Tuesday, 22 January 2019

A No Kidding menopause: The emotional issues (Part 1)

After my quest to conceive was over, I had mixed feelings about my period. It was insulting and pointless to have it every month when I couldn’t conceive,. But at the same time, that wasn’t unusual for me, or for all the women my age (and that would be most) who were, for whatever reason, not trying to conceive. I had tried to conceive for several years, but had not tried to conceive for decades. So it actually made me feel normal, for a change. It was, for all of us, a waste of time and money, and was a huge inconvenience. For a while there, I liked just being normal for a change.

Likewise, as perimenopause came along, cycles became erratic and symptoms began to make themselves known, I at least knew that this was normal and to be expected. I could join in on conversations – though to be frank they were few and far between – with women my age and it was irrelevant whether we were mothers or not. Perhaps I was lucky, but I didn’t have to listen to any of my friends rue the loss of their fertility. By our mid-late 40s-early 50s, these issues were in the past for us all. The reasons why were irrelevant.

I remember taking a pregnancy test at about 45, after an unusually long cycle. I knew that, with two blocked tubes, pregnancy was physically virtually impossible. But still. After two ectopics, I did not want to risk ignoring a potential third ectopic. The thought of being pregnant filled me with dread. Because I knew that in the unlikely even that I was, it would a) most probably be another ectopic, b) if it wasn’t ectopic then a pregnancy at that age would bring higher risks of miscarriage and foetal abnormalities, and c) I realised that, at 45, I didn’t want to become a new mother either (and my husband, at several years older than me, felt the same).  It’s a weird feeling realising that what I had wanted so very much only five years ago was something I would not welcome now.

Time helps. Yes, it’s a cliché, but in those four to five years, I was able to recognise and almost even celebrate that what would have been right for me back then was not right for me now. So it wasn’t a contradiction to not want it any more. Still, I can’t hide the fact that the relief I felt at the negative test result was punctuated by some tiny little questions in my head. “Maybe you didn’t ever want it enough?” It can be hard to escape those thoughts. And I still missed the four and five-year-olds I would have had by then had my pregnancies worked out.

Perimenopause inevitably continued. However, as the physical issues became more complicated, I experienced a lot of frustration. None of my friends were experiencing quite the same level of inconvenient symptoms. Was my reproductive system once again letting me down? Was I having these problems because I - or my body - was abnormal, in the way my ectopics and infertility weren’t “normal?”

I tried not to dwell on this, and for the most part I succeeded. Fortunately, infertility and coming to terms with having no kids had taught me how to shut down some of these doubts, self-accusations, these unhelpful negative thoughts. I liked to think that my reproductive status was irrelevant to this situation, and by experiencing these issues I was simply being normal for a woman my age. (Though again, taking that point of view did mean I didn’t seek help early enough.)

Still, I did experience anger and frustration at once again being inconvenienced by my reproductive system/body. It wasn’t a self-hate issue, but just sheer frustration at the injustice of these issues. And yet, because of the experience of childlessness, I’ve learnt that even when I say “its not fair” it’s more a general complaint than a question of “why me?” I know the world is not fair. I accept that.

And if I’m honest, and put things in perspective, for most of my life my cycles had been reasonably well-behaved, with the exception of regular cramps one or two days a month. I know a lot of women haven’t been so lucky. And so I realised that feeling frustrated at the bleeding, at the menopause that wasn’t coming when I was well and truly ready for it, was probably not an unusual emotion for women. After 30-40 years of monthly periods, pretty much every woman on the planet would welcome their cessation, surely! In that, I was part of a much bigger group. Part of the majority. Normal, for once.

Friday, 18 January 2019

A No Kidding Menopause: The Bloody Version

Menstruation and its cessation at menopause are “things that shall not be named” or discussed. I have discussed it occasionally with friends and less often with family (perhaps simply because I don’t see them as often), let alone openly and casually. I was talking about it briefly with a SIL recently, when my BIL heard us speaking softly, and demanded to know what I was saying.

I sighed. “I said,” I said loudly, “that because I do not have a uterus, I do not have to take the combined estrogen/progesterone HRT.”

My elderly FIL, who heard this, quietly got up and left the room. Men don’t want to know about these things, but they don’t like us talking quietly either! BIL looked slightly uncomfortable, but knew he’d asked to hear whatever I was going to tell him. I spared him the blood-and-guts version. I shouldn’t have. He didn’t deserve to be spared!

But again, the level of shame that I felt talking about this in front of them was, of course, totally ridiculous when it is part of life for half the population. In that way, it is very similar to the feeling of shame many of us have felt when talking about infertility, or not having children. There is nothing to be ashamed about.

