We're All Insane - Menopause at 25

Episode Date: May 29, 2023

Thanks HelloFresh! Go to HelloFresh.com/ALLINSANE16 and use code ALLINSANE16 for 16 free meals plus free shipping! Get $10 off at Nutrafol.com when you use promo code Insane! Ovarian failure, also known as primary ovarian insufficiency (POI), refers to the loss of normal ovarian function before the age of 40. When it occurs in a woman's 20s, it can lead to early onset menopause. Premature ovarian failure can have significant physical, emotional, and psychological effects, with symptoms such as irregular periods, hot flashes, vaginal dryness, and mood swings. Causes can include genetic disorders, autoimmune diseases, infections, and treatments like chemotherapy. Managing ovarian failure and early menopause often requires medical intervention and emotional support. Hormone replacement therapy and fertility preservation techniques may be options. Seeking advice from healthcare professionals specializing in reproductive health is crucial for managing this condition effectively. If you'd like to contact Hanna with questions, her email is [e-mail]. Video explaining primary ovarian insufficiency: https://www.osmosis.org/learn/Premature_ovarian_failure If you have a unique story you'd like to share on the podcast, fill out this form: https://forms.gle/ZiHgdoK4PLRAddiB9 Learn more about your ad choices. Visit megaphone.fm/adchoices Learn more about your ad choices. Visit megaphone.fm/adchoices

Hey guys, it's me DeVora. I just dropped an all new bonus episode inside my new subscription channel, We're All Insane Plus. This week's bonus episode is called My Brain was slipping into my spine. Listen now by subscribing to We're All Insane Plus inside your Spotify or Apple Podcasts app or go to we're all insane.com. Hey guys, I want to thank HelloFresh for sponsoring today's episode. HelloFresh is one of my favorite meal services. you can get 16 free meals plus free shipping. When you go to hellofresh.com slash all insane 16, that is hellofresh.com slash all insane 16 for 16

free meals plus free shipping. I would also like to thank Nutrafol for sponsoring today's episode. Nutraful is the number one dermatologist recommended hair supplement brand and is physician formulated with 100% drug-free ingredients. Just go to Nutrafol.com and enter the promo code insane to save $10 off your first month's subscription plus free shipping on every order. Enjoy today's episode. Hi, I'm Hannah.

And when I was 25, I went through menopause. And I want to talk about it a little bit chronologically. And I feel like I should say bottom line up front is that everything is really good now. Yeah. But the journey throughout the last year and sort of learning how to live postmenopausally has been a little bit rough. So I'll sort of talk about where my body and my mind and sort of like my headspace was throughout the journey as it was then. But with the peace of mind of knowing that, everything is good now.

Right. We're doing a lot better. Good. But it really starts with, I feel like my reproductive health has sort of plagued me ever since puberty. It's just not been a good situation for me. I always had really painful periods. And I went on birth control when I was in high school.

and it was largely due to just the cramping and stuff. Yeah, like painful periods, not wanting to interfere with sports and stuff. I never really had to. I know a lot of my friends were going on birth control for things like acne. I didn't really deal with that too much, but for me it was mostly just really painful periods. My mom always said, all the women in our family have really painful periods, and that's kind of, you know, my lot in life, basically. When I was on birth control in high school, it really wasn't working well for me.

I just, like, the estrogen was just not sitting well with my body. me so nauseous. Yeah. I remember for like the span of a whole year, I would wake up every single morning I would end up fainting because I was taking my birth control at night and it just did not work for me. Really? Yeah, it was weird. And for a while, we didn't know what was causing that until my doctor told me,

try taking your birth control in the morning. And I realized it was the pill causing me to like overheat in the morning basically every time I stood up. Yeah. It's interesting. It's crazy that like it can do that. Because I feel like those are the effects that, like the side effects that they don't really talk about from the pill and stuff like that. That's wild. Yeah, especially because I think too when you're

young woman and you go to the doctor, I mean, they'll give you the birth control pill for anything without really telling you too many things about the side effects. And it affects everybody differently too. Yeah. So then I was on and off birth control for most of high school and then throughout most of my undergrad experience in college. I did a two-year undergrad, four-year grad program and graduated with my farm D in 2020. I've been practicing pharmacy since then with most of my background being in long-term care. I switched to retail this year. So working with all the birth controls and stuff is actually kind of new for me. It's been a little bit exciting to be back in the mix with that. But everything kind of went to crap a little bit when I think it was 20-20,

the year that I graduated from pharmacy school, I switched from using the combined birth control. estrogen and progesterone to the progestin-only mini-pill. Okay. And from there, I started to have, you know, like, breakthrough bleeding. It really just wasn't working for me. This was right around the time my husband, Marco, and I started dating. And I finally got to the point where I was like, if I'm always having breakthrough bleeding and my cramps are getting worse, then what's the point?

Yeah. So I went off and I decided to try something different and do the copper IUD instead. and coming off of hormone birth control ended up causing my endometriosis to flare. So this is the first time then in my life that I suddenly was having all of these really intense symptoms. And just with my background, I started thinking, oh, it really seems like I might have been dealing with endometriosis this whole time. And being on and off birth control, the birth control suppresses the symptoms.

So switching to a non-hormonal birth control ended up causing this horrible flare-up of symptoms. and then I was kind of stuck between a rock and a hard place because I really liked the copper IUD. A lot of people find it to be intolerable due to the fact that it can cause more cramping and heavier bleeding in a period. But for me, my period was never super heavy bleeding-wise. And the cramps weren't, I mean, the cramps were like bad enough. I mean, I guess just nobody likes having cramps. But when I had my first few endometriosis flares, it was like everything else was way worse.

I was throwing up a ton. I would start throwing up like an entire week before my period even started. And it really was affecting me at work to, I was like having to take breaks to throw up at work and had this horrible abdominal pain that was so different from anything I'd experienced before. It was like from my waist all the way up to under my boobs. It was just so tender. Even to the touch, it felt like if somebody like brushed their hand across my stomach or I bumped into something, it was excruciating.

And it would be like that for like a week and a half to two weeks before my period even started. Then you have your period, you know, and that's, you know, another few days. Right. It felt like I was just becoming consumed with my reproductive health once again. And so I decided to go get evaluated for endometriosis and get surgery. That's usually how they diagnose it for like a clinical diagnosis of endometriosis. a lot of times it can be diagnosed sort of anecdotally based on symptoms and signs, but if you want to get it clinically diagnosed, which would be, you know, getting it like a tissue

biopsy and getting it identified on a pathology report, you have to have what's called like a laparoscopy. I had a da Vinci laparoscopy, and they went in with a little camera and a little cotterizer biopsyed some of the tissue, removed some cysts. And after that, my symptoms got better and I never had my period again. So my ovarian failure journey really starts with having that surgery. So after that surgery, did you still have the IUD in or no? I did. Yeah.

So I had the IUD in. I was using that for contraceptive since at that time I was dating my now husband. But like did they tell you that after that surgery that your period might just stop altogether or no? No. Okay, so they didn't have any idea that that might happen. No, and I've even been assured by most of my doctors since then that the surgery was probably just the final straw on top of, I guess, what my ovaries could handle. Okay. When I went into the surgery, they told me, by that point I'd had some ultrasounds done and they could see that I had cysts on my ovaries and on my fallopian tubes.

And I feel like it's worth mentioning that even though I had a lot of cysts, I never was diagnosed with polycystic ovarian syndrome. or PCOS. That's sort of a different reproductive disorder that has to do with like an imbalance of your androgens. I never had that. I just had a lot of cysts and most of them were endometriomas, which are the endometrial tissue sort of back flowing out of the uterus through the phlobian tubes and sticking to other parts of the body. Mine were stuck to my ovaries and my large bowel and my abdominal wall. And what happens is those pieces of tissue that flow, out of the uterus will then respond to estrogen throughout your cycle. So the problem becomes that every time you have your period, those spots within your abdomen

are also bleeding as well as like what's coming out of the vagina. So a lot of the pain and endometriosis comes from inflammation just from those tissue spots bleeding every month. And that also causes scar tissue adhesions. So one of the really charming symptoms of endometriosis that I struggled with was really bad constipation and it turns out that I had a scar tissue adhesion that was like pulling really strongly on my large bowel. So thankfully surgery was able to alleviate a lot of my symptoms.

But I did have sort of, I think, my first preview that there might have been something wrong with my ovaries in my follow-up appointment with my surgeon. At the time, I didn't really understand what she was saying or why she was telling me this information. but I went into surgery with the goal of getting a tissue diagnosis so that treatment options would be covered by my insurance. They were going to put me on a medication that would effectively put my body into a medically induced menopause.

That way, you know, the fluctuations in estrogen wouldn't be making my endometriosis symptoms worse month by month. It is kind of ironic that I did end up being postmenopausal after the surgery. So I guess, you know, like in a kind of roundabout way, I did achieve that. but in my follow-up appointment, she told me that they were able to biopsy the tissue and it did come back as endometriosis, but she made sure to tell me that my ovaries looked rough

and that basically as soon as she opened me up, my ovaries, I guess, had these endometriomas on them and they sort of like hemorrhaged open and like filled my pelvic floor with blood. And the point of telling me that I think she was saying, that because of that, the biopsies they took of the ovary cysts came back as like a ruptured corpus luteum as opposed to being endometriosis. And in my mind, when she was telling me that, I was thinking, well, the other tissue came back as endometriosis. So I think we really checked

the block. But I think that that was almost her way of saying that my ovaries were in rougher shape. And I think I kind of, I think that just went over my head. I just didn't think about it. Hey, I'm Jeremy Schwartz from American Criminal. On this, season, robbery gone wrong or cold-blooded murder. Either way, Boston will never be the same. Listen to American Criminal, the murder of Carol Stewart, wherever you get your podcasts, or to get early ad free access, subscribe in Apple Podcasts, Spotify, or at American Criminal.com. And after the surgery, they do tell you that your first period will, you'll miss it, just because the ovaries are, you know, they have to heal after that. I had, going into surgery,

I had two tubal or like fallopian tubal cysts. I had two cysts on my ovaries that she talked about in the post-op. And then I had a ruptured cyst on ultrasound that they had seen in my pre-op appointment. And so I, you know, I kind of recognize that there was a lot of carnage. The recovery process was kind of tough too. I mean, they do. They blow air into your abdomen to sort of inflate it. It's very weird because then you have this extra air floating around in your stomach.

And you have to sort of like, watch. around and walk it off and the air is moving all around. You can feel it moving. It's really strange. I'm sure. And so then the month passes. You know, I'm just recovering, trying to get the extra air out of my stomach, trying to remember what my body looks like without it being like completely inflated. And I was actually on my period the day of my surgery. So it was like I had my surgery on April 25th. So we get to May 25th. I'm like, okay, not going to have a period. This makes sense. So my period should have come by the end of June. Mid-June, we actually moved.

So by this point, I was really only following up via phone and trying to get in with a gynecologist in my area. That could just keep up with me and manage the medication that I was supposed to be starting. Had you had started it yet or not yet? I hadn't started it, but I was enrolled in their program. And so I had a nurse that would call me like every two weeks and be like, hey, did you start it? Do you have side effects? every two weeks I would tell her I'm sorry Rhonda but I don't have my period yet I'm just waiting on that oh so you would have had a wait to start it until you got your period yeah they basically

told me just wait till you get your period back that way we know there's no additional complications you can start the medicine then so you know we get to June 25th I am not even feeling like PMS there's just nothing in the in the there are no signs that I might be having a period coming soon And I called my surgeon and her office prescribed me 10 days of progesterone. The goal being to sort of build up your progesterone. Progesterone builds the lining of the uterus. So the way they try to sometimes trigger a period if you haven't had a period for a while is they'll give you 10 days and it sort of builds up that endometrial thickness.

