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 50^th 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.