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Mary - Interview 01

Age at interview: 57
Brief Outline: Mary describes menopause as 'the most fundamental loss' ending her hopes of becoming a mother. Her decision to take HRT to improve poor memory was 'like a miracle'. Withdrawal on doctor's advice after 5 years, however, saw a return of symptoms.
Background: Mary is a self-employed charity consultant. She is married with no children. She started the menopause at age 46 and had her last period at 53. Ethnic background/nationality' White British.

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For Mary, the onset of irregular periods at the age of 46 marked the final realisation that she was never going to be a mother. She describes this as ‘a great tragedy, a great and serious loss’ which had a considerable impact on her emotional state during the menopausal transition.

In addition to this sense of loss, Mary found that problems with memory and concentration during the menopause posed significant challenges in her work life as the director of a medical research charity. These ranged from forgetting appointments to inability to remember people’s faces and names.

Referred by her GP to a menopause specialist, Mary was prescribed HRT (Premique Cycle) which she describes as ‘unfailingly excellent’. After 5 years, however, Mary moved house and registered with a new GP who was opposed to women staying on HRT long-term. As a firm believer in the medical profession, Mary followed her GP’s advice and stopped taking HRT. She experienced an immediate return of symptoms including memory loss, hot flushes, night sweats, weight gain and loss of libido. Although the severity of these symptoms resolved over a period of 6 months, Mary wonders whether in retrospect she could have continued safely with HRT until her sixties given its positive impact on her quality of life and the protection it offered against osteoporosis.  

Mary describes the menopausal transition as taking place over a ten year period, with her experience influenced by other life events which further compromised her general health and well being. These included the illness and death of her parents, a month apart; the stresses of running a business; and treatment following a positive Pap smear test.  

As a postmenopausal woman, Mary reflects on the menopause as bringing both positive and negative changes in her life. While she regrets her childlessness, lost libido, poor memory and weight gain, she strongly believes that she has reached a level of contentment in her life. Mary feels she has emerged from the menopause transition as a ‘wise woman’, defined not by her sex appeal, but by the contribution she makes to society through her business and voluntary work.

Mary was interviewed for Healthtalkonline in December 2008.

 

When Mary realised that she would never have children it was a ‘fundamental loss’

When Mary realised that she would never have children it was a ‘fundamental loss’

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Firstly I don’t have any children and that was a great sadness to us. And I did a lot of the sort of examinations and tests to find out why and I went on to a trial of a new drug for endometriosis. I had endometriosis with no symptoms and quite severe fibroids. So those things which aren’t really relevant to the menopause are relevant to my mental state when hitting menopause. Because once you realise that you are perimenopausal, that your periods are getting less frequent, rather more erratic you realise that this is it. It’s call it a day. We’re not going to have kids. And so for me the menopause was all tied up in my mind, emotionally with the final realisation that I was never going to be a Mum. And although everybody would have said it would have hit me ten years earlier, because after all I was well into my forties by this point, you never completely give up. If you think you are still ovulating, if you still think there’s a chance, you never completely give up. So for me the menopause was associated with, I suppose, the most fundamental loss.

I think my overriding concern about approaching the menopause was having to cope with the fact that I was never going to have a child. And I think the other concerns sort of faded into insignificance really, it didn’t seem anything other than a great tragedy, a great sort of serious loss. It was like a period of bereavement. But I think other people go through a period of bereavement as well, it is very similar in many ways to a bereavement, the menopause, you are losing something which you don’t necessarily love but you’ve kind of grown used to. And so many women’s lives revolve around their husbands and children, their partners and children and that was what I wanted, so I guess you adapt if you’re flexible you can manage but it wasn’t easy.

 

Mary wonders if her urge incontinence is connected with the menopause

Mary wonders if her urge incontinence is connected with the menopause

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Any problems with urinary tract and so on? Going to the toilet?

