Unfinished Business: One Woman's Attempt to Reverse Menopause
This essay was originally published in Wildfire Magazine: Fertility After Cancer, Vol 1, Issue 6, December 2016. Wildfire is a reader-generated, subscription-based digital magazine for young women who have been affected by breast cancer.
Interested in learning more about this topic? Join Living Beyond Breast Cancer March 2 for a free webinar that will address how cancer treatment might affect your fertility, tests you can get to assess your fertility after treatment, the impact of pregnancy on risk of recurrence, what to do when pregnancy doesn’t happen easily, and more.
When I think of the picture, it still, even all these years later, raises the tiny hairs on the back of my neck.
Anyone else viewing the picture sees a happy, smiling family: I’m standing beside my husband, our five-year-old daughter on my hip. All of us are tan, smiling, even laughing a little. Behind us, framing us in the picture, is the lush, green lawn of my brother’s front yard in early July. We were in Montana for the Fourth of July holiday and it had been a wonderful trip. Think: sparklers and kid’s firecrackers glittering and popping light in the darkness, BBQing wild game and roasting ‘smores, floating lazily down the Clark Fork River, the famous “big sky” full to choking with stardust…
But when I later scanned through my photos from that trip, chronicling beautifully all the things I just listed, it was this one particular family photo that stopped me in my tracks. It wasn't a particularly good picture, nor was it my near-bald head or the softness of my body after first pregnancy and then breast cancer that gave me pause and a sharp inhalation of air.
No, it was something not in the picture at all.
Looking at the picture at all our smiles I felt a sudden sadness wash over me followed by a prickly unease.
“Someone’s missing,” I thought. For the first time, I had the overwhelming sense that our perfect little family of three was not quite complete yet. Someone was not yet in the car.
As of this writing, I’ve had a few years to adjust to this new desire for another baby and it isn’t lost on me that perhaps one reason I want another child is for a do-over: This time I won’t have cancer when my child is three. This time I won’t have to be consumed with my own health for well over a year. This time I will know it is my last baby and really enjoy it: the pregnancy, the newborn time, preschool…
The year before our Montana vacation, I was deep into chemo for ER/PR-, HER2+ breast cancer. The diagnosis came right around the time my husband and I were just starting to even think about whether we should have another baby. (One the one hand, we’d just emerged from babyhood and it finally felt like we were getting things back under control... On the other hand, a sibling would be pretty great...) Our daughter was three-almost-four at the time and I’d been fantasizing about the notion of having a baby when she was five and starting kindergarten (I oh-so-naively imagined she’d have her own life at that point, her own friends and schedule, and wouldn’t need me so much; I pictured it being the perfect time to nurture a baby without neglecting my first-born).
But then breast cancer came long. It’s never a good time. For me, it was March 2012; I had just turned 35.
Two weeks after the diagnosis, I got my period the same day I started chemotherapy. (I remember feeling that was hugely unfair of the universe.)
There was no talk of freezing eggs or taking measures to preserve my fertility. Rather, there was an emphasis on speedy treatment.
My doctors strongly cautioned me against getting pregnant while on chemo. There was a day when calls went back and forth between my oncologist and gynecologist regarding IUDs. I remember sitting on the playground watching my child play, fielding these voice mails. It all felt so surreal. But then everyone seemed to suddenly realize at the same time that my cycle would soon stop in response to the chemo anyway. This proved true.
After seeing the picture from the Montana trip and having the prickly sensation that there was still a child out there floating around in the ether, I brought up getting pregnant at my next check-in with my oncologist. By then I had been through “my cancer year:” chemo, radiation and a modified mastectomy. I was twelve months post-Taxol and FEC, and six months post-Herceptin and by all accounts I was doing very well. Although I was not on hormone-suppressing medications, my period had not returned and I was experiencing hot flashes, insomnia, and other signs of menopause.
In response to my asking about getting pregnant, my oncologist was in favor but said it was standard protocol to urge waiting for at least three years. At the time, two more years felt like a long time to wait, but seeing as how my period hadn’t yet returned, I didn’t have much choice but to wait.