And then when you stop taking it, you have the crash of progesterone causing the endometrial lining to then slough off and you have a period. So I do the 10 days of the progesterone and I'm just waiting and days one and two come after and I call my doctor again and I'm saying, hey, it really truly feels like there's nothing going on. By this point, I was having menopausal symptoms. I actually started having hot flashes the day I had my surgery. I remember getting home from surgery and the hot flash is so different from what you would imagine. it feels like I think I remember when my mom was going through pari menopause and she started having hot flashes we would kind of laugh about it you know and she would get all sweaty and whatever and the first time I had a hot flash it feels like this burning heat that just comes from within and it just felt like my face turned into like a pure heat canon it was just like really bursting sweat

and it passes in like two minutes but then when it passes it leaves you freezing because you've just then, you know, I started having hot flashes right after surgery and I was having them about every hour and a half. Wow, like throughout the day. Yeah. Oh, and night too. Waking up every hour and a half just to have hot flashes. And so by the time I was supposed to have my period in June, I was really ready.

I was like, I can't keep up with this. I mean, it's hard to have a conversation with a friend and you're just like, all of a sudden you burst into sweat and it's unbearable. And in addition to sweating, which I didn't realize, I should have taken hot flashes a lot more seriously. When my mom went through perimenopause, I think it's karma. Your blood pressure drops. My heart starts racing. It kind of leaves you winded a little bit.

And so the whole experience is just terrible. And then I noticed that my temperature regulation was just completely off. I was basically only ever having hot flashes. And if I was in an environment where I should have been hot, I was just neutral. if I should have been cold, I was just neutral. It was pretty much like my temperature regulation was just non-existent except for the hot flashing. And I'm trying to think if by that point, when I started doing the progesterone trying to get my period back in June, I think the hot flashes were the main symptom. But I also noticed by this time that when I had my surgery, I was able to work out again.

Up until then, I was really struggling with my endometriosis symptoms. I had such bad pelvic pain that it was really interfering with my ability to do any kind of workout. So after my surgery, I really got back after it. But I noticed that my body was just holding fat in different places, different places I wasn't used to, like my stomach, for example. And at first I was able to attribute it to the swelling, like the air that was still in my abdomen. And I had some edema after surgery too. that took a long tempered to go away. But after a couple months, I noticed I'm like, you know, I'm gaining weight, like pretty

quickly and I've never, my weights never really fluctuated like that before. And I was so confused because I was working out again. I was running. I was lifting weights more. And it was just different from what I was used to with my body. I feel like people kind of generally know what they need to do to do anything to their body really like I know for example if I want to like you know tone down I'll run more right and it'll you know I get tightened up for summer and I generally speaking know what it takes for my body to

change in any way but this was just completely different for me and yeah just like holding fat in places I didn't recognize and it was just so you know the opposite of where I was at with my fitness too so this is like only the first couple months after my surgery by the end. end of, you know, June, I'm just exasperated. I'm like, ready for this to be over. I do the 10-day course of progesterone and nothing happens. At this point, we were, we had just moved. So I was trying to get in to see a gynecologist. And I, let's see, I was able to, so that was the end of June. I wasn't able to get into my new gynecologist until the beginning of August. So there was just a lot of, you know, hurry up and wait with that.

So, like, during that time, you just, it was the same thing. It was just happening with the hot flashes and something like that. I was just gaining weight. I was having hot flashes. I was starting to work again because we had, you know, we'd moved to I got a new job. Yeah. I was really having a hard time. It's weird to be talking to a patient or giving immunizations and all of a sudden you have a hot flash

and you're young and people don't know why you're sweating. And it doesn't inspire a lot of confidence if I'm getting ready to inject someone. Right. I'm sweating. Right. Right. They're like, would it? They're probably like, is she nervous? Yeah.

What is this? Were you still in contact with the doctor that did the surgery? Like, were they concerned that you hadn't gotten your period? I was in contact with them, and the message that I kept getting was, oh, you're so young. Sometimes it takes time. Give it a little bit more time. So they weren't that concerned. Mm-mm.

Okay. No, they did pass along the message to the surgeon herself, and she just kept encouraging me like, oh, it'll be fine. Just wait it out kind of thing. Yeah, just wait a give it another month. the progesterone restarted your cycle. Maybe you didn't have the period, but maybe you, you know, restarted it.

But I knew, like, in my heart of hearts, because there was just nothing going on. I mean, usually, like I said, I was having, like, nausea and all these other symptoms more than a week before my period. Right. And there was just nothing happening. So I knew I was like, in a week from now,

I'm not going to be having a period. I just kind of knew it. So it took a little bit to get into, to the gynecologist, which was hard because, you know, I just felt like I really can't do anything. I was trying desperately to, yeah, actually, I think during this time I almost completely cut out alcohol. I was working out a lot more than normal.

Just kind of desperate to see any kind of positive change. I will say, though, worth noting that the surgery really did help with my symptoms so much. I got so much in my life back. Just being able to work out, not, you know, throwing up as much, not how to be. having that abdominal pain. That part was really nice. I was enjoying that quite a bit. I still am, actually.

So that's at least good. By the time I had my first gynecology appointment, they decided to do another round of the 10-day progesterone course, which was a little frustrating because it just felt like that takes so long. By this point, you know, when you're having hot flashes every hour and a half and you're losing sleep, it's like, I don't want to wait to. more days. I'm really ready for this to be solved now. But my gynecologist was pretty urgent. He was like, we're going to do the 10-day course. I already have your follow-up date in case

you don't get your period back. And then on that date, we're going to do these, these, these, these, and these labs. Actually, I think they drew the labs the day I went in. And we were going to talk about the labs at the follow-up appointment. And he told me, you know, during this 10 days, if we get your labs back and anything is really wrong, we'll call you. And so that gave me some peace of mind. So throughout the 10 days that I'm waiting for my period to start, at least in the back of my mind, I was like, okay, well, if anything is really crazy, I will, I'll know, I'll know before 10 days is over. So I go back for my follow-up. This is the middle of August. This is like August 16th. And I go in there and the intake nurse at my

gynaecologist is really sweet. I was telling her about, you know, all of my gripes and all this edema and all this weight gain. I was telling you, I was holding out the water so much. and she was telling me, girl, you're going to feel so good when we get your period back. It's going to be great. You're going to shut all that water. You're going to be so happy. So I'm sitting in there and I have this sort of naive sense of confidence because he didn't call me. And he told me he would if it was going to be bad.

So he opens the door. Worth saying, too, I really do like my gynecologist. He's a good guy. That said, he opens the door and he goes, we have a major problem with your labs. I was like, oh my gosh, what happened to good morning? What happened to hello? Now I'm scared. And so he told me that my labs came back and they all indicated that I was postmenopausal.

And he told me that I at this point was beyond his scope of care and I needed to be referred to a reproductive endocrinologist like immediately. And that was it. And he didn't even sit down and he like stood me up and walked me to the nurse who was going to work on my referral. And I was just so shell-shocked. I mean, the appointment was like three minutes long. Right. And I appreciate his sense of urgency in hindsight because it really was like, okay, he didn't like give any information of it like, I guess he figured.

No, he gave me a printout of the values and which values were high and stuff to indicate that I had the biological footprint of a menopausal woman. And then that was pretty much it. He put a hand on my shoulder and said, we're here for you. anything. I was like, it sounds like I need a lot of things. You're not really offering me anything. Now I'm scared. And I could tell the nurse that I had been chatting with, like, she was visibly upset. I was like a baby that doesn't know if they're supposed to cry or not. I was just so mind-blown. And confused too, because I feel like you don't really have any information of like, okay, well, like, what does that mean? You know what I mean? Exactly. And at this point, I'm still

thinking, is that permanent? Right. Is it a reversible? Yeah. Yeah. Like, what exactly does this entail really. So the nurse starts working on my referral. I go on my merry way. I happened to, this was an early morning appointment and Marco happened to not have been at work. Yeah, he had went in late. I just remember getting home.

I was like shell-shocked and shaking and didn't. I just didn't know how to process that. I'm like, what? I mean, I don't know. I was pretty upset at that point. Thankfully, he was home, which was nice because I was able to kind of, like, hemorrhage tears. I'm like, I don't know what's going on.

I don't know. how I'm supposed to feel, should I be panicking? And yeah, I was panicking, basically. So at that point, I'm thinking, okay, you know, the hot flash, this sort of like flesh prison of sweat that I'm trapped in right now is there's no end in sight for me. That's a bummer. And with the weight gain, I was still gaining weight. I kind of plateaued in weight gain by August. So, I mean, thankfully, that was around that same time. So, but I was still really perturbed by. it because once again I've been running so much I've been lifting weights I'm you know like cardiovascularly like doing really well fitness wise not that I had anything to show for it um

and I had to just wait for my referral so I do and a week goes by and this is where being a pharmacist I think was very helpful in this process because there was so much red tape with just getting a referral. And I was a little bit, just I guess familiar with the process a little bit more, just by virtue of working in it and was able to help speed that along. So I haven't called the place that they referred me to. I was like, hey, it's been like, you know, three or four days. I was supposed to hear back. And they're like, oh, we actually don't accept fax referrals. I was like, well, so you received the fax and you didn't accept, could you have called me and just told me that or my doctor? So then I had to call the doctor's office and there. I was

like, well, we don't do phone referrals. We fax our referrals. It just ended up being this like back and forth. It took days. I finally got my appointment from that clinic. And it was, let's see, what day I got it. I got on August 29th of the year of 2022. I get an appointment notification from the place I'm referred to. And they're like, we're going to take such good care of you, girl. we will see you June 6th, 2023. And I'm thinking, what? That's, hello? I thought I read it wrong.

I was like, no way. I mean, because then at that point, too, I'm aware, I'm like, if I am in menopause and I want any chance of fertility in the future, I've got to like freeze eggs or something so that I have a fighting chance. So, you know, every day that's passing, I'm like, my eggs could be dying. And they were, but I didn't know that at the time. and so yeah i just felt like i was like are you serious am i a joke to you i mean june of next year i was like i can't go and also you would think in some way it's like an emergency yes so it's not something just like exactly i mean they certainly made it seem like an emergency at the gynecologist so i knew it was urgent and i was so bummed so i once again thankfully was able to navigate

the health care system even though it was difficult um i basically just called around every reproductive endocrinologist that I could find to try to see one that would take my insurance and I did find one. And during this time when I was waiting for my referral at the end of August, I decided to get my IUD removed because at that point it was just taking up space, not paying rent or doing anything for me. So got my IUD out, got my referral, and then needed to find a place that would see me sooner for my own peace of mind, especially because I was getting closer and closer to the

brink of just simply not being able to do the hot flashes anymore. My tolerance was so, like, my patience was worn thin. It was terrible. The place that I ended up finding was able to see me, like, I think, a week after I called them, thankfully, which was a relief because, and they were really sympathetic on the phone. They were like, can you wait until Tuesday? And I think this was like a Wednesday I called them. I was like, I can wait until Tuesday, thank you.

than waiting a whole year. Yeah, seriously. And this sort of segues my journey through like ovarian failure into almost like a first infertility journey because my reproductive endocrinologist was based out of a fertility clinic, which many of them are. And I, you know, up until this point, Marco and I had not done any family planning. We've been married almost two years now. and it's just not been something that we have done before. And it's not really something that's even on our radar now. So being, you know, getting the news that I was in menopause, I was pretty open with my family and friends about it.

