winter vagina

In ALL, ILLNESS by Stephanie Klein10 Comments

“Winter Blues.” That’s what people call it, when you don’t want to leave your house, and it just so happens to be winter. You hibernate and wear the same clothes on Sunday that you did on Friday, and you do so pretty matter-of-factly. The thought of showering means getting wet, which means getting naked, which means 1) passing a mirror, in winter, when you look like glue that’s been left to dry on a toddler’s collage; 2) facing up to just how many hair bits shouldn’t be hairy, and then determining how much longer you can get on with them being hairy (what? You can’t help but wonder if they’re keeping you warmer, though shaving your toes is perhaps a good idea); 3) getting cold at some point. Quite frankly, I’m to the point where even reaching for a makeup wipe—which to be clear, is the laziest possible way one can clean her face of makeup and debris—is reminiscent of the anticipatory terror I’d feel as I braced myself to breastfeed. Winter Blues, though, in my case, might want to be renamed Winter Reds.

Man have I been pissed lately, and I don’t really get mad. I really don’t. I get annoyed. I’m awesome in the complaints department, but I don’t have the anger gene. Except when you fcuk with my kids (I’m willing to bet, it hasn’t happened yet) or with my health insurance. Because when health insurance tries to arm-bar me, that means they’re screwing with my meds, which means they’re diddling with my hormones, which means, I’m a pscyho mama from hell, and you want no part of this. Let me explain for a quick second.

I’m in full blown menopause since before age 36. At age 36 I was officially diagnosed, but I remember specifically having hot flashes in 2009, at age 34—of course, never thinking it could be menopause, so I never considered having myself tested. I thought my lack of period was just due to diet, stress of twins, moves, Phil’s health. Nope. Premature, Full On, Menopause. Joy to the fishes in the deep blue sea. No one knows why. My mother didn’t hopscotch her way into menopause until age 52. Some people think, SCORE, no more periods! Awesome for you. Mmm hmm, a new paunch, an attractive new hairstyle to try for thinning hair, a total gain (all of it weight), oh, except for the loss of your sex drive, and energy, but at least there’s these inspiring words: vaginal atrophy. SCORE. Ooh, and you know what else? You begin to piss out your bones. Not to mention, the delivery of the news, “you’re out of eggs. You can no longer have children.” Thankfully, I was already good there and hadn’t intended to have anymore children. It also felt like a validation of my intuitive skills—years before I knew any of this about my health, I went off the pill and told Phil I was ready to start to making babies married or not, pronto! People thought I was rushing into things, but clearly my body and intuition knew it was time to step on it. Boy/Girl twins, the labor jackpot—they were in a rush too, arriving the first week of December, when the weren’t due until Valentine’s Day.

We switched healthcare providers sometime last year. I’m on Estrogen, Progesterone, Testosterone, and Estring (local estrogen for the vag, which keeps the tissue young and healthy, which is my doctor’s way of “puttin’ a ring on it”). The ring is replaced every 3 months. Life before the ring was agony. Sex was very painful. Phil was afraid to have it because I was in tears. It was a bad scene. One of the joys of menopause is that the walls of vag can thin and harden and sex can be very painful. Bone dry. My doctor had provided me with a sample of the Estring, and I had filled a prescription before we switched healthcare providers, so it hadn’t been an issue. I went to the pharmacy to refill my prescription, and my new healthcare, CVS CareMark had denied coverage. Joy. That will be $300 each and every time you fill just this one single prescription, for next 15 years. CVS CareMark has been dishonorable, doped up on incompetence, tripped out on true negligence.

I went through the whole song and dance, having my doctor’s office fax in the necessary forms showing medical necessity for the Estring, right down to the clinical measurements of my vagina! Denied. I phoned customer service, asking what was needed. There’s “outstanding information from your doctor.”

“Why, thank you. My vagina is pretty outstanding.”

“Pardon me, ma’am?”

“What information is still needed from my doctor exactly?”

“Well, that was faxed to your doctor, ma’am.”

“Yes, I’m sure. But, I’m asking you now.”

She can’t tell me. She puts me on hold. For twenty minutes. I am transferred to three different people. Someone explains that since my doctor has already submitted an appeal once before, and this is the second appeal? My doctor needs to explain in writing why the formulary alternatives for the Estring cannot be used, showing documents where I have used these alternative drugs, giving dates, or giving reasons why it would be harmful for me to use them. It then lists these formulary alternatives. Okay, I explain. But my doctor already phoned the Urgent Medical Necessity Appeal hotline, since I’m in pain, and was standing in the pharmacy, waiting for my medicine. It was absurd for it not to be covered. I’ve been on it for three years. There is no other “ring” on the market, no “generic” ring. There’s Estring. The formulary alternative is a cream, Estrace, that is applied DAILY for the first two weeks, then applied twice weekly.

