It’s been 18 months since I got sterilised. I’ve been considering whether to write about it ever since the operation, on the one hand eager to share my experiences but on the other eager to avoid the negative response that so often greets a woman choosing not to give birth.
In my case the childless state wasn’t wholly my choice. I’ve known since I was 17 that I was highly unlikely to conceive naturally. That was fine with me. I already knew that I didn’t want to conceive at all, so I reconciled myself to my infertility quite easily. However, several other women in my family had been told the same thing and had gone on to produce legions of offspring, so I knew better than to take any risks.
The most logical solution, it seemed to me, was to seek tubal ligation. A one-off minor operation struck me as a far better option than an endless round of pills, patches and injections. I approached my GP to ask for a referral. I was told I was too young to make a decision with permanent consequences. I argued that having a child is a decision with permanent consequences, and if I was legally old enough to do that then I ought to be considered old enough to take responsibility for myself. Nevertheless, my request was denied.
Thus began an annual battle with a succession of GPs. Every year, like clockwork, I would turn up a year older and ask for a referral. Every year, like clockwork, they would advise me that no-one would take my request seriously until I was at least 30 and probably more like 35. On one occasion, when I was 25, I succeeded in persuading a young male GP to refer me. It felt like such a triumph until I met the gynaecologist I’d been referred to. She informed me that I would want babies, no matter what I might think, that if I didn’t have them I’d regret them and that any woman who said otherwise was lying to herself.
I looked into the possibility of going private but chose not to. What put me off wasn’t the idea of saving up for it, or even the knowledge that I’d have to have the procedure done in the south of England, far away from my support network – it was the fact that this had become my personal ideological battle. If I had been in my 20s, married and struggling to conceive, those same doctors would have been bending over backwards to help me. If I’d been producing one child after another for all those years, no-one would have called me ‘entitled’ for using NHS resources to bring them into the world. If I’d presented with gender dysphoria and sought SRS I would not, based on what I hear from trans friends, have been told that I was too young to make decisions about what to do with my own body. But because I was choosing to consolidate my infertility rather than fighting to become a mother at all costs, I was being shut down. I felt utterly disempowered, but I was determined that I would keep fighting.
In the meantime I had to seek other means of contraception. For eight years I used Depo-Provera, the contraceptive injection. The noticeable side-effects were bad skin and low mood, but it kept me pregnancy-free and stopped my periods. Menstruation had always been a miserable experience for me, bringing with it cramps, nausea, vomiting, anaemia and cluster headaches at irregular intervals from the age of 13 until my first Depo jag at 18. Ceasing to menstruate was incredibly liberating. I felt like my life had been given back to me. I loved it. I was quite prepared to stick with Depo for as long as it took to win my battle for sterilisation (by which time I hoped my cycle would have settled down).
Then, when I was 25, I was sent for my first bone density scan. It revealed that had osteopenia and was on the cusp of osteoporosis. The cause, I was informed, was Depo. I had to stop my injections immediately and start carefully managing my calcium intake and absorption. I was advised that with proper calcium intake and a boost in oestrogen (provided by a change in contraception), I should be able to minimise the damage and I could expect to be back to a normal bone density for my age… by the time I hit menopause.
I wasn’t happy about all this, but what could I do? I did as I was told, altered my diet and began the quest for a new form of contraception. I tried the pill in various forms, followed by the patch, without success. It quickly became apparent that anything involving oestrogen is detrimental to my sanity. I experienced sharp, uncontrollable mood swings and became extremely aggressive, to the point where I genuinely feared that I would hurt someone. I was also anaemic from bleeding constantly, which wasn’t helpful, and gaining weight every time I switched contraceptives.