Well that’s interesting isn’t it?  No I mean I have, I don’t have any problems in that respect although from time to time I do find I need to get to the loo in a hurry and especially if it’s cold and I’ve been out for a long time and haven’t been, I get in and actually don’t quite make it. I’m not sure whether that’s a characteristic of the menopause or a characteristic of being rather unfit and overweight. I mean I know women who’ve had babies often have that problem which is, I’m not sure, it’s urge incontinence I think that’s what it’s called, as distinct from the stress incontinence which I believe is the one where you have incontinence when you take exercise or sneeze. I don’t have that, but I do have urge incontinence. When I need to go, I need to go. But it’s not severe and it’s not enough to warrant being worried about. But I’m not sure it’s associated with the menopause, is it? I don’t know.

 

Mary’s notebook and electronic diary have been indispensable in running her business

Mary’s notebook and electronic diary have been indispensable in running her business

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It seems like everything kind of disintegrates but the worse thing is the memory. It is the worst thing. The lack of concentration, the appalling inability to remember people’s faces and names, forgetting appointments. I was running a two million pound operation I couldn’t afford to forget a thing. So, I developed coping strategies but if you’ve always had a really sharp memory it’s extremely hard to admit.

What sort of strategies did you come up with to help?

Notes, all the time. Notebook, notebook. All the time notebook. If ever I said to somebody, “Oh, I’ll send you one of those” or “let me get in touch with you and talk to you about such and such” or “I’ll ring you and we’ll make an appointment” I would, the first moment, I would even disappear into the loo to do it. I would go into the loo, get my notebook out and write send such and such to Fred or ring Jean to fix an appointment to meet John. It was the only thing I could do. It was absolutely impossible. And I developed the electronic diary as being an important thing with massive numbers of reminders that come up which say do such and such, buy such and such, go to such and such.

 

Mary’s experience of HRT had been ‘unfailingly excellent’. Her symptoms returned when a new GP...

Mary’s experience of HRT had been ‘unfailingly excellent’. Her symptoms returned when a new GP...

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And so I was referred by my GP in London to a specialist, I suppose they are obstetrics and gynaecology people but she was actually a specialist in managing the menopause, and she put me on HRT; which was like a miracle. I mean it was completely rejuvenating. I was still having occasional periods, maybe once every three, two maybe two, three, four months, and it was something called, “Do you want me to mention the name of the drug?” it was called Premique Cycle and I went on to that and it was like being rejuvenated. All that weight I was putting on dropped off, I felt my libido came back, my whole ambition, all that kind of I want to make my work really work. I was running a medical research charity at that time called [name], and it was a very very busy job and a lot of pressure with lots of staff and very hard work. And I felt I was capable of doing it again. It was really marvellous. So my experience of HRT was unfailingly excellent.

 

It was about six years ago when I came to live in [city] and when I was obviously transferred from my old GP to a new GP that she said she was very opposed to women staying on HRT and that I should come off and I’m an obedient woman and didn’t think twice and so I just simply stopped taking it. And it wasn’t until quite a lot later that I discovered that that was completely not the right thing to do and so all of those symptoms that I’d been complaining about previously, the hot flushes, the loss of libido, the lack of concentration, the weight gain, they all came back in such a massive rush I thought I was dying. I mean I thought I was literally on, I just couldn’t believe it. But I did cold turkey and I came through it.

 

Mary has become a ‘wise old woman’, too busy to worry about her lack of libido

Mary has become a ‘wise old woman’, too busy to worry about her lack of libido

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I have no libido, I have no sex drive at all and I have no interest in sex which is probably quite a good thing because nor has my husband. And aren’t hugs lovely and you do learn the benefits of a friendship and a physical closeness which is not a sexual relationship and maybe I miss it a bit but on the whole I don’t really think about it because I’m really too busy.

Well, it’s funny I mean it’s actually now I feel as if I’ve joined the wise old women’s group which is another very positive image, I look around myself at church and I look around myself at family parties and work arrangements and I look around and I think “yeah, I’m a wise woman now, I’ve joined the wise women”. I’ve got a secret, I know. You don’t. And that makes me feel great, because I’m no longer looking in a room and thinking who can I pull, phew, I wonder what he’d, phoow I’d like to know what he’d look like with no clothes on. I don’t do that anymore. That’s lucky because I’m not going to.

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