Down Regulation- The Heat of the Moment- 10-23 August 2012

As mentioned in a previous post, I started my down regulation spray (buserelin) on 10th August 2012 on cycle day 1, the day of my period. I was instructed to take the spray once in each nostril at 6 hourly intervals 4 times a day. I followed the nurses recommendation of choosing 6am, 12 noon, 6pm and 12 midnight as the easiest times. My alarm clock is already set for 6am on weekdays. The hardest bit during the week was the midnight spray as I would generally be asleep long before this. The only way around it was to set an alarm clock at my bedside to wake me to take the spray. The reverse problem occurred at weekends when the same alarm clock had to be set for 6am. I used reminders on my phone also to prompt me during the day. Thankfully one of the possible side effects of the spray was being a little more tired than usual, which meant that I was generally able to fall back to sleep quite quickly even if I had to wake myself mid sleep for my dose. With such a regular dosage this often meant my sprays had to sometimes be taken in odd locations- at least 3 different supermarket carparks, one public bus stop, on a bus, in the ladies of a pub at an anniversary party, a friend’s house and of course most days at the office. Having said that, it was a quick and simple process.

For the first week, I noticed very little. The spray left a slight aftertaste which was offset by chewing a mint. I couldn’t say I noticed any particular side effects apart from being slightly more tired.

After a week or so I noticed some more side effects although these were still relatively minor. I started to get hot flushes. I never really understood what was meant by these. Thankfully, mine were not very strong or obvious. I would just every now and then feel centrally heated, a warmth building up from inside my chest and reaching my face. I would then usually remove my cardigan, if wearing one, and get a glass of water. This hot feeling would only last for a minute or two and it could be hours before I would get another. I tended to get them more often soon enough after having the spray or in the evenings. This all coincided with a period of humid sticky weather which probably did not assist matters. It did not result in any sweating on my face or anything like that thankfully. I don’t think my face even got redder.

The spray slowed up my period, which is generally fairly light and a 3 day event normally. A few days after the end of the period I had a brownish discharge that lasted a couple of days.

Another side effect was a little bit of bloating in the tummy area. To be honest I am not even sure this was a side effect as I had this problem after quitting the pill and in the luteal phase of every menstrual cycle. I found myself wearing skirts and dresses more often, especially to work, as these were more comfortable and less restrictive than trousers around the tummy area.

I had only one headache that required Paracetamol- a nurse told me it was ok to take this. I am not even sure it was a side effect of the medication.

My moods remained relatively stable and I was quite calm throughout down regulation although my acupuncturist may disagree. She said I was over thinking the whole thing and needed to let go. She also used a few needle points to help with hot flushes.

I also had a gastrointestinal upset with a nasty bout of diarrhoea for 2 days. I don’t think this is particularly related to the medication, but may simply have been a bug I picked up. It passed quickly and I checked with the clinic before taking some Immodium tablets and Dioralyte replacement salts. Sometimes I still get cramps in my bowels but I am not sure if this is completely unrelated to the medication but rather a consequence of my high fibre and veg diet and supplements regime. The clinic believes it is unrelated in any case.

I also had some problems with seasonal hayfever and asthma which only afflict me during the month of August. In the end I had to see a doctor who gave me a steroid inhaler called Symbicort. This is inhaled directly into the lungs rather than taken as a tablet. The clinic was ok about my using this medication also although they noted it on my file. I guess I have to be able to breathe!

The down regulation time passed quite quickly. My down regulation scan and blood test was scheduled for 23rd August, which was day 14. I chose my ‘scan outfit’, a long sleeveless top, a light cardigan, light trousers and shoes I could kick off. After a breakfast I couldn’t quite manage, and a couple of trips to the bathroom, I presented myself to the clinic that morning. It was a really quiet day. There was only one man in the waiting room and another lost looking man in search of his wife. I had barely taken a seat when I was called by a nurse. It was a different nurse and different room to the last time. I was left alone to get ready this time and this nurse showed me what was happening on screen as she did the scan. She said that the womb lining was ‘nice and thin’ and that the ovaries were fine and that there were ‘lots of follicles’.  I was relieved to hear that no cysts had formed that would hold me up at the next stage. The nurse left me to get dressed again and said I would be called into another room to be given an injection demonstration and to have a blood test. I got dressed and waited sitting in the scan room but no one came back. After a few minutes I heard my name being called. I looked out into the corridor but could see no one. As I was looking another nurse appeared in the scan room from a different doorway and brought me through into the nurses’ office adjacent to it. She apologised for the confusion as there had been a shift change. This was the same nurse as I had seen at the pre-period scan. She took a blood test and said that I would receive a phone call later that day to advise if I could start the stimulation medication. The scan was fine but the bloodwork also had to be fine with hormones at the correct levels.

She then proceeded to go through the process of setting up and giving myself injections. I had brought in my stimulation medicine Puregon (Follitropin beta) in my cooler bag and the nurse noted the quantity in the cartridge. She took some further supplies to give me, a Puregon pen, a sharps container and packs of alcohol swabs. My previously supplied pack of Puregon contained a cartridge containing medicine and boxes of replaceable needle tips. The nurse showed me how to assemble the Puregon pen, how to insert the medicine cartridge inside and how to attach and detach the replaceable needle. She also explained how I was to set the correct dosage for myself (150) and what to do if I set the dosage on the pen too high (basically bring it all the way to top dosage and it would reset to 0 again). She advised that my cartridge of medicine would contain 6 doses. She also showed me where on the tummy I could inject myself, basically anywhere beside and below the navel. (The thigh is also an option). She also gave me a booklet of instructions for using the pen, which outlined what she had told me. I was told to take the medication in the evening and to continue my nasal spray (buserelin) at the same dose. I was told to wait on the phonecall with the blood result as that would indicate when I would start. I would then have to make an appointment for day 7 on stimulation medication.

After this I left the clinic with my new acquisitions and went straight to work. The appointment was quite short and I was not even late. The office was quiet so I was able to store my Puregon in the office fridge for the day, concealed in another bag.

Around lunchtime I got a phonecall from another nurse to say that my blood results were fine and that I could start the stimulation medication that night while continuing the spray. I asked her if the time of evening mattered and she said it didn’t, even a variation of half hour or an hour would be ok but to keep it broadly at the same time of day. The nurse tried to put me back on to appointments to make my day 7 appointment but had difficulty so she ended up making the appointment for me herself. This will take place on Wednesday morning 29th August. This will be the first of several scans in the stimulation phase.

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