Battles From a Female Triathlete: When Your Body Fails You

In July 2019 I had just completed Ironman Austria in Klagenfurt. My stomach had yet another meltdown and I needed to make some changes. After reading Stacy Sims’ book “ROAR” I was inspired to start tracking everything my body was doing, specifically around my menstrual cycle. There is some very good research in this area that is just now coming to light for female athletes. We are not small men. If you are female, buy this book ASAP and read it. If you are a male, buy this book for the female closest to you.

Right after Ironman, I went off my birth control that I had been on for over 10 years (having been on birth control since 2000 due to endometriosis and menstrual issues). I wanted to see how my body felt without adding in synthetic hormones. I had a lot of questions that needed answering: Were my stomach issues caused by birth control? How was my menstrual cycle affecting my training? Would I get faster off birth control if I could train to my cycle properly? The last question being my main motivator.

I want to clarify something, I was not under the guidance of a doctor. Why? I grew up in the US and moved to the UK in 2013. Since moving the UK I had battled with every single GP around my birth control choice (Nuvaring). Every single GP was trying to persuade me to get off of it and to put me on the Mirena coil. My answer to them: ‘If it ain’t broke, why fix it?’ I will also clarify for non UK citizens, your GP is your ‘general practice’ doctor that oversees the patients’ health, they are not gynaecologists nor specialists in women’s health. Because I spent years with a gynecologist (actually a fair few) while living in the US, I did not trust that they wanted to change something without any medical evidence or backing, nor wanting to learn the benefits that Nuvaring had (they were making a decision based on costs and a repeated method that they prescribe, zero personalization at all).

Nuvaring came out in the US as a non-systemic birth control mechanism that was low dose progesterone. During the early years of treatment for endometriosis I tried ‘the pill’ in various types, doses and frequencies. Headaches/migraines were something I did not cope well with, and the high hormones really screwed up my cycles, cramping, levels of bleeding, etc. Nuvaring is not something that most GPs are aware of as it’s almost never prescribed within the UK. Meaning that since moving there I had to plead my case, quite literally, every 6 months to be able to continue on this medication. It also costs more to the NHS, so they’re less likely to prescribe it. Gotta save the monies first!

So yes, I proceeded without a gynaecologist overseeing my treatment. I can also say, I am pretty damn good at listening to my body. Within a month I started having pain, vomiting and other delights. Excruciating pains. I went to my GP to get an appointment. Nope, couldn’t get an appointment for severe pain. I called several times, still unable to get an appointment after a week. However, I was told to come in for a urine test. I provided them with a urine test, it came back negative. They called me and said, “we’ve prescribed you antibiotics.” Huh. My response: “But I don’t have a UTI, clearly. Can I please get an emergency appointment with the GP?” Nope. Still I was unable to get an appointment, they were adamant I needed antibiotics. I refused and drove myself to an immediate care center the next morning to be the first patient in the door.

The doctor asked me to provide another urine test. Negative again. He said to me, “There is nothing that I can do for you. You need to go to A&E.” I drove to a local emergency room and saw a doctor. They took an x-ray (why does the NHS always take x-rays?). That showed absolutely nothing except that I had some poop in my bowels. They handed me Buscopan (IBS meds) and said to call my GP. I cried right there in A&E and pleaded with the doctor to help me. I told him I tried for over a week to see my GP and they wouldn’t get me an appointment. He looked pretty frustrated. He left the room and came back. He had scheduled me an ultrasound for the next day.

I went back to the same hospital for an ultrasound. They found nothing. Of course not, ultrasounds can only pick up certain abnormalities. I was then advised to go back to my GP. I laughed hysterically. When I went to work on Monday morning and mentioned to my manager about my experience and told her I was struggling to work. She looked at me and said, “We have private insurance, use it. We even have a private GP service.”

