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Margaret - Interview 15

Age at interview: 59
Brief Outline: Five years after a hysterectomy at age 37, Margaret's remaining ovary failed. Menopausal symptoms included night sweats. Prescribed HRT but discontinued after diagnosis of breast cancer. Recent problems with vaginal dryness and loss of libido.
Background: Margaret is a retired administrator. She is married with no children. Following a partial hysterectomy at age 37, she began to have menopause symptoms at 42. Ethnic background/nationality' White British.

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Following a history of severe endometriosis, Margaret underwent a hysterectomy at age 37 but retained one functioning ovary. Five years later she began to experience menopausal symptoms including bad night sweats. Margaret’s GP prescribed HRT which helped considerably in alleviating physical symptoms. As night sweats eased, Margaret’s sleep and concentration improved, and she found she had more stamina.

The onset of the menopause coincided with Margaret’s return to the UK from abroad. Coping with menopausal symptoms as well as adjusting to giving up work and moving to an isolated rural area contributed to feelings of frustration and depression. Alongside this, Margaret’s realization that she was not going to have children (and consequently grandchildren), added to her feelings of sadness, finding an outlet in distressing dreams. Her parents’ deaths also made the menopausal transition difficult.

At the age of 51 Margaret was diagnosed with breast cancer (DCIS – ductal carcinoma in situ) and immediately stopped taking HRT. Although night sweats returned and Margaret had some problems with memory, these settled down in time. However, in recent years she has experienced vaginal dryness and thinning and tearing of the vaginal skin. These have made sexual intercourse extremely uncomfortable and contributed to a loss of libido. A three-month course of oestrogen cream was effective in easing the discomfort; however, because of her history of cancer, Margaret was advised to discontinue its use. Replacing this with an over-the-counter ‘silky smooth, ultra-glide’ lubricant (Astroglide), and a considerate husband, has helped overcome these problems.  

Margaret believes that women need emotional and practical support from partners, family and friends during the menopause and reassurance that ‘they aren’t going mad’. While GPs and practice nurses should play a key role in guiding women through the menopause, she suggests that pharmacists could also act as a resource, providing information and advice on treatment options.

Having finally reached the end of her long menopausal journey, or, as she describes it, ‘rite of passage’, Margaret has renewed confidence, feels more relaxed, and tries to live ‘in the moment’ away from the pressures, stresses and expectations of her earlier life.

Margaret was interviewed for Healthtalkonline in February 2009.

 

Since having breast cancer treatment Margaret can no longer use oestrogen cream to relieve her...

Since having breast cancer treatment Margaret can no longer use oestrogen cream to relieve her...

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Yes, I think there was a combination of factors but certainly extreme discomfort and vaginal dryness was a big factor. Because I’d been taken off the HRT because of the oestrogen problem. I went to see another GP, a very nice lady GP in the surgery and asked her what I could do and she got permission from my surgeon to prescribe oestrogen cream. Which I used for about three months and I think it possibly had some effect but when I went to get a repeat prescription they wouldn’t let me have it. So I don’t know whether their thinking had changed. So I had about three months of it but, the problem being solved, the skin had got so much thinner that it was tearing and it was very, very uncomfortable. My husband is extremely considerate and gentle but it did make it very, very difficult.

In the last three or four years the vaginal skin has got very, very thin. It tears very easily now, I bleed very easily. Which is disconcerting in the extreme. And puts you off the fun.

 

Margaret is unsure whether her poor memory was caused by the stress of her parents’ death, ‘a...

Margaret is unsure whether her poor memory was caused by the stress of her parents’ death, ‘a...

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My memory. Was absolutely, I’ve always had a good memory. I’ve been able to remember phone numbers, names, addresses, all kinds of, just the information of daily life. And I couldn’t remember words. I couldn’t remember where I was supposed to be. I had to start writing everything down. I thought it was stress. I thought it was because of losing mum and dad and that, that it would come back.

And in fact it has come back a bit better but that’s mainly because I’ve been studying so I’ve been making myself remember stuff because I’ve been having to take three hour exams and things. Really had to concentrate. And now I’m approaching 60 and it is better but I said to my husband the other day, “I’m really worried about the fact that I start a sentence and I can’t remember what I was going to say.” And that I find really quite worrying and whether that is a hormonal thing or whether that is a result of coming off the HRT I really don’t know or whether it’s the beginning of something to do with getting much older. I don’t know.

 

‘Inner turmoil’ as well as night sweats affected Margaret’s sleep for many years

‘Inner turmoil’ as well as night sweats affected Margaret’s sleep for many years

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I think the biggest problem of all through the menopause was lack of sleep. A combination of night sweats, my own particular emotional turmoils but I was very badly lacking sleep. For quite a long time. One of my friends said, “Now you know what it’s like having a new baby in the house.” That’s what it really was. For about eight years I suppose I didn’t have an uninterrupted night’s sleep. And funnily enough it started again after I had those big operations, and I don’t know if it’s the anaesthetic but actually I don’t sleep at the moment as well as I would like. My definition of a good night’s sleep is nine hours unconscious.

 

Margaret feels that pharmacists are an ‘underused resource’ for information about the menopause

Margaret feels that pharmacists are an ‘underused resource’ for information about the menopause

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And the NHS is not structurally, it’s not possible under the NHS to get the right information to everybody when they need it. It’s just logistically almost impossible. I think the one place where it would be really, really useful to get the information would be from a pharmacist. I think pharmacists are a very underused resource. They have a vested interest in making sure that their customers have the information that they want, they get the drugs that they want. They’re a very accessible place to go because if you go into the surgery you’re going to run into various neighbours because you live in a small community and people are going to see you and they’re going to say, “Oh, she’s in the surgery. I hope she’s all right. I wonder what she’s in for.” Go into Boots. You’re going to buy a shampoo, you’re going to buy foundation and you’re going to go and talk to somebody about menopause. It’s just a more accessible resource. I’ve thought for ages actually that pharmacists are very well trained, very highly trained. And I would like there to be more. Even little consultation rooms, little cupboards where you could go and just say, “I’ve been on this HRT for about three years. I really don’t think it quite suits me. Is there something else I could get?” I’m not suggesting they take over from doctors but they could say, “Yes, there’s this kind and these side effects and those side effects and those side side effects. Have a look through that and then go and see your GP and he might be able to prescribe something else.” It takes less time from the GP and makes it easier for the person too.

 

Margaret had a hysterectomy at 37 after years of treatment for endometriosis. No one had prepared...

Margaret had a hysterectomy at 37 after years of treatment for endometriosis. No one had prepared...

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I was married again when I was 33 and endometriosis was diagnosed fairly soon after that and it is thought the D & C* was a contributory factor to the endometriosis. I then had four years treatment with drugs to try to solve the endometriosis. It didn’t work. I didn’t get pregnant and the cysts were spreading all through my insides and so when I was 37 I had a hysterectomy. One ovary was taken out, one was left behind.

I was not properly counselled about the effects of the hysterectomy and being childless as well, none of that was dealt with. It was all done in Hong Kong, where it was very mechanical. There was no emotional input to it all. So I kind of went into the menopause in a very raw state, raw vulnerable kind of state. It was not explained to me, they said, “Oh, you’re all right. You don’t need HRT, you’ve got an ovary.” They didn’t point out or tell me that after five years the ovary would stop working therefore I would go effectively straight into the menopause with no kind of warning because I had no periods so I had no other physical warnings.
(* D&C = dilation & curettage – scraping of the lining of the womb)

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