A Menopausal Memoir

Letters from Another Climate

Anne C Herrmann, Ellen Cole, Esther D Rothblum

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317712336
• Topic: Social Sciences
• Subtopic: Gender Studies
• Index: Social Sciences

The only extended, first-person narrative about menopause, A Menopausal Memoir: Letters from Another Climate explores the connection between menopause, mourning, and memory through nine fictional letters written to different addressees. The letters explain the author's own experience of having a hysterectomy (without her permission) during surgery for endometriosis and being thrown into instant menopause. Herrmann expresses her experiences differently in each letter based on the recipient's gender, sexual identity, and age, revealing the complexities of accepting menopause. Psychotherapists, psychologists, physicians, medical students, academics, and those interested in women's health and women's studies will receive insight into one woman's experience and will learn how our bodies mold our sexual identity and shape many aspects of our lives.Writing these letters from the point of view of a scholar engaged in personal narrative but not in the familiar narrative of a woman married with children, Herrmann examines her journey of loss, recovery, and healing through feminist theory. The letters in A Menopausal Memoir reveal many other issues, including:

• the relationship between the female body and the meanings attached to it
• the different ways women tell their stories about difficult experiences
• negotiating the relationship between growing older and sexual identity
• the body's response(s) to the loss of organs that form/inform its history
• the connection between body, identity, and disease A highly personal, yet theoretical, approach to the experience of menopause, A Menopausal Memoir explores how changes in the body affect your sexual identity, your relationships, and your feelings as a woman.

Chapter 1

Letter to the Reader: Mourning and Memory

Whoever says You does not have something;
he has nothing.
But he stands in relation.

Martin Buber, I and Thou

This memoir is the result of memory work—Memory work as the product of mourning. Mourning the loss not of a family member, but a part of the body. Not as body part but as female body. Mourning not a lost potential for motherhood, but of one’s body image as female. Same-sex desire as the wish for a female body: one’s own as a body that can be narcissistically invested; the mother’s, so as to deny her premature and inevitable loss; the other woman’s as the body threatened by nonexistence, yet made attainable through the disavowal of its unattainability.

If I speak in terms of loss you will assume I couldn’t be mourning the loss of my organs. You will think I must be grieving my childlessness, the fact of its irreversability. You will wonder why recovery is taking so long, since I’ve never wanted to be a mother anyway.

Why do I need to speak at all?

I lost my mother in my twenties. Recovering from the loss of my ovaries and uterus made me remember, one more time, the loss of her. I imagine an improbable dialogue with her, in the form of a letter. All the letters are to people I have been close to, but not all those who are close to me now appear as addressee.

I am telling you this because how else will you know?

I wrote this memoir as part of a recovery process: from a benign condition that compromised my menstrual cycles for possibly most of my life (endometriosis); from surgery that involved the removal of reproductive organs (hysterectomy and bilateral oophorectomy); from an unexpected, premature, and precipitous entrance into menopause. Recovery required recovering the histories of the body/bodies that had been lost from a position of intense isolation within the body. Bodies cannot speak to one another. They require mediation, through the professional purveyor of legitimate medical knowledge, through the laying on of hands by alternative healers, through language.

As a feminist I have spent most of my life thinking about the relationship between bodies, gender identity, and the category of experience, asking, how do we know that what we have had is an experience? As a literary theorist I have thought about what counts as experience and how it enters language, losing its relationship to the real by acquiring the attributes of representation. As the bilingual offspring of (Swiss) immigrants I repeatedly return to the epistolary as a way of both enacting and disavowing the inherent division(s) within language. This memoir is a work of literary nonfiction: nothing I say has been invented, but the form, and thus the meanings, are solely my invention.

Who am I addressing?