I got an appointment that very same day with the private GP service and they scheduled me for an internal ultrasound in a private clinic. I went for my scan and BINGO, they found cysts on one of my ovaries. I was then referred to a gynecologist, who saw me fairly fast and within 2 weeks he had scheduled me for a laparoscopy (this would be my second laparoscopy for endometriosis). Prior to having the laparoscopy performed, I had asked to have a tubal ligation completed at the same time (getting my tubes tied has been a long term dream for me, I just didn’t want an unnecessary surgery).

After the surgery was done, the doctor said that with my endometriosis I would need to be on birth control until I hit menopause. I made the choice to remain off birth control and try to find a natural cycle for a while. I was not convinced that the birth control was doing me much good. As I was recovering I still had some pains, but chalked it down to post-op recovery.

Trial and Error

In the summer of 2021 (18 months after my surgery), the pains were not going away, and it wasn’t just a ‘recovery thing’ anymore. I was getting pain, nausea, vomiting and a few other symptoms. At this point, I was ready to look at my options. My body wasn’t able to function without some kind of issue, constantly. I bypassed my local NHS GP office and went straight to the private GP service. See, I have learned my lesson, take the path of least resistance. I was referred to a gynecologist again.

In the US I chose a female gynecologist because I feel they are more empathic to our bodies and many of them focused on women’s health as a whole. In the UK, it’s a middle-aged male option. I found the ONLY female gynecologist within an hours’ travel (excluding London). Talk about an industry that needs some diversity in it, I see more diversity in tech than what exists in regards to female UK gynecologist options.

I went to see the female gyno (we’ll call her Doctor S), she was adamant about the Mirena coil (she is head of gyno at a local hospital, so I thought she’d know her stuff). I was not surprised about this suggestion, I agreed to it and had it installed pretty soon there after. Holy f*ck Batman! The worst freaking pain of my life. The 6 inch needle into my cervix didn’t help things, and I spent 30 minutes sweating on a procedure table wishing for the pain to end. After being a brave little soldier they made me sit outside on a chair to make sure I was okay. I was not. I have never had such pain in my body like this. Apparently, this was normal. Great.

I went home and the pain never resolved. I was told to take paracetamol, right… I took freaking codeine. Nothing eased the pelvic pain and cramping. I spoke to the gyno and said that I felt like someone had a samurai sword inside my cervix/uterus and was stabbing me repeatedly as well as the pain was causing nausea and vomiting. I wanted the demon out of me. I was told , “give it 3 months.” I was also scheduled for an ultrasound 30 days in and told, “everything was in the right place.” Like hell it was. Why the hell am I bleeding all the stinking time?!

I hit the 3 month mark and asked to have it out, again. The same doctor said, “you must wait until 6 months for it to work.” I cried. A lot.

I had planned a trip in the meantime to visit both of my parents after over 2 years of not seeing them, planning to spend 1 month in North America. I first went to the Bahamas to see my mom and stepdad for a week of scuba diving. What I did not know was how sick my mother had been. Read about my mom here. I then travelled back to my old place of residence, Colorado, for 3 weeks. In that time in Colorado my mother passed away. Which took me to Florida for her funeral, deliver her eulogy and start sorting out her estate. In total, I spent 6 weeks in the US.

As soon as I flew back the UK, I was a mess. The pain, vomiting, more pain, grief… I fell apart. I always called my mom and asked her what to do. I no longer had that option. Her passing messed me up pretty bad, I lost my best friend, the one who taught me to scuba dive, took me on road trips, encouraged me to be bold, taught me about persistence, and she could make anything better.

One of the results of having insane meltdowns was that I had hit the end of my ability to cope with the coil any longer. It was not right from day 1, I was miserable and needed it out. My private insurance will not pay to remove the coil, even where there are complications. I was directed to use my local GP. I was certain that at 5 months, I was done with it, zero regrets. I couldn’t take any more emotional or physical pain. I was over it.