A history lesson in me: I am SHIT with creams. Do you know why? They leave room for HUMAN ERROR. They are not exact. They drip. They remain on your hands and clothes. And what’s worse, I don’t care what people say, they TRANSFER TO YOUR KIDS. You wash your hands, but these hormones transfer. I am totally paranoid about it. I am very sensitive about it. As it is, having to take testosterone in a gel format, I am NOT THERAPEUTIC and I do not take it as often or as prescribed because of the dosing, because of the method, because of the measuring and because of the fear factor with my kids!!! NOW you want me to add ANOTHER FCUKING CREAM?!

I HATE YOU. I seriously hate you. You cannot do this to me. I won’t do it. No. I am not adding another cream, another hormone that can harm my kids. It freaks me out. Twice weekly, for the next 15 years? No fcuking way. No. Just no. No. No. No. No. No. No. No.

No.

“Sorry, ma’am. But, that’s our final decision.”

“My doctor says she sent you all the necessary documentation on January 15, via fax. She can’t imagine what else you could possibly need from her.”

“It seems your doctor sent us a 25 page fax on January 15, but we sent it back, because we closed this appeal on January 14. So, we don’t need to read it. Anything you want us to read going forward needs to be handled externally, through the State of New York. Good luck.”

“Did you seriously just say, ‘Good luck’?”

“Yes, ma’am. Is there anything else I can do for you?”

“So, no one read it?!”

“Is there anything else I can do for you?”

Oh is there. I’m still thinking of an answer. Seething.

My other issue with the cream, aside from the inconvenience of application, and fear of transfer, and worry about being non-therapeutic because of both, is that the absorption rate into the overall body is different than that of the ring. Studies found that the estrogen creams, like Estrace, appear to have a higher absorption than the Estring, so even though it’s applied locally, and there to support local estrogen therapy, it’s absorbed into the rest of the body, which may increase your risk for breast and other forms of cancer. And it’s all being denied because of how a form is being filled out?!

There is obviously medical necessity here. I have been in tears over this for the past five days. My gynecologist doesn’t accept insurance, and perhaps her office manager doesn’t know how to properly fill out a form. Perhaps she could have clearly stated that the formulary cream that’s covered by insurance, Estrace, would be a health risk for me because of the absorption rate. My doctor has since sent me a ring, so I’m good for 3 months, as I fight this battle.

Perhaps it means fighting it through New York State. Perhaps it means making an appointment with a new doctor, who’ll write the same prescription, and who’ll know exactly how to fight it before it becomes a war. I feel like I need a new game plan, preferably something that involves nothing to measure, and nothing that can transfer onto my kids.

And now, I must prepare this house for the 24 inches of snow that are to come with this blizzard tonight. Please, do not let us lose our power, because for us, that means our heat, our stove, our oven, and perhaps my vagina.

Comments

  1. I understand your frustration. I recently made the difficult decision to terminate a pregnancy at 16 weeks because my baby was diagnosed with Trisomy 13 and both my doctors and I felt the baby would die before it was born. I’m already high risk and would be super high risk for preeclampsia delivering a Trisomy 13 baby. My insurance covers medically necessary abortions, but not anywhere that is available to have a second trimester abortion. The last thing you want to do in this nightmare is fight with insurance. It sucks. The whole situation sucks and fighting with insurance sucks even more. “Good luck!”

    1. Author

      Cathy, I am deeply sorry for the emotional and physical havoc you’ve gone through recently. Having to make those decisions, in themselves, are painful enough. Thank you for sharing, and I hope you’re able to find peace in all of it.

    2. Cathy, that is heartbreaking, horrifying and maddening. I’m so sorry to hear about what you’re going through. What is wrong with these insurance companies? Any time you try to reason with them it is a complete nightmare.

  2. Is it possible to switch back to your old insurance or to meet with an insurance expert who, once being informed of your specific needs, will recommend an insurance company that will fill those needs? We switched a year or so ago after meeting with an insurance specialist (free, btw), then checked the best formulary reputation with a doctor and proceeded from there. So far/so good.

