd had for a little over a year. Nexplanon (also known as Implanon) is a type of LARC, Long Acting Reversible Contraceptive. IUDs, the shot, and the ring fall into this category even though the latter two options aren't as long term as IUDs or the implant. LARCs are any kind of birth control that don't require daily maintenance like the pill but aren't permanent like tubal ligation (getting your tubes tied). The Nexplanon is supposed to be replaced every 3 years, but there are some IUDs that can last up to 10 or more. 

Since this chart was created, Liletta, a new IUD, has gained FDA approval and entered the market. It lasts for up to 3 years. Chart by  Kirsten Thompson  in partnership with bedsider.org and the Bixby Center for Global Reproductive Health.

Since this chart was created, Liletta, a new IUD, has gained FDA approval and entered the market. It lasts for up to 3 years. Chart by Kirsten Thompson in partnership with bedsider.org and the Bixby Center for Global Reproductive Health.

 

In my doctor's eyes, it was fine that I didn't want the Nexplanon anymore, but my refusal to start another kind of hormonal birth control gave her pause. Given my age, in her eyes I should want to take advantage of all my options to prevent pregnancy. But before we get to why I didn't want hormonal birth control anymore, I have to explain how I got here in the first place. 

I first got the Nexplanon in February 2016, after the most stressful college semester I'd experienced up to that point. I had been on the pill since I was 16, first recommended to me after an ovarian cyst ruptured and I learned I had PCOS, polycystic ovarian syndrome. PCOS is an endocrine system disorder that results from too many androgens, or "male" hormones. These excess androgens can cause symptoms like excess hair growth and acne. For people with PCOS the egg that is supposed to release every month during ovulation just doesn't, creating a fluid filled cyst on the ovary. This happens so frequently there will be multiple cysts on each ovary (hence the poly in polycystic). 

Sometimes, these cysts continue to grow until they rupture or require surgery to remove. For me, I thought I was just having really bad period cramps but they didn't stop. The doctor originally thought it was appendicitis until I got an ultrasound. I was in so much pain that I felt it on the strongest dose of Percocet I could be prescribed. It's one of the top causes of infertility because people with PCOS don't ovulate frequently and hormone imbalances can cause miscarriages. Unfortunately, there is no cure because the cause isn't known. It's linked to genetics and environment, but nothing definite.

Because I was so afraid of another cyst rupture, I took the pill every day for almost 5 years straight. It wasn't until the end of the first semester of my Junior year in 2015 that my schedule got so out of whack I started missing pills for days on end. By this point IUDs had exploded in popularity in my friend group, and I was willing to give something more long term a shot. My rationale was that my schedule wasn't suddenly going to lighten up so I should be proactive.

The idea of an IUD still freaks me out because of the potential for uterine perforation (literally the IUD poking through your uterus), so I researched other options. That's when I came across the Nexplanon arm implant. It's a matchstick sized device that your doctor puts into your inner upper arm just underneath the skin and releases hormones that prevent ovulation, thicken cervical mucus to make it harder for sperm to travel, and change the lining of the uterus so it's harder for a fertilized egg to stick. With my health insurance, it was free (#ThanksObama) so I made the appointment.

The actual insertion process was easy and relatively painless. My gyno gave me a shot of lidocaine to numb the area on my left bicep, put the implant into a little tube, slid it into my arm, pulled the tube out, and that was it. It took about 2 minutes from numbing to getting the bandage put on. I was so happy I wouldn't have to worry about remembering to get my pills or taking them anymore. Things were good, until they weren't. If I'm being honest, I think I remember my time with the Nexplanon as more hassle-free than it actually was. There's a prevailing unspoken attitude among people invested in protecting access to contraceptives that the benefits outweigh potential negatives so we should just sweep those under the rug. I'm being only slightly hyperbolic.

Read more about my Nexplanon experience and what led me away from hormonal birth control in part 2. 

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