And so naturally questions start coming up about fertility, family planning, you know, what are we thinking, that those kinds of, a lot of different questions that we had not confronted at that time, especially because my journey was so focused on my own body. I really wasn't thinking about family planning at this point. So going into my reproductive endocrinology appointment, I was getting worked up for ovarian failure. And that is also referred to as primary ovarian insufficiency,

I think is the term that's more commonly used for it now. Because you can, and that just describes, anyone who's ovaries stop working before the age of 40, it's actually classified as a rare disease. I think it affects like, I don't know, it's like 1% of women. So it is pretty rare, and that's what they were trying to assess to see if I had. And it's worth mentioning too. I think my case is a little bit more on the extreme end of things.

So when I talk about ovarian insufficiency and ovarian failure and infertility, I feel like you've got sort of like the spectrum of what's possible where I'm just so far on the side of like what's impossible that I don't want anyone listening to think, oh, you know, if I have these symptoms or these experiences, it means that infertility is impossible. That's not the case. It's just as the case for me. So I just wanted to lead with that because you can have, ovarian insufficiency can actually be caused by things like chemotherapy.

Okay. And it can be reversible. Like your ovaries can then heal. we actually have a friend that did experience that. They did chemotherapy. They preemptively froze embryos just in case knowing that ovarian insufficiency would be a probable outcome, and it was. But then a few years later, they ended up getting pregnant naturally as her ovaries healed in time. So it can have a much more positive outcome.

I refer to it as ovarian failure still just because my ovaries really truly did fail. in like every sense of the word. Yeah. So that's what they were looking for to see, you know, is ovarian insufficiency something I'm dealing with? And is there an identifiable cause? Maybe that could be reversible. So I go into my appointment and I'm still not really,

I guess, identifying with an infertility journey per se. Just because family planning wasn't on my radar, but I was in a, then I was in a facility clinic. And I remember doing the intake paperwork and it was, I was having to do intake paperwork from Marco too. They were assessing us both together. And I was thinking, oh, that's interesting because, you know, this isn't about fertility for me.

I'm trying to figure out if my ovaries are totally off the market here. And that was, it ended up being a really cool experience. So I'm really glad that we did things the way that we did because at first I was so focused on what's wrong with me, what's wrong with my ovaries, what is, you know, what's going to be possible for me. And as soon as I met with my doctor that I ended up seeing, he explained to me why they do things like that, which was helpful because, like I said, I wasn't in there for family planning.

So it may be, you know, it may be, I guess, common knowledge or common sense to somebody who has dealt with infertility. But he told me, he sat me down and told me that. in order to figure out what happened to my ovaries, they were going to do a series of three fertility tests. And one of those tests was going to be on Marco, it was going to be a semen analysis. And their approach was to look at us as a couple. And based on our results, they wouldn't tell us any of the results until all three of us or all three of the tests were done. And then they would just present our options to us as to what we could do.

I was in his office asking questions like, like, well, what about? IVF, can I freeze eggs? Can I do this and that? And he basically told me to, we will tell you what you can do. There's no point in stressing about what the other options are. And that way, it's less about what's wrong with you and more like, what can y'all do together? Exactly. It was really nice. It really took a lot of the pressure off because it made me feel like, okay, so no matter what the outcome is, they'll be able to treat my ovarian failure if that's what it is. And in the future, if we want to grow our family that way they'll be able to take care of us that way too which was nice i think it definitely helped with peace of mind in a way yeah i think it was it was good for peace of mind i think it was

a lot more of a grounded approach to things i really appreciated my doctor he was super um sort of not i feel like stern is the wrong word but he definitely he was like no nonsense about he was very objective like no nonsense he's one yeah and he wasn't he wasn't he He was finally the first provider who wasn't like, you're so young, you'll be fine. Right. He was like, I don't know. We'll find out. I even asked him, I said, when you see women with, you know, the symptoms I'm having, the labdom having, how often are they able to, you know, like, have eggs or conceive?

And he was, he told me, he goes, well, what does that really matter to you? He's like, if you're like the one in 10 women who can't, what do all those women's results really matter? We're just focused on you. So it wouldn't do you any good to know that either way. And I was like, wow. It's like tough love. Yeah, good doctor. Yes, it was very assuring for me.

So he absolutely sort of assumed control of my emotional well-being for the period of time that we did the testing. And it was really nice. It definitely helped me to think, oh, you know, there's no point in belaboring sort of these different possible options. This is another thing that I didn't know going into, you know, fertility testing that I learned at my first appointment was that if you can't ovulate, you can't do IVF or in vitro fertilization. And to people who are listening, that may sound so ridiculous. I just didn't know anything about IVF. I always figured if conceiving was challenging, I knew that there were a lot of options out there. And I had heard a lot about IVF. So I always, I guess, in the back of my mind,

naively assumed that IVF would be an option that was available. But he explained that the first test that would be done would be a Lupron challenge test where they would essentially test my ability to ovulate at all. They also did some ultrasounds, I think, when I first got there. And the big test I was worried about was the Lupron challenge because as soon as I figured, oh, if I can't ovulate, I can't do IVF, I can't freeze my eggs. that's when I was kind of like, oh, man. I started to realize, even though I hadn't really thought about family planning,

if I didn't have the ability to freeze eggs, I knew that was just going to be something that was hard to cope with. So that was the big one. Even if you weren't thinking about it yet, that's something that probably down the road, you would want it to be an option. Exactly. And I always envisioned, you know, having kids in the future. And being a newlywed, too, I think, you know, you get asked a lot of questions.

Oh, are you going to start having kids? Right. What's next? So you do think about it. And even though we had discussed it and we knew we weren't ready, we knew that in the future, we would probably want to explore that option. So that started to live in the back of my mind where I was like, I'm going to have to emotionally prepare for that outcome. So the three tests that were done, the first was a Lupron challenge.

where they take a medication called luprolide and they inject it, they draw your labs, inject it, and then the next day you get your labs drawn again, and they look for your body, your estrogen response to that. Okay. And the way it was explained to me was basically, if you are, you know, in your prime reproductive years, you'll have this big jump in estrogen. And if, you know, you're a little bit older,

then maybe your estrogen will jump only so much, and they can do math to figure out how much medication they need to give you to get you all the way up to ovulation. And then the third option is it doesn't really move at all, and in that case, medication's not necessarily going to be enough to be able to get you to ovulate at that point. And then, let's see, I have the papers for what the other two tests in the order were, because I had a procedure done.

It was called a sonohistorography and a uterine tissue biopsy. And they do that basically to look at any kind of structural abnormalities that might be existing in the flopian tubes or in the, sorry, I'm trying not to make too much notes. No, you're okay. The papers. They do that to look. Oh, yeah.

So here's my infertility testing introduction. So we got the Lupron Challenge test. the sonohistrogyrography and oh the sauna historography is the same day as the semen analysis so those two kind of go hand in hand and then the uterine tissue biopsy and the key is that they just would withhold all the results to the tests because they don't want and this makes sense in retrospect as an inpatient person I was like oh my gosh I wish I could just know the results of the Lupron challenge test first but you know they don't want to give you the result of one test only to find out that maybe like your fallopian tubes

are blocked and that's why or something like down the road there. The sauna historography involved spraying sort of saline through my fallopian tubes just to make sure that they were open. They did a uterine tissue biopsy where they went in. They just cut out a piece of my uterus. They also looked at my ovaries while they were in there. And that, day, they always coordinate that with the semen analysis day because they do give you light sedation and you need a driver. So that was the day Marco came in and did his semen analysis test. The problem with the testing process was simply the amount of time that it took for it to happen for me. I think overall, we started in September and we got our results at the end of November.

Oh, wow. So it was a little bit of a challenge. And then I, I was a little bit of a challenge. And then I was able to harness the powers of being a pharmacist once again to get my luprolide prescription, which was really hard to get, it wasn't really hard. It was not super intuitive to get that covered by insurance. It wasn't covered at my regular pharmacy. I had to coordinate with my insurance provider to find out where I could, like, why they couldn't fill it. It was going to be, I think, like $400 out of pocket.

But because it's a specialty medication, I had to get it filled at specialty Walgreens. and then they had to order it and stuff. And that was, for me, pretty easy to, like, figure out. But it was, once again, just one of those things that I was thinking, man, if I didn't know about how, like, the logistics of how insurance works with medication, it would have just been waiting, you know? I don't know if I even would have known to call my insurance and ask them why it was delayed or why it was that I had to fill at Walgreens versus Publix where I normally fill

because that doesn't seem super different, but it's a specialty medication. So it had to be filled at a specialty store in order to get it covered. So that, you know, it just added time. And then you're not able to schedule your next test until you have the current test done. So I went, I had my Lupron challenge done. And then I was able to call them. And by then it's like, oh, the next appointments three weeks away. So I was like, oh, this is tough.

We were kind of, you know, our backs were kind of against the wall as well because Marco had a work trip in December that he was leaving for and he would be gone throughout Christmas and New Year. So he was going to be gone for a little while. So it was like a race against the clock to see if we could get everything done. They wouldn't give us the results either if we didn't go in together for them. So it was really. Yeah, it took a lot of coordination. And I do appreciate the fact that they treated us as a pair. Right. It definitely added to like the logistics sort of hurdle of figuring out how to do it, though. Ultimately, it was for the best.

I also feel like it gives you that support, too. Yeah, definitely. It was nice. It once again made it feel like less of what's wrong with Hannah and more like, what can y'all, what can y'all figure out? Yeah. I think going into the testing process, I was pretty convinced by this point that my menopause was permanent.

And I feel like I should also sort of say, to that when you have ovarian failure or ovarian insufficiency, you don't really experience menopause the same way. Menopause is usually defined as being like 12 months after your last menstrual cycle and they can confirm it on labs by looking at follicle stimulating hormone and it's normally really high because usually that is, there's like a negative feedback loop where your pituitary gland will release follicle stimulating hormone to get your ovary to grow a follicle and have an egg mature. When that follicle starts to grow with the egg in it, the follicle releases estrogen.

And then as the estrogen builds and increases, that has a negative feedback loop with your fsh. So the more estrogen, it'll then turn off the fsh, just letting your brain know, hey, we did it. We grew the follicle and we did it. Yeah. So when you are postmenopausal and you're not producing estrogen from your ovaries anymore, there's nothing to turn off that fsh that your pituitary gland is releasing.

And so that's why they use fsh as a marker of menopause commonly. Now, by the time that I got diagnosed as being postmenopausal, which was in August, it had not been a year since my last period, but my FSH was so high, I was not having a period. My estrogen was so low that I had all of those typical biomarkers. And you were still having the hot flashes, I'm assuming. I was having the hot flashes. Normally when these changes happen over a period of time that starts, we could start in your 40, like late 40s, early 50s.

That period of time is called perimenopause, and that's when women will start having hot flashes. Their periods might slow down or become irregular. and then ultimately stop and then they'll get diagnosed as being menopausal or postmenopausal at that time. So for me it was like 100 to zero where everything was fine and then all of a sudden boom like totally nothing. And that ended up having sort of an impact on what the results of our fertility testing was because I guess maybe I'm jumping the gun a little bit there.

but even for somebody who's postmenopausal, my labs ended up being pretty bad by menopausal means too. So there's a lot about, I guess, the experience of my particular ovarian failure that was like maybe a little bit more extreme even, which is also, and this is just like my own hypothesis, but I really feel like going 100 to zero made the hot flashes a lot worse. And they were constantly. I mean, it was every hour and a half all the time. all the way up till I ended up doing hormone replacement therapy.