  3. What a nightmare. Insurance companies are just so crazy maddening. Anything out of the ordinary seems to give them open season to deny coverage. And then you get the “well just no” answers. My husband also has CVS Caremark insurance and alot of health issues too. His income is barely enough to cover all of the prescriptions he needs. Terrible!

  4. Sorry about the insurance racket. I have been through the ringer with E’s 1000’s of meds and insurance. I didn’t even know CVS Caremark is a also an insurance carrier.

    There are so many BS things that go on with meds & insurance, it’s crazy. I took E to the doc yesterday and the lady at the front desk told me- “oh. your insurance now covers NO labs. So make sure the nurse knows not to ask you for urine and run away if she wants to take blood- because it won’t be covered. You have to take him to a lab”. So, now, even if he’s really sick, if he needs any kind of lab work, I have to then get a scrip and then make an appt at a Labcorp or I will end up with a bill that could be for 100’s of dollars. WTF? So there is absolutely nothing convenient whatsoever. The doctor’s are under the insurance, but not the work they have to do to give you any kind of answer. I want to take him for a strep test but I’m confused. Am I going to get there and tell me that I will have to pay out of pocket for that too- unless I want to go sit at a Labcorp??

    I don’t know how they can tell you that the ring and the cream are the same thing. Clearly they aren’t. It’s just…deflating. How no one seems to give a crap what you’re going through and everything is a fight. You just want to say- CAN’T ANYTHING JUST BE SIMPLE??!

    Well, I hope you didn’t get too much snow. Seems to have pretty much bypassed us in Jersey.

  5. Publicize this. Not only on this blog but everywhere. Write to the newspapers, tell the story on Twitter. Make it PUBLIC. It’s the only way to get through to these blindfolded people.

  6. Girlie you talk so much about your lady bits (ew, gross term) and all about your troubles with having painful sex b/c of vaginal atrophy. What I don’t get is that for a smart girl, why you wouldn’t have researched alternatives to all the shit meds that are DEFINITELY gonna increase your cancer risks. Get some info on laser treatments for the vagina (please just use the proper term from now on). The treatments in the past for this condition were painful. Google “Mona Lisa Touch” by Cynosure. Brand new treatment on an old methodology. Bergen Aesthetics in Paramus does it for $1200, 3 treatments, 4 to 6 weeks apart. Call them. Not really a fan of yours but this problem you have affects millions. Go get it done Barnard and get back to racier stuff than what purse you have to return at a shop in Soho.

  7. Long time reader, first time commenter.
    I am so sorry you are going through this BS with your insurance. Can I share my story? It is lengthy. In 2013, I was diagnosed with DCIS. My husband had insurance through the state (the Cadillac, kind… prior to Scott Walker’s overhaul)and I had coverage for EVERYTHING. My gyn looked at my profile and said, “oh, you have good insurance.” wink, wink. Prior to that, her nurse practitioner told me that if I didn’t follow the “standard of care” (at the time), I would have full blown breast cancer in less than a year. She knew, she used to work in the breast clinic after all. My surgeon was cool and his nurses subtly alerted me to the Pink Campaign and some of the well meaning people who are in effect, scaring women who may in fact never have invasive cancer. I had the surgery and the 6mm lesion removed. I then was sent to the cancer center at our local and prestigious hospital. The Rad Onc intern was telling me how I needed 6 weeks of daily radiation for my CANCER. I tried to tell him that my DCIS is technically not cancer. He talked over me when I cited publications that suggested radiation was not needed in a case like mine. I then went my oncologist who was a little less alarmist but told me that the current standard of care included 5 years of hormone therapy as well since my lesion was receptive to estrogen. Then I went to my gene therapist (who was so lovely when I broke down and cried from all the confusion). Since I was considered “young age” at diagnosis, I was also allowed the expensive and intrusive and somewhat scary BRCA 1 & 2 tests (Angelina Jolie’s NYT editorial had run earlier that year – much hype). In the end, I came up with my own “standard of care” and opted out of radiation (I work in the radiation oncology industry and respect and am in awe of the advances made for those who truly have cancer), opted out of hormone therapy and only had surgery and genetic testing done. My point in this lengthy comment is, because I had “great (state taxpayer funded at the time) insurance” they wanted to capitalize on said coverage. It was beyond infuriating to find out what was being hidden from me in the name of profit. If things were done correctly and medicine and insurance got back to the business of treating patients properly, my excess coverage would have gone to people who really need it, like you.

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