The GP booked me in with a GP that was also a women’s health specialist. When meeting her she wasn’t convinced the coil was not necessarily causing my pain. Neat, take the thing out. Great news, she couldn’t get it out. The gyno had cut the strings too short, so the doctor couldn’t reach it. She advised me I can try a local sexual health clinic nearby or I would require surgery. You’re kidding right?

I booked an appointment at the local sexual health clinic and as the GP was speaking to me about options, I also asked for a gynecologist referral so I could engage my private insurance AFAFP. I was off the next day to the clinic and I had an appointment with a new gyno a few days later. The nurse at the clinic also wasn’t able to remove the coil, and by this point I was calling it “the demon.” She also noted the strings were too short. Next step, book an appointment with the gynecologist.

The new gyno was named Dr. E, and his secretary confirmed that he was fully prepared and capable to remove the coil/demon. I was aware that my private insurance would not be footing the bill. There is a point where the costs are worth it, I was prepared to pay out of pocket. This couldn’t wait any longer and money was no longer a reason to be this miserable.

The gynecologist looked at me and said, “I like a challenge.” This guy was the right person for the job. Again, while I would have preferred a female gyno, the last one did not work out (I will not go into details, but her knowledge and expertise was pretty limited as she was unwilling to try anything else except a hysterectomy). After some digging, the coil demon came out. The relief was magical. Not only that, we discussed a path forward. I asked him to put me back on Nuvaring ASAP. It worked for 12 years, let’s go with what works. He agreed and I left a pain free and happy camper.

The Return of Discomfort

Stress does some odd stuff to our bodies, with the passing of my mother I really tried to separate what was stress, from other symptoms. With the removal of the Mirena coil I still had some persistent symptoms. I had been tracking everything with both my Garmin app and Wild.AI (Again, all females should check out this app for menstrual tracking) in looking to find patterns to my symptoms and my hormonal cycle. I also had invested in Fourth Edge testing a year prior to see what my hormones and vitamin levels were doing.

I was still training, tracking my symptoms, bloodwork, diet etc. Doing all of the right things to address the ongoing health issues that I had. In the spring of 2021 the symptoms were still prevalent despite being back on the Nuvaring. My menstrual cycles were back on track with a glorious 28 day cycle, knowing down to the hour when my period would start, how I would feel and how long it would last. Amazing. But… I was still nauseous, having night sweats, emotional issues, energy issues and I was not recovering well from my training. Over the next many months, I was doing the following to address one symptom at a time:

1. Continued with regular bloodwork with Forth Edge every 90 days
2. Scheduled a Sweat Test with Precision Hydration
3. Tracked my cycles and all of my symptoms, looking for patterns
4. Eliminated foods from my diet that I thought were not working (also working with a nutritionist)
5. Started a strength program

The symptoms were not being alleviated with diet changes, it was time again to call the private GP service helped to do a few things: get me on Vitamin K (a very underrated supplement for women), as well as Calcium supplements and maintain hydration by taking in a hydration table daily. Because yes, I was still training. The GP sent me to both a GI specialist and an endocrinologist. My bloodwork showed low oestrogen, which started setting off alarm bells around my symptoms. All other bloodwork had been normal.

The GI specialist ran bloodwork and performed an upper GI scope, also checking for any abnormalities as my mother passed away from oesophageal carcinoma. Nothing found. He was stumped as to why I was nauseous and vomiting.

The endocrinologist ran every test for every single obscure thing, plus bloodwork for thyroid issues, as well as checking me for diabetes. Except, she never ran a hormone panel. That was odd.

Everyone was completely stumped, so I called the gyno and booked another appointment, yes the same guy who removed the coil. I went in and said, “tell me this isn’t perimenopause. I have every single symptom and my oestrogen is low.”  He put me on HRT and ran some bloodwork, ding ding ding! Oestrogen level were through the floor.

I start to feel better again, HRT plus Nuvaring was working.. kinda.

