Age at interview: 48
Diagnosis: Spontaneous early menopause
Age at diagnosis: 40
Background: Debra works full-time as a psychologist. She lives with her husband and their three children in a metropolitan city. Debra is from a Canadian background.
About Debra: Debra was diagnosed with spontaneous early menopause at 40, following diagnoses of glandular fever and chronic fatigue syndrome. To manage her menopausal symptoms, Debra was initially prescribed the birth control pill for two years. She then took Hormone Replacement Therapy (HRT) for seven years until recently deciding to stop taking it. Debra has experienced some fatigue and anxiety since coming off HRT, but feels that her life is ‘better’ now.
More about Debra: Just before turning 40, Debra was diagnosed with glandular fever and chronic fatigue syndrome. During this time, she felt ‘unsteady’ emotionally, wasn’t sleeping well, and began experiencing gaps between her periods before they stopped altogether. Debra said that her GP insisted on a pregnancy test, against her wishes as she knew she was not pregnant. She was then diagnosed with spontaneous early menopause. Debra found it challenging to be told by her GP that she needed to take ‘something’ to prevent her becoming ‘old.’
Debra was initially prescribed the oral contraceptive pill for two years. However, after experiencing hot flushes, night sweats and ongoing poor sleep, a gynaecologist prescribed her systemic (affecting the whole body) Hormone Replacement Therapy (HRT) to better manage these symptoms. Debra took systemic HRT for five years, and found that while it ‘didn’t fix everything,’ she had ‘a much better quality of life and felt quite stable.’
Although she said that her relationship with her gynaecologist was ‘good in many ways,’ Debra described continually wanting more guidance and information, particularly in relation to making treatment decisions. After reading about research suggesting that taking HRT for menopausal symptoms increased the risk of breast and other cancers, and talking with family members, Debra decided to stop the treatment. While her gynaecologist ‘respected [her] decision, she felt the decision was ‘on [her] shoulders.’ After stopping HRT, Debra had ‘a lot of symptoms for quite a number of months’ but they are now subsiding.
Debra’s menopause symptoms included sleep difficulties, anxiety, hot flushes and low energy. She also has low bone density. She takes calcium and vitamin D supplements, does meditation and weight bearing exercises, monitors her diet, and occasionally takes melatonin to help her sleep. For Debra, early menopause was ‘quite private;’ she only shared her experience with members of her immediate family, including her mother and daughter, and her doctors. However, as one of her good friends is now going through menopause, Debra feels they can ‘finally’ talk about it.
Debra described trying to ‘keep [herself] young in some ways,’ particularly regarding how she dresses and presents herself. She urged doctors not to call women experiencing early menopause ‘old,’ to spend time answering questions, particularly in relation to HRT, and to send women to specialised services for ‘full comprehensive care.’ Debra also encouraged women not to be ‘afraid’ of HRT as it helped her. While she is concerned about cardiovascular disease and osteoporosis, Debra feels ‘quite good,’ especially now that her hot flushes are tapering off, and has regained ‘trust’ in her body.
 Use of HRT until the natural age of menopause (51 years) is recommended for women with spontaneous POI for menopausal symptoms as well as bone and heart health, unless there is a medical reason not to take oestrogen, e.g. women with personal experience of breast cancer, or who experience side-effects they cannot tolerate. Research which showed an increased risk of breast cancer with HRT involved women over 50 years and the findings are not applicable to young women with POI.