Poetic Menopause

The Allegory of the Memory by Antoni Pitxot Soler

Long time no write. I meant to write a 'one year on' post, then a 'two years on' post but found I had so little to say, so this is something of a 'nearly three years on' post. I went for my regular check-up recently with the lovely Karen at St Mary's and was told to come back next year for what will be my penultimate visit. It has been particularly nice to see the same nurse each time and that she has been kind and supportive. My hot flushes have faded away after the first year and I only get them very rarely now, and it would be hard to pin down any other symptoms that have caused me any particular trouble. I debated deleting the whole blog because I didn't feel I had anything helpful to say on the subject but decided to leave it just because of the endometrial cancer and how important it is for women to be aware of the risks and symptoms. And also because I like looking out for the very occasional mention of menopause in literature.

Today I bring you a poem. I picked up randomly (it's the best way to pick up poetry) 'How the Stone Found its Voice' by Moniza Alvi (the cover image being the one above) and I found this one:

The Thieves

A period, you'd imagine, is no use
to anyone, but the woman who owns it,
who thought she held it secure

in the safe of her body.
Yet thieves broke in and grabbed it,
took it instead of her jewellery:

She's forty-nine, she won't miss it -
we'll just take the one, maybe two.
On the other hand, we'll have the lot,

stash them away. Nothing to boast about.
Not anything you'd forget, though.
To make off with them on a quiet night - 

it's like stealing the darkness itself,
or taking the moon, bowling it away,
expecting it to retain its glow.

Expensive People

Long time no post. I keep meaning to write a 'One Year On' post but have nothing much to add. I debated just leaving it here but decided I would keep up with my 'Menopause in Literature' posts, just because it amuses me when I come across them. This one is from 'Expensive People' by Joyce Carol Oates, reviewed today over on Silencing the Bell. It was written before she had experienced menopause so I guess she just had to go with the cliché.

"'My mother is inclined to hysteria,' Gustave explained. 'It's the change of life, you know. You can't be too careful with them at that time.'
'What's wrong with her?'
He stared at me coldly. 'It's a biological condition,' he said.
Biological conditions of mothers always frighten me, so I said nothing.
'It began a few months ago, and I knew at once what it was. I had had sense enough to be reading ahead. Father doesn't have the slightest idea what's going on - he wouldn't want to admit his own age - and I can't possibly tell him. How could you tell your father anything so personal? I've left a copy of the Reader's Digest around with a lead article on the subject, but ... My mother gets upset all the time, she cries if the toast is cold for Father, she's always picking on our maid Hortense, and she's always on the telephone, it's embarrassing, and yesterday her parakeet Fifi died and she spent all day crying, then accused Hortense and me of not giving a damn about the parakeet. so she took the corpse into the kitchen and put it in the garbage disposal, and before I could stop her she had turned it on. She was hysterical about that. This is a difficult time of life for both of us,' Gustave said vaguely." (p.55)

Surgical Menopause

It feels a bit like it's all over now. The wounds are all healed, leaving little pink marks that barely look like they will scar, it's most disappointing not to have anything to show for it. I expected to feel more different, like there was something missing somehow, but no. I am officially in 'menopause' and don't have to wait for it to be a year since my last period. There is no more uterus, no more ovaries, no more hormones. Having a total hysterectomy is also referred to as a surgical menopause because it happens all at once, there is no lingering dwindling of your oestrogen levels.

Wiki Commons

It turns out that oestrogen is a bit of a double edged sword. I was worried about the impact of the hysterectomy on my risk of osteoporosis but on having a chat with my GP she reassured me that since I am of normal menopause age it will not increase my risk, since my hormone levels were already in decline. Oestrogen has a protective effect on your bone density which is why the menopause puts women at higher risk of having fractures. If you were to have a hysterectomy at a younger age, say 40, it would substantially increase the risk, because you would be losing all those extra years of oestrogen production and protection. On the other side of the coin however an excess of oestrogen is one of the risk factors for endometrial cancer, for example, experiencing early puberty, late menopause or never having children. 

So, the hot flushes have finally arrived, and I have been quite enjoying them. Is that weird, I'm sorry. I was feeling quite bereft since they seem to be an almost universal symptom. My mum commented that she has found a surprising small benefit of menopause that she doesn't feel the cold as much as she used to. I have certainly felt that my body temperature in general seems warmer. I am guessing that my flushes are probably quite mild as I don't tend to pour with sweat or need to remove layers of clothing. I find them to be quite a pleasant sensation, like warmth washing over your body. They do wake me at night and I just stick my legs out of the covers, but mainly it feels like a positive thing on winter nights. 