So a lot of women don't really experience that. And I think it's because it's usually gradual. Yeah. I was taking supplements too. There's, I think, two over-the-counter supplements that I was using. And there were, I think it was like two of different types of estroven. Okay. They were supposed to help with the hot flashes.

Yeah. And I know that there's other supplements too that can help. But the estraven really wasn't. And I was taking it as described. on the box. I was using it around the clock and it really didn't make a difference for me. I was also, I think, kind of in denial. I mean, a lot of people told me that this was going to be an issue that resolved itself. So there might have been more I could have done to make the hot flashes less bad, like trying different supplements and things. But beyond the estraven, I didn't really do

anything else. So maybe that I, maybe my hot flashes were that bad partially because I didn't do as many supplements as I could have. Going back to the testing, I guess I've sort of talked about how it took a really long time. The Lupron challenge was really low drama. I just got my labs drawn two days in a row after getting the shot. The son of historography was, it was great for me, and here's why. Because they give you a, they give you two shots in the butt before the procedure starts. One of them's a torridol shot, which is just an N-SET, a non-steroid anti-inflammatory. It's just a strong pain reliever. The other shot is Promethazine, which is a nauseamette, and Demerol, a light sedative. And then they gave me a valium for anxiety. I didn't fall asleep. I was awake.

They let me have my phone. I was chilling. It was actually great. And then Margo was in the other room doing a semen analysis. I'm texting him. I'm like, besides my butt, I feel really good. The shot's really hurt. But everything else, I was like, oh, this is great. And then my doctor, who was actually the attending, this was my first time meeting him. He's the one that did the procedure. The nicest guy ever. He was so cool. He was talking to me about patient, dignity, and advocacy.

And he was asking me all these questions to make sure that Marco is a supportive husband. And I was trying so hard to engage in a way that was coherent. I'm like, he really is the best. Yes, let's advocate for women. Yes. But I'm really, you know, I was on this little like valley and I was like cozy there in the little bed. It was so funny. When I left that procedure, I remember Marco was helping me get in the car and he's on the phone with someone.

And I was like, who in the world is he talking to on the phone right now? Like at a time like this. And it was the attending. And he was calling to recommend him some Italian soap operas. Oh my gosh. Because I told him that Marco was Italian. Yeah. It was so funny.

He was just the nicest guy ever. That's so sweet. He, at that point, too, I got prescribed doxycycline just for, because they had cut into my uterus. So they gave me the antibiotic just to make sure I didn't get an infection. That was great. That's how I found out I'm allergic to doxycycline. So that was fun. In the process of that, the first couple of days I took it, I was just, it was making me throw up.

Right. And that's pretty normal with that antibiotic. It is hard on the stomach. So I called my, I called the attending. And I was like, can you please? Oh, they had given me promethazine. But promethazine is, it's for nausea. It's a little bit more like sedating and can have like stronger side effects than

Zofran. And I had taken Zofran in the past. So I was calling to ask him if he could give me Zophran. He ended up giving me like the mother load. He gave me, it was like 90 Zophrans, the like 8 milligram disintegrated. tablets. Like the higher dose of Zofrani gave me 90 of them for like a seven day course of antibiotics. And I didn't end up even taking them because on day two, I ended up getting a full body rash. So I stopped it. And it was funny. He three way called the pharmacy tube and was like, is her insurance

cover this? Okay, cool. So she can come get it in 15 minutes. And I heard the pharmacist and he didn't know I was a pharmacist or maybe he wasn't remembering that I was a pharmacist. But the pharmacist on the the other line was like, no, she cannot get it in 15 minutes. What are you talking about? And I was like cracking up in my head because I was like yeah there's yeah that's wishful thinking but I appreciated the energy he brought there so that was fun margot got the results of his semen analysis that day too generally speaking they sort of presented the results but then in context they talked about it a lot more in our follow-up appointment so we didn't really have um too much information on that going into the follow-up appointment but it went fine for him uh overall pretty low drama experience

there. Oh, I also got that day I got a follicle ultrasound. So this was kind of, uh, sort of, I thought I thought I was read into what was going on because I got a vaginal ultrasound and I had been having pain on my left side and I thought, oh, maybe I have another cyst on my ovary or on my tube. So during the ultrasound, I saw her when she was looking at the left side. She's, you know, circles something and fills it in and I know nothing about imaging. So let's not, let's not get it twisted. But in my mind, I was like, oh, maybe it's a cyst. Like that would make sense. So my left side's been hurting. And then I just, I was telling myself, Hannah, you really can't, don't read too much into imaging because you don't know anything about it.

And there's no reason why you would know anything about it. But in my mind, I was like, that explains why my side's been hurting so much. So that, I guess, is kind of all the context we need going into the follow-up appointment, the day that we got our results. Because they didn't really explain the ultrasound, of course. I mean, they're not supposed to. They were going to present it to me at the follow-up appointment. I finished my, oh, the sauna historiography was November 3rd.

So it really took a while between. I had my Lupron challenge done on September, 21st and the next appointment I could get for the son of historography was in November. So it was kind of tough to have to wait that long. And then from there, our follow-up appointment was two weeks later. It was on the 22nd of November. And our follow-up appointment was really early in the morning. It was, you know, our specialist that we see is in a city that is like 40 minutes away from us.

So it was actually supposed to be on a Friday, which was going to be great because then we would take off work. We would get our results. We would have the weekend to be together. And then the following week was Thanksgiving. And our family was coming into town. And we're like, this is excellent. We will be able to, you know, just spend the weekend of two of us and get our thoughts together and move on from there. And our doctor got sick and moved the appointment to Tuesday.

and it was the Tuesday before Thanksgiving, which was the day that my parents were coming into town, which was fine. It's just, you know, I was like, wow, I really would have liked to have had some time, you know, for us to sit with our thoughts. Because, I mean, we really didn't know what to expect. And, you know, we're like, we might need some time to heal, to grieve.

We don't know what's going to happen. Tuesday comes around. I block that time off at work. I'm like, I absolutely cannot come in that day. Marco did the same thing. So the morning of our appointment, both of our phones are blowing up somehow. I'm like, what is going on? There was an emergency at work that warranted my attention.

I was so bummed. And they knew that that was like my protected time too. And it's obviously not their fault. But getting blown up in the morning calls that are like, when can you be here? Like, can you come in? And I'm thinking, I really, I don't, you know. This is tough because it's, I'm going to be at this appointment all day. I won't even be able to get there until after lunch, but I'll come after.

I'll just drive straight there from my appointment, you know, whatever. It was one of those things push comes to shove and you have to, you have to show up. I was like, hopefully I'm in the right headspace to be able to do my job well today. The same thing happened with Marco. His work, just catastrophic emergency at work that warranted his attention as well. It was super unfortunate for both of us, but at least it was on both. things. Right. And now word from our sponsors. I have never been somebody that's good at cooking and enjoys going to the grocery store, finding all the ingredients I need, reading recipes online,

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Nutraful.com promo code insane. Now back to the episode. So the day, the awaited, the long-awaited day comes where we're supposed to get our results. And by this point, the anticipation had built up a little bit. For the most of the months that I was doing the actual testing, I was doing pretty well with not, you know, belaboring it in my mind and over-analyzing everything because my doctor did such a good job with presenting everything so objectively. But going to the last couple weeks before our follow-up appointment, when everything was said and done, I was really nervous and I was trying

really hard to prepare myself for the worst. So that morning, you know, Margot and I are, our piece is shattered by the fact that both of our work to have catastrophes. Valid catastrophes, not of their, it's not their fault, but it was just a little unfortunate timing. We go into the appointment, and this is Marco's first time meeting my doctor, not the attending who did my sauna historiography, but the doctor that I would see regularly. And I forgot to mention that this man was so, he's a chatty man. I forgot to tell Marco that morning.

And I just remember, you know, we were trying to make time at this point. We both know we have to go to work, so we're like, okay, let's get this appointment done, like, lickety split. Our doctor is chatting with us. He ends up making small talk for 26 minutes. 26 minutes. I'm looking at the clock. It's 926. We're still making small talk.

And it's just, you know, about, you know, Marco being Italian and all this stuff. And, you know, Miami. It was, it was, I could tell Marco at the wheels were turning. He's like, what is this? why is this happening? I was starting to get anxious myself because I'm like, man, like, this is, he's really talking a lot. Right.

So he finally stops talking and he says, I'm so sorry. When I get nervous, I get chatty. And to be honest, I've been really nervous for this appointment. And I just felt my heart sink. I was like, oh, no, that means it's going to be bad. Yeah. And he looks at me and he says, it's really rare that I have patients who come in and they're exactly right about what's been going on with their body.

body and unfortunately you've been right about everything. So once again, my heart is sinking. I'm like, oh, no, oh no. And he kind of makes this sort of like side comment, like, blah, blah, blah, you don't have eggs. By the way, Marco, and he starts to talk about the female reproductive system, sort of the anatomy just to give him context and like the hormone chains and stuff. I'm sitting there thinking, did I hear that right? Did you just say I had no eggs and then he just moved on?

I was sitting there. I felt like my eyes were welling up with tears too, and I was like, and I told Marco's giving me the side eye, like, is she okay? Is she okay? Is she okay? Yeah. And he goes through the chain of hormones during the menstrual cycle, and, you know, it's kind of explaining that unlike, you know, the male reproductive system, you know, you

have this sort of chain of events where if one part of the chain doesn't work, then down the line, nothing can really work. and I had a problem in the line and therefore there was nothing that they could really do to make me ovulate. And, you know, I'm thinking, okay, this was not, you know, completely unpredictable. I did kind of figure that this might be the outcome. But then he pulls up this de-identified list of 1,200 patients that he's seen. And he goes, out of 1,200 patients that I've seen since I started my fellowship here, I've only had one woman to have the same type of test results that you do, who was your age, and she actually

spent six months on deployment, giving x-rays with no protection. And she irradiated her ovaries. And your biological footprint is exactly like hers, except you don't have a reason. And I was like, wow, okay. So he was telling Mark, oh, you married a one in a million woman. I'm still sitting there processing like, so there's no eggs? Right. You're saying there's no eggs.

So he tells me that going through the results of the testing, I did the Lupron challenge. And I was told, you know, there's these three options. And he tells me that there was a fourth possible result he didn't even tell me about because it was so unlikely, which would be that they gave me the Lupron shot. And then my estrogen dropped. And he said, and I quote, That's a sign that your ovary would rather kill itself than produce an egg. And he said, I'm sorry, I didn't even present that as an option because I just thought it was so unlikely.

Yeah. But that's what happened with me. So I was like, oh, cool. Okay. My ovary's clue. So after that shot that you got, the levels went down rather than up. Okay. Yeah, rather than up or rather than just not moving.

