Menopause is a normal phase in every woman's life, typically marked by a gradual transition. But for some women, like Deborah, menopause comes suddenly not by nature's clock, but through surgery.
Deborah's journey began when, at 52, she was feeling a lack of energy and experiencing abnormal periods. She assumed it was the onset of menopause. “I thought it was the last hurrah and I shouldn't be concerned,“ she recalls. But the abnormal bleeding was more than just menopausal symptoms. It lasted a year, and it was a biopsy that finally revealed after a clear PAP test that she had stage one endometrial and uterine cancer.
Though Deborah was in understandable shock, her doctor assured her that she was also fortunate the cancer had been detected early, and he was hopeful that surgery alone would be sufficient to treat it.
In January 2020, just before the COVID-19 pandemic shut down elective surgeries, Deborah underwent a radical hysterectomy to remove her uterus, ovaries, fallopian tubes, cervix and fibroids. The doctors found cancer forming everywhere. Thankfully, the surgery was successful in removing the cancer, but it also initiated a new chapter in her life: surgical menopause.
It was like a tap was suddenly turned off.
Unlike natural menopause, which occurs gradually as the ovaries slowly produce less estrogen, surgical menopause is abrupt. Deborah likens the experience to a faucet being turned off. “I had a steady drip of estrogen that was in my body in my 30s and 40s, helping me function, you know, mentally, physically and sexually. But then it was like a tap was suddenly turned off,“ she explains. “It was like being in a different woman's body.“
Deborah's experience is not uncommon for women who undergo surgical menopause. Gynaecologist Dr. Marie Christakis, who specializes in mature women's health at Sinai Health, explains its profound impact:
“Surgical menopause can often feel much more dramatic than natural menopause because it feels like women are experiencing the changes all at once,“ says Dr. Christakis. “Also, women who are having their ovaries removed are losing testosterone in addition to estrogen. That's a consideration for their libido and energy levels moving forward.“
For Deborah, the effects were immediate and overwhelming. Her energy levels plummeted, her libido vanished and she began battling brain fog and depression, struggling to recognize the person she had once been. One of the most challenging aspects has been the impact on her sexual health.
“You lose your sex drive,“ she says. “It becomes an intellectual exercise. You have to kind of remember what it's like, you really don't have any physical desires.“
This is a common issue for women going through surgical menopause, but it's one that isn't often discussed or understood. “A lot of women I've met say their partners are not understanding...and many are breaking up,“ says Deborah.
Deborah's frustration with the scarcity of information and support surrounding surgical menopause drove her to seek answers, but she found little satisfaction in the responses she received. “The most common reply from doctors was that they only receive about 20 minutes of training on menopause,“ she recalls. “They didn't have the answers I needed.“
Fortunately, Deborah discovered the support she had long sought in Dr. Christakis, who became her doctor during this pivotal period. “With Dr. Christakis, I found someone who's genuinely listening,“ she explains.
Many doctors are not well-versed in the specific challenges of surgical menopause, which can lead to women being left without the information or support they need to manage their symptoms. Dr. Christakis emphasizes the importance of education for both women and health-care providers:
“It's important for women to understand what they may feel like after menopause. And for them to know that in many cases it's advised that they go on estrogen therapy to protect their bones and heart health,“ she explains. “We really need to do a good job of educating women and providers about the risks of surgical menopause and how we can preserve the longevity of our patients.“
Deborah's journey has inspired her to take action. Drawing on her background in public relations, she has written a book, Menopause Speaks, a compilation of courageous conversations with women about menopause.
"I've been in public relations for over 25 years,“ she says. "And I started to wonder, why aren't we talking about this?“
Deborah's book, set to be released in 2025, features candid, often humorous and heartfelt quotes from women discussing their experiences with menopause.
In her social circle, Deborah found that many women began to rely on her for advice. She found herself suggesting questions to ask their doctors, and before long, friends were coming back to her, thanking her for helping them get the information and treatment they needed.
“They were taking my suggestions and when I'd meet them again, they'd say, 'Oh my God, you've completely saved my life because I asked my doctor this question.' And now they have the tools, medication or hormone replacement therapy they needed,“ Deborah says. “I thought, wow, this is really powerful and it's just in my small group.“
Deborah's mission aligns closely with Sinai Health Foundation's campaign to expand menopause care, research and education by establishing the Centre for Mature Women's Health. You can read more about the campaign here.
The centre will focus on the full spectrum of women's health issues as they age, including the impact of surgical menopause. It will also expand existing and develop new educational resources for women and health-care providers, ensuring that everyone is better prepared for the changes that come with menopause whether it arrives naturally or via surgery.
As Deborah prepares to release her book, she hopes her journey, alongside the stories of other women, will ignite a much-needed conversation about menopause.
“The overall attitude in the health community seems to be, 'You're 55, so you should slow down, retire soon.' But why? No. We need to be having these critical conversations instead.“
For Deborah, the message is clear: the best is yet to come.
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