Being unable to take oestrogen means that my bone density will always be poor for my age, so I’ve just had to get used to having fractures every so often. But I still needed contraception, so I enquired about the IUD. I was advised that since I hadn’t had children this wouldn’t be ideal, but my options were limited. I tried the copper coil first. Cue nausea, cramps and heavy bleeding for six weeks until it had to be removed. Then I had a Mirena coil fitted, and in spite of repeated warnings that it was unlikely to suit a childless woman, it turned out to be the best option I had. Yes, there was more weight gain, mild mood swings, dysthymia, bad skin, tenderness and bloating, but at least I wasn’t actively throwing up or talking myself down from punching people who looked at me funny.
By this time I was 28. I’d spent three years switching from one form of contraception to another, having my hopes dashed again and again, paying the physical price for each failure. Fair to say that I was scunnered. And all the while I was being told again and again that I could not be sterilised because I was too young. It was incredibly frustrating.
As soon as I hit 30 I made the usual appointment. I opened with my absolute certainty that motherhood has no place in my life. I went through the usual list of contraceptives I’d tried and been told to discontinue. I closed with the argument that I was biologically old enough that I could have a teenaged child of my own, whom I would be responsible for educating about their contraceptive options, so it was increasingly ridiculous that I was not considered ready to be responsible for my own body.
The GP, an older man whom I had not seen before, simply nodded, agreed that I was old enough to make informed decisions about my own fertility, and referred me on. I couldn’t believe how helpful he was. Suddenly, now that I was out of my 20s, everything had changed. The gynaecologist offered no opposition, she just checked that I knew what the procedure involved and understood that it was permanent, then put me on the waiting list.
I was 31 by the time we found a suitable operation date, and it all went very smoothly. I will admit to a flicker of frustration when I was being prepped for the operation itself – I can understand why the nurses were checking with me that I understood that the procedure was permanent, but I didn’t appreciate being asked to confirm that my husband was happy for me to have it. Again, I can see why they asked, but the idea that my control over my body was somehow in my husband’s gift rubbed me up the wrong way.
A quick general anaesthetic, a few incisions and a couple of Filshie clips later, I was done. Goodbye fertility, hello freedom from constant synthetic hormones. The IUD was removed in the same operation, bringing down what felt like five years’ delayed period pain upon my poor body all at once. I spent a week curled round a hot water bottle and praying to Diclofenac for deliverance, then everything calmed down. I’ve spent the past 18 months learning what the new normality is. I still hate my menstrual cycle and resent its presence in my life, but the pain and blood loss happen at a manageable level these days. It’s an inconvenience rather than something that puts me completely out of action for days on end.
What annoys me is that this could have been my life years earlier. If my decisions had been respected and my early requests for sterilisation granted, I could have avoided a great deal of pain and inconvenience. Without the brittle bones I might have avoided numerous hospital trips and time spent rocking splints, plaster casts and crutches, or just fighting through invisible pain from the various fractured vertebrae I’ve had.
The argument against early sterilisation is always “What if you change your mind?” Does any doctor ask you this when you want to get pregnant? I’ve never heard of a doctor saying “Are you sure? You’re only 28, that’s still very young. What if you get to your 30s and find you don’t want a child then? What if you meet a man who doesn’t want children? Come back and see me when you’re 35, and if you still want children we can talk about it then. I just don’t want you making a decision you’ll regret.” And I very much doubt that a 31 year old woman going for her 12 week scan is repeatedly reminded that this decision she’s making is permanent, and asked to confirm that she understands the process that her body is going through, and quizzed about whether she’s considered termination instead. A woman choosing to bear a child is generally assumed to know what she’s doing. A woman choosing to forego motherhood is generally assumed not to.
If I ever regret my choice, then it will be up to me to take responsibility, accept the decision I made and find a way to get on with my life. I’m 33 now. I’ve yet to feel even the slightest flicker of activity from my supposed biological clock. The thought of being pregnant still fills me with horror, and I’ll be absolutely astonished if that ever changes. But if it does, if I suddenly find myself teleported into a chick flick and start obsessing over babies, it will be my responsibility to accept the choices I made and find a way to live with them.