I’m not crazy about birthdays, but crying in a church is a touch more melodramatic than I anticipated for my 31st. It’s January 2017, and my friends and I are watching standup comedy. As laughter ricochets around the gothic architecture, I look down to conceal what’s about to happen: flared nostrils, downturned mouth, wincing eyes. Utter devastation.
Sneaky weeping has become my dirty little secret. It started at Christmas, when the sweetness of family and food was kiboshed by the same sudden thwack of melancholy. It was also happening during my work hours, as a music writer and editor: one minute I would be proofing a three-star review of P!nk, then boom, off to a toilet cubicle for a silent scream.
Brain fog leaves me exhausted and unable to form a coherent thought, let alone a sentence. I haven’t had a period for a year
2016 was a rough year for the world. But, selfishly, I’d got married to an outstanding man, and my fringe was looking good for the first time ever. A brief, golden chapter of my life had arrived: a segue between the scrappiness of my 20s and what I figured would be the seriousness of my 40s. The last blast of fun before real life kicked in. I had a steady job, lived in a house in London, one with actual windows and a bath. I was zipping around the city seeing friends at shows or gigs most nights. Until the aforementioned episodes, I felt indestructible.
I visit the doctor and tell him about the sudden short-lived sadness now seeping into hours and days, as if someone has murdered my soul, or something to that effect. “Would you consider antidepressants?” he asks.
“I’m not sure. This doesn’t feel like depression,” I say.
“How are you sleeping at the moment?”
“Terribly,” I reply. I refuse the drugs, leave the appointment promising to meditate and exercise, and decide to take matters into my own hands.
There are other symptoms I’ve been accruing; and, after the usual incurable cancer diagnoses, Google offers what will turn out to be a shockingly accurate suggestion. I really am on the cusp of a new chapter of my life – only I’ve skipped a couple and raced to the part that normally starts at 50. I am a 31-year-old newlywed going through the menopause.
It all started with the sweats, as so many awful things do. Around five times a day, and as many throughout the night. They began when I was 29, but got worse every year. A prickly heat in my face that courses around the rest of my body, taking 10 to 15 minutes to subside. They often arrive before I am about to do something moderately stressful (such as ask for holiday leave, or say a single thing in any meeting) so I presume they are a manifestation of standard workplace worries. It makes life arduous; I accrue a thick film of sweat above my top lip that sometimes drips into my mouth. “You going through the menopause already, Harriet?” jokes one colleague, who absolutely hates the roaring sound of my bronze USB desk fan.
Then there is the rage. At a school reunion in a flat-roofed football club in a field in Essex, I confront a series of people from my youth who I feel had wronged me in some way. A rogue energy ripples through my veins. Furious, and uncharacteristically confident, I ambush otherwise pleasant conversations with boys I used to know by asking, “Do you realise how [minor incident] made me feel?” They don’t, they’d forgotten, and hastily move on to another conversation with someone else about sports day or loft conversions. Another time, I go to a gig and enter my first moshpit for the purpose of trying to push people as hard as I can. Again, not the time or place; it is an Ash reunion concert at the Roundhouse, a grand grade II-listed building in Camden, not Megadeth at Bloodstock festival.
By September 2017, I am rocking a full house of menopausal symptoms: a strange feeling of anxiousness that manifests in breathlessness, numbness of my left arm and pain in my chest. Cracking headaches, so piercing that I spend a day waiting in A&E to get one particularly violent attack checked out. The vision in my left eye starts to go. I am unable to sleep: along with the flushes that wake me up with a pinch, I am feeling wired at night, my legs twitching and tense. I sleep on the sofa sometimes, and have night terrors in which a large, dark creature storms towards me and envelops me until I wake, gasping for breath. Then there is brain fog, the most psychedelic of them all: it leaves me confused, exhausted, and unable to form a coherent thought, let alone a sentence. I haven’t had a period for a year, but they’d always been erratic. I want also to list vaginal dryness as a symptom, but there is no way of proving it: my sex drive is nonexistent. I Google “Malcolm Tucker shouting”. Still nothing.
I’ll be on HRT until I’m in my 50s, to prevent the day-to-day symptoms, as well as cardiovascular disease and osteoporosis
I stop showering and exercising, preserving my energy for basic tasks such as “putting on the same massive grey jumper as yesterday” and for wallowing in my own disgustingness. In spite of my greasy hair and unusual temper, my husband Mark still cares about my wellbeing, and encourages me to be persistent with the GP so we can get an official diagnosis. After a year of puzzled doctors and lots of blood tests, I am summoned to an endocrinologist in a hospital in central London.
