Learning to let go

I chatted to someone the other day about my hysterectomy. I hadn’t thought about it for a long time, and it was interesting to look back. In particular, to think about the emotions surrounding it, as well as the physical effects. Before the operation, I remember wondering how it would affect me emotionally. I was lucky in many ways. It was ten years since my infertility journey had ended, and since I had begun living a No Kidding life. Ten years during which I had come to terms with my life, and embraced the wonderful parts of it. Ten years, during which I had become menopausal, and had realised that I did not want to be pregnant any more. As the person I was talking to said, I had wanted to have a child five years earlier.

In those first five years when I was no longer trying to conceive, I went through a lot of emotions about my cycle. At first I was bitter, and hated the appearance of my period, especially when it was painful or became heavy (something I was lucky not to have experienced before). After a year or so though, I realised that what I was going through was what every woman went through – whether we wanted children or not, whether we had them or not. I appreciated that. I appreciated being normal. Along with all women my age, I was facing the end of one part of my life, and the beginning of the next.

Unfortunately, society has trained us into thinking that this is when we might feel worthless, unattractive, washed up. Fortunately, in the 4-5 years before I began facing this, I had done a lot of thinking around what was my worth, how society valued women, and whether I bought into that. The answer is, of course, that I had never bought into that. I’d always chafed against the idea that women’s biology created their value to society. I’d been a feminist since I was four! But there’s something about infertility, about the inability to have children, that gets you sucked back into those old traditional, pronatalist views. You start questioning yourself. But then you start answering those questions in the way you always would. At least, that was my experience. I denied the little voices in my head, and denied the voices of society, which were so limiting, and just plain wrong.

Those first five years were the critical time when I had trained and retrained my brain to accept and then embrace my reality – the reality that there would be no miracle* baby and that I would never have children. I’ve talked and written about this a lot, because it was the main thing that helped me heal, even though it was painful at first. This self-training has also helped me gain control over other thoughts since then. I realised only subsequently that it was, effectively, cognitive behaviour therapy. Self-administered.

When it came time for my hysterectomy, I was keen for it to be over, but I was nervous at the same time. I was nervous that some of those thoughts around self-worth, about feeling like a complete woman, might return. But you know what? They didn’t. Or if they did, they were swiftly banished. Sure, my uterus was gone, but – aside from the freedom from bleeding – I didn’t feel any different emotionally. Its absence didn’t make any difference to my life. And as I sit here, I don’t feel any different either. As usual, the anticipation was harder than the actual outcome. And the freedom? Well, the freedom is still fabulous, seven years on!

Note: I wrote a series in 2019 about menopause (including hysterectomy), the physical and emotional issues. You can find all my menopause posts – including ones written leading up to my hysterectomy – here. And posts about banishing those negative thoughts are here.

A No Kidding Menopause: The emotional issues (Part 2)

(Part Two: Emotions around my hysterectomy)

When I finally sought help, and needed to undertake investigations then surgery, I wondered how I was going to feel about still more scans/procedures etc focused on my reproductive system. The first step was another scan for fibroids, ten years after my last, traumatic scans, and as I’ve only ever had bad news from an ultrasound, I was ready for any emotional reaction. But I actually found it a routine procedure. I had much less emotionally invested in this scan than I did for my ectopics. For once I did not hope for good news, and the news I received was, on the scale of bad news, actually fine. These scans are never pleasant experiences, but at least in this case, I wasn’t beset with wild emotions.

The OBGYN’s office with the Wall of Babies, on the other hand, was like a slap in the face. After the most unpleasant and humiliating pelvic examination I have ever had (and I’ve had quite a few in a teaching hospital), I stood up to put my clothes on, and was confronted with the sight of all these babies. The timing of it was awful. My guard was down, because I’d been dealing with this issue in a very matter-of-fact way. As I mentioned in Part One here, I had been deliberately not thinking about it in fertility terms. But then, suddenly, I saw the wall. Not only was I reminded that I had been through great trauma and loss when I’d been trying to have children and had last been through some of these traumatic pelvic examinations, but I was reminded that I was not in the club of grateful mothers sending photos of their babies. After an examination that had made me feel vulnerable, the Wall of Babies made me feel even more so. I immediately felt “less than.” I hadn’t experienced those feelings for a long time. (I wrote about it here, and the comments section has a lot of interesting points. I was particularly appalled at the doctor who not only has a Wall of Babies, but a Ceiling of Babies too!) I wish I’d said something. I still think about sending a note to him, or a copy of my previous post.

Once I recovered from that moment (and it did take a while), the news that I was to lose my uterus was not devastating for me. It was a means to an end, and there was no doubt this was necessary. I’d said good-bye to my once-hoped-for fertility over ten years earlier, and my uterus was just an anachronistic remnant of that. As I said to a nurse, it had never been any good to me, so it may as well go. I didn’t mourn its loss, and perhaps because I’d never blamed my body for my infertility, I didn’t hate it either. It was simply a problem to be solved.