I was anticipating something more dramatic, emotional outbursts or something, but rather dry skin seems to be the only other symptom. Life is quietly going back to normal, as if the whole thing never happened. Exactly eight weeks after my diagnosis my nurse called to say that they did not need me to come in for an appointment since my biopsy results were all clear and there was no sign of any spread of the cancer. It must be the shortest time that anyone ever had cancer. I went back to work after Christmas and plan to go back on delivery next week. My tummy muscles feel a bit achy after a day standing up but I'd be hard put to blame my tiredness on anything other than the fact that I sat around and did nothing much for five weeks. 

Doing my bit for medical science

So the operation is all over and done with but I will write about that another day. It felt surprisingly like consolation to be offered the chance to take part in some medical research, I mean when you have something serious it feels important that some small good might come out of it. I got a call from one of the doctors at St Mary's to see if I would take part in a drug trial, and then had a meeting with her after I saw the oncology consultant. The drug Metformin is prescribed to diabetic patients and has something to do with balancing blood sugar (it was explained in more detail than that but I don't recall). It was noticed coincidentally that for women taking it who also had endometrial cancer their tumour appeared to grow more slowly. The trial is seeking to establish if there is a link between the drug and tumour growth and so non diabetic patients with cancer are being given the drug in advance of their surgery to see if there is any effect on the growth of their tumour; I took the tablets for the four weeks up until my operation and then they will compare the biopsy results taken at my hysteroscopy with the ones done after my hysterectomy. It was not part of my treatment and there was, of course, a 50/50 chance that I would be in the placebo group anyway.

The information listed some disconcerting side effects but I was fortunate enough not to really experience anything, though my tea did taste a bit weird for a few days one week. I saw the same doctor when I was admitted last week and she took another armful of blood, and that will probably be the last I hear about it, unless I actually seek out the study when it is published.

The second piece of research is being conducted again through the oncology team at St Mary's and is looking into Lynch Syndrome, an inherited gene mutation. It has strong links to several cancers, most significantly bowel cancer, but also endometrial and ovarian cancers. The purpose of the study is to find out what proportion of endometrial cancers are due to Lynch Syndrome and so be able to argue that patients should get routine screening so that preventative checks for bowel cancer could be offered. The doctor said that they were particularly keen to get me signed up because I did not have any of the other risk factors for endometrial cancer. In this study I will get actual results from the test, either positive or negative for the gene in question, and then the option for follow up care.

Leaflets and more leaflets

If leaflets could make anything better I would already be well on the way to recovery. You find yourself reading them as much for comfort as for information. The fact that they produce such leaflets indicates that this is all kind of normal, happening to lots of people, an everyday occurrence. Imagine having something so rare and frightening that there was no leaflet to explain it to you. 

This post is about to become an object lesson in getting that unusual bleeding checked out. Pretty much the entire of my menopausal symptoms has been unusual bleeding, so this was my problem. Things had been progressing much the same over the last however many months since I last posted, random intermittent periods, some lengthy, some long gaps. Then in June I got a letter inviting me to come for my cervical smear test. Then I started bleeding, so I put it off. And I carried on bleeding. And then it went on a bit longer. It faded in and out a few times but was mostly continuous until the end of August when we came back from holiday. The beginning of September (17th) I finally made an appointment and saw the nurse. When she gave me the 'Can you give me the date of your last period?' question I explained to her what had been going on. I thought nothing more about it but a week later I got a call from the surgery inviting me to make an appointment to discuss it with the doctor. (28th September) She listened to the same description and then did an examination. She said there was a polyp on my cervix and she wanted (because of my age) to refer me to the hospital for further investigation. Like with the breast lump it was one of those 'get an appointment within two weeks' things. Later that week (1st October) Monkey and I were in the Arndale in town on my day off when a nice young man from the hospital called. He said they had a cancellation and could I come in that afternoon.

So a few hours later I found myself at St. Mary's with a camera up my nether regions, having a hysteroscopy. It was actually quite cool to get to see the inside of my uterus, and in hindsight nice that I got to see it before they took it away. She removed the polyp and they took a biopsy and she said that although the wall of my uterus was a little thickened  and I had a small cyst on one ovary everything looked fine and that I should make an appointment to come back in 3 months. I went home, feeling reassured. The letter came from the smear test people and everything was normal.

Then the following Friday (9th October) the young man called again while I was at work and said there had been a mistake and I needed to come back for my test results. I said to him, oh no, I was told to come back in three months. He said he had an appointment for me the following week, and when I tried to say that it was not convenient because I would be at work he told me it was urgent.

That was the first time I cried at work. 

I tried very hard to be calm and rational but the next week was not much fun. As you might imagine stuff went around my head. Thursday 15th October I left work early and sat for over half an hour past my appointment time. Then the consultant I had seen the previous week, plus a nurse specialist, sat me down and told me that I had endometrial cancer. It was a relief to have it said out loud, because once the worst has happened you are in a far better place to deal with it. Then she said I would be coming in for a total hysterectomy within the next month. This includes the removal of the cervix, fallopian tubes and ovaries. Because the cancer is hormone based they are taking away the source of oestrogen completely to help ensure it does not recur. It is very small and early stage. They will not know until after the operation but they are fairly confident that it will be contained within the uterus and that I should not need any further treatment. I was then referred on to a gynaecology oncology specialist and saw one doctor who is on the team on the 28th October, though she will not be the person doing my operation. She gave me their first available appointment, so I am due to be admitted on the 24th November. 

