Menopause in Young Adulthood 101 by Louise Bell

 

Final Exam Answer Key

Directions: Choose the answer that best goes with the situation presented. Please feel free to expand upon your reasoning in the space below.

1)   For many people born with a uterus and ovaries, painful and debilitating conditions related to the menstrual cycle may arise. You’ve received the diagnosis of premenstrual dysphoric disorder (PMDD). What is PMDD?

A. A disorder caused by a severe negative reaction to the natural rise and fall of estrogen and progesterone during the luteal phase (after ovulation).

B. A disorder that produces higher-than-normal amounts of male hormones.

C. A condition in which endometrial-like tissue grows outside the uterus.

D. A condition in which the endometrial tissue grows into the muscle of the uterus.

Answer: A. Sometimes referred to as an “extreme version of PMS,” emerging research indicates that PMDD is due to a cellular genetic malfunction in the brain. Regardless of the cause, you spend nearly two weeks before every period with worsening symptoms of depression, anxiety, and irritability. You barely manage to finish high school and will drop out of college at least three times before you graduate. Your relationships suffer, and you spend the weeks in between the fluctuating moods and hormones attempting to repair the damage. It is believed that Sylvia Plath also struggled with PMDD, which makes sense as you spent high school re-reading her collection of poems from the bathtub to feel less alone. You’re unsurprised by what the emerging data states: that nearly 35% of people with PMDD attempt suicide.

2)   You have been prescribed Lupron by your OBGYN. What is Lupron?

A. As an injectable hormone used to treat disorders such as endometriosis, fibroids, and PMDD. It ceases the cycling of progesterone and estrogen, thus inducing menopause.

B. A burning, gel-like substance that is plunged into your deltoid every three months by a nurse whispering “I’m so sorry” the entire time.

C. “Birth control,” because that is a fringe benefit of Lupron, and you really don’t feel like explaining the whole “chemically-induced menopause as a form of treatment” when the person you recently started dating asks if you’re on birth control.

D. All of the above

Answer: D. All of the fucking above.

3)   Part of menopause is having bone-density scans. The radiology technician is understandably confused to see a 26-year-old having these scans done, as this is normally done in people twice your age. How do you respond to the technician asking why someone so young is having this imaging done?

A. Set a strong boundary from the start by saying, “I don’t want to talk about it.”

B. Ignore her question and change the subject to something less emotionally-charged, such as: the Israeli-Palestinian Conflict, what to do with post-Reconstruction-era Confederate monuments, or the effects of climate change.

C. Tell her that you have been taking Lupron for three years to provide relief from symptoms related to PMDD.

D. A and C

Answer: D. Sure, you try to set a boundary with the nosy technician. When she asks again, you consider a more curt reply. However, lying prone on a table in the midst of this questioning leaves you feeling vulnerable and unable to fight back, so you tell her what she wants to know so you can get out of there.

4)   It took a lot of self-advocacy and dealing with dismissive doctors to finally be prescribed Lupron. Now that you’ve gotten a sense of what life looks like when not being debilitated by issues related to your reproductive system, you would like to pursue permanent relief via a total hysterectomy. Which of the following are you most likely to hear in response from your doctor?

A. It sounds like you’ve really done your research and know what is best for you and your future. Let’s get you scheduled for a pre-op appointment to discuss this further.

B. Sorry, what is a hysterectomy?

C. (Laughter) No one would touch your uterus with a 20-foot pole!

D. Your ability to reproduce is more important than your quality of life.

Answer: C. But they really mean D.

5)    You manage to find a doctor who listens to you and accepts the evidence you provide (you’ve been keeping a paper trail of symptom tracking and notes from other clinicians). This doctor agrees to perform a hysterectomy. Due to the nature of your diagnosis, it is technically referred to as a bilateral salpingo-oophorectomy and hysterectomy. What will be removed?

