Finding a way through infertility and early menopause: Elena’s story

Elena was only 30 years old when she first experienced symptoms of menopause. She was on a cruise with her boyfriend, and she suddenly was hit by waves of nausea. Her heart started pounding out of nowhere. She was overheated and nothing could cool her down. When others on the cruise came down with a stomach bug, she chalked these symptoms up to a weird combination of the flu, heat and seasickness.

Her boyfriend proposed on the cruise, and they came home excited to plan for their future together.

But when she got home, the symptoms persisted. Then her period, which had always been regular, started to fluctuate. First, it got shorter and shorter. Then one month, it was almost six days late. Concerned that something was wrong, she contacted her doctor. After bloodwork that showed unusually high levels of follicle-stimulating hormone (FSH) and other tests, she got devastating news at a follow-up appointment.
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The diagnosis? Premature ovarian insufficiency (POI) – a term that refers to when a woman under 40 goes through menopause.

“It appears that you’re entering menopause,” said her doctor. “It might just be a phase that will correct itself. But you’re young and recently engaged. If you want to have a baby, you’re going to need to see a fertility specialist because whatever is happening to you is happening fast.”

“I was in shock,” says Elena, recalling the days after that conversation. “I immediately started researching the best doctors for infertility.”
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First, she was told she would have to wait two years to see the specialist she wanted to work with. But her tests indicated that she didn’t have that much time. With the support of her primary care physician, her partner, determination and countless follow-up calls, she finally got an appointment – less than a year after her initial diagnosis.
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For the next year and a half, Elena underwent aggressive in vitro fertilization (IVF) treatments. But the process came with a cost. Once the fertility treatments were complete, she would enter full menopause even earlier.

“It’s an emotional roller coaster because your hormones are up and down. You’re happy one minute and you’re down and crying for three hours the next,” says Elena. “As a woman, you’re thinking, ‘Why am I not able to bear a child? Maybe I’m not good enough.”
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Going into the process, Elena knew she only had a 40 to 50 per cent chance of successfully conceiving a child. But that didn’t make it any less difficult when they got the news that they had lost their last viable embryo.
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“When it didn’t come through, that’s when I hit a very dark, dark, dark point. I hadn’t eaten for a week. I mourned the greatest death. It’s what you want to do, what you want to create. But as time passes, you make peace with things.”

While processing the grief of knowing that she wouldn’t be able to give birth to the child she’d dreamed of, Elena was experiencing significant hormonal shifts and symptoms of menopause: hot flashes, headaches and sleeplessness. She was only 35.  

That’s when she was referred to Dr. Lindsey Shirreff at Mount Sinai Hospital, part of Sinai Health, to help her manage her symptoms. They started with blood work, and then a trial of medications. Elena came once a month as they explored the treatment plan that worked best for her. Eventually, they settled on a hormone replacement therapy, and she was able to reduce the frequency of her visits to every three months as her symptoms subsided.

“I wish every woman had the opportunity to have her as a doctor,” says Elena. “I’ll research and I’ll ask questions. Then Dr. Shirreff will get on her own computer and we’ll research together. She’s so hands-on and she always listens to me.”

Elena is grateful for the support she’s received from Sinai Health as she navigates a complex, often misunderstood condition. That’s why she is excited about the ongoing $50-million campaign to establish the Centre for Mature Women’s Health at Mount Sinai Hospital. Supported by a generous community of donors, the centre aims to address the gaps in care that so many Canadian women experience when it comes to menopause and conditions like POI.

“This work is so important because, in general, doctors are not taught a lot about menopause,” says Elena. “So, when you go to your family physician, they have no idea how to help you or treat you.”

By expanding clinical capacity, training more physicians in caring for menopausal women, and spearheading new research into conditions related to menopause, the centre will provide instrumental support to women like Elena when they need it most.

“There needs to be help for women. There needs to be guidance. I was lucky because I had a great doctor who took my concerns seriously,” says Elena. “The support system here, at Mount Sinai Hospital is huge and it needs to be shared.”