Right. Yeah. So that was kind of a surprise. And, you know, he asked me if there was any reason why I might have effectively. Oh, no ovaries. So my left ovary totally gone, missing in action. He told me that, oh, I forgot to mention this. During my son of historography, when I'm in my little cozy valium snuggle with my awesome doctor,

he told me that he made a passing comment about not being able to see my left ovary. Oh, it's probably just tucked back there behind the uterus. That went over my head. I didn't even think about it because I'm like, sure, why? not. But I then remembered that during the ultrasound, she circled something, which I thought was a cyst, but it turns out that was just the place where my ovary was supposed to be. And it wasn't. And it just wasn't there anymore. I was like, are you serious? So, and it's funny because during my initial laparoscopy, they gave me photos. I have photos of my ovaries from April. So then it's now

November. And my left ovary is just has faded to the background. And then my right overre. And then my right ovary is also on its way out as well. So what is that? Like where does it go? It literally just. The body just and apparently this is a natural part of the menopausal process. But, you know, when your body's not really using tissue, it'll just kind of reabsorb it and take in the nutrients and recycle them. Right.

So yeah. I was just surprised it happened that quickly. Yeah. Especially, you know, I was holding on to hope that maybe we could freeze eggs. So the going from maybe I could freeze eggs to your ovary is gone. Right. It was kind of a mental gymnastics I was doing there like, oh, right. Okay, cool.

And everything else was fine. But they did say that, well, everything else was fine. I had, they did a, you know, they looked at the follicles that I had in my right ovary. Now there's the follicle was like the fluid filled sack around the egg. Every egg is in a follicle. It's like a one for one, one egg. per one follicle. And during the menstrual cycle, your ovaries will start to develop a few follicles.

Ultimately, one of them will win out, and that would be the egg that would ovulate. So by the time they, you know, looked at my right ovary during that ultrasound, I had a few follicles developing, but they were all empty. I guess they were able to tell that on ultrasound. So they were, they drew a lab and it is called, let me talk about it. I still talk about my labs because they're kind of important for the, context for I guess how little of anything I had going on in my ovaries. Yeah.

There's a marker of ovarian reserve and it's called anti-malarian hormone. And it's on its own, can't tell you like a full picture of your fertility, but it's associated with the amount of eggs that you have that can still develop. So sometimes older women, like if you're over 35, they'll recommend that you get your anti-malarian hormone drawn just to see what your egg reserve might look like. If it's a little on the lower end, it might just mean that you might have to work a little bit harder to conceive. It doesn't necessarily mean that you can't conceive. And then in post-menopausal women, there's sort of a range from optimal to undetectable.

and even women in menopause can still have anti-malarine hormone. It might just be like really low because even in menopause you might have, you know, you might have eggs left. It's just they might be poor quality. It might not be able to ovulate. But there could still be eggs there. My anti-malarian hormone was undetectable, which even by menopausal standards is kind of rare. But it just added to the picture of just.

no eggs at all to the point that my doctor even told me that it's possible I was born with congenital hypogonadism and I maybe never had eggs in my whole life and yeah right I was mind-blood I told him I've always had normal periods yeah and he said you can have a period and never ovulate it was it totally blew my yeah perception of self a little bit right wow what if I really never Even having them. Yeah, right? Thinking about all the times I had irregular periods and took pregnancy tests. Right.

Well, that was a lot of money spent on those things. Yeah. So, yeah, I had undetectable anti-malarian hormone. My follicle stimulating hormone was still high, of course, which makes sense for somebody who's postmenopausal, really low estrogen. Another level that they took was DHA, which is made in your adrenal glands. and it's a precursor to androgens and estrogens. And usually in menopausal women, it's higher because what happens is you have,

there's, I think, three endogenous types of estrogens, which means that they're made within your body. The main one is estrodial, which is made in your ovaries. And when you're postmenopausal, you're not making esterial anymore. The second type is called estrone, and it's made in the adrenal glands mostly. And then I think the third one is estriol, I think is what it's called. And I think it's mostly made during pregnancy. And what happens in menopausal women is that their adrenal glands start working harder

because they're not making the ovarian estrodial anymore. So in order to make estrone, you know, your adrenal glands are just working hard. So basically anything that's coming out of your adrenal glands is going to probably be elevated just because they're working overtime. So DHEA was one that was high. And then another one that is really elevated in menopausal women is cortisol. I'll talk a little bit about cortisol, I think, later once I kind of get through what this last appointment looked like for us. But cortisol plays a big part in why menopausal women struggle to lose weight and hold their fat in different places in their body.

So going back to our final appointment, finding out that I had no eggs, I actually found out that they ruled out a pituitary tumor. Totally did not know that was on the table, but it makes sense that they look at, you know, pituitary causes of infertility because your pituitary gland in your brain releases your follicle stimulating hormone and your lutenizing hormone, which are the two main hormones, I guess, involved in regulating your cycle. He was like, yeah, thankfully we were able to rule out the pituitary tumor.

It was like the pituitary tumor. Yeah. The who? You don't really mention that part to me, but thank goodness. Um, he did say that my uterus in my fallopian tubes were fine, which meant that when it came down to the options for us, for what, if we decide to grow our family in the future, theoretically we could use an egg donor and Marco's sperm. And then I could, in theory, carry the baby in my uterus. Um, and they would just manually supplement the hormones throughout my entire pregnancy. Okay. So that's, you know, when they talked about some of the options, that was probably like the most, I guess the main one that they outlined that they could help us with. Right.

They went over the results of the semen analysis with Marco. And this was really funny because it was pretty soon after, you know, he really, he could not overstate how few eggs I had. No ovaries, eggless, no estrogen desolate. So then he moves on and I'm like still tearing up and they're talking about Marco's semen analysis results and this was interesting because they had like a camera, like they recorded footage of the individual sperm in the sample and they had like a pen sort of tool that traced the paths of the sperm. So we're looking at his semen analysis and you know you have the sperm that are like swimming and some are like, you know, going in circles or not moving and stuff and

it's pretty average, I guess, in terms of like his sperm count and their motility and all of those things. And so then he says, I'm going to show you like a sample from one of our donors. And we're like, okay, yeah, sure. He pulls up this, the image, like the sort of the video footage of the donor sperm, all the sperm out, they're like zoom in. They're like, lines. They're straight. There's no one dead in the water. I'm like sitting there trying not to absolutely crack up because we're like, what is this guy than Michael Phelps of sperm, like, this is crazy looking. That is so funny. I was like, you didn't have to show us this.

Right. You know, if it was average, it's fine. Like, we're, yeah. Oh, my gosh. And then, you know, the doctor is saying to Marco, don't worry, man, you know, we'll get you on a multivitamin and that'll really help. And I'm, like, laughing internally because Marco takes multivitamins already. Right.

And so he's sitting there, he's like, oh, a multivitamin? Like, what, what vitamins specifically do I need? And my doctor was just kind of like, It was just a regular multivitamin. I was cracking up on the inside because I'm like, I know this man takes vitamins, but I mean, he did not have to do him like that. Right. It was nice way to let him know that. Seriously.

Oh my gosh. It was really funny. That is hilarious. And then, let's see. Other than that, for my last appointment, we talked about getting enrolled in the egg donor registry. and that was exciting. So then in terms of the ovarian failure, which was then confirmed, so we now, you know, ovarian failure to like the fullest extent of the law.

And at that point, I was asking him, okay, well, now that I know this is permanent, don't I need to be, don't I need to do something? Don't I need to do something? And he, the recommendation was basically to go back. to my regular gynecologist and look into hormone replacement therapy and what those options would look like. So that was pretty much at that point. They shifted gears and they were like, okay, you know, these test results are valid for the

next five years. And if you decide you want to, you know, use one of our egg donors will help you and we'll manage you throughout your pregnancy and stuff. So it was kind of the end of what they could do for my ovarian failure diagnosis and treatment. But it feels really good to know that for the next five years. We have the option of going back and using them. But I looked through the donor registry. And we're not family planning.

We're still not. But it kind of made me feel as I was very much filled with admiration for the women that were on the registry. I was like, oh, my gosh. I mean, good for them. But for us, I think, kind of solidified that we might want to use a donor maybe that we knew. Yeah. And then beyond that, we haven't really approached family planning again, and I went back to my regular gynecologist and my primary care provider. My primary care provider is the best person maybe ever.

He is pretty young. This has like become his crusades. He told me that he and his wife struggle with infertility as well. And so this has become like his thing. Like he's going to help me with this. and we talked about, you know, just the ways that I need to now use supplements for trying to stave off some of the long-term effects of menopause. For example, I have an increased risk of a cardiovascular event by virtue of how long I'll be in menopause compared to the average woman. It's kind of funny, though, because birth control can also increase your risk for a cardiovascular event, so it's kind of like either way of me of sort of dodging a heart attack here.

Yeah, the rest of my life. But estrogen plays such a vital role in so many different body systems that the symptoms of menopause is like, there's a lot to address. For example, you know, bone health is one that comes to mind pretty immediately because estrogen plays a big part in the life cycle of your bone cells. And that's why when you're postmenopausal, you're more likely to get osteoporosis and taking calcium and vitamin D is really important. So I have a bone scan scheduled for later this year.

So we'll find out how my bones have held up in all of this, you know, lack of estrogen. We talked about supplements. I talked to him about diet and exercise, which has been like the thorn in my side because there is so much conflicting information about diet and exercise for postmenopausal women. and especially with exercise, I felt like it was so hard to find anything that even really, like, pertained to me. Because if it wasn't, you know, based on menopause, it was recommendations based on age. And I'm like, okay, I don't really fit a menopausal, but I am only 26. And, oh, one of the tests that they did, they measured my metabolism, and my metabolism is normal.

And so it was kind of interesting in the context of, you know, I'd really, up until like August, really struggled with weight gain and then plateaued. And then at that point, I wasn't gaining more weight, but I also wasn't burning fat. Coming out of our fertility appointment, my focus became basically how do you live with menopause in a way that is sustainable. How can I avoid having a heart attack? How can I avoid osteoporosis? How can I avoid all these horrible things that are now on the table for me? And I started to consider hormone replacement therapy because it's now, you know, it's November.

I'm still hot flashing like crazy. It's terrible. It was actually worse in the winter too because I would have a hot flash in response to the heat kicking on. So annoying. So I would have even more frequent hot flashes in the winter than I was in the summer. So I did kind of, I tackled everything. health from sort of three different angles. I went back to my gynecologist to do hormone replacement therapy.

And I went to my primary care to do the everything else therapy. And then for diet and exercise, I met with a nutritionist, specifically a sports medicine one. So I'll talk about each one of those individually. So I guess I'll start with the gynecologist because this was sort of the biggest thing that I did. That's made the biggest difference for me. I went to back to my gynecologist, the one that had said, you know, oh, you're beyond my scope of practice. I got in to see him.

It's actually his wife. So he stopped. He started doing surgery only. So then my provider was his wife. I went in to see her and I was feeling by this point, oh, you know what? I skipped all of Thanksgiving and this is worth circling back to the day of our appointment. And then, which was comically terrible because then I had to go to work after that, so did Marco. Yeah.

Marco ended up, you know, we're driving back like for 40 minutes and we're both in the car making calls, trying to coordinate with work. And he even says, Hannah, we have to talk about this. Like, we're going to have to talk about this appointment at some point because your parents get here tonight and this drive is really the only time. But we were both on the phone the whole time trying to handle these work emergencies. Marco is at work till 3.30 in the morning that evening. I get home from work. My parents were in town. They're asking questions, of course. It was really nice actually to have them there.

