Three Excruciatingly Personal Blog Entries, No.2

The trouble with the grand plan I have now announced twice (viz. writing three posts that push the limits of the personal) is twofold.

First, I find that those limits are mutable. After a few days, Excruciatingly Personal Blog Post No.1 came to seem far too personal, with the potential to involve other people’s emotions and senses of privacy. And so I deleted it. It was an interesting exercise, all the same. Meredith made a beautiful comment, to the effect that poems usually take much longer than blog entries to grow and develop, and by implication, to develop a sense of the readerly exchanges they might invite, and the emotional effects they might set off.

Second, the genre of the blog doesn't naturally lend itself to plans. I've been caught out many times planning a blog entry - even taking the photos for it - and then because I don't write it that day, feeling the moment has passed.

But in this case I do feel that my blog has been working towards this second of three posts, for some time now, and I think I'm ready. So here goes:

The Menopause Post

I have never been a purely cerebral thinker or writer. I'm always deeply conscious of my surroundings: light, temperature, sound, bodily disposition. I've never been good at working in cafes, for example. I notice everything around me; and I think it's both a strength and a weakness in the kind of work I do. But ever since I announced my cancer diagnosis and made the decision to keep on blogging, I have been even more conscious of the fact that I am writing, here, and other places as well, both as a body, and as a mortal being. So in fact, this will probably turn out to be a post about menopause and ageing, not just the former.

It's more than a year since I began the hormone therapy that will last five years in all. I'm being treated as part of a global clinical trial that is testing the side-effects and recurrence rates of cancer under drugs that are normally prescribed according to one's menopausal status, being used in a range of conditions. It will amuse many readers of this blog to know that it is called the "TEXT" trial. So while Tamoxifen is routinely given to pre-menopausal women, I'm being made post-menopausal by an additional regime of ovarian ablation: this takes the form of a monthly injection to suppress ovarian function and the production of estrogen. Tamoxifen works to "lock up" any breast cancer cells that might remain after surgery and radiotherapy, and to stop them feeding on estrogen: the Triptorelin injections suppress the production of estrogen. There are a number of different kinds of breast cancer: mine was of the slow-growing, estrogen-feeding kind.

So, while menopause usually involves the gradual diminution of estrogen, its onset in my case was very sudden. Menopausal symptoms result from changes in estrogen levels as the body adapts to this changing hormonal environment... But I should put a disclaimer in here. Of course, I'm no medical expert. This is just what I have picked up.

The breast cancer booklet available from the National (i.e. Australian) Breast Cancer Centre lists these as the side effects of anti-estrogen drugs like Tamoxifen: menopausal symptoms, blood clots, stroke, cancer of the uterus and changes in vision. And the good news? lowered risk of osteoporosis, lowered cholesterol levels.

Menopausal symptoms are also spelled out: hot flushes, sleep disturbance, vaginal dryness and/or discharge, decrease in libido, no menstrual periods or irregular ones.

This is a shortlist; the leaflet with the Tamoxifen lists many more, though they affect only a tiny proportion of women.

Here's another list I found:

Other symptoms that can occur include anxiety, poor memory, poor concentration, insomnia, fatigue, palpitations, decreased libido, muscle pains, crawling skin and urinary problems.

And to really cheer you up, here's a list of 34 symptoms!

Of all these potential symptoms, the only one that's caused me any significant discomfort, to the point of thinking about any kind of medical or psychological intervention, are the hot flushes. It's like functioning with a broken thermostat. It's a little easier now but for most of last year, I would wake many times in the night, alternately freezing cold (even cold to the touch) and then burning hot. Imagine the most embarrassing deep blush you can; and imagine it spreading over your whole body. Twenty or thirty times a day. Every day. Then imagine being so cold, half an hour later, that you could see the sense of a nose-warmer, just to add to the dignity of proceedings. The flushes are often accompanied by a rush of perspiration, running down the back of your legs, say, when you have just introduced someone at a conference, or yourself at a "research lunch" hosted by the vice-chancellor.

My oncologist says if it gets bad enough, it can be treated with a low-dose anti-depressant, but whenever we have this discussion, we usually say something like "well, let's see how it goes, and we can review in three months".

I've written elsewhere about heightened levels of anxiety, especially when I went back to work last year. Of course it's impossible to say whether anxiety — which I've learned is sometimes regarded as a form of depression — is a direct result of hormonal changes, or compounded by other things like a cancer diagnosis and treatment, or major changes to the work environment, such as we've experienced at Melbourne over the last two years, or the general condition of trying to juggle several writing and research projects with teaching and administrative tasks. (Truly, most of you academic readers in the US: You Have No Idea how many such tasks senior academic staff are expected to take on in Australia.)

Other symptoms come and go a bit, while there seems to be a bit of dispute in the medical profession about what is a symptom or not. Heart palpitations? maybe. Changes to the constitution of one's tears? possibly. Weight gain? disputed.

And then we are quickly in different territory. Because of course it's not just menopause we're dealing with here: it's also the after-effects of serious illness; and it's ageing, too.

About six months ago I looked in the mirror and thought I must have absent-mindedly let my pen draw a vertical line down the side of my mouth. But it was a long crease in my skin, a new wrinkle, or a fold. I'd heard of people's hair going white overnight as a result of shock. This seemed to me to be of the same order. And very shocking it was, too.

Now I've read enough feminist theory to have a sense of the social and cultural climate in which women experience menopause and ageing, but I'll admit I was still unconsciously thinking of both these things as a kind of end, or even as a kind of failure, or flaw. I see myself looking at women younger or older than I am, and see myself making judgements about them. And I've lived enough of my life in the light of The Gaze to anticipate its withdrawal as a loss. But on balance, I thought I would mind much more than I do about starting to look older. OK, seeing that line on the side of my mouth was a bit of a shock, but it certainly hasn't provoked any lasting trauma.

But what I can really see now is that one's mortality is a much bigger deal than one’s ageing, or one’s hormonal status: that really is an end.

I never anticipated what it would really feel like to turn 50, as I will do next month. I think I have quite a strong capacity to empathise, but I could never identify with academic folk who talked about retirement, or with characters in fiction who were concerned about their life's work coming to an end. I can, now. I don’t mean to sound too dramatic: of course I have lots of good and productive years ahead. But I can see, now, that just as the ovaries only have so many eggs, I might have only so many books and essays left to write, that there might be a finite number of years ahead. Unexpectedly, thinking about my own mortality makes me, if anything, less anxious about writing and finishing project after project. It seems to take some of the pressure off, somehow.

And so, really, there's nothing very special about this set of menopausal side-effects, or really, effects. I am just about the perfect age to go through this, and I'm sure this makes it much less traumatic than for younger women, especially those who were planning to have children, or more children. My friends and I now regularly talk about our symptoms; and they all seem to be perfectly calm and cheerful about it, even about the anxiety and moodiness that beset us. There’s no doubt that naming and sharing the process is of immense comfort.

Menopause, then, turns out to be like so many of things we go through: childbirth, marriage, love, death, puberty. The experiences might be universal, or at least common, but the "going through" is not. It still feels, each time, for everyone, like an individual rite of passage. It’s made for blogging.