In the same month I went from menstrual cramps to hot flashes overnight.
By Sheryl E. Mendlinger, PhD
In 1994, at the age of 43, I was diagnosed with stage 1 invasive breast cancer. At that time, treatment options were very limited, it was more a “one size fits all,” unlike the targeted therapies available now 20 years later. Taking into account the size of the lump—1.5 centimeters; my age—young enough that I was still pre-menopausal; and lymph nodes that all tested negative, my oncologist recommended I undergo a lumpectomy, a procedure that removed the lump and the surrounding breast tissue, followed by adjunctive chemotherapy and six weeks of daily radiation treatment. I became a statistic; although chemo was not a necessity, I was told that it would increase my chances of long term survival. I had been married to the love of my life for almost 22 years and had two teenage children, a son, 19, and my daughter Yael, 17. When I heard my diagnosis, I welcomed all options on the table, even the most extreme, as an answer to the frightening diagnosis of cancer, with hopes for a long life to see my own children grow into adulthood.
The doctor informed me only about some of the side effects of chemotherapy including: nausea, loss of appetite, hair loss and the possibility that my period might cease during treatment. However, no one addressed the fact that I would most likely go into overnight early onset menopause, which meant that not only would my ovaries stop working and vaginal dryness would set in, but my brain and cognitive abilities would experience a major shut down as well. One day I was bleeding and puking my guts up from the chemo, while days later I started to wake up in the middle of the night, in a pool of sweat, sheets kicked off the bed and I soon realized they were hot flashes. Menopause had arrived in full force.
Whether from the chemo treatments or menopause, I started to gain a lot of weight and most of the clothes that hung in my closet no longer fit properly. As I wrote in my book Schlopping: Developing Relationships, Self-Image and Memories:
“I ballooned from a size 8-10 to a 12-14. The additional fifteen to twenty pounds on my short frame and the new menopausal body made me feel extremely self-conscious, and the only way to continue to look good and feel better was to hide the bulges under baggy clothes, oversized blouses, or sweaters and leggings. The only pants that fit over my rounded belly were those with stretch elastic waist like old ladies wore….I dealt with the extra weight by buying clothes that fit my new changing body. I just accepted the changes that were taking place because it was a sign of me getting well….I felt the additional weight was good for me…and that my body was overcoming the illness… At the end of the treatments, I had very short, thin, white hair and a very puffy, fat, and full face…”
I remember approaching my oncologist very early in my chemo treatments and telling him that I felt my brain was fuzzy and that the connectors didn’t seem to be connecting; it was as if the entire “hard drive” in my brain had crashed and all the information was deleted. At that time, in the 1990s, doctors were convinced that “chemo does not pass the brain membrane.” To say the least, it was a strange, frightening, and terrible experience. I began to forget sentences in mid-thought in addition to having a lot of other medical problems. This memory loss happened at the onset of chemo, even when I was still getting my period. Once my period ceased, near the end of treatment, my cognitive abilities seemed to take a turn for the worse.
Several years after my treatments, in 2000, when I saw one of the first papers on “cognitive function and chemotherapy” in which the word “chemo-brain” was used, I felt a sense of relief that I was not the only person to have experienced this. Although this concept has finally been accepted in the medical world, and scientific research is being conducted in the area, there are still questions as to what causes the cognitive decline. Is it the inflammation from the cancer itself, is it the chemo, is it changes in thyroid functioning or B12, or is it the sudden loss of estrogen with the early onset of menopause? When speaking to young women who have undergone hysterectomies, they too complained of many of the same issues of cognitive decline.
Early onset menopause can affect so many aspects of overall health and the quality of life. More research, knowledge and information will better equip young women in coping with their changing bodies and understanding that it’s not “only in their heads.”
Sheryl E. Mendlinger, PhD, is an author, advocate for women’s health, daughter, wife, mother, and grandmother. She co-authored, with her daughter Yael Magen, “Schlopping (schlep+love+shopping): Developing Relationships, Self-Image and Memories” a book about finding answers to life’s challenges through schlepping with a loved one while shopping. Sheryl’s expertise is inter-generational transmission of knowledge and health behaviors in mother-daughter dyads from multicultural populations with a focus on menstruation.