There was a lot of, I think, a learning curve for the next couple months with talking to family and friends about everything. I really had no idea what I was feeling about anything. I was just so shell-shocked, I guess, because my results were so. extreme even for ovarian insufficiency, even for menopause. My parents were asking, you know, a lot of questions about how I was feeling, well, what's going to happen next? Like, what are you going to do? Are you going to do hormone therapy? What are you thinking about fertility? What are you guys going to do to grow your family? What do you need from us? And I really was just, I don't know, I really don't know. I have no idea. The week of Thanksgiving goes, and it's sort of like a whirlwind. We had

all our family in town. I did confide in some of my friends kind of the results of what was going on. I talked to some of my coworkers about it. And I, at that point, was still really hung up on sort of the body horror of knowing that I had no ovaries anymore. And I really was struggling to get past that. And it just felt like all the questions we were getting asked were about. family planning, babies and like what was going to happen in the future. And it was just a really interesting experience.

One that I'm grateful I had with my family because I would rather, you know, I didn't know what things they would ask that might either hurt my feelings or, or make me sad or whatever. So it was nice that they were in town and I had to, you know, I could have those conversations with them versus with friends, you know, you don't want to, I can like, fall to my knees and cry and be like, mom, dad, I'm not ready to talk about that. But I feel like if I did that with a friend or a coworker, it would be a little bit come off a little bit more unhinged.

We got a lot of advice. And we got, you know, we some of the, I guess I'll sort of like condense some of the maybe more inappropriate things that were asked throughout like, not just Thanksgiving week, but like throughout the next couple months after that. But there was, we were advised to get a second opinion, like pretty heavily from a few different people. And it was like almost they couldn't accept the results of what happened. And that was really challenging because I felt like I finally had a little bit of closure. It was like, okay, this door is maybe closed.

I finally have answers. Yeah. And it's like we know what we can do moving forward. So my doctor told me, you know, you're going to have to. over time, make peace with the fact that you won't have closure because we don't know why this happened. Even after all the testing and everything, we just, you know, there was still a cause, which is actually the case in, I think, 90% of ovarian insufficiency is actually idiopathic or they can't attribute it to a cause, which made, you know, figuring out the next steps even

more challenging. So yeah, we were, you know, heavily advised to get second opinions. And that was really challenging because I was like, you know, this is my one chance for closure. I can't. I just did three months of testing. I'm not ready to go back. Yeah, exactly. Like, it's, you know, I got, I was sort of made to feel like I don't believe in miracles because I don't think I can spontaneously conceive. And I'm sitting there thinking, you know, I don't have eggs. That's not going to be the miracle that happens in this process. It was kind of, it was hard to hear people say things like, have faith or just believe that it'll happen. Like you never know what could happen. And I'm like, well, I know I don't have eggs, but I'm fully willing to like believe in the miracle that we might

be able to grow our family in the future or that the future will be really lovely. But if I, you know, hang up on this hopeful miracle that I'll spontaneously conceive, then I'll be disappointed forever. Yeah, exactly. So it was hard. I did. There was like a few different instances where, you know, I was kind of made to feel like I was the one being closed-minded about your own body.

Yeah, exactly. There was a, you know, I had a couple instances of people sort of almost reacting like I was being closed-minded to like adoption or other options that don't involve eggs because I was so sad about not having eggs. And that was wild because I was, you know, really struggling. It's like come to terms with the fact that I didn't have ovaries anymore, not just because of family planning. It was just in general.

I think it is kind of horrifying to find out maybe I never had eggs. Who knows? I didn't know why that threw me off so much. I really actually did struggle with coming to terms with that. And it wasn't, you know, I was like, I'm not thinking about adoption. I'm not even thinking about a regular baby. You know what I mean? I'm not.

So it's not like I'm closed off to that idea. It's just I have to figure out why it is that me not having eggs or ovaries is something that's upsetting me so much. And to this day, I still don't really know what it was. I think just, I think it was just like a subversion of my expectations for myself and my future. And it's not like I feel pessimistically about our future family options, including adoption. It's just I needed time to process what happened. And so that was a little bit challenging. It made me feel a little bit like it was hard to talk about family planning because I didn't know what to say because we weren't thinking about it.

And I didn't want to say something that made it sound like I was, I don't know, close mind. It was very strange. Yeah. It just wasn't the first thing on your mind about the whole. Yeah. It kind of led to questions. I would ask Marco, like, am I wrong for feeling like my focus is on, I'm like really sad for me and my body right now and I'm scared because I don't know like what I'm supposed

to do medically moving forward, but everyone's talking about babies and nobody's like asking about me. And like it really threw me in the beginning. I just needed time to kind of get my feet under me. And now I'm a lot more open. into talking about the future. But at the time, before I even had a plan for hormone therapy, before I even knew what I was supposed to do for supplements, I was still, you know, not sure what to do to just treat

menopause in general. Right. It just felt like everyone was like skipping over all those steps and being like, we're going to have this baby. I'm like, what baby? Yeah. There's not a baby yet. My bones could be brittle.

I have no idea at this point. So Thanksgiving week was a baby. It was pretty not just Thanksgiving because this was over, I guess, like a couple months period of, you know. It was good, though, to have those conversations with my close circle because we really do have like the best support system. And I tell Marco all the time that it's like we had the best case for like the worst case scenario. Yeah. You know, with our friends and family were really awesome. And it was good to be asked things that maybe pushed my own personal boundaries.

because then I knew what my boundaries were. Whereas if, you know, I'd been asked that by, like, a coworker or a friend, maybe it would have been harder to handle gracefully than with my family. I could be like, oh, actually, you know, that question maybe made me feel a little bit attacked or made me feel a little bit sad or whatever. Right. So that kind of segues into then December. Marco goes on his trip.

And this is only a week later after our appointment, you know, our family was in town for most of it and we really didn't have too much time to sit down with the two of us and figure out how we felt and that was I think probably the hardest aspect about it for him because he was always you know his biggest priority just being like am I doing okay which I super appreciate but I know that it was hard on him to know that his he had this work trip coming up and he was going to be leaving me with so many questions and um so yeah December was kind of, it was a really important month for me because I kind of made a commitment to myself to sort of work through, I don't want to say work through my grief just all in one month,

but for the time that he was gone, I really wanted to kind of answer some of those questions that I was having in my mind so that by the time he got back, we could, you know, meet at the same starting line and heal together from there and look forward to the future. So I did, few different things. Like I said, I met with my gynecologist, my primary care provider, and a nutritionist. I also started doing audio journaling. And it was funny because I was listening to those audio journals before I came here today. And I left, it's funny, I don't remember doing this, but I left so many notes to my future self. I'm like, Future Hannah, if you're listening, I hope that, you know, you can listen to this and smile and feel better about where you're at.

And I really, I do. It was very nice. Audio journaling really. helped a lot with just processing my feelings and try to answer questions. Like why I really struggled with guilt after finding out that I had no eggs? And I'm like, what is that about? I mean, like, why am I feeling so guilty? And was it something I did that caused this? Because we don't know. So we don't know if maybe it's my fault. And being able to vocally process the, just the confusing emotions that I had was really helpful for me. I went back to my gynecologist and saw, like I said, the guy's wife, who was now my main gynecologist to talk about hormone therapy.

I was initially pretty averse to the idea of it because the thing is, I told her my big fear is that if I go back on hormone therapy, you know, I had the worst experiences with birth control growing up. Right. And I know for a fact that my endometriosis will come back in response to me, having estrogen again. So it was a matter of finding a balance where I could have estrogen and progesterone and not trigger an endometriosis flare and how do you find that balance? She pretty much told me, you know, if you are left untreated, you'll perpetually have these hot flashes

and you'll be miserable. You'll be miserable. You have a higher risk for a heart attack like soon. and then you, you know, your bones, all this stuff. So I was like, okay, maybe the endometriosis is not as bad as a cardiovascular event. We talked about some options. And by the time of my appointment, which was, let's see, maybe it was like January or February, it had been since April that I had estrogen. So I was starting to actually suffer from the genitoneurinary syndrome of menopause, which are just the typical, like, vaginal and urinary symptoms that you sort of affiliate.

Vaginal dryness being the main one, and that can lead to complications down the road, mostly vaginal atrophy, which, so the lining of the vagina actually needs estrogen to maintain its integrity. And what happens when you're postmenopausal is that lack of estrogen causes that vaginal lining to thin and become dry. and if, you know, I'll be in menopause for a much longer time than anybody else. So there's like the chance that it could get so dry and thin that it fully just shuts. And that's, I was like, let's try to, let's get in front of that.

You know, my doctors were like, oh, we'll treat the vaginal atrophy. I'm like, can we not get in front of it maybe? Like, let's do, can we try to avoid that at all costs? So by the time I had my gynecologist appointment, I really was having. you know like I would go on like a long run and by the end it felt like the vaginal dryness honestly it's hard to describe but it felt like almost like chafing but like on the inside really yeah it was super uncomfortable and I was interesting that you could feel that like with it like on the inside of too yeah and it was so it was really affecting me most in my day to day and I had been

counseled you know by my gynecologist about vaginal dryness and encouraged to like you know use lubrication during intercourse, which is where a lot of women struggle with vaginal dryness being most prominent during intercourse because it can lead to painful sex, which makes sense. But for me, it's like, you know, during intercourse, you can use lube and that helps. But like when I'm on a run or if I'm standing in the pharmacy all day and I have this vaginal dryness, I'm not going to go lube up at work, you know what I mean? So for me, I think the vaginal dryness and sort of like the urinary. syndrome was more of a problem in my regular day to day than versus like in my intimate life.

Right. And they were, you know, I was told by one doctor, like, you'll have to become comfortable using loom. Like, ah, yes, become comfortable. Got it. Yes, I will learn all about that. But yeah, so I talked to her a lot about that aspects. I'm like, yo, I don't want this.

Vaginal atrophy is not, it can't be on my 2020. Bingo card. Right. I've seen enough at this point. Like, what can we do? So before I started systemic estrogen replacement, I started using estrogen intravaginal tablets. And I did those for two weeks and then went back because she was like, take two weeks,

think about what you want to do for estrogen. Because I really told her I wanted to use a cream because you can use creams that get absorbed systemically. Okay. She really wanted me to use the Nuver Ring. I had a lot of reservations about the newver ring. So we compromised. and I used the newvering.

I kind of went into my appointment with the mindset of I just have to do whatever she says because she's like a little bit obstinate and was kind of not really hearing what I was saying. Yeah. She actually, I think at one point, I started tearing up in her office because I really just didn't know what to do. And I'd been told by everybody like, oh, you just, you know, you have to figure out what's best for you. Like you have to do what's best for you.

Every single person told me that. And I'm like, I don't know how to figure that. out. I have no idea. So I was, you know, telling her like, I'm sorry. I'm just, you know, I'm a little emotional because I feel like I've gotten that advice a lot and I really just don't know where to start. And that's why I'm here. I'm trying to figure out what's best for me. And she said, see, your body needs estrogen. You're crying for no reason. It's a sign that you need to start supplementing with your estrogen again. I was like, for no reason. I just explained it. I have plenty of reasons. Yeah. I was like, I thought I was kind of eloquent.

with how I just explained that decision fatigue and all that. But yeah, so I just decided I was going to try whatever she wanted me to try. And I started newvering in, I think, March. And it was really nice because after a week, the hot flashes went away. And I have not had a hot flash since, which is fabulous. I'm sure that's a big relief. Oh, my gosh. So the quality of life that I got back.

So, and I mean, I was waking up every hour and a half in the middle of the night, sweating, like, throwing the covers off. And now that I can sleep a little bit more soundly, I felt I slept through the night. I had the most productive day of my entire life the next day. I was like, holy cow, I'm like a superhuman now. But I was still, I'm still, like, relatively new to using Nouver Ring. It hasn't been that long. And I, it's not the perfect solution for me I've noticed. part of the problem is that NUVRING is only FDA approved for contraception.

