Adios Ovaries

The countdown is on. Surgery to remove my ovaries and plunge me into instant menopause is scheduled for August 5th. To say that I am not looking forward to this is an understatement. I am not looking forward to surgery. I am not looking forward to the recovery. I am not looking forward to getting totally out of shape and fighting my way back to my current level of fitness. And I am NOT looking forward to menopause.

My fear of menopause is tinged with a level of irony. My first period arrived on my 12th birthday. I was appalled that I would need to endure this nuisance monthly for the next 30 to 40 years. Now, while I do not relish my monthly period, I am more appalled by the stage of life that the lack of this event portends. There is no way around it. Menopause means dealing with the issues of aging.

Dr. Karen Hurley at the FORCE conference a few weeks ago talked about why preventive surgery decisions for those of us at high risk are so emotionally charged. She said that for many of us this is the first time that we must face our own mortality. I think she is right. For me, as for many of us, removing my ovaries is much more than giving up fertility, although that is clearly an important aspect of the issue. Rather, it involves squarely facing issues of aging and acknowledging our mortality. We must begin worry about our bone and heart health because the estrogen that has protected us for the first half of our life will be gone.

And then there are those lovely menopause symptoms to look forward to: hot flashes, night sweats, sleep disturbances, sexual functioning issues, mood swings and others. (My husband's biggest fear is that I will become a raging *itch with no libido.) Of course we may not have all of these symptoms and the severity of the issue differs from woman to woman, but few make this transition without a few bumps in the road.

My BRCA mutation comes from my mother's side of the family. None of the women on this side of the family have gone through natural menopause, at least not in the past four generations, which is as far back as our collective memory goes. My mother's early menopause was caused by her breast cancer treatment when she was forty-three. All of the other women on this side of the family had total hysterectomies, which included removing their ovaries, in their thirties or forties.

All of these women have dealt with osteoporosis, which leads me to worry a great deal about my bones. By the time she was in her sixties, my great aunt's spine had degenerated to the point that she was in constant pain. Fortunately drugs available now can prevent bone loss and can actually increase bone density. These drugs were not available to my grandmother and her sister.

The key to keeping bones healthy is to know your bone mineral density and to intervene with these bone building drugs before the damage becomes severe. This means that post menopausal women (and older men) need to have regular bone mineral density tests to monitor bone health. For most people, the bone mineral density test involves a radiological scan of the lower spine and a separate scan of the hip. It is painless and takes only a few minutes. The reason the spine and hip are used for these scan is that people with osteoporosis have a higher likelihood of breaking these bones and because these bones are a good indicator of what is going on with the rest of the bones in the body.

I went this week for my first bone mineral density test because I will be entering menopause in few short weeks. I have to admit that thus far in my life I have not been good about taking calcium supplements and I am allergic to dairy products so I was a bit worried that I would not be starting from a good baseline point.

After the scan, the technician gave me a copy of the report that she sent to my doctor. The report contains bone mineral density scores for a number of locations on the bones of each scan. These numbers are then averaged into an overall score known as a T-score. Because peak bone mineral density occurs around age thirty, the T-score compares your bone mineral density with that of the average thirty year old. Here is a reference for the meaning of the T-score:

• A T-score between +1 and -1 is normal bone density.
  

• A T-score between -1 and -2.5 indicates low bone density or osteopenia.

• A T-score of -2.5 or lower is a diagnosis of osteoporosis.

Fortunately all of my bone mineral density scores were above 0, which puts me squarely in the normal range, and the overall T-score for my spine was actually greater than 1, which means my spine is a bit of an overachiever for my age. What I hope is that this means I won't start getting shorter any time soon!


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