As I sit in the waiting room, the garish pinks and blues of Loose Women punching their way out of the tiny TV, I imagine how awful it would be if I was actually fine. All the moaning and sketchy behaviour for nothing. Or maybe it’s more serious than the menopause. Could there be something fatally wrong with me? A classy funeral, maybe in Edinburgh. Intimate, but a few famous faces come along to pay their respects. Will Mark ever find love again? A doctor calls my name.
“Your FSH [follicle-stimulating hormone] levels are very high: 109,” says the sixtysomething male doctor, giving off a strong “last appointment of the day” energy. “For a woman your age, it’s normally under 10. So this means you have a condition called premature ovarian insufficiency, or the early menopause. It’s not uncommon, but it means you have less than 5% chance of conceiving.” He unloads the news in such a formal, monotone voice, it’s almost as if he’s hoping I’ll leave without acknowledging I’ve just been told the worst news of my life.
“But I’ll be able to do IVF,” I say.
“You won’t be able to do IVF – you have a low egg supply, and your ovarian supply will not respond to IVF drugs.” This is a twist. I had skipped over the fertility details on Google, assuming there would be a simple scientific solution to my eggs being low. This is one of those pivotal moments: the ones where women stand up for themselves at the doctors. Demanding answers. Not leaving until they have their way. I’ve heard about them, and only in my wildest dreams have I imagined being obstinate in the face of a health professional.
“I can’t do IVF?” I ask, haughtily. The tone doesn’t really suit me. I immediately regret it.
“No, but your womb can carry a pregnancy, so a donor egg would be your most viable option.”
My brain spirals into panic. “Can you write this down for me, please?”
I leave the hospital holding a prescription for hormone replacement therapy drugs, which replace the oestrogen and progesterone that are at a lower level in menopause, and a piece of paper with some diagrams scribbled on it that I shove in a bag and never look at again. The plan is that I’ll be on HRT until I’m in my 50s, to prevent the day-to-day symptoms, as well as cardiovascular disease and osteoporosis. For now he’s given me a patch called Evra that I stick on my arm, and which pumps oestrogen into my body. If the symptoms continue, I can take the contraceptive pill Yasmin. Blocking that 5% chance of conceiving does feel slightly counterproductive, but I used up all my energy with the IVF question, so I accept my fate and move on.
I call my sister Libby. Seven years older than me, often in a car with her two boys, she’s the person I normally turn to when things get real. She’s driving and I’m on speakerphone.
“It’s not great news. I’ve got premature ovarian insufficiency and I’ve got less than 5% chance of getting pregnant on my own,” I shout while walking through the rush-hour crowds.
“So what does that mean?”
“I’d need to get someone else’s eggs,” I reply.
“You can have my eggs,” she responds, as if at a breakfast buffet. And so begins a dual journey: my quest to get pregnant, and my battle against the demon hormones.
Mark, an optimist, is relieved we have a plan for the former. We’ll use Libby’s eggs and have a little baby, and we come to the decision as naturally as the offer was presented to us. Obviously, I was hoping I’d get through life without having to understand what happens during fertility treatment, but this will not be the case. The latter question, of hormones, however, is more complex. The patches are awful. The hot flushes are knocked on the head, and for a week I can see colour in the world, but I am furiously hungry, my nice clothes stop fitting, and I begin to change deeply; spiritually almost. My sense of fun slowly fades.
We get to work on the egg-borrowing situation immediately, and are referred to a nearby hospital. My sister, my husband and I meet for the first of many visits. It is the greatest privilege to embark on this with two of my favourite people, and often I am so overwhelmed by the weight of what we are about to do that I turn up on the brink of tears. They are cheerful and encouraging, while I am quietly pessimistic and panicking; I feel bad for making them spend so much time out of their day because of my physical failures.
In the waiting room is a poster for an infertility support group called Empty Arms, with a grainy black and white image of a woman with a shaggy bob cradling thin air. Like something out of a Julia Davis comedy, only a touch too tragic.
Debbie, our nurse, talks us through the process: blastocysts, fertility investigations, egg transfers. I take notes, but none of the information goes in. Mark gesticulates wildly in time with the doctor’s insights, a sure sign that he has no idea, either.