So here is the message: unusual bleeding - go to the doctor, especially any bleeding after you are official post-menopause. Pay attention to your body, take care of yourself, catch it early.

Old lady sex

I have just reviewed 'Love, again' by Doris Lessing over on Silencing the Bell but wanted to add an apposite little quote here. The book is about an older woman (in her 60s), how she falls in love with a very young man, after being widowed and alone for twenty years. She is thrown into confusion by the strength not only of her feelings but of her physical desire for the man who becomes the object of her affection. Her reaction is to opt not to admit her crush to anyone, not even her closest friend, for fear of censure:

"He would have to overcome, for a start, some pretty orthodox reactions. Most men and more women - young women afraid for themselves - punish older women with derision, punish them with cruelty, when they show inappropriate signs of sexuality. If men, they are getting their own back for the years they have been subject to the sexual power of women. She consoled herself with: When this business with Bill is forgotten, I shall still be Stephen's friend." (p.129)

Interestingly there is no sex in the book at all; she finds herself entangled with several men but does not succumb to their advances or her own desires. I was left, rather disappointingly, with the message that it was some weird kind of aberration to fall in love with an old woman and that it was better for all concerned if they just moved on.

Hormonal hotspots in the Guardian

Kibbutz Hagoshrim Wiki commons

Having discussed it recently with my sister I came across this article on the Guardian about HRT and whether it really is the cure-all that has been so often claimed. It makes me cringe that the arguments seem to centre on the idea that the menopause is a disease that can be cured (or at least treated), and it reminds me so much of the medicalisation of childbirth (and how pissed off that made me), the way that pregnancy is also treated as an illness rather than a natural process that the human body has been going through since the dawn of time. Doctors just seemed to jump on the bandwagon with the pharmaceutical companies and there seems to be a distinct lack of decent studies into the long term health effects of taking hormone replacements. It is not about being all 'natural' and not wanting chemicals in my body, because plainly they have relieved the symptoms of millions of women, it's just about women being able to make properly informed consent to the treatment.

The lives and concerns of women-of-a-certain-age seem to be quite a hot topic these days, with all these celebrities/film stars reaching their middle years and 'proving' that women over 50 can still be sexy and attractive. The briefest follow-up perusal of the Guardian's website gave me a handful of other articles that expanded on this most vital of issues. Mariella Frostrup complains about the invisibility of women in our age group, while pointing out that we are healthier and wealthier than other age groups and our predecessors; I did love her comment, "the demographic we share our closest links to aren’t retirees but teenagers. Our hormones are raging, we’re interested in pleasing ourselves and the rest of the world be damned." Old age isn't what it used to be, the problem is that employers attitudes to ageing have not changed leaving us potentially facing mid-life redundancy. She claims dishearteningly that women struggle alone through menopause, too embarrassed to complain or discuss it with friends; not strictly true in my experience, though I did agree with her final quip, "Having our worth totted up in childbearing and rearing for millennia has caused us to view the close of that chapter as a mini death."

Jeanette Winterson takes an entirely different tack and goes on the offensive against HRT, with a lengthy exposé about her search for a more natural response to her menopausal symptoms. Thanks to private health care her doctor looks in closer detail at the other things that are going on in a menopausal body and she goes down the route of bio-identical hormones. Don't take her advice and google 'Premarin' if you are currently taking HRT, though she gives you a brief run-down of the worst of the gory details of its production. Thought provoking quote of the article, "Hormone treatment is not a miracle cure for misogyny. Society does not value older women, and often, older women do not value themselves."

Helen Walmsley-Johnson's article was more annoying (she writes a blog for the Guardian called Invisible Woman, about 'clothing, body image and getting older'). She lost me pretty much completely with her opening paragraph: 
"At the end of the Women Starting Over conference in London recently, delegates were handed a little bag of treats containing two magazines (one of which was Countryfile), a card from a meditation coach, two lots of 50+ multivitamins, two sorts of anti-wrinkle moisturiser, a pack of artificial sweetener and two condoms (one male and one female), plus one anonymous envelope containing "natural intimate moisturiser". Not a bad insight into what women entering, or emerging from, the menopause are expected to be interested in."
Well, no. I would not be interested in any of those things. While I did like her annoyance on the idea that women still need to feel that they have to be given 'permission', be it to love their bodies, to eat what they like or to engage in middle age sex, she lost me again with the assertion that we all grew up with 'a good deal of baggage' around sex. Having said that I agree we could all do with a little mojo reclamation.