The high price of preventing cancer
Angelina Jolie's decision to have her ovaries removed has plunged her into a premature menopause. Psychologist Dr Marie Murray analyses how this can affect a woman - particularly if she doesn't have any children
The decision by Angelina Jolie to undergo surgery by having her ovaries and fallopian tubes removed so as to avoid ovarian cancer (a condition from which her mother died) has caused her to enter premature menopause and has brought this issue, and that of infertility, starkly to the fore.
Almost every young woman assumes that having children is an option for her if she wishes to at some time in her life, when the time is right - until that choice is taken away.
Motherhood is one of the major assumptions we make until it doesn't happen. When the taken-for-granted possibility of motherhood is threatened for any reason -cancer, chemotherapy, genetic factors, problems of pelvic surgery, inborn metabolic disorders, autoimmune disorder or premature or early menopause - then the psychological fall-out is great.
If menopause at the expected age and stage brings many women experiences that are distressing - fatigue, sleep disturbance, swings of mood, occasional depression, a body that is just not responding as quickly, as efficiently, as reliably and in as stable a way as before - then how much harder is it for women who enter menopause prematurely or early?
The psychological response to premature menopause depends on so many factors. The most significant is whether or not a woman already has children and is ready for the next stage or whether she has found herself suddenly and unexpected deprived of that possibility and the grief that follows.
Of course the age of diagnosis is significant, whether or not a woman is in a long-term relationship, her general sense of herself as a woman, her self-esteem, her career and prospects, her lifestyle, interests and attitudes, psychological and life history and other life satisfaction levels. There is also the culture in which she lives, especially if it is one in which womanhood is defined in terms of motherhood and motherhood is revered.
Premature menopause that denies a woman motherhood can span a range of psychological issues in its relationship to bereavement, loss, mourning, isolation and social exclusion.
It is a process with stages: the first is the diagnosis and realisation that pregnancy is not the automatic event anticipated and then there is the fear that follows that realisation.
The second stage of mourning for a young woman deprived of children who wants to have a child is when friends have children, visiting her girlfriends in hospital with their new babies followed by the unavailability of old friends as they get caught up in new, child-centered lives or acquire new friends amongst other mothers.
Alongside this, some women feel that they are almost at a different life-cycle stage to others, one of ageing and decline rather than the vibrancy and beauty of young womanhood.
Let us not forget, too, that what happens to women happens to the men who love them, and so there is the distress of the couples who believed they would have a child or would have more children; those who looked forward to the idealised, imagined child who now may not be while couples often feel the practical sadness of who will now inherit the result of their hard work and even in the future who will tend their grave.
Womanhood is not confined to motherhood but motherhood deprived does eat into the heart and soul of women and men as couples who want children grieve for the loss that each of them feels and grieve for the loss for each other.
It is no surprise then that psychological research on premature menopause shows that in many circumstances it can cause high levels of depression and stress, low levels of self-esteem and poor life-satisfaction compared to the general population. Premature menopause, as with most transitional physiological events, needs very sensitive management, recognition that the initial diagnosis and early days can be a time of crisis for the woman and those around her and for mental health and wellbeing, which is why psychological services supporting everyone at this time are essential.
Dr Marie Murray is a clinical psychologist. email@example.com @drmariemurray