However, that doesn’t mean that emotions weren’t involved. I remember lying in the hospital a few days after my hysterectomy, on a sunny Sunday afternoon, after my husband had visited and gone home, and everything was quiet. I had the window open, heard people in the distance, and thought about all those mothers celebrating Mother’s Day. Feeling alone, feeling the absence of children, is common on this day for many of us. Usually I manage to arrange the day so I can ignore it. But that afternoon in hospital I felt doubly low, briefly resentful that my uterus had neither delivered children, but had also caused me to be lying alone  in hospital.

That feeling didn’t last long, thankfully. And ultimately, I had fewer negative emotions around my hysterectomy than I had perhaps expected. Part of the reason may have been because I knew I was lucky. After all, I had my hysterectomy at an age which was unsurprising. But it was all a reminder that our equilibrium can be lost, even for a short time, because of our past experiences. Fortunately, it was also a reminder that we survive these episodes, that they don’t last long these days, and that equilibrium returns. 

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.

No more room for excuses

Tomorrow will be six weeks since my surgery.  Whilst I’m still under the care of my surgeon, and will be for a few more weeks until some issues are resolved, today I was cleared to start some gentle exercise, and resume most normal activities.

I have to say, I feel alternately exhilarated and terrified.  Both for the same reason.  Because now (or at least in a month or two) there is no longer any room for excuses.  The health issues that required me to have surgery have influenced my life over the last few years, and very intensely since we returned from our extended overseas travels late last year.  They have restricted my life in a number of ways, and this resulted in a loss of confidence and a mental block when looking at the future.  

But I'm pleased to report that right now I feel free, unencumbered, and enthusiastic about the future.  I remember that this is also how I felt years ago when I realised that I was enjoying life without kids. I realised that I was feeling professionally challenged and satisfied, personally buoyed by accomplishments and skills and feedback as a volunteer, and as a result, personally content with all that was going on in my life.

My aim is to get back to that place.  And the difference is that this time, I don’t have to overcome grief and self-doubt to do it.  … OK, maybe a little self-doubt, but that’s only natural isn't it?

Blogging block

Yes, as you may have noticed, I am struggling to post.  Pre-surgery, I would spend hours a day at my computer.  Of course, I am self-employed, so my computer is where I do my work.  But even when I’m not working (eg now), I climb the stairs to my office, and do stuff at my computer.  I sort and edit my photos, create my photo books (still haven’t finished the third from our summer/autumn overseas last year), write blog posts, read essays and articles, look for jobs, and watch The Daily Show.

Well, pre-surgery The Daily Show disappeared.  Or rather, New Zealanders were geo-blocked from its content.  I've discovered that was because it is now on one of our cable channels, and so I've been watching it from my red leather couch downstairs, where I have been recuperating from the surgery and pre-surgery illness. 

And I discovered that sitting at the computer for long periods of time is verboten.  Tiring easily and pain stopped me coming up here (for that is where I am typing this) for quite a while.  And typing (and commenting) on my iPad isn’t easy, and anyway, typing also requires me to sit up.  So blogging, and all sorts of other computer-related activities have been severely curtailed.  For which I apologise.

On top of all that, my mind has been swirling with Too Much to Think About.  I've been worried about the future (though I accept I can worry about that when I'm better), worried about my recovery (which is now going to plan), alternately worried about and frustrated with family, and angry about the misogyny that I see everywhere, and have been seeing since I was a girl, and wondering if it will ever change.  Recovering from a uniquely female surgery has I think accentuated my feelings of vulnerability and injustice over recent internet discussions.  Then to top it off the childless Pope tells us we will be bitter and lonely in our old age (is he?) -  at the same time condemning millions of people in the developing world to poverty and illness and maternal death and child mortality because he believes in "fruitfulness."  So my head hasn't been in the right space to post, even if my body was.

I promise that in a week or two, I will resume normal service.  Even better, I’d like to post more regularly.  There.  I've said it.  Make sure you hold me to it!

Explanation

Thought my post on A Separate Life here might explain a bit more about what I've been through the last ten days.

12 things I wish I'd been told about the Big M

I was going to title this “For Women of a Certain Age” but I realised that that was making assumptions, and the one thing we've learned about assumptions in the reproductive health sense is that we cannot make them.

I'm writing this nervously too, knowing that anyone googling my real name (potential employers, for example) could in fact find themselves here, men or women.  I hope that the fact that I'm writing under a pseudonym, and that I'm writing about intimate women’s issues, will let them know this is not for them, and turn them away now.  NOW!  Because this is a warning of TMI (Too Much Information) for pretty much everyone.  When I tell my husband what I'm about to tell you, he covers his ears and makes loud noises.  So hopefully, that warning will turn anyone else away too.  Though my husband isn't usually so lucky, as my response is “if I have to live it, you at least have to hear about it!”   These are things women share, privately, in the kitchens during dinner parties, or in cafes, or on the driveway after lunch, or in the bathrooms at work amongst other women of or approaching a certain age.  These are not things we share with men.  They know it happens.  But they don’t really want to know.  Consider yourself warned.

I know this isn't a No Kidding related post.  But I feel it sits better here, in a community that is predominantly women, that is knowledgeable about our reproductive systems, and that is accustomed to talking about things that are generally considered to be TMI.

