Photo by Claudia Guariglia via Stocksy
Hot flashes and night sweats are terrible at the best of times, but try experiencing them when you're 28.
"I'm self-conscious of sweating. Now I have to think about what clothes I'm going to wear. One day I thought I'd be fine and I wore a pale grey T-shirt to work and that was a disaster. The hot flushes are crazy—they come out of nowhere at any time and I'm suddenly drenched in sweat."
Sophie is 31 years old. She works as a television producer at an advertising agency in England. Like many young professionals, her priorities include her career, a mortgage, maybe marriage. She didn't plan to add menopause to that list.
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The Londoner suffers from severe endometriosis. Her endometrium—the cells that line her womb—have migrated to other parts of her body. In Sophie's case, that means her uterus and bowels. These cells follow her menstrual cycle, building and then breaking up and bleeding when she has her period. But unlike regular cells in the womb that are shed during menstruation, the excess blood has no way of being released and leads to chronic pain, heavy periods, inflammation, and the formation of scar tissue.
In order to prepare for an operation to have this excess endometrium cut out, Sophie was injected with Zoladex, a man-made hormone used to effectively switch off her period for three months. This will tame the endometrium, making it less bloody and easier to manage.
They did some blood tests and said, 'Right, you've just been through menopause. That's it. We can't do anything about it. Off you go.'
Dampening Sophie's oestrogen production and switching off her periods has flung her into a temporary chemical menopause. She suffers from hot flushes, night sweats, lack of libido, and an interrupted sleep pattern. But there is light at the end of this sleepless, sweaty, unsexy tunnel: Zoladex's effects will wear off after three month. If all goes well during the operation, Sophie will be back on track as a normal 30-something-year-old within a few months.
Sophie is one of the lucky ones. Aside from her chronic pain and major surgery, her experience of premature menopause is completely reversible. Emma,* a teacher who lives in Hertfordshire, England, was far less fortunate.
Side effects of premature menopause include hot flushes, night sweats, and lack of libido. Photo by Simone Becchetti via Stocksy
"I was 28 when I was diagnosed. I had a boyfriend and had been on the pill for a while. I decided to come off the pill because I felt like I'd been on it for a long time and probably should think about having children at some point. Then I only had two periods in six months so I went to the doctor. First time I went, they said, 'Don't worry about it, it's nothing, it'll sort itself out.' I went back again a few months later. They did some blood tests and said, 'Right, you've just been through menopause. That's it. We can't do anything about it. Off you go.'"
The causes of premature menopause—also known as premature ovarian failure (POF) or primary ovarian insufficiency—fall into two categories: Primary and secondary. Secondary causes include chemically-induced menopause, as in Sophie's case, and includes surgical menopause where the ovaries and/or womb have been removed as the result of cancer treatment or an infection such as mumps. Primary causes are where things get tricky. Some are straightforward enough, such as chromosome abnormalities such as Turner syndrome or autoimmune diseases—but a sheer majority lie in the realm of the inexplicable.
No known cause, no family history of it. I'd never heard of it and they still don't know what caused it.
Dr Euan Kevelighan, an obstetrician and gynaecologist based in Swansea, Wales, confirmed that premature menopause is rare and difficult to determine. "It's not mainstream [gynecology], we really don't see a huge amount of [cases]. The most common cause is that we don't know. We call that 'idiopathic,' or unknown."
Emma's case reflects this undefined, under-researched territory: "No known cause, no family history of it," she said. "I'd never heard of it and they still don't know what caused it."
In addition to the 'idiopathic' nature of premature menopause, the side effects are harsher and more severe than those associated with natural menopause. As the body is producing far less oestrogen, the risk of osteoporosis is much greater. As Dr Kevelighan puts it: "A woman in her 20s who stops having her periods will have the bones of a 70 year old by the age of 40 because she'll be losing bone density year on year."
"It was awful," Emma said. "Especially because the doctor was so dreadful about it. I remember I burst into tears and she said, 'I don't know what you're crying about, it's not that bad. You can just use an egg donation. All you should be worrying about is you'll probably get osteoporosis.'"
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Lack of oestrogen also increases the risk of cardiovascular disease. Dr Kevelighan stressed the importance of hormone treatment to counter this risk. "It's very important that POF women get diagnosed and get treated, usually with hormone replacement therapy (HRT), which is a combination of oestrogen and progestogen in a cyclical manner, and as a result will have a withdrawal bleed. Or they are put on the combined contraceptive pill, which also contains oestrogen and progestogen. This will reduce the risk of cardiovascular disease."
And there lies the greatest irony of premature menopause: Using the contraceptive pill to treat an infertile woman.
Perhaps the most painful side effect of premature menopause is infertility—to have the option of having kids wrenched away from you before you've even contemplated having children. It's a difficult thing to deal with when you're suffering from the worst PMS of your life.
"You're completely up and down, mood swings and irrational and you're trying to deal with something very psychologically difficult (infertility) anyway," Emma said.
You really do feel like someone has died. I know from my experience and others I've spoken to it takes about two years to come to terms with it.
She likened this experience to bereavement. "You really do feel like someone has died. I know from my experience and others I've spoken to it takes about two years to come to terms with it. You almost go through the stages of grief."
There is a stigma surrounding natural menopause. Suzanne Moore expresses this public distaste in a New Statesman article titled "There Won't Be Blood." She writes: "Women dry up. Youth is moist, wet, dewy. Old women are husks with coarsened skin and thinning vaginal walls and the cause of this curse is hormonal: Oestrogen."
If this is the perception of a woman in her late 40s and 50s going through natural menopause—a collective female right of passage—then premature menopause is an isolating anomaly.
For Emma, it was tough to even reveal her condition to others. "When I was diagnosed they just said 'premature menopause.' And I think the associations with that, with being 'old,' is hard. People assume when they hear it that you're going to age before their eyes."
Aside from society's perception of menopause, and in turn premature menopause, the effect on the individual can be devastating. Further into her article, Moore muses, "If one enters 'womanhood' with menstruation, now you are exiting it." So how does it feel to exit womanhood well before you are ready to?
"It doesn't make you feel like a woman. You don't feel like a complete person. You feel like a complete failure," Emma confided. "I remember saying to my mum at the time, 'I wish I'd been diagnosed with cancer, something rather than this.' Which sounds awful now, but that felt like a more natural thing, whereas this felt so unnatural."
Twelve years later, with two children from egg donation, Emma can look back and laugh at her traumatic experience of premature menopause. She works occasionally with The Daisy Network, a charity specifically focussed on supporting women with premature menopause, offering support and guidance over the phone.
"When I was diagnosed I felt very alone. I decided to do the telephone support so that other people hopefully don't feel that way and can speak to someone who understands. [I wanted to] give them hope that you do come out the other side and can be happy again."
* Name has been changed
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