Today I’m a few months shy of my five-year cancerversary, well outside that three year window. Happily I have remained no-evidence-of-disease this whole time. Sadly I also remain no-evidence-of-fertility.
I’ve had my follicle-stimulating hormone (FSH) levels checked twice. Most recently, at the beginning of the summer, they were just shy of 40. (Women in menopause have high FSH hormone levels, above 40 mIU/ml.)
My doctor said, quite bluntly, it would be virtually impossible for me to get pregnant without medical intervention.
I was crushed. It’s funny how sometimes we don’t know how badly we want a thing until someone says that thing isn’t possible…
A couple of months ago, my husband and I sat together and had the conversation: do we both still want a baby in spite of everything? My heart was pounding as I sat beside him. We hadn’t really discussed this in awhile. Our daughter was now eight, I was going on 40… I felt as nervous as I did the day some twenty years before when I asked him if he, like, liked me? I was blushing and shy and stumbling over my words, the blood roaring in my ears – and here it was happening again. Finally I blurted, “Do you still want to have another baby?” To my relief and delight he said, “Yes! Absolutely yes!” I asked him what his best case scenario would be and he said without hesitation, “You pregnant with twins right now!” I burst out laughing, my heart was full.
That was the easy part. After that came the harder questions of how to have a baby. Because this is life after cancer, right? It’s not just, hey, let’s have a baby! Now it's “let’s figure out how to have a baby.” And not just how physically/logistically, but also how monetarily. How far are we willing to go to get a baby? IVF, adoption, surrogacy, etc.? These were harder questions to answer. Money is an issue, but an equally big issue is how much do we feel comfortable putting my body through.
In the end we decided IVF isn’t for us and we've pushed surrogacy to the back burner for a rainy day.
What we decide to pursue now is a middle of the road approach: Chinese medicine. Acupuncture and herbs for one year. We’ll invest our hearts and wallets for one year of weekly Chinese medicine fertility treatments. For one year, we’ll try.
I think a lot about a quote from Jack Kornfield’s Buddha’s Little Instruction Book: “In the end, only three things matter: How much you loved, how gently you lived, and how gracefully you let go of things not meant for you.”
Maybe baby number two isn’t meant for me. Maybe I should let go of that idea so that I can move on and more fully appreciate the wonderful daughter that I do have. The trick is knowing when something isn’t for me, and when I simply need to work at it. For now I’ve decided to work at it. But not endlessly, just for one year. If it doesn’t happen after one year we’ll reevaluate our options and maybe go about the process of acceptance.
As for right now, I’m mid-way through my fourth month of fertility-focused acupuncture.
On Sunday I got my period. My first in a very long time.
Update from April: March 2018
It's been about 15 months now. I'm 5-going-on-6 years out from cancer, no evidence of disease, and also no evidence of fertility. Yes, we gave it a year. Yes, we really tried. My period did come back and settle into a somewhat predictable pattern, but that's it. I just turned 41 and am starting to really feel like I'm running out of time. And yet, even after all that, I'm really not sure I'm ready to be done with the idea of what I thought my family would look like. I can't help but feel like one of us is still out there somewhere, missing. I still think about it a lot. So much for no regrets.
A couple of different friends have offered to carry a baby for me. Incredible, I know. I can't even express how lucky I feel that someone would even say that out loud to me let alone follow through on the offer. I haven't pressed them on it. Is that was I'm supposed to do? Is that how my family becomes complete? I feel like I'm in a place of limbo and indecision. And heartache. Always the heartache. I don't know if I'm supposed to let go of the baby dream and accept what I have or if I should keep fighting/trying/striving.
This update was hard to write because I don't have any answers. I don't have any clear message of hope for anyone crossing their fingers for fertility after breast cancer.
In the meantime, I rescued a really adorable dog. Maybe he'll teach me how to gracefully let go of things not meant for me. Or, maybe my son is here. He simply has four legs instead of two.
April Johnson Stearns is a writer and the founder of Wildfire, a reader-generated, subscription-based digital magazine for young women who have been affected by breast cancer. April lives in Santa Cruz, California, with her husband and young daughter. She was diagnosed with stage IIIB HER2-positive breast cancer in 2012 at age 35.