Twelve things I wish someone had told me about the lead up to menopause:

1. Men don’t understand what you’re going through.  They’ll have a rough idea, based on general knowledge and bad jokes on American TV sitcoms.  And the truth is, they don’t want to know what you’re going through.  I try to tell my husband some of the TMI details, and he covers his ears and makes loud signs.  My response is “if I have to live it, you have to hear it.”  Don't get me wrong, he is sympathetic.  But until it happened to me, he had no idea.  And would rather not know.
   
   
2. Weight will arrive.  It will sneak up on you, and it is difficult to shift, even though I exercise regularly at the gym.  I always thought that was a cliché.  Um.  No, it’s not.  Don’t let it sneak up, and don’t assume you will be able to get rid of it in the way you did even a few years ago.
   
   
3. Emotions will go up and down like a yo-yo.  Again, because you’re feeling them, they sneak up and don't seem so unusual.  I - finally - managed to recognise the mood changes, and reel them in a little.  Fortunately, this aspect seems to have abated recently.  All I’ll say is that my husband’s a saint.  (Shh.  Sometimes.  Don’t tell him.)
   
   
4. Our reproductive parts, having already caused many of us such grief, might just quietly go to sleep and turn out the lights without a word.  But equally, as a dear friend commented to me recently, some of us might find that our parts are not dying down quietly, they're going out screaming. Loudly.
   
   
5. And this is the thing no-one ever tells you.  Well, no-one ever told me.  I wish women were warned, because I have tolerated this for too long.  I have been dealing with regular chainsaw massacre-like events.  The nine hour flight to Singapore was no fun, and I was nervous for weeks in advance that on our South African safari the lions would smell blood and attack!  (Fortunately, for once, timing was on my side and attacks were averted.)  Having googled a little, I tolerated this because I thought it was normal.  It is common.  But it is not necessarily normal.  And there are degrees.  So talk to your doctor, because …
   
   
6. There is medication that can reduce the carnage, and make your life more tolerable.   Actually, this is relevant for anyone, no matter what age, who might be similarly inflicted.  I am going to talk to my niece about it.  I don't think she knows.
   
   
7. Living in a hot climate might help.  When I was in Qatar and Jordan last year, at 40-plus Celsius, I didn't even notice if I was having hot flushes.  (OK, that’s not a serious one, but it was good not to notice them!) There are degrees of hot flushes too.  Sometimes they're just a gentle flush of heat.  Other times, it feels as if you're suddenly thrust into a sauna.
   
   
8. They estimate that up to 80% of women have fibroids by the time they reach menopause. Many women have them, but as they have no symptoms, they're not even aware of it. Fibroids can cause major problems - heavy bleeding, pain, frequent urination, etc.  We've all heard of the stories of people growing huge basketball-size fibroids.  But what I didn't know was that even one or two can do a lot of damage.  And they grow and multiply quickly in those last ten years before the Big M. That pregnant-looking belly may not just be down to mid-life weight gain.
   
   
9. Most importantly, if I was back in my early 40s now, I would do things differently.  In particular, I would get my FSH checked every year or two, to see where I was in the process.  I would certainly get it checked if I noticed disturbing changes.  Why didn't I? Because I didn't realise that it would help me know if my symptoms are normal, or whether further investigations are necessary.  My gynaecologist said that my FSH indicates that everything should be over by now.  Yet, up until about six months ago, I was still reasonably regular.  But apparently that wasn't normal.
   
   
10. Talking is good.  In fact, talk to your older female friends, your mother, your aunts, older sisters.  Find out what was normal for them, so you get an idea about what might or might not happen. Some of them will tell you just to wait and it will be over.  Don't listen to them.  Talk to your doctor instead.  It might be the case that you can just wait.  It might not.  (Not, in my case it turns out).
    
    
11. Listen to women who are going through this, understand, empathise, and learn.  But please don’t compare your own sterling health/regularity with theirs, even if you want to be over it too.  (I'm not sure if I did this myself or not, but I wish I'd thought about it).  If you’re not having difficulties, don't be pleased with yourself.  I've had a number of people do this and it makes me feel broken and judged and old before my time (even though it is not, apparently, "before my time") all over again.  (One woman's comments - about how "normal" (or the implication being, exceptional) she was because everything was continuing without change at a couple of years older than me - took me right back to the dinner table conversation we had had years ago when she and her husband were asking about my ectopic pregnancy, and he said proudly, smugly even, "my wife, she has no problems.")  The best reaction was from a friend who said "I want to hear it all.  I'm following you in a year or two, and want to be prepared."  She may not have any issues (she's not that much younger than me, and so far so good).  But she listened.
    
    
12. Remember that ultimately, it’s just another transition in life.  One I was not looking forward to, but one I realise now is no big deal.  One that will give us more freedom than we, as women, have ever had.  Think about that freedom, what it means, what we've put up for months, years, decades, and what we can - when we’re ready - cast aside, both physically and emotionally.  It is not an end, it is a beginning. I am now ready, and I am welcoming it. Nothing is ever simple though.  Changes for me, it seems, will come surgically next month. To be honest, I can't wait.