Over the next few months, there’s a lot of admin, and even more transvaginal ultrasound scans. Libby and Mark will have tests to check their fertility (they’re both fine), and they’ll need to make sure my womb will be a hospitable place for a baby (it’s surprisingly fine). Two weeks before we collect her eggs, Libby will have to administer IVF injections, which will make her feel menopausal and increase the number of eggs her ovaries produce, so that we can get as many as possible and fertilise them with Mark’s sperm.
We also need “implications counselling”, to ensure we will all be able to cope with the emotional voyage we’re about to embark on. Mark and I have a session, in which a friendly therapist asks if and when we might tell the child about our fertility story (we decide we won’t keep it a secret, and will explain it as soon as they possibly can comprehend it). Then Libby has a session, during which the therapist gently quizzes her about how she might feel once the baby is born. She tells them all she wants is for me to experience the same joy she’s had from being a mum. And I am honest, too: I can’t see a downside. Any child would benefit from her genetics; her elegant charm and ease with the world. There’s no rivalry or baggage. While this is life-altering and enormous, it feels like the most effortless exchange of true love.
I am shocked by the early menopause diagnosis. And my friends can’t relate to anything I am going through
All of the above takes about a year. The NHS is busy. I go on a cocktail of new hormones to prepare my body for the eventual egg transfer, but the new HRT they’ve given me doesn’t go down well. I later discover that taking oral progesterone can make you sleepy, and I’ve been popping one every morning before work.
Beyond feeling exhausted, I am shocked by the early menopause diagnosis. I am displaced; my friends can’t relate to anything I am going through, and while they try, it feels boring and gross to burden them with my existential crisis. Instead, I spend a lot of time gazing at women at work who are possibly in their 50s and looking a bit hot, and fantasise about cornering them for a whinge. My memory loss is getting embarrassing, too. If I go to a meeting, I write down exactly what I need to say, down to the small talk, but the moment a curveball question is asked, my brain has an enema.
My extracurricular hobby is now trawling messageboards. Thankfully, I find the Daisy Network, an organisation set up to support women with POI (premature ovarian insufficiency). I learn a lot about the condition: spontaneous POI affects 1% of women before the age of 40. Approximately 5-10% of women with POI may still conceive. Some women have the condition because of surgery or cancer treatments, while about 5% get it as a result of an autoimmune disease. This makes sense: just before the menopausal symptoms begin, I was diagnosed with Hashimoto’s disease – a disorder that makes you feel really weak, as your immune system attacks your thyroid. It is fixed by taking a small white Levothyroxine tablet first thing in the morning.
There are members of the network in their teens, some with no symptoms, and others who have been diagnosed much later, living with the destabilising symptoms for most of their adult lives. I attend a couple of group sessions at the Chelsea and Westminster hospital – there are doctors there who do Q&As about fertility and hormones. Those women are there – the ones who demand answers – and boy, do they get results. I just want to ask everyone if they are OK. In one of the meetings about POI’s emotional toll, we are all given a leaf to hold. I’m not quite sure why, but it’s nice, and for a few moments we sit in silence and feel connected by our grief.
Social media is a hellscape: I mute friends who have got pregnant by accident. I avoid seeing people who have children
Waiting lists for specialists are long, and often women with POI bounce from GPs to pharmacists who have no idea about HRT and the condition in general. Together, on the Daisy Network’s Facebook group, we join the dots, share helpful articles and tips on how to combat symptoms, how to apply certain medicines, or simply unload our frustrations and sense of helplessness. Testosterone is currently a hot topic. I’m tempted to try it, for its confidence-boosting properties, but it also might make me hairy. It’s a relief to share this discombobulating diagnosis with these women, but on my worst nights I spend too much time online absorbing strangers’ trauma, and getting overwhelmed by my own.
Technically, I could still conceive. For women with POI who still have ovaries, their fertility can be fickle and unpredictable. But is it possible to even consider sex when you can barely look at yourself most mornings?
Social media is a hellscape: I mute or delete friends who have got pregnant by accident, or who post pictures of their weekend family utopias. I avoid seeing people who have children. My gorgeous niece and nephews’ birthday parties are painful; we can’t stay too long.