I was considered completely well until it was discovered that I had been harboring an illness. For how long, no one will ever know. Because I was suffering from a non-life-threatening condition and not a disease, I could have been living with it for most of my adult life. While never threatening my life, it had largely governed it, affecting a monthly cycle whose pain and affective volatility I had learned to manage with determination and discipline over the course of thirty years. Because the condition can be diagnosed only when observable to the human eye, it requires surgical intervention, in its least intrusive form as laparoscopy. Eliminating the symptoms (which I had in the form of a diagnosable condition only for as long as it took to remove its cause on the operating table) requires the cessation of the menstrual cycle through the removal of both ovaries. Without the ovaries the risk for uterine cancer increases, thereby medically mandating the removal of the uterus. This induces instant menopause and precipitated me, without anticipation or preparation, into middle age. Initiated under anesthesia, menopause lasted for as long as I was estrogen deprived. Since the condition is known to be estrogen dependent, I was advised to defer HRT (Hormone Replacement Therapy) for at least three months. At forty-three, on HRT, I have finished menopause and have barely begun to understand middle age. I have lost the organs, not vital ones, that from an early age I never intended to use.

No one will ever know how long I suffered from endometriosis or what it can be held accountable for. That can only be reconstructed in the form of a “coming-out” story: the condition that was always present but never recognized that retrospectively makes sense of almost everything. Once called the “career woman’s disease,” it is more common among those who defer child-bearing but is taken seriously only when it leads to infertility. Endometriosis occurs when the lining of the uterus attaches itself to nearby organs—ovaries, bowel, urinary tract—instead of moving out of the uterus with the menstrual flow. No one knows why this happens. Like any other endometrial tissue, it bleeds every month, potentially causing severe pain. Unlike other diseases, the severity of the symptoms are no indication of the amount of endometrial tissue present: very little tissue can cause immense pain; the severest case can result in only sporadic symptoms. The most common symptom is extremely painful menstrual periods.

But what criteria are there for distinguishing between normal and abnormal menstrual pain, or, for that matter, between any normal and abnormal discomfort associated with the female body? How is one to differentiate between a life governed by (as opposed to) tyrannized by a monthly cycle? Because the potential for reproduction remains the focus when treating the female body medically, any anomaly or abberation will necessarily be made subordinate to it. Even if never exercised, that possibility remains the difference that constructs sexual difference, at least gynecologically. This is why being unable to bear children is not a reason not to have them in some other way, and this is why not wanting children does not make this a tale not to be told.

I can’t remember my periods ever not being painful, although over a lifetime they became normalized through increasingly powerful painkillers. Occasionally, as an adolescent, a summer month would pass without my realizing that I had forgotten to take some form of medication. But that was a rare occurrence and eventually a nonexistent one. In high school I remember taking a taxicab home every month (after the nurse received permission from one of my parents, usually my father, since he was more likely to be in his office) to spend the afternoon writhing on the bed due to the ineffectiveness of Midol. By dinnertime the acute pain had subsided, leaving me to feel as though I had just arisen from a sickbed. I remember standing in front of the Chicago Art Institute when my mother told me that my (menstrual) pain bestowed a certain beauty Another time, years later, she and I turned around on the way to San Francisco because the pain had become so unbearable and I spent the drive home groaning in the backseat. Did her irritation stem from the fact that we had missed Judy Chicago’s “Dinner Party” or from her concern about my condition? Recently a colleague in the Women’s Studies program mentioned that she could always tell when I was menstruating because, in spite of the medication, the pain could be read all over my face.

Several years ago I began experiencing additional discomfort between periods. During certain months the bloating was so severe I could barely eat; at times I even found it difficult to walk. Then one month the pain persisted. My period came and went but the discomfort had failed to disappear. I went to see a doctor. I gave her a medical history that included two different but interrelated narratives. The first involved severe bloating that once precipitated me out of a collegewide meeting into the emergency room, where they sent me home with a stool softener and antacids. On the way there a student found me in tears running across campus. He offered to accompany me, parked the car, and eventually took me home for homemade chicken soup. The second narrative involved an episode that had begun several years earlier. Approximately once a year I would be stricken suddenly by the most intense abdominal pain, causing me to heave and writhe on the floor. While the acute pain subsided almost as quickly as it came, the effect was so debilitating that I would spend several days in bed, unable to stand up straight. Since I don’t have to appear in an office every day and these episodes seemed not to coincide with the days I taught, they never interfered with work performance and thus were not considered dysfunctional. These episodes have since been attributed to the rupturing of ovarian cysts (known to be excruciatingly painful). I would mention them to various gynecologists during my annual visits, but they either did not respond or took copious notes or told me to come back during one of the episodes.

