My name's Richard Anderson, I'm Professor of Clinical Reproductive Science at the University of Edinburgh
and I also work at the Royal Infirmary as a specialist in Infertility and Reproductive Endocronology.
The menopause normally happens at about the age of 51
and it's something of course that happens for all women.
One of the problems with some of the cancer treatments that we're talking about
is going through an 'early' or a 'premature menopause'.
These are defined as menopause before the age of 45, that's an early menopause,
or before the age of 40 is what we generally refer to as a premature menopause.
These can happen for all sorts of reasons, but as I say, commonly associated with cancer treatments.
What that means is that you stop having your periods, and what that in turn reflects,
is that your ovaries are no longer able to produce the hormones that generate the normal menstrual cycle.
One of the reasons the term 'premature insuffiency' was introduced was to reflect
the variability in women's experience of how ovarian function seems to come and go a bit
when it often seems to be not working terribly well in younger women.
A not uncommon situation is a woman will not have periods for several months,
and she might have other menopausal symptoms, such as hot flushes,
and pretty well seems to have gone through the menopause --
and then everything seems to go back to normal for a few months, with regular cycles
and of course some women will have a chance of conceiving during that time, if that's what they want to do.
[Juliet] It took a little while to get a formal diagnosis that I had had the menopause.
But when I did, after I had pushed for blood tests and got those results,
there was a sense of relief actually, there was a sense that I could draw a line,
that I understood that I had been through the menopause.
Actually I went through a phase where it worried me quite a lot, in case I accidentally became pregnant again.
My husband and I had talked about it quite a lot actually, and decided that what we definitely didn't want to do
was have another child while I was ill or while there was a chance I could relapse again.
[Richard] Very commonly, the symptoms would be of course, not having your periods,
but some of the other symptoms that can be really quite challenging are
the hot flushes that can be quite disruptive,
and many women find that these can be particularly difficult to deal with at night, so it disturbs sleep.
It's often a really common symptom of menopausal problems.
These aren't necessarily hot flushes that you're particularly aware of in sleep, but you just wake up early,
you're just waking up through the night and generally have a lousy time
and of course that really impacts on how you're able to function the next day.
Other symptoms that might be quite common are mood changes,
and of course that can reflect things like the hot flushes, the sleeping difficulties that distrupt your life
but also more direct affects on your moods.
One of the issues is that some of these symptoms of the menopause, such as hot flushes or night sweats,
can actually be similar to the symptoms some women have had from their lymphoma.
So it's important that you do discuss this with your medical team.
[Juliet] Having lymphoma and going through the menopause at the same time is quite confusing
because many of the symptoms of lymphoma are also the symptoms, as I understand them, of the menopause.
Temperature regulation, hot flushes, itching, mood swings [laughs].
I'm sure that all was tied up in both the menopause and the lymphoma,
and indeed the treatment for the lymphoma.
In terms of those symptoms, it was never really very easy for me to distinguish what was what
and why I was having what.
But I did have a final ending of my periods,
so there was a time when I was in remission when I was still having periods
and then after the stem cell transplant I didn't have periods at all, full stop.
It was at that point I also wanted to have confirmed by blood tests that I had had the menopause.
I wanted to know for certain.
There was something in me at the time, although looking back on it, I think I was wrong,
where I felt like I had become less of a woman, that because I couldn't any longer have children,
that there was something missing that was quite fundamental to who I should have been.
Yeah, there was a period during which I felt really like there was a loss, like I had lost an opportunity
and it was sad.
[Richard] After treatment, it may be that your cycles are back to normal and everything seems to be great,
and your fertility is probably going to be unaffected,
but if you are worried, if your periods have not come back or they're irregular,
or you've been trying to get pregnant and it's not worked out,
then do speak to your doctor about this because they can do some assessments,
they can refer you on to a reproductive medicine specialist team if necessary,
and there's lots of help that can be brought out to help you through this difficult time.
[Juliet] I would say, if you're young, or younger, and going through the menopause,
and managing all of the affects of having an illness, having lymphoma and treatment and so on,
then, own it.
It's a difficult thing to do.
People may feel uncomfortable that you've got menopausal symptoms
and they may feel uncomfortable and not quite know what to say
about you being younger and not being able to have children,
but actually, if you're straightforward about it and if people ask about it,
and sometimes people do, if you can be straightforward and honest...
I didn't experience a huge amount of judgement, merely curiosity.
People actually are concerned about how you are and how you're feeling,
and in my experience will take more care of you, not less.