I suddenly need a lot of attention and sympathy. I tell everyone I know about my condition; at the teapoint at work, at parties, whoever will listen. I am just so lonely, and looking for a connection. Everyone is kind and sorry, but it’s the menopause: a condition still shrouded in secrecy and embarrassment. It’s not quite dramatic enough to get that all-encompassing hit of compassion I’m after. Almost every day I consider posting a meme on social media of a cartoon of a woman on the phone saying: “I’m just in the middle of the menopause, can I call you back in about five years?” but wimp out.
Back to the baby. It’s November 2017. A year since I first Googled “have I got the menopause?” and nine months after our first fertility appointment. It’s time for the egg collection. Libby heads into theatre for her general anaesthetic and the quick procedure during which they remove her eggs. I watch Mark eat a huge fry-up in the desolate hospital cafe and wait for her to wake up. Once the collection is over, we check on her. Libby lies on a hospital bed completely conked out, her grey pallid skin and still frame giving her the presence of a corpse. It’s one of the most chilling moments of my life. As she’s not allowed to travel alone, we are joined by Paddy, designated driver, mood-elevator and husband to Libby. The four of us head off to an Italian restaurant to celebrate. I bump into Debbie the nurse on the way out.
“We got three eggs,” she says with a conciliatory smile, and a defeated nod. “We’ll give you a call tomorrow to let you know how the fertilisation goes, and then we should be able to do the transfer.”
Three eggs sounds OK, but every day the numbers will diminish; ideally we’d wait until day six, when we’ll have the strongest possible embryo to do the transfer. It’ll be remarkable if any stay alive that long. I keep the sober exchange a secret so as not to lower the mood over lunch.
At 7am the next day I get a call from an unknown number. A nurse from the hospital. She has bad news. None of the eggs has fertilised.
A year of medical tests, desperate anticipation, thousands of pounds of IVF drugs and a sister pumped full of insane hormones. We are all broken; Mark and I spend the day walking around our local park, avoiding buggies.
The next morning I get another mysterious call. It’s a nurse and she’s in a good mood. As a precaution they kept our eggs in the lab overnight, and one has fertilised – it’s a miracle!
We rush into the hospital so they can implant it into my womb immediately. Two weeks pass. On the 14th day we do a pregnancy test. I’m not pregnant. I call my sister to tell her the bad news.
“I’m so sorry, Hat,” Libby says, her words strained with sorrow. It’s not an empty platitude; she means it. I reassure her it’s not her fault, she says she wants to try again. Barely capable of speech, I quickly thank her, tell her I love her and say goodbye.
Pregnancy is a breeze after the past few years. It’s a profound shift and I am careful to not get carried away with the glee
In the weeks after the test, my husband can see I am struggling. He is, too. I can’t face putting Libby through it again; it’s a lot of time and physical and emotional labour. At this stage we are introduced to Dr Luca Sabatini by Debbie. A clean, strong, pragmatic Italian man, who is a consultant obstetrician and gynaecologist. My hero.
“How about an anonymous donor?” the doctor says. “It’s not a big deal. The baby’s still yours.” Mark agrees. I nod, but it does feel like a big deal. My body has been a scientific experiment for over a year now, and I need some space. I am horrified by the thought of putting someone else’s body into my body.
Two months go by. I can’t sit on this decision for too long. Anyone who’s ever done fertility treatment knows the waiting around is one of the worst bits. To have self-imposed limbo is foolish. It helps that Mark has remarkable clarity. We either want a baby, or we don’t. And we do, so we decide to put our absolute faith in the professionals and do whatever Sabatini tells us. Because of my condition, I don’t qualify for any free rounds of IVF, so we decide we’ll see him privately in London, and get the donor from a clinic in Madrid. It’ll be fast and they have an excellent success rate.
We make contact and have a series of video chats with the clinicians in Spain. Again, we have no idea of what is going on. We are underprepared and have no decent questions to ask, so nod a lot and say, “Sounds good!” They are pros; incredibly to the point and transactional, but not in a bad way. It’s what we need. We send over the paperwork, I do more tests, Mark goes to Spain to “do a sample”. They find an anonymous donor with similar colouring to mine, and two months later, we go to Madrid.
It’s a tense trip. This time I’ve been healthy: no alcohol, meditation, lots of exercise, good food – so my body and brain are prepared if it goes wrong. The anticipation is agonising. It’s made all the more surreal by the fact that Mark has booked us into a hotel in the gay district that is 50% purple leather, 20% pink fur, 10% black silk and the rest in bowls of condoms. Still, the egg collection goes well; we get nine eggs, and after the fertilisation process have two blastocysts (the strong stage of an embryo, five or six days after fertilisation), which is very positive.