And so I have decided to do a series on menopause. I’ll give my own experience first, which is specifically of menopause and hysterectomy, then I’m going to talk about the emotions of all this for the No Kidding / childless / childfree amongst us in another post. Settle in, it’s going to be long. And I apologise too. I’m not sparing you the blood-and-guts version, because I wish someone had told me what I might have to face.

Menopause for me began in my mid-40s. Periods started becoming more erratic. I remember having six or seven weeks between a cycle and feeling both grateful that I didn’t have to deal with periods, but also wondering if I might be pregnant, even though I know it was almost an impossibility, with two blocked tubes. I also didn't like the irregularity. But everything then strangely settled down, with fairly regular periods. They did however get increasingly heavy.

This, I have since learned, often happens. In fact, “increasingly heavy” is an understatement. Effectively, the floodgates opened. I’m not exaggerating. Heavy pads AND multiple tampons at once didn’t stem the flow. Older friends shared stories of bleeding through their clothing, but at least one shrugged and said, “ride it out” as I was dashing back and forth to the toilet to deal with the floods. I remember my aunt being unable to make an appointment with me because she’d had to go home from work to change, as her period had arrived when she had thought (hoped) it was gone forever. I have a story that is so embarrassing I can’t bring myself talk about it (but I am pretty sure at least one reader of mine knows what it is). Yet once again, I wonder why I should feel so embarrassed, when this happens to a huge proportion of the population. I had a nightmare nine-hour flight to Singapore once when I was bleeding heavily. Thank goodness for an aisle seat! I went on safari for my 50th birthday, slightly worried that if I had my period, the lions and leopards and hyenas would smell the blood!  I also spent a week in Rome pretty much trapped in my AirBnB (fortunately we were there for a month), despite the previously-helpful medication I'd been given. So, on my return, I talked again to my doctor. Her horror at the idea of being unable to explore Rome for days finally prompted her to investigate! How I wish I'd asked earlier if this was normal.

First step was a blood test, which seemed to show I should have entered menopause by now (at 51). I was a bit peeved, until I realised that 50 or 51 is the average age of menopause (when there has been no period for a full year). It was time for it to end!

Next step was a scan, to ensure there was nothing sinister going on. Heavy bleeding in perimenopausal women is common, and fibroids in perimenopausal women are common too, but it doesn’t always mean the fibroids cause the heavy flow. Apparently, there are three different types of fibroids, and only one of these cause heavy bleeding.

The scan showed some large fibroids, and so a visit to an OBYN surgeon delivered, along with the most humiliating pelvic procedure yet (and I’ve had a few), the news that fibroids had set up shop, grown profusely, and were causing this heavy bleeding. There was no doubt, he said, that they needed to come out. And my uterus with it. By now, I had expected this result.

I was started on medication that was supposed to stop the bleeding and shrink the fibroids. The surgeon’s nurse manager kept in touch with me, and I told her that I was still bleeding heavily, and even worse than usual. I must have sounded calm, because she didn’t seem to think it was that unusual. I didn’t want to be over-dramatic, so failed to note that I was losing perhaps 1-2 cups of blood a day, if not more, and that I was feeling breathless when climbing the stairs in my home! So, when three days before my scheduled hysterectormy I had the required blood tests, the panic button was pushed. My red blood cell count was dramatically low. (Normal haemoglobin levels are 120 to 180 g/L, and mine were about 80!) Within two hours of the blood test I received a call from the surgeon, whisked into hospital, and given a huge blood transfusion that day, and another one the next morning!

After that, the hysterectomy was able to proceed on schedule, and was largely routine. Once I stopped bleeding from that – the freedom from my period was … well … bliss. I wished I had sought assistance several years earlier, and not downplayed what I was going through. So the moral of the story is that if you’re bleeding heavily, you should have regular blood tests, express clearly to your doctors what is happening, and ask for scans to ensure everything is normal.

Whilst a hysterectomy is quite a common operation, and I was lucky enough to have a laparoscopy, with an improved recovery time, it is still a major operation. I was quite surprised that it took me so long to recover. Equally, my surgeon was very strict about what I should and shouldn’t do. (He was appalled that I had so many stairs in my house, as usual advice is to avoid stairs altogether.) He was very clear that the women who developed post-surgical problems were the ones who tried to do too much. So I recovered on the couch, reading and snoozing and binge-watching.

What I didn’t realise until later was that the removal of large fibroids (and mine were large!) through the vagina is similar to the passage of a baby’s head. So kegel exercises became important for me. Another message for the childless. Whilst we might not have (mostly) given birth, we are not immune to the fall in (o)estrogen in menopause that affects our pelvic floor health. I was appalled when I first realised this!