Because I had once visited a PMS clinic I kept close track of my menstrual cycle on a PMS chart which led me to observe that these bouts always occurred several days after ovulation. I mentioned this to the two male interns in the emergency room who showed no interest. But my family practitioner said it was the clue that led her to request the ultrasound that led me to the gynecologist who eventually performed the surgery.

The report from the radiologist on the ultrasound came back as follows:

Findings: There are bilateral hypoechoic ovarian cyst lesions. These contain low-level echoes as well as focal nodular areas of tissue within the cysts. The maximal dimension of the largest left-sided cyst is 4.4 cm and that of the right 3.5 cm. The uterus is normal and no free fluid is seen.

Impression: In a premenopausal woman the possibilities include endometriosis, PID-related diseases, hemorrhagic ovarian cysts and neoplasm.

My ensuing discussions with the gynecologist revolved around what kinds of cysts these were, an elevated CA 125 blood count, and the amount of pain I regularly experienced. All the numbers were right in the middle, she said. The cysts were large, but not dangerously so, not over 5 cm. The CA 125 was elevated, but far from the numbers of those with diagnosed ovarian cancer. Even my age. Had I been younger she would have said, “Let’s wait and see.” Had I been older, she might have encouraged surgery. All the evidence, including the fact that I was symptomatic, pointed in the direction of endometriosis.

The two options presented to me were surgery, which I had never experienced before, or medication. In my case, it was Lupron, a drug that induces instant menopause (which I had never thought about except in connection with my mother, who had died fifteen years earlier). Apart from side effects such as hot flashes, joint aches, and insomnia, if taken longer than six months Lupron begins to bring on osteoporosis. There was, of course, a third option, which was to do nothing. Since I only had these debilitating bouts about once a year, I could just live with them, she said. But then there was my age, too much “in the middle,” to not do anything at all.

For two weeks I worked on arriving at a decision. My mother had died of cancer. My stepmother had died of ovarian cancer in her early forties. Was it worth not taking advantage of the possibility of early detection? The drug had terrible side effects, although their progress could be reversed. Reminiscent of a Christa Wolf story I once wrote about, “Self-Experiment: Appendix to a Report,” was about a female scientist who chooses to test a drug that will turn her into a man (so she can better understand the man she loves), knowing that there is another drug to reverse the process. The point of course is that after she lives as a man for a while she opts for the second drug. But why? Drugs with severe side effects were sure to affect me more severely. And besides, how quickly would the cyst have to shrink and how far, before one decided whether it was having an effect? And would surgery then be necessary after all?

I consulted friends, colleagues, physicians. My gynecologist refused to offer an opinion, willing to take questions but unwilling to provide me with any kind of answer. Some said I should get a second medical opinion. Others tried to help me decipher which way I was leaning. Others said, “If it were me, I would want to know for sure.” Post-op I learned that there was less than a one percent chance of ovarian cancer, in which case my life expectancy already would have been greatly diminished.

I opted for surgery.

Surgery was an unknown and ovarian cancer was a ghastly specter. The “chocolate” cysts were identified as “complex,” which made them less decipherable. I was convinced that most likely it was endometriosis. But in that case it was better to know exactly where it was and what it looked like. Hadn’t I been reminded often enough that “I had so much in me that I needed to get out,” intellectually, in terms of artistic expression, as someone known for her reserve?

I realize now, in retrospect, that the fear of cancer affected my decision much less than it influenced the advice of others. Having watched my mother die brought it into the realm of experience, and thus made it imaginable. What seemed unimaginable was the thought of taking a drug that would additionally compromise a body without finally being able to recognize that body as ill. Taking a drug would keep me in a work life marked by burnout and immune deficiencies. Choosing surgery would allow me to opt out. Opt out completely, at least temporarily. The day of the surgery, I had no physical symptoms. The most likely prognosis, said the intern two days before (but then what did she know, she said, having only been at this for five years) was that they would pluck the cysts off the ovaries and leave everything else intact.