This time we do things differently: we leave the clinic. I go straight to bed and don’t move for four hours. We fly home the next day. Mark carries the luggage. For the next two weeks, I do little physical movement – avoiding baths and heavy lifting. I am so still. On day 14, I have a blood test to see if I am pregnant. We wait for an email to tell us the results, and walk slowly through the park, careful in case I’m carrying a foetus, careful as if bracing for the almighty grief of another failed attempt.
At 12:11 I get the email: “Please find attached a copy of your results which confirms a positive pregnancy test.” We can’t believe it. It’s worked, what a wonderful fluke. The fear of losing the baby now we’ve come so far is mammoth. Because my body may not be able to produce enough oestrogen and progesterone to carry a successful pregnancy through, I remain on a cocktail of hormones for the first three months, taking batches orally and vaginally at the same time every day until it is safe enough. This colossally important routine is so intense that two years later, I still wake up in the middle of the night, panicking about missing a dose.
Pregnancy is a breeze compared with the past few years. It’s a profound shift to go from infertile to pregnant, and I am careful to not get carried away with the glee. It’s high-risk, but things go to plan. Bit of sickness, a bit of bleeding, lots of apples. But the birth is less straightforward. Plummeting heart rate, baby’s stuck, episiotomy, forceps.
“My baby,” I cry, as he is raised from between my legs and immediately moved on to a table. The doctors huddle around his body. Mark is devastated. The baby is unresponsive, blue and limp. “It’s OK, it’s OK,” I tell Mark. I am as high as a kite from the epidural, but I am certain, from the depths of my soul, that he will survive. Mark puts his hand on my shoulder. “It’s OK,” I smile.
A few minutes later we hear his cry. A lovely croaky cry.
As I haemorrhage everywhere, I am handed my son for what feels like 20 minutes. I have a bad internal tear. The first set of stitches goes wrong, and the doctors wheel me into theatre, leaving Mark in a room filled with my blood and the overwhelming presence of our tiny naked son.
And what a son he turns out to be. Fun-loving, impressively rhythmic. A club comic and jazz maestro in an elf’s body. Beyond being a huge dollop of the most delicious pudding, he is mine. Any kind of spooky emotions about identity that might arise postnatally are nonexistent. I can only compare it to baking a cake. They are a vital gluing agent, but nobody eats a slice of lemon drizzle and compliments the baker on the egg.
There is a foreboding cloud above me, however. When the pregnancy hormones end, the menopause will return, and I’m not exactly sure when. I am fragile as it is, so I ask the Daisy Network group, and the responses vary: it could be after three months, six months, a year. My son begins to lose interest in breastfeeding at around seven months, and so we stop. The milk-making hormones wear off quickly. A few days after giving up feeding, my hot flushes are back and I’m unable to think straight. I’m dizzy, have terrifying heart palpitations, and am not able to get to sleep, which is terrifying when you have a baby who wakes throughout the night.
HRT does its job pretty quickly, though. A few months before I gave birth, Sabatini had introduced me to a menopause specialist at St Bartholomew’s hospital, who listened to my backstory, and understood my desperation to get HRT for the minute the menopause kicks back in (so much of surviving the chaos of the female anatomy is finding a doctor who treats it with the delicacy and seriousness it deserves. She is one of them). I use gels and take tablets. Things feel good for a month, then very bad, so I speak to the specialist and double my dosage: four pumps of gel spread across my legs, upper and lower back, and two progesterone tablets at night. For the first time in five years, I am steady.
I’d like to say this is the end of my hormonal adventure, but my hormones will continue to shift throughout my life. I am constantly weighing up if I am tired-tired or brink-of-mania, HRT-not-working tired. Nothing in excess. Careful with food and alcohol. No caffeine. Tonnes of supplements. Exercise.
My 30s haven’t been the liberating time of calm inner-confidence I was promised, and I am far from indestructible. While there’s definitely rewiring to do, I’ve gained a certain fearlessness. A timidity from my girlhood has been beaten out of me by the full-throttle emotions and exhaustion of the last few years. I feel as if I am waking from a period of hibernation, not exactly refreshed, but certainly renewed. I am thankful for those who kept me warm. Thankful for my baby, who will know his life was so wanted. And ready to grip the hand of the next hot, teary, angry woman I see hiding her breakdown in a busy room. Or not. Whatever makes her happy.