Another wall…

The pain was back, despite being on the Nuvaring and HRT (Hormone Replacement Therapy) for several months. Nausea and vomiting were also still hanging about, but the night sweats had dissipated with the use of HRT. I called the gyno again. He discussed my options. An ablation (which I couldn’t find much evidence for resolving endometriosis explicitly), or a hysterectomy. Right, let me think this through. The previous gyno who installed the demon, would only proceed with a hysterectomy. I felt that was pretty nuclear, I really needed to research and think about my options.

Stacy Sims’ book “Next Level” came out and read it in about 2 days. This book digs into perimenopausal and menopausal women, really bringing forward some great research on how to feel better and get stronger. I immediately started to implement some changes: diet, ashwagandha and adding in strength training (specifically lifting heavy shit). Enter in Mark Palfrey at Studio-1 who wrote me a strength plan and diet plan. I have been told that I am not eating enough to recover from my training sessions. Mark was focused on building my muscle and kicking my butt with heavy strength sets, I was loving it. I also realized how imbalanced my meals were, also not consuming enough to recover for my next session. It isn’t about the session you’re trying to complete, it is how you recover for the next one. Mark really nailed my macros and I was finally getting in the correct macros, recovering better and ready to smash the next session. Previously, I struggled with what to eat for lunch and sometimes breakfast, I now had a plan that also aligned to Stacy Sims’ macro counts. The nausea was mostly under control and that breakthrough brought me a lot of hope.

After a regular set of bloodwork my local NHS GP said they wanted to change my HRT, the one that was working. I halved my dose and felt terrible. They ran another blood test and saw immediately that my oestrogen had dropped. Because the wait to get a blood test and another appointment with the GP was so long, I had already corrected my dosing. The doctor agreed that was the correct decision seeing my numbers. I was then told that I am at risk for blood clots because I am over 35 and using Nuvaring, and also, as I am still menstruating I needed to be on a higher dose of progesterone to prevent cervical cancer with HRT treatment.

The GP added in FOUR types of hormone treatments to my daily regime. In the past, high levels of hormones in my birth control pills caused me issues. Many years later, that was still the case. I started on this high dose regime and lasted about 2 months before my body declined again. I can’t explain it, I knew this was all wrong. The GP was throwing everything, including the kitchen sink at me, I had had enough. Adding to this, I was now high risk for blood clots due to my age AND I had to be more conscious about cervical cancer. The GP was adamant that the four types of medication were the answer. My body vehemently disagreed.

At this point, I needed someone to review my entire medical history and help me gain insight into this mess. 4 types of hormones, too many risks and I was declining again. In Stacy Sim’s book, she referenced a doctor that specializes in women’s health and triathletes. I needed an answer beyond a 10 minute call with a GP, I need a 10,000 foot view of everything in my medical history to find a path forward. I engaged with Dr. Kiki Silver, and not that I am biased, but I found while living in Boulder, Colorado that there are some amazing physicians that understand what as triathletes, we are trying to achieve. I provided her with all of my medical history, which was extremely thorough, and we engaged in a 90 minute video call. Dr. Silver reviewed everything in depth in preparation for the call and we discussed the options.

Her summation of all this fun was this: my body was reacting to the Nuvaring as it should, suppressing my hormones to ease the endometriosis. Hence why my Oestrogen was low. In an ideal world, I’d go off the Nuvaring and measure my hormones at 3 and 6 months. I had been down that path and felt we’d already know the outcome,which she agreed with. The endometriosis would flair even further, it was a huge risk and 6 months of more misery was not something that I could handle. We both agreed a path forward.

I chose to have a hysterectomy. I called Dr. E and asked when his soonest appointment would be. Why the hysterectomy? I needed a long term fix, with endometriosis, it doesn’t just ‘go away.’ It can only be treated with birth control or a hysterectomy. My hormones have been messed with for over 24 years. The risks of HRT and birth control were too high for my liking, and honestly not working. I opted to forgo the risk of blood clots and cervical cancer, proceeding with a permanent fix.