And the way that it's used is you do three weeks on and then one week off to have a period. But I don't have a period. So she told me just use it all four weeks. And in that last week of the month, I noticed that it's almost like I go through menopause again, the last week of every month with Nouvering. And I read the package insert and the drug information says you can wear it for four weeks, but I noticed in the last week, I do get, like, vaginal dryness, like, pretty badly. It messes with my mood a lot.

It makes me nauseous. And then every time I change my ring, I get really nauseous. And I think it's because of just, you know, the ebb and flow versus if it was more constant. So I've not yet cracked the code on exactly what's going to be best for hormone replacement. I use the intravaginal estrogen tablets a lot during that. last week before I changed my ring, but I can't go three weeks on and change my ring because insurance won't pay for you to fill it soon, like that soon, like a week early every month,

unfortunately. So I don't really know moving forward what I'm going to do about that. And it's still all pretty like new and fresh, too, that it's like I feel like with anything, it's a lot of trial and error and like experimenting to see, like you said, what works best for you. Definitely. And if you recall, I have an appointment coming up on June 6th of 2023 that I never canceled because I forgot about it. And so it's with, you know, the initial clinic they referred me to. So I was like, oh, this is perfect. I'll go see them. And then, you know, they'll, you know, maybe at this point be able to tell me if my hormones are where they're supposed to be with the new ring. So you'll get testing again? What I think, I'm not going to go through all the fertility testing again, but what I'm hoping that they'll do is just draw my hormone levels again. Okay. Because I haven't had them looked at since I started hormone replacement therapy.

And I don't think they're as high as they're supposed to be. Okay. The guideline recommendations for ovarian insufficiency are to supplement with systemic estrogen and topical estrogen. and ovarian insufficiency, you tend to need more estrogen than just regular hormone replacement therapy and menopause because you're ideally trying to get your estrogen back up to the appropriate level for your age. So my theory is that I just don't think I'm quite all the way back up where I need to be and I can just tell because of the breakthrough menopause symptoms I still struggle with.

So I'm hoping if they can remeasure my hormone, levels, maybe they can find a way to optimize the therapy I'm currently on, which would be nice because it would save me a trip going back to my regular gynecologist who doesn't, I don't think, she just gets an idea and then wants to do it. I don't think she really listens to me very well. So that was a big change. I also went to my primary care provider, and we had just regular labs drawn, which was how I learned that when you're in menopause, your cholesterol spikes. which I didn't know until I got my lipid panel done and now I have high cholesterol which was I was like awesome yeah just add that spiless yes it was like great fabulous love to hear it uh so yeah

I take fish oil now but it was kind of funny because the the girl that called me to read my lab results this was after like a really emotionally charged appointment with my primary care provider who like wants to help me so much and understands my struggles with um you know like diet and and he knows how hard I'm working and everything like that. But it was funny. I got the call to read my labs. And, you know, the girl was saying, oh, yeah, so your cholesterol is a little high. I recommend maybe changing your diet and exercise to try to just add a little bit more exercise.

You can bring your cholesterol down. I'm sitting there like, you have no idea? I'm trying so hard. I don't know what else to do. I will add fish oil. So I'd be interested to see. see my cholesterol now, now that I have estrogen again since that was the only thing. Because I've had, I've had lipid panels done just like routine. And really the only difference is that I went through

menopause. And so I'd love to know now that I have estrogen, maybe is my cholesterol lower? Right. I don't know. So we'll see. My primary care provider also did some autoimmune testing because one of the possible causes of ovarian failure are like a range of autoimmune diseases. And I actually had some come back positive. So I've got a rheumatology appointment later this year. That was kind of out of left field. I had like some really high autoimmune results. That got me referred really like quicker than would be normal.

So maybe I'll find out a little bit more as to what possible. caused this. I think that, you know, a question that I've been asked a lot by family and friends is why is it that you don't think that the endometriosis or the surgery itself caused it? And the answer to that would be that, well, basically because every single one of my providers told me that it was not likely that the laparoscopy was the thing that caused them to actually fail. It was probably just, you know, my over.

Aastral. Yeah, just the stress, the ovaries just couldn't come back from it. And then with endometriosis, it, you know, I think there's, it can, I guess, cause by virtue of injury to the ovaries. But it's not like a super common cause of ovarian failure. And my endometriosis was diagnosed as being mild anyways, which blew my mind because my symptoms were so bad, but it was supposedly mild. So I don't think that was necessarily maybe what caused it either.

So I'm not so fixated on finding a root cause anymore as I was at first because I just think as long as I can do my due diligence to rule out certain factors, then that's about as good as it's going to get for me. And like you were saying before, too, it's more so about like, okay, but what are the positives that you can do from here? Exactly. You know, like for yourself and just in general. I feel like that's the best way to look at it too, like the positive outcomes of it in a way.

Definitely, especially because I feel like I can be a person again. I feel like I spent the latter part of like 10 months, just solely focused on this. It's affected every part of my life. Now I feel like I've got this hormone therapy. I've got a plan in place. I met with the nutritionist. I kind of got a plan for that as well. And now it's, you know, I can just kind of, I can move forward and be a real human.

Right. And I feel like in those aspects, you do have answers. what things can help. And I feel like the more, like even like the next appointment that you go to, they might even have more suggestions. So it's like at least you have those outlets of like, okay, well, what can help me and make me feel better? Because like nobody ever wants to be miserable, you know.

Exactly. And if I have, you know, I have appointments moving forward, which gives me a little structure. I know I can look forward to that versus, you know, at the end of our fertility testing, it was kind of like, okay, bye. and then I had to decide what I was going to do from there. And that was really like a major challenge. Right. I also, you know, they were able to rule out like thyroid causes of ovarian failure for me,

which was nice because that's another one that can really contribute. And it was a question I got asked a lot by some of my other doctors too was if I had my thyroid looked at and I did like to a pretty extensive extent multiple times. And so at least one of my glands is working well. Yeah. That's good to hear. And like you said, too, so this is something that a lot of times they don't know the calls, right? Yeah, the majority of the time actually.

Most of the time, they can really only attribute it if it's something that's been like chemotherapy-induced or if the patient's already had a diagnosis for autoimmune, they can try and attribute it that way. So with the autoimmune stuff, you won't really know. Like the one test result said that you were, like, what was it? So I had a, it was basically just an antibody, like the autoimmune antipsomene. don't know exactly yet. Right. Okay. So I'll go to a rheumatologist in the fall and they will.

They can like specify more? Yeah. Because there's actually, there are specific antibodies geared towards the ovaries. And if those are high, then that would mean that my body had at some point attacked my ovarian tissue. Got it. And that's kind of what I think might have happened. I did have this sort of random event when I was first dating Marco.

There was this time where I had an endometriosis flare. But during that week, I woke up in the middle of the night with, like, the worst abdominal pain. It was like, it was so bad. But then it didn't go away with my period. It lasted like a couple months after that. And it just felt like I was injured on the inside. And so in retrospect, I wonder if there was like some sort of autoimmune, something that happened. And that might have been because that was right before I started the process of getting tested for endo and then getting the surgery.

So it would have been right before the. laughing at the cat. I know. I'm like, what is she up there? I'm like imagining her up there walking in circles, just crying for no reason. I kind of love it. We have cats at home. We actually have a lot.

We have four kittens at our house right now. Oh, my goodness. Yeah, it's fun. They're all getting ready to go to their respective homes. Oh, that's so cute. Yeah, it's been a good time. What else? I'm trying to think of.

Oh, yeah. One thing I wanted to talk about a little bit was what I learned about the way that, diet and exercise is so different from menopause because I know I mentioned a litany of times that I struggled a lot with it throughout this process and kind of where I'm at now with it. What I didn't really realize was that cortisol plays a really heavy role in the way that your body uses and metabolizes fat. It does a lot of different things. So does estrogen actually. Kitty? please kitty's like i just want to be a part of this please kitty yeah relax

maybe maybe just relax a little bit huh we're just hanging out i know she's just want to squish her she's right i know she's just kitty oh my gosh okay i keep going you just ignore So estrogen plays a pretty big role in the way that your body uses and stores adipose tissue. And then cortisol also plays a big role in the way that your body uses and metabolizes fat and carbohydrates as well. And it does a lot of other things too. But in the context of menopause, I didn't realize that your adrenal glands end up working a lot harder because that's where you're getting your esterone. from when your estradial isn't coming from your ovaries anymore. And so my doctor was explaining to me that postmenopausal women tend to have really high

cortisol and basically everything that comes out of your adrenal glands ends up being elevated because of that. They're just working a little bit harder. And so the way that that impacts your diet and exercise is like pretty profound and kind of contributes heavily to sort of why there's so much conflicting information about what to do for diet and exercise for menopausal women. Not a super heavily studied population menopausal women, especially not an exercise science. But I was, you know, I figured that with my background, I would be able to like peruse,

you know, the literature and try and figure something out and maybe be able to piece something together. I was so confused. I was looking through all this information. There were so many conflicting things like articles that say, you know, long running is like a worst thing you could ever do, you know, it increases your cortisol to, like, anytime you exercise your cortisol increases, that's normal. But, you know, long running can really increase it. And then you should do high interval intensity or whatever that's called, hit training.

I've seen articles that say, whatever you do, don't do hit. If you're in menopause, it's so bad. So it's great. It's so confusing. And so. So I figured out something that works for you or like has helped at all? So I, you know, this kind of. You know, this kind of. kind of all forced me to really have a lot more grounded expectations for fitness and lifestyle, which has been really nice. So most of my fitness is geared towards just general health and bone health. Yeah. Which is good because it's not so much about like a look. And I think that's a lot better too because I really like running. I just find it really relaxing.

So I would do a lot of like a long running. So all of a sudden I'm seeing all this information. I'm like, don't long run. I'm like, oh no. what am I going to do? I actually started doing a lot more weightlifting because the impact on the bone health is so good. And I've been doing that now for over a year. And I noticed that that's been the thing that actually really did change the way my body was shaped finally after all this time. So lifting heavy has been, or I should say heavier for me, lifting heavier has been a lot better. And then with running, I think what I've deduced is that running with like a higher level of intensity is better than doing like slow, longer runs. Yeah.

But then, you know, I also recently saw a woman who does like marathon and half marathon training plans for postmenopausal women. Wow. Okay. Yeah. So it was really cool because I think that her stuff is more, it's like the types of training is just different and prioritizes recovery because obviously sleep. sleep and recovery is the way that you want to reduce cortisol. Oh, there's nothing more patronizing or demeaning than going through all these articles trying to figure out what to do. And it's like, your cortisol can be elevated when you're postmenopausal. Try and relax. Try and chill. Try and make

sure that your cortisol, don't stress. I'm like, okay, I'm super stressed. Right. That's not a tangible for me, unfortunately. I was going to say, too, you know, there's definitely other people out there that, you know, might be experiencing this or going through something similar, but it's probably such a small percent that that's why it's not really like research. And there's not like, I feel like exact information on what can you do or what works and what doesn't. So that's interesting too. Like I said, it is another example of even in that aspect, trial and error, just figuring out, well, what's going to work best for me?