So the absolute freedom from cycles and bleeding was the major advantage of the onset of my official menopause. Even now, almost four years later, I find it unbelievably liberating. But there are, as you will know, a number of downsides to menopause or perimenopause. Men really don't know how lucky they are. And I admire, more and more, women who go through this and run households and companies and countries at the same time.

After my hysterectomy, my hormones went crazy. Even though they did not remove my ovaries, the hysterectomy still delivered major hormonal effects. This isn’t unusual, apparently, although I can't tell you why. I hate to imagine what would have happened if I had lost my ovaries at the same time, and have real sympathy for women who suffer this. I don’t recall being particularly forgetful (ha ha) – a common symptom – but I know I was irritable. Very. It was like having PMS (or even IVF drugs/clomid-induced PMS) all the time, on steroids. I became a person I didn’t like very much. Sometimes, a person I didn’t like at all. After finally learning self-acceptance in my 40s, this loss of equilibrium was a major blow.

It was the onset of the hot flushes which drove me to seek treatment, however. Prior to this, I had begun experiencing hot flushes (flashes, to North Americans) occasionally, but they had been more gentle. I would throw off the bedclothes at night, and might be forced to remove a jacket or cardigan in the midst of a hot flush, but it was bearable. I remember joking to my sister-in-law in Doha, when the temperature was 40 degs C, that at least I couldn’t tell if I was overheating because of the temperature, or because of peri-menopause. But post-hysterectomy, the hot flushes became extremely intense. I didn’t really sweat badly, but my face would become red, and I felt as if I was burning from the inside. I counted that I was getting at least 25-30 hot flushes a day, and was woken by several a night.

I discovered a lot of anti-HRT articles and discussions, until I heard an interview of Jean Kittson, an Australian comedian who wrote a book aiming at “breaking the cone of silence around menopause” called You’reStill Hot to Me. Immediately I bought the book. At my followup appointment, the OBGYN surgeon prescribed me a non-HRT medication as a first step. It didn’t help at all. I researched it extensively, and found that whilst some studies claimed it should help, others said it would provide no more relief than a placebo. (It was a form of Black Cohosh, for the record.) I felt as if I had been victim to the idea that “it’s only in her head.”

So I headed back to my trusty GP (as in NZ, we don’t see OBGYNs for routine issues), who had a long discussion with me about the options, gave me all the necessary information, including risks and benefits. As I had had a hysterectomy, I did not need the combined oestrogen/progesterone pill and would rather take oestrogen-only HRT, which dramatically reduces the risks, and in fact improves general health in other areas. I had already determined that for me the benefits outweighed the risks. So my GP prescribed a low-dose HRT. It helped, but I was still getting about 15 hot flushes a day, which is one-two an hour when I’m awake, and so she increased the dose. It was extremely effective, the hot flushes ended, I began sleeping much better, and my mood improved and equalised.

Yes, one day I will need to come off HRT, and may then experience these symptoms again. I will do so very gradually to avoid this as much as possible, but I cannot report what it will be like. Not yet. I’m giving myself several more years, and I’m not looking forward to the process!

And so, because I am on HRT, I cannot give a full account of menopause. But then, neither can any woman, as we are all so completely different. Some of my friends had no symptoms whatsoever. Another – well, I just realised I’ve never asked her! Another is also on HRT, after experiencing a horrible buzzing throughout her body which is another, less-known, symptom of menopause. We all have a range of experiences. Still, I hope my story might have helped inform you of what might come, gets you thinking about issues before you (may) need to confront them, and prepares you to ask for investigations and help if you need them.

Monday, 14 January 2019

No Kidding in 2019


I’m hoping in 2019 to address some issues I’ve been thinking about for a long time.

I have a post about menopause in the works. It is getting quite long, so I might end up doing a series.

Secondly, I’m thinking about grief again, what role it plays, whether it stays with you as the years pass, etc.

I’m going to continue to revisit some favourites, such as the Pain Olympics, saving the world, pity and empathy, and so on.

And I’m going to continue to think about the place of the No Kidding in the world, and how that affects us day-to-day.

Along with all these goes the issues around blogging and support, and I have some thoughts about that to work through. And the best way to work through any of these thoughts is to write about them.

I'm hoping to have a few guest bloggers giving their unique perspectives here too, giving us all some more food for thought. 

Finally, don’t forget to check out my 2018 No Kidding post in review, which I published rather belatedly over the weekend.

Are there any issues you’d like me to think about, revisit, or feel that I’ve neglected over the years? I’d be happy to take requests, either in the comments, or via email (malinzblog at yahoodotcodotnz).

Roll on 2019!

Saturday, 12 January 2019

2018: The year in review

Loribeth recently wrote a year in review post for her blog, reminding me that I try to do this too, in lieu of the missing Creme de la Creme that Mel used to run. The idea is to choose your favourite posts of the year, so that your readers can enjoy them again, or see them if they missed them in the first place.

