Menopause at 35

My story of a preventative oophorectomy

Two years ago, I had my ovaries removed, and at 35 years old, I entered surgically induced menopause. Let me start with the opposite of a trigger warning: this story has a happy ending. So, if you are awaiting your own oophorectomy and have been avoiding the myriad of horror stories on the internet, you can safely read on.

Let me start from the beginning: I was diagnosed with BRCA2 at 25. At my first appointment with my gynecologic oncologist, We reviewed my family history. There is both ovarian and breast cancer in my family, but the ovarian cancer was on the younger side. My aunt was diagnosed with ovarian cancer at 45 and died soon after. Ovarian cancer is particularly deadly and challenging to detect. Because of this, my oncologist strongly recommended removing my ovaries at 35 (5-10 years earlier than a typical woman with BRCA2 might have them removed).

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A very brief explanation of the BRCA mutation:

BRCA1 and BRCA2 are tumor suppressor genes, which means they play a role in controlling or preventing cancer. When a BRCA1 or BRCA2 gene mutation occurs, an individual is at increased risk for certain cancers, including breast, ovarian, prostate, and pancreatic cancer. For more information, check out The Basser Center.

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I had 10 years to prepare. It wasn't enough. I am not going to go into detail about the emotional roller coaster I went on after my diagnosis (possibly a story for another time). Still, those 10 years flew by, and in January of 2023, my surgery was fast approaching. On paper, I was ready. I was married with two kids and had plenty of healthy embryos without the BRCA mutation on ice. I had my fallopian tubes removed during a c-section with my second (another ovarian cancer risk-reducing measure). I had started seeing an endocrinologist to get a baseline sense of my hormones, and I had avoided reading horror stories on the internet (until the night before the surgery, that is).

However, every day that took me closer to the surgery, the fear sank deeper into my bones. The dread clouded just about every aspect of my life. I became convinced that I would wake up from the surgery an old woman, my skin sagging, my bones brittle, and my sex drive decimated. I basically felt like my youth was abruptly ending. My oncologist and endocrinologist both assured me this was not the case, that the menopause symptoms could be easily and safely managed with Hormone Replacement Therapy (HRT), and that I might even feel better after the surgery. I just didn't believe them.

I had my second child in June of 2020, and by January of 2023, I still had not really "recovered." Yes, I was technically healed, but I still felt like crap almost all the time. I started seeing my endocrinologist about six months before my oophorectomy to both prepare for the upcoming surgery and to figure out if there was something awry hormonally. Fortunately, or unfortunately, besides slightly low estrogen, there was nothing glaringly wrong with my hormones.

So, as my surgery date drew near, the fear omnipresent, and my health at a low, I did the worst possible thing: I went online to read women's stories about their oophorectomy the night before my surgery. Spoiler alert – that was a bad idea. All the stories were terrible and confirmed all my worst fears. I was going to become old overnight. The HRT wouldn't work for me, and I would have to experience menopause at 35. My youth was over. I was angry, sad, depressed, and anxious all at once. I got in a huge fight with my husband (very unlike us) and cried and cried and cried.

That night, I felt intense resentment for my kids and husband. I questioned if I would be doing this surgery at all if it wasn't for them. The reason for the surgery was to prevent ovarian cancer and early death, but what did it matter if I died young if I had no quality of life? If I were an old lady for the rest of my life? I was so fearful that I would regret the surgery and that I would never be able to put my ovaries back. The decision felt so final.

As a side note and maybe a topic for another time, the fact that my fears revolved so heavily around this concept that I was going to turn into an "old lady" says so much about our culture's views of aging and menopause as a disease to be avoided and not a healthy and natural part of life. I have a lot of thoughts on this topic, but I will leave that for another time.

The following day, I pulled myself together. My husband drove me to NYU. I put on my gown, went through pre-op, met with the anesthesiologist, and sat holding hands with my husband, awaiting my oncologist for one last conversation pre-surgery.

As soon as my surgeon, Dr. Leslie Boyd, came in, I told her I didn't think I wanted to go through it and to wait and see what happened. I get emotional thinking about how that conversation went.

I am sure Dr. Boyd had a full day of surgeries scheduled with women who were actually sick and many whose prognoses were grim. But she took the time to talk me through my fears. She started by telling me that I absolutely did not have to go through with the surgery. It didn't matter that it was booked, the surgical room prepped, and the team ready to go. I could cancel, and that would be fine.

