“I learned of my early menopause at age 28”

Premature or primary ovarian failure (POI), better known as early menopause, affects 1% of women under 40 and 0.1% of women under 30. Leslie, a speech therapist living in Luxembourg, is one of these 0.1% of women. Now 33, she learned she had premature menopause during an assisted reproduction consultation at 28. Operated twice in 2013 and 2015 following borderline ovarian tumors, the young woman only has a piece of her right ovary. Her surgeon assures her that pregnancy is possible. Four months after her second operation, she observed a period delay and believed she was pregnant, but the tests were negative. It was not until several months later that the verdict fell: Leslie is in menopause.

“You will never be able to get pregnant again, you are in menopause”

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“I started to worry during my second and last late period (they never came back) with still negative pregnancy tests, it was 6 months after the operation. We therefore decided to consult a gynecologist specializing in fertility (8 months after the operation). From the first consultation, we understood that our baby journey would not be easy, but we left ourselves a little hope while waiting for the blood results and ultrasound follow-ups. At the second appointment at the assisted reproduction service, the verdict was: “You will never be able to get pregnant again, you are in menopause”. The term “menopause” hit me. I collapsed. I felt like I was dying from the inside, to be rotten. I did not understand. The professor at the university clinic assured me that I could get pregnant. I felt a lot of anger and injustice. I thought of my husband, because the news of my infertility was robbing him of his desire to become a father one day. I was also afraid for my femininity: in my head, I was going to age prematurely. The gynecologist continued her consultation by offering us “solutions” to accomplish our child plan: either egg donation or adoption. We did not discuss the subject of early menopause: neither its symptoms, nor its consequences, nor its treatment.

My husband and I therefore decided to give ourselves some time to think about the route to having a child. At the same time, I undertook psychological support to be able to express my anger and mourn my lost fertility. We had a lot of support from our family with whom we were able to openly talk about our discomfort. Moreover, it was thanks to an open discussion with my little brother, a medical student at the time, that I was made aware of the consequences of IOP and its treatment.

The onset of symptoms

It was only at the end of 2015 that I started having various symptoms: hot flashes, night sweats, joint pain, insomnia … I even had urinary leaks, I was extremely ashamed of it. I was very self-conscious about my husband. I am a very flirtatious woman, but the hot flashes did not make it easy for me: sweat marks under the arms and on the back, sticky hair, dripping makeup … Unfortunately, I could not be replaced immediately, because I still had ovarian tissue and my gynecologist feared recurrence under treatment.

Between 2016 and 2018, my husband and I therefore took all the necessary steps to benefit from an egg donation in Spain. It was an intense experience which unfortunately ended in a miscarriage and the failure of a second attempt.

I wanted to “leave my body alone”

Thanks to this journey in Spain, I realized that I was not ready for pregnancy in the context of assisted reproduction. I had certainly mourned my fertility, but my body was in pain with this early menopause. Even though I still have a very optimistic temperament, I was exhausted. After the two surgeries, the many long and heavy gynecological follow-ups, a lot of doubts and stress, I wanted to “leave my body alone”. I had only one desire: to take care of myself and find harmony with my body. In October 2018, I therefore decided to have my right ovary completely removed in order to benefit from hormone replacement therapy (HRT). Since then I have been living again.

Initially, I was taking a single pill containing estrogen and progesterone which really alleviated my symptoms. It relieved me for 2 years, then the symptoms slowly returned. So I went to a hospital department specializing in menopause. I had to do a blood test, a mammogram to rule out all risks of breast cancer and a bone densitometry to check if I had osteoporosis. We evaluated my cardiovascular risks, but also my mental health. For 1 year, I have been substituted by estrogel and utrogestan. My body needed some time to adapt, but it’s only positive. All of my symptoms are gone. I also take vitamin D to support healthy bones. I was also advised to consult a dietician to better adapt my diet as well as to do regular physical activity. I had some apprehension while taking the treatment. It is not uncommon to hear women say that it has harmful effects on health: risk of cancer, thrombosis … However, the gynecologists with whom I was able to discuss and read many articles m ‘reassured, because the benefits of HRT outweigh its risks: prevention of osteoporosis, cardiovascular and neurological diseases and depression.

Reconnect with your body and initiate an adoption procedure

I found harmony with my body. We still do not have children, but we have started adoption proceedings because we have realized that all the love we have to offer a child goes beyond pregnancy. The wait is not straightforward, and we both have an age when many of our loved ones are or will soon be parents. The topics of conversation change naturally and a slight shift is made. Some of our relatives are embarrassed and do not dare to broach the subject of children for fear of being indiscreet or of hurting. In any case, we thank all our relatives for not putting this social pressure on us that a happy, married couple must have children. Personally, I see this situation well. I had to learn to accept and respect myself in order to cope with the “happiness” of pregnancy or parenting my friends and other family members.

I admit that I nevertheless felt very alone in this whole process. Until last year, talking about menopause with other women was not easy. Most women go through menopause after age 50. As soon as I broached the subject with them, they were shocked to know that I was in menopause so young. We certainly have the same symptoms, but we do not have the same life plans. I asked the hospital service if there was the possibility of creating a discussion group between young women, but the gynecologists in charge did not seem more excited (medical confidentiality? Health crisis?). Fortunately, social networks offer the possibility of exchange groups and I was able to interact with many women of my age.

Today, I am very happy and fulfilled. The road to acceptance of IOP is long and we often feel alone as young women. The management of menopause is still too vague. Many young women remain in the dark and are too little informed about the consequences of POI. I think it is essential that gynecologists take the time to educate, inform and listen to their young patients. I also think, after many readings, that we need to further deepen our knowledge of the female cycle, because this is how I better understood and accepted all these upheavals in my body. “