I will freely confess that 2018 wasn't my best blogging year here on No Kidding. I blogged my heart out on x365 Take Two, where I blogged daily for the entire year, had lots of fun in months where we covered themes like Food and Travel or Objects, but found it quite stressful in months when we covered Horror/Suspense or other scary things, and Whining/Negativity. Both these months were hard, and made harder in some ways because I concentrated on the negative, rather than looked for the positive. That experience reinforced for me that my choice here to look at the positive - where possible - is right for me. (This is almost encroaching on thoughts about blogging for another post, so I'll stop there.)

I can see that I started last year as I started this one, by thinking and writing about ageing without children, with three posts on the topic last January! It's an issue that has been top of mind the last few years, with my mother's death then intensive periods of caring for the elderly in-laws during and after illnesses, followed by my MIL's death and now all the relevant FIL-care issues.

Ageing without children (again)
https://nokiddinginnz.blogspot.com/2018/01/ageing-without-children-plan.html
Another (3 this month) on ageing without children

February and March were busy months, but by April I can see I had a resurgence, thinking about the positives of life without children, or simply how it gets better, even when we can't imagine that might be possible. I also had more thoughts about my belief that the No Kidding or childless are also success stories, given the mountains we've had to climb, and continue to climb in our post-infertile lives.

Childless Success Stories Revisited


As autumn and winter wore on, I finally finished my Gifts of Infertility series (woo hoo!), and thought about:
Acceptance,
That Question,
and being Worthy.

I think my favourite post though was where I thought about the resilience skills I'd learnt as I came to grips with living a No Kidding life, and was able to apply that to a stressful situation here.

Redirecting No Kidding Resilience

Oh, and I produced a little book - No Kidding in Brief.
And that was 2018 here on No Kidding in NZ.

Monday, 7 January 2019

Who will advocate for the childless?


A friend reminded me of a discussion we had a couple of years ago, after she had advocated strongly for her father in hospital before he died. Like me, and Bamberlamb, she had also suffered ectopics and infertility, and has no children. So she was, inevitably, wondering about who could advocate for her in her old age.

Since we had the discussion, my mother was hospitalised (needing advocacy) and died, and most recently, my mother-in-law also experienced this.

I have a few thoughts. The first is that having children doesn’t mean they’ll be there to advocate for you. When I was there for my mother in her penultimate hospitalisation, the elderly woman in the bed next to her was alone. Her son lived about two hours away, but hadn’t visited. He wasn’t even picking her up to take her home (when she was being discharged on a Friday). She had to rely on friends.

The second is that even having children who are there to advocate for you doesn’t mean that they’ll advocate the way you want them too. As we found recently with the in-laws, there were four different approaches from each of the siblings, and at least one wasn’t prepared to take into account his mother’s wishes. She was vulnerable and needed someone to speak for her, but only one or two did. So it wasn’t entirely the end-of-life experience she would have hoped for.

None of that of course makes it any easier when we are thinking about who will advocate for us. In terms of needing someone with a Power of Attorney, there are people – lawyers or representatives – who will do this for us. (I learned this from a retirement home). Or I have nieces and nephews who may be able to do this for me, but they won’t necessarily be there when I need them to advocate for me if I am in hospital or at end-of-life stages, simply because they live a distance away. Though of course, you don’t need to be present to be in contact – either with me, or with doctors etc. So it could work. I was thinking this morning, too, about my only adult niece living in NZ, and realised that I don’t know enough about her views to know how she would behave if I was vulnerable and needing her. Of course, I may meet some other younger people in my life who could play this role for me. But I can’t rely on that.

The key, I think, would be to put appropriate Powers of Attorney in place before we start to lose competency, so that it is appropriately drawn up. I would make sure that my wishes are appropriately outlined so as to give the person holding the POA guidance. After my MIL’s death, I can tell you that at least one brother-in-law and his wife went home and documented in detail what their wishes would be in a variety of circumstances. My SIL’s bottom line: “If I can’t use my phone, then pull the plug!” I know I need to do this too. Because if we haven’t made our wishes known, then how will anyone know what we would have wanted?

So once again, my only solution to this conundrum, the only thing I feel I can do to keep a small semblance of control, is to plan. In detail. Looking at all possible circumstances, and in terms of my wishes, and legal protections.

The first step to doing this though is to start thinking. To face facts. Ask the “what-if” questions, and answer them. However much we hope we won’t find ourselves in these circumstances. If we won’t have people to advocate for us, then we need to advocate for ourselves. We can do this, as much as possible, simply by planning and then – most importantly – making our wishes known in advance. Time-travel advocacy!


Note: I have decided that this year I am going to abandon my efforts to stick to an eight-sentence limit for Microblog Monday posts.