The menopause, we are told, is a natural transition, experienced by all women, like puberty and pregnancy. But what happens to younger women plunged into a rapid menopause as a result of treatment for breast cancer? This is my story.
I hadn't thought about the menopause when I approached my 40th birthday in 2009. My daughter was 2 years old; I was warming my partner up to the idea of another baby when I was diagnosed with an aggressive breast cancer. My Oncologist warned that chemotherapy would bring on an early menopause. To me, menopause equalled 'no periods,' but I realised I was being gently prepared for the loss of my fertility. As my greatest fear was whether I would live to see my daughter off on her first day of nursery, an early menopause seemed a small price to pay for the life I so desperately wanted. It was only much later, when the eye of the Cancer-storm had passed that I grieved for my lost fertility.
Chemotherapy brought on 'Chemopause' - a term coined by women to describe the experience of plummeting into early menopause. The night-sweats, bone-pain and fatigue associated with menopause morphed into the misery of the whole chemotherapy experience. By March 2010, I had finished my treatment. Yes, I ached, I was exhausted, forgetful and suffered from hot flushes and terrible insomnia, but more than anything I felt lucky to have survived and grateful to be alive.
In the year that followed, my body recovered. It was liberating not to have periods and I celebrated this new-found freedom by gleefully throwing away all my tampons and panty liners! Having suffered from PMT for years, I was accustomed to the peaks and troughs in my mood before, during and after a period, but without estrogen, my mood was like the continuous, unchanging line on a graph. I felt as though I had been catapulted back in time to my 12 year-old self.
By February 2011, I had not had a period for over a year which, according to online information meant I was officially 'post-menopausal.' My body, however, had other ideas and my periods returned, ending up in a reversed menstrual cycle - a three-week period, with one week off. It was hellish. Eventually, I had a Mirena coil fitted which changed my life.
By the time I had my ovaries and fallopian tubes removed in 2013 (in response to the news that I had a BRCA1 mutation) I had dealt with a recurrence of my breast cancer, more chemotherapy and another Chemopause. I recovered quickly from the surgery. I thought that because I was already post-menopausal, the side-effects would be minimal, but within a few days, I was lying awake at night for hours on end. My skin crawled and my old friends, the hot flushes, returned with a vengeance; I was constantly close to tears. Since then, I have tried different types and doses of estrogen-only patch, trying to find a balance between benefits and side-effects. HRT has not been a 'quick-fix' solution and I have persevered mainly because it addresses specific symptoms, such as osetopenia (low bone density), which for me, have only emerged over time. I finally have enough stability in my health to get fitter and stronger, though I am not symptom-free.
"I actually love being in menopause" Angelina Jolie-Pitt reportedly told the Sydney Sunday Telegraph. How could she say anything else? We don't talk about the menopause. When I went through puberty and pregnancy, my friends and I talked about the changes we experienced in our bodies, comparing notes and passing on advice. I am out of step with my peers - hot flushes disturb my sleep in the same way that babies give my friends sleepless nights, but with none of the accompanying joy. Managing an early menopause has been a lonely experience but peer support can really make a difference. This is one of the reasons I support The Research Centre for Building Resilience in Breast Cancer which has a private group where women can share experiences, where we find we are not alone.
Sadly, I am not unique - of the 57,000 women diagnosed with breast cancer in the UK this year, around 10,000 will be premenopausal women. But I am one of the lucky ones. Because my breast cancer did not have hormone-receptors and I have had preventative breast surgery, I can safely take HRT. This isn't an option for the vast majority of women who are diagnosed with estrogen+ breast cancer and who are often left to struggle on their own. How can younger women who have had a breast-cancer diagnosis support their overall health and well-being in the longer term? What are the options for younger women for whom HRT is not an option? We desperately need more information, advice and support.