She reminded me of the 10 years we had gotten to know each other, screening every 6 months. The surgery was not a decision made in haste but one I had made and re-affirmed for the last ten years. I thought back to the time a year or so before when my CA-125 (a protein marker for ovarian cancer) was elevated. The fear I experienced upon getting those results was intense in a way that I had never experienced before. All I could think was that I did not want to die, and I would do absolutely anything to see my kids grow up. It turned out to be nothing, but at the time, I wanted my ovaries out immediately. I ended up waiting as there was no medical reason to move the surgery up.

Dr. Boyd also told me that most of her patients felt fine after the surgery and that she was confident I would have a great experience with HRT. Finally, she said, Lauren, I know you; if you do not do this surgery now, you will regret it. When she said that, I didn't feel like she was imposing her own ideas on me. I felt like she had taken 10 years to get to know me, and she was mirroring back the woman I was. She was right. I would have regretted it, and it would have haunted me daily. I was not willing to take that risk, so I went through with the surgery.

Besides a bizarre case of vertigo that may or may not have been related to the surgery, my recovery was pretty easy. I had to wait a few days to start HRT, and those were the scariest. I remember on the second night, the night before I started HRT, I experienced my first hot flash (or so I thought). I was sitting in bed and getting hotter and hotter – it didn't feel like a flash but a gradual warming until I was uncomfortably hot. Of course, I started to panic; my doctors had told me I probably wouldn't experience any menopause symptoms and that my estrogen shouldn't drop that fast. But as I got hotter and hotter, I felt like all my worst fears were coming true. My husband came into the room to me in tears and rushed to see what was wrong. I told him about the hot flash, and he got a quizzical look on his face and replied that he actually felt pretty hot, too. He went to our thermostat, and somehow, it had gotten set above 90. I wasn't having a hot flash; I was just hot and anxious. We laughed, he turned the thermostat down, and the next day I started HRT.

After my oophorectomy, I became hyper-focused on my health. I was determined to battle all the negative side effects of early menopause in every way possible. I had my endocrinologist managing my hormones, my cardiologist managing my risk of heart disease, an NP and nutritionist helping me with supplements and diet. I made many lifestyle changes that I might not have had the motivation to make otherwise. At the same time, my kids were getting older, my business was becoming less stressful, and I felt incredible.

It's hard to pinpoint exactly what led to the tremendous changes in my health. I responded well to the HRT. I had more energy and less stress, lost weight, got stronger, and generally felt happier and healthier than I had in years. It was a self-fulfilling prophecy. The healthier I felt, the more I doubled down on my clean diet, exercise, and all the other interventions I was experimenting with (supplements, sauna, cold plunge, meditation, etc). In retrospect, I went a little overboard on the "health and wellness" trends for a time. However, it allowed me to sample different interventions and find what worked for me (yes, I still love a sauna, but no, I do not cold plunge every day, and I only eat fish and vegetables 70% of the time).

Two years later, I have settled into a lifestyle that works for me—a healthy one, but one of moderation, with plenty of indulgence and room for life. The HRT continues to work well. I did not turn into an old lady overnight. In fact, I feel about five years younger.

I am so incredibly glad that I got my ovaries out. Not only do I feel better, but the stress of ovarian cancer is not hanging over me. I no longer screen every six months, anxiously awaiting the worst. And while I still have the risk of breast, pancreatic, and colon cancer, removing my ovarian risk did make a huge difference.

Writing this story was therapeutic for me. I meant to do it sooner, but I am glad I waited. I now view the time leading up to the surgery with interest and compassion. I find my obsession with aging curious and can think clearly about why that came up. I struggled through an experience that all women go through (albeit in different ways) and came out of it with a more robust understanding of what it means to be an aging woman in our society. I don't feel like I am in menopause, but it doesn't bother me that I am, and I have never once wanted to put my ovaries back.

This story would not be complete without mentioning my incredible team at NYU Perlmutter Cancer Center – Dr. Leslie Boyd, who managed my ovarian cancer risk for 1o years, and Dr. Freya Schnabel, who continues to manage my breast cancer risk. Thank you for keeping me safe and treating me like a person, taking the time to get to know me, talking to me, and understanding my goals.

For anyone in NYC who has BRCA or thinks they might have BRCA, I highly recommend NYU's Perlmutter Cancer Center. It is an extraordinary place filled with compassionate and brilliant doctors.

THE PILL BOX

And now for an LES plug – After my oophorectomy, I was taking all of these supplements and medications, and I searched for an aesthetic pill box to keep out in my bathroom and found NOTHING. So, I designed my own! Now, my daily medication ritual, once a source of great anxiety, is something beautiful.