A. Nothing.

B. Just the cervix.

C. Ovaries, fallopian tubes, and cervix.

D. Ovaries and fallopian tubes.

Answer: C. They all must go. The nuances of your reproductive system are the impetus of your suffering. To stave off hypothetical uterine cancer, your uterus would need progesterone from either your ovaries or 2 mg of norethindrone daily. But the sensitivity to progesterone is what caused all of this, so it all has to go. This includes the cervix for convenience’s sake. “It just makes my job easier,” the surgeon shrugs as he describes the carnage that is the removal of an entire organ system from your body.

6)     You’re sitting in the living room of the woman who will become your sister-in-law. You’ve already had the discussion about not wanting to have children after she made a presumptive statement regarding “your future children.” She’s bouncing her six-month-old on her knee as you explain to her your history with Lupron and the upcoming hysterectomy. She shrugs and says, “I guess it’s convenient that you don’t want kids when you need a hysterectomy.” How do you respond?

A. Get up and leave.

B. Laugh and agree with her. She’s not wrong.

C. Say nothing. What could you say to this?

D. Scream.

Answer: B While something in your gut turns as she says this, you don’t yet have the understanding or wording to explain that the grief that accompanies this kind of loss has very little to do with whether or not children are in your plan for life.

7)    Your parents fly in to be with you for the surgery. You can’t help sobbing as the nurse bellows to some unseen colleague on the other side of the curtained cubicle in preop, “This 26-year-old is having a hysterectomy and no one thought to do a pregnancy test!” What do you do?

A. Be grateful that your mom is there to hold you like she did when you were five. She understands what you haven’t yet learned, the visceral loss and liberation that will come.

B. Breathe.

C. Remember that this was your choice, and even now you stand by it.

D. All of the above.

Answer: D. Of course it’s D. Your mom was ten years older than you are now and had already had two children when she went through this. But she gets it. She’s seen the havoc that your body and soul have endured, and she’s seen the possibility of what your life can be when those hormones are paused by Lupron. These are things that are impossible to see when you’re the one in the middle of it all. But you both know that this is the key to a life worth living.

8)     You made it through your hysterectomy. You stayed overnight at the hospital, kept company by the Dilaudid drip and middle-of-the-night nurse checks. How do you spend your time recovering when you get home?

A. Sleep, drink plenty of fluids, make sure you’re getting up and walking around.

B. Eat the leftover cake you had made before the surgery. It’s strawberry with a buttercream uterus and ovaries and says, “See you later, Ovulator!”

C. Attempt to become familiar with the new topography of your body. Your belly button is distorted by the surgical glue that is holding the small incision together. There are two more that follow it, a new constellation of laparoscopic incisions to join those from previous surgeries. You wonder what occupies the recently vacated space inside of you.

D. B and C

Answer: D. Sleep is fleeting, thanks to the disruption to your endocrine system. Your head is foggy and digestion has seemingly ceased, thanks to the anesthesia and narcotics. While your partner and animals sleep, you lie alone on the couch with your thoughts and cake.

9)    Over the coming years, you will confront and explore unfamiliar emotions. Therapy and time prove to be the best teachers for this unknown part of yourself. You realize this journey can be lonely, especially because very few people experience menopause in their 20s. However, you do find that camaraderie in unexpected places. List below the people who “get” it:

The woman who cuts your hair who had a seizure due to eclampsia and wrecked her car while six months pregnant. The 20-something woman whose mother didn’t support her decision to marry a woman, and now is alone in her struggle with infertility. The supervisor who understands and respects the confusing feelings of betrayal that emerge when she tells you she is finally pregnant after years of fertility treatment and heartbreak. The friend who now has to begin her own journey into the dichotomy of loss and liberation that her upcoming medical procedure will provide. The people facing the consequences of dissolving the once Constitutional right to have a say about if and when a pregnancy occurs.

Image Credit: Ken Schwarz / Flickr Creative Commons