The Pregnancy Switch

 

 

For years women are fearful of accidentally falling pregnant. As I ask the 18-year-old with the abdominal pain, “is there a chance you could be pregnant?” trying to exclude an ectopic pregnancy or early pregnancy bleed as the cause, the look of shock and response, “God, I absolutely hope not” is fairly standard. Fast forward 10 years though and the same woman comes in suddenly desperate to fall pregnant having stopped the pill yesterday. For a while I’ve marvelled at the sudden switch that women experience – and I was no different.

 

I was an extremely rigid with my pill in my twenties, I would follow the rules like the type A personality that I am. If I missed a pill, if I even thought I might have missed it you could be rest assured I would be considering emergency contraception. I was fearful, like many women I now treat, of getting pregnant.  Then something happened, Will and I had been married for 4 years, I had started to look at babies and yearn for one and I stopped the pill – I remember the day distinctly. I had gone from a regimented pill taker to a woman desperate to get pregnant. One cycle passed, nothing – and then I panicked. Yes, I’m a GP. And yes, I know the statistics (92% of women will get pregnant with regular unprotected sex within a year, and 98% within 2 years) BUT like many things in life my GP brain blew up and I lost all ability to rationalise.

 

I often think back to that time and marvel at how quickly the switch flicked for me. I went from fearful of pregnancy to desperately yearning it within days. My patients are no different. After years of trying to find the right contraception – my patients suddenly come in ready to get pregnant and often the expectation is – it will happen today. Patience and rational thinking go out the window very quickly- the desire to get pregnant almost induces a temporary insanity of sorts – I say this in the kindest possible way having been there before!

 

I should point out that some women never experience this switch – some decide they don’t want children and that’s fine too. Having children is a choice – some choose to have them and still sadly, cannot whereas some despite having the ability to conceive decide they don’t want to pursue that aspect of life. I’ve spoken to several of my friends who have made the choice not to have kids and they experience loads of judgement from people too, “what you don’t want kids? Why?” or “Gosh, I can’t imagine a life without kids.” Personally, I take my hat off to those women – I think lots of us do things in life to simply tick boxes and fit in – those women who make firm choices, stick by them and stay true to themselves I believe deserve credit.

 

To go down a health tangent for a moment (I can’t help myself), most forms of contraception actually don’t have an impact on future fertility despite what many patients think, and what gets written on forums online. The combined oral contraceptive pill for instance (AKA “the pill) doesn’t affect fertility later – it may take up to 3 months for the underlying menstrual cycle to return to normal after one stops the pill but in many it returns immediately. The Mirena (the intra-uterine device) is one of the best forms of contraception for return to fertility – fertility returns immediately in most cases. With the Implanon, the rod that sits in the inner arm secreting progesterone, it can take several months for the underlying menstrual cycle to return.

 

 

The journey of fertility/ trying to conceive is a tricky one. You lose all control, you lose the ability to plan and for some that can cause stress. For those in same sex relationships it’s even harder – the ability to simply stop the pill and “try” doesn’t exist, the ability to control any portion of the journey is somewhat taken away.

 

For the last 2.5 years I have absolutely shuddered (to my toes) when I think of pregnancy or another baby. For a long time, I thought 1 child would be enough for us; I’ve been terrified of delving into the lucky dip again for lots (and lots) of reasons. And yet literally 6 weeks ago I looked at Will, a sudden certainty had come over me, “I’m ready to have another baby.” Will, who had been gently trying to convince me or a while beamed back at me. The same tendencies started to creep back – I wanted control, I wanted it to happen on my terms, I wanted to know exactly when I would be pregnant. Full disclosure – I am not pregnant, nor are we currently trying – but the switch has somewhat flicked, I would call it a half flick – I’m not averse to the idea, nor am I completely ready but the desire to control every aspect of the conception journey, the switch from aversion to desire has again occurred suddenly – again.