And then even like you said, even making it, I mean, it's annoying and it sucks because obviously when you work out, you want to see a change and you want to see results. But at the same time, it's kind of nice to have that shift of, okay, well, at least I know I'm doing it for general health and taking care of my body and bones rather than just like, okay, well, how do I look at the outside? Because obviously, like, I feel like the whole point of all of this is like to know that you're healthy on the inside, you know,

and to keep doing what you can to keep that up in the best way that you can. Yeah, definitely. I think it was a good sort of maturing point for me too. Oh, absolutely. forced me to have those better and more grounded goals, which I think has been really, you know, I've made so many like strides in my general fitness that I've been really excited about too. So, yeah, it's been a good mind shift.

And with the diet, too, you know, I think I kind of just had to end up figuring out, figuring out what's best for me. I kind of, you know, we eat, we kind of lean into like the Mediterranean style. But I also try really hard to increase my dairy since I need calcium and vitamin D. Man, I have never liked milk and I really feel like this is coming back carmically to like bite me in the butt because I have not, I don't, I still don't drink milk of any kind. But, and now I'm like, oh no, my lack of dairy is finally catching up to me. This is all my fault. I need to eat more cheese.

Thank goodness I'm not lactose intolerant. At least I have that going for me. But yeah, so it's definitely been a major lifestyle shift. And in a lot of ways I think are, oh, I will say, I am really glad that I am young enough to be able to make new habits. Right. Right. I imagine for women who experience these drastic changes when they're like 40 and 50, that's like 40 and 50 years of habits of like eating and moving and I, you know, silver lining is that at least I can figure out, you know, the things that are sustainable for me. Absolutely.

And continue to do them moving forward. Yeah. I'm like searching for silver linings everywhere, but that's been one of the positives. And then another thing to what you said about the fact that, you know, only a small percentage of the population is affected, I'm definitely sort of reliant on research for women who are postmenopausal. But, you know, like you said, that still doesn't, a lot of that stuff is they compensate by doing age-based research. Right.

And I'm not 50. No. So what's just going to say, too? I think automatically people kind of just know that the older you get, your metabolism slows down. So it's like it's harder to lose weight when you work out. And you have to kind of watch what you eat more. But yeah, like you said, that's more like age-based. Yeah.

So when you're younger and like I said, if they're like the percentage is probably so small of like girls that are going through this. So it's like it doesn't really line up at all. It doesn't. It's hard. I even, you know, initially I tried to find. like support groups that of girls with the same issue as me but at the time that I was looking for them I think it was just a little too like soon a little too raw I just felt like I need to process yeah they take a step back and figure out what I'm feeling first but um yeah it's interesting

because I the age like the age related changes I remember you know being early to mid 20s you start to notice like things change right so it was really interesting was after the surgery you're just seeing everything go to like the millionth extent and being able to be like, oh, so this is like the estrogen stuff versus the, you know, what I normally affiliate with aging. And actually one thing that was, two things that were really affected, were my skin and my hair. And I noticed that I didn't, I used to have normal skin. Now I have like really dry skin.

And even with estrogen replacement therapy, I still deal with dry skin for the first time in my life. And then it was kind of funny. I went and got my hair done. And it was like a month after I started newvering. And my hair dresser was like, wow, your hair's really grown a lot. She was like, wow, it's just like, it feels so healthy. Like, what are you doing to it? I was like, estrogen, I guess.

Right. I guess it really did make a big difference because it was, it just was thin and like almost like falling out a lot more. Yeah. So it's interesting to see those effects as a young woman because I'm like, I saw, you know, I can't attribute all of it to age. But then I think about like the normal process of aging and how menopause on top of that. I mean, that just creates such a drastic change that I don't think that, you know,

I think that postmenopausal women are really preyed upon too by diet and supplement industry and also the cosmetic industry. And right now, you know, anti-aging is sort of everything in terms of like what's trendy right now and stuff. But not a lot being done about, you know, research into. Things that can actually help with health and wellness, like exercise science studies on postmenopausal women or people with different hormone statuses in general. There's like so many different kinds of hormone disorders or reproductive health disorders that affect men and women. Absolutely.

You just don't really see them represented a lot in literature. And it makes sense because it's such a small, probably it's not like a super profitable market. But it's interesting to be, you know, in the position that I am. as a healthcare worker and, you know, navigating this as a patient at the same time. It's been a definitely an eye-opening experience. And I've always had a lot of, like, sympathy and respect for my menopausal women I take care of. But now it's like to the million of sex.

I'm like, wow, this, I mean, I knew it was bad. Yeah. Yeah. For sure. You know, this is way worse than I thought it was going to be. Yeah. And it's interesting, too, because kind of going back to what you were saying before about all of the questions.

and I feel like people around you, obviously family and friends, like there, I feel like natural reaction in question is like, oh, what about kids and stuff? But I feel like it probably is easy to forget and kind of brush over like what you are going through even physically. Like all of those years and all that time of like the pain and like even prior to any of this, but like the periods too. Yeah. And it's like I feel like there was never like a break for you to just like get yourself

together and figure out like, okay, how can I? get to a point where I actually feel good and like I have it together in process and like I have my own things down and then I can like worry about and think about those kind of things in the future you know and it's I just think that that's interesting because I feel like it that happens so often where people don't always know the right questions to ask her like they don't really know not even just that but it's easy to not really understand like what someone's going through in a way yeah so yeah I just thought that was interesting too because I feel like that that is enough response for people to ask that question. Because even like as you were telling me, the story

like my first thought was like, can she have kids? You know what I mean? Because I think naturally, especially when you are in a relationship and being, I mean, we still are young. You know what I mean? So it's like we might not be ready for it and thinking about. I mean, there's like times where I was like, no, I don't want them. And then there's times from like, okay, maybe. So it's like, that can be like heartbreaking and a let down and for anybody, you know? Because like I said, that option is then taken from you in a sense. But I feel like that. like too it's nice that you focused on for yourself like let me just get myself healthy and like every way possible because that is the most important like you are the most important at the end of the

day yeah i appreciate you saying all of that it's a lot of um a really good poignant points there um especially with you know one of the things that margot and i talk about a lot is that we don't want to do anything reactionarily in terms of family planning you know if we weren't already family planning we're not going to like jump into trying to do a donation now worry too much about yeah yeah like we want to make sure that we take care of the two of us first and it's raised a lot of questions like fundamental questions we haven't thought about yet which makes sense because we weren't family planning but the things like what does parenthood like really mean to us like what do we want that to look like and um yeah i think it's going back to sort of like the subject of guilt i felt so much guilt like

during this process and I couldn't like really put a finger on on wire what that was about. But I was reading a study about ovarian insufficiency. And there was a, the person who wrote the article was saying that, you know, you need to, you need to focus on like these patients. Like they agree from like the loss of dreams and their expectations for the future. And that resonated so much because I was like, I realized I was struggling with guilt because I felt like, do I feel like I can? am I allowed to grieve when I'm not sure if I was even ready or if that was what we were going to do?

Like, is it even okay for me to feel like the heavy weight of an infertility journey that, you know, when we weren't even trying? And I realized, you know, I always just pictured us having kids in the future, even if it's not tangible right now. Right. And that, you know, when I thought of it that way and I thought of like, what if it was my friend to ask me about that? I would be like, of course, that's super valid. And then you know, you're more than worthy of feeling that grief and like processing it and letting it go. And thinking, being able to think about it in that sense or putting myself in the position of somebody else and trying to think about, you know, the woman and not just like their capacity for fertility. Oh, my primary care provider.

I love him so much. He sat down with me and he was like, do you know your worth outside of being able to reproduce? And I was just crying. I do because thankfully my husband is fantastic and he's such a great support. And, you know, I've never had to even think about if being infertile would affect our relationship, thankfully, which is like something I'm so grateful for. Absolutely. But when he sat down and he was just so stern about it, like, do you know your worth?

Has anyone told you that, you know, you're still worthy of all the love and the care and the attention you receive, even if you can't ovulate or have no eggs? And I was just crying. And I think he thought, you know, because I was crying that like maybe I had heard that but it was just it was so sweet that he was yeah that's important it was like aggressive loving I almost felt like he was shaking me by the shoulder do you know you're ready of love I'm like I do thank you so much for saying that and um thankfully I've had most of my doctors have said that and you know my attending when he was doing my sauna histography and I was all on those really comfortable

loopy drugs he was you know making sure is your partner good support is your husband giving you the support you need does he know that um you know like women are everything and yeah all this stuff like the woman's the backbone of the household he's saying all this really empowering stuff and so yeah thank you for it's great thank goodness i mean yeah it's important to have you know support in every aspect too even from your doctors oh yeah um because those are going to be the people that make you feel i feel like safe and the answers that they give and and with the help because that's who you're relying on at the end of the day is like oh definitely you know so yeah it's um the weight of an infertility journey has been

like a super heavy one and it makes me just like really sympathize with women who have to experience you know deciding to start their family and then finding out. I'm like right for us I don't think we'll ever really struggle with like jealousy because we know what we have to do going into it. Right. For us we don't really have anything to compare to. We won't ever have to really deal with comparing our own timeline to like our friends who might be family planning at the same time because we already know like we'll be brewing babies in a witch's cauldron somewhere instead of you know doing things differently like it's a very like mechanical and intentional timeline if we decide to have kids and I think it's like in a way too you're you're going to be used to that

and ready for it yeah because of even how the testing and stuff like that was laid out it's it'll just be kind of like the next step in the process when you're ready for that. that when you're there. Yeah. So it's almost nice because it's like you're prepared for all of the steps up into that. Yeah. I totally agree. It takes some, you know, it does take a big, a big burden off of our shoulders with that.

And yeah, it's, it's so interesting. I remember the week of Thanksgiving. I was just so, like, sad. And listening back to my audio notes, too, it was just so sad. And even with all of the different advantages that we have, like we just said, you know, we know exactly what to do moving forward. and it just makes me think, oh, gosh, like women who deal with infertility and I just, like, my heart goes out to them.

And sometimes that does affect, like, the relationship someone has with their partner if it's unexpected. Like, I know that can really wear in a relationship. And I'm just so grateful that, thankfully for me and Marco, that's not adding to the already stressful. Yeah, definitely not. Yeah. Do you have any other questions you want me to elaborate on?

You hit everything. Dude, I'm so verbose. It's crazy. Like, you are spot on. You did such a great job. Like I feel like it was so informative. And like I said, I feel like too, there's always people out there, even though the percent is so small. So I feel like that's why it's always so important to talk about things like this.

And yeah, you literally did incredible. Thank you. Thank you so much. Of course. I really appreciate all having us. Of course. Thank you so much for coming on. Like I said, I really can't stress it up.

It was so informative. Like even the fact that you brought your labs and you were so, like you explained everything so well. So seriously amazing. Thank you. I really appreciate that. I'm hoping that. You know, people who listen to it, there's so many different kinds of reproductive health issues. Yeah, that too.

I just, you know, hope that people who listen can just know that it's, it doesn't really matter what kind there is. Like, it's such a big community of people who struggle. Yeah, for sure. And health issues in general. Like, I just feel like, even if it's like, no matter what issues you're having, I feel like it's always the same kind of routine of like with these tests and not really necessarily having answers.

And then it takes forever to get them. And it's just, I think so many people can probably relate to just the process on its own of all of that, which is just a total pain. But I feel like once you kind of get through it and you have some of the answers in clarity, it's like then you can kind of start on your path of like a new way of living and like adjusting to that. Yeah, definitely. But yeah, no, but thank you. You did so good. Seriously. Thank you so much, guys.

Of course, of course. Great job.