Instead, the surgeon found Stage IV endometriosis. “It was as though someone had poured chocolate syrup all over your abdomen.” “Chocolate”: my one vice, my one concession to my (Swiss) nationalist pride. She spent three hours removing the cysts, which had attached themselves to the bowel and urinary tract, cauterizing the endometrial tissue that had migrated all over my abdominal area. She removed the ovaries and the uterus. “I wouldn’t have done you a favor by leaving anything in there.” When I came out of anesthesia I was told that I had lost my reproductive organs. She could have sewn me up and consulted me, she said. Could she have prepared me better psychologically in that we never talked about the severest case of a benign condition, only about the possibility of malignancy? she wondered, months later. She hoped that she had been able to remove all of the ovarian tissue. If not it might lead to future pain, which would need to be corrected with more surgery. But a blood test at a later date would indicate whether the estrogen level had dropped sufficiently. That was the last thing she mentioned before I left the hospital—more surgery. I couldn’t even imagine it.

Does one mourn the loss of organs?

Would the vagaries of menopause replace those of menstruation?

Am I menopausal, postmenopausal, and do I remember ever having permimenopausal symptoms?

“Surgical” menopause necessarily entails an experience of loss, at the very least, of any one of several reproductive organs. A radical hysterectomy is not castration in as much as it does not involve the removal of an organ principal to sexual pleasure, i.e., the clitoris; it is not amputation in as much as the lost body part is not visible, like a breast. With the loss of these organs comes the loss of the menstrual cycle and a reproductive capacity, all factors constitutive of a gendered capacity, even as a female gender identity is not reducible to them. All women will lose the potential for participation in a reproductive function regardless of whether that potential has ever been realized or not. In as much as femininity should not be confused with maternity, what does it mean to lose, rather than outlive, this potential? What does it mean if one chose not to have children in the first place?

For those who anticipate the removal of their organs, a hysterectomy entails not just loss and subsequent grieving, but also the fear of loss, the fear of losing a capacity for sexual pleasure: what effect will the removal of the uterus, of the cervix, have on the capacity for sexual pleasure? How might estrogen depletion affect a woman’s desire, already compromised in myriad ways, for sexual activity? From a medical point of view, any physiological dysfunction induced by menopause can be regulated by replacing the hormones, since for the medical profession there is nothing “natural” about menopause in the first place. On the one hand it doesn’t appear “in nature,” since in all other species the female reproduces until she dies. On the other hand it is a relatively recent phenomenon in human history, an occurrence, among such large numbers of women, of only this century.

What distinguishes the process of mourning associated with “surgical” menopause from other forms of grieving is the fact of the body’s participation. Abdominal surgery is known to require the longest recovery period of any surgery—a year to a year and a half. Recovery entails not just recovering from surgical intervention but readjustment within an entire endocrine system, especially if accompanied by estrogen deprivation. In my own case HRT was deferred for three months, inducing hot flashes, nights sweats, sleeplessness. The body can no longer be invoked as an ally against loss because the body itself embodies fragility. The body does not necessarily shift from ally to enemy but induces a different understanding of the dependency between mind and body than the one enabled by and recognizable from youth. It is no longer strong, reliable, pliable, something that can be pushed in order to stabilize emotional volatility. Strategies for pain managem...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgments
• Chapter 1. Letter to the Reader: Mourning and Memory
• Chapter 2. Letter to My Mother
• Chapter 3. Letter to an (Ex-) Lover
• Chapter 4. Letter to a College Friend
• Chapter 5. Letter to My Father
• Chapter 6. Letter to a Gay Man
• Chapter 7. Letter to (Two) Young Women
• Chapter 8. Letter to My (God) Mother
• Chapter 9. Letter to Myself
• Bibliographic Essay