For a majority of my adult life I had a solution that worked. My body changed, hormones change, and it was time to take a new path. I learned a lot about my body in that time and I was confident that I had exhausted every other option before choosing the hysterectomy. This is something where I wish I could pick up the phone and ask my mom advice. Despite that, I am 120% confident that she would approve.

Hysterectomy scheduled in 6 weeks. I continued to train when my body would allow, my coach Richard Laidlow showed great patience and understanding, for that I am grateful. I kept my diet clean and kept strength training with Mark, loving his weekly beastings

The Surgery

Surgery day had arrived. Leading up to it, people couldn’t believe how excited I was. My body knew it was coming because the pains were increasing again. It solidified to me, how right this decision was.

Dr. E performed the operation, the same guy who gallantly removed my coil and had been treating my symptoms for the past year. I was confident in him entirely. Prior to the operation we discussed what type of hysterectomy would be performed. On the day, I confirmed which part were coming out and I told him, “I trust you to make the right call about my left ovary.”

Post operation he came in to tell me about the procedure and show me the fancy photos he took of my insides. I love a good picture. He removed my right ovary, both fallopian tubes, my cervix (did you know that if you keep your cervix, you can still menstruate? Neither did I. Hence why it was coming out), and my uterus. Why did I keep my left ovary? The idea is that my body should be able to produce its own hormones, and give myself a few years before I go into full menopause mode. Dr. Silver outlined a plan to test my hormone levels at months 3 and 6, leftie should work as expected and I won’t need HRT for a while (fingers crossed). My body, should in theory, be able to produce hormones naturally without birth control or endometriosis interfering. Time will tell. So why did righty go? Because righty was an a**hole, it was were I had a lot of pain for years as well as cysts, I was not going to have another procedure and didn’t want to leave it in.

Post procedure, Dr. E had informed me that he found the clips used in my tubal ligation surgery three years ago, they had fused to my womb. Also, the doctor that had performed that operation used 2 clips on each fallopian tube, instead of the normal one. I joked that maybe he took my comment about ensuring the baby factory was completely shut down a little too seriously. Dr E was amazed at how much pain this was causing me on top the endometriosis.

I was drugged up and, in some pain, there was some closure around knowing that there was more than one cause of pain.

Lessons Learned

I am sitting here just a week post op with zero pain (some discomfort), but actually not in any pain. I am resting and not taking any pain medication. I had zero expectations going into this procedure of how I would feel after. It’s been a beautiful surprise. Yesterday, that reality hit me. I am shocked at how little pain I am in now. It made me realize how much pain I had been in prior to the operation. I was overwhelmed with the unimaginable pain, the hormone issues, the everything…. It felt so good to be free from pain. I started crying, I had been miserable and didn’t realize HOW miserable I had been. Sometimes we don’t even know how bad something can be until we’re on the other side. Usually, we try to tell ourselves that it can be worse.

I did a lot of things to troubleshoot my health issues over the past several years, nutritionists, doctors, tests, dieticians, etc. The list is exhausting. It is pretty much trial and error. Track your cycle, find out what helps and what hinders you. Throughout all of the struggles, I had some good days and some not so good days. Knowing when your cycle is going to start, how to manage it, etc is crucial for every female.

As I recover, I will slowly start training again. Since I have my little left ovary, I will still get a cycle of hormones, just no period (THANK YOU SWEET BABY JESUS). I will still need to track how I feel and what my hormones are doing.  Let’s see what happens in 2023.

The lesson is, listen to your body. Don’t let someone tell you what is ‘normal’, if you are uncomfortable, speak up. Only you know your own body.

Read Stacy Sims’ books. Lift heavy shit. Train to your cycle. Eat your protein. Get good rest.

I’d like to dedicate this post to Hannah Brookes. Hannah suffered from cysts and did not receive the appropriate medical care. Hannah took her own life because of her pain. This isn’t acceptable. Get help, keep fighting until you have an answer. #FuckCancer