It sounds odd, maybe, that something can shake your self-image so much. But it can and does. Most women, when they learn that they are going through premature ovarian failure or early menopause, go through a very difficult time emotionally. It’s a devastating experience. Often you feel as if someone or something had died. And, in many ways, something has died: Your youth, or, at least, your image of it.

When you learn you have POF or EM,  you suddenly feel older, different from your peers. You feel as you have been cheated out of the normal possibilities of life. In your 20s or 30s, you are unable to fulfill the "normal" reproductive capacity women have.

You’re plunged into a completely different mind-set than the one you had before you were diagnosed. Your body is out of control and you are helpless to change what is happening. You’re angry, upset, and numb. But, somehow, you have to keep going. . . .

It isn’t easy. I know this through my own experiences and through talking with so many other women coping with premature ovarian failure or early menopause.

Early menopause and POF bring with it a wrenching emotional change along with the physical. Your emotions are already affected by the shifting hormones in your body -- and the reality of your condition affects your emotions even more. In fact, a study conducted in London found that premature menopause was associated with higher than average levels of depression. The single most upsetting element of premature menopause, according to all the women surveyed, was the most basic: Their loss of reproductive capacity. It didn’t make a difference if they had children or not -- or even if they had been trying to have children. The sudden switch from fertile woman to irrevocably infertile woman was the biggest blow of all.

To make matters even more difficult, fertility is more than just the actual biological ability to have children. It symbolizes much more than this to yourself and to society. Fertility is youth, womanhood, the essence of being female. It is a substantial part of how we define ourselves as women. So, when the ability to have a child is suddenly stripped from you before the normal age, you often feel like less of a woman. You just don’t feel whole any more.

I wouldn’t have necessarily believed this if I hadn’t talked to so many women who said the same thing. . . and if I hadn’t gone through it myself. In fact, I never really realized how much the idea of being fertile was a part of my self-image. Yes, I planned to have children, but I was also a career woman, very focused on my work. . . and I identified myself as a writer above all. Yet when I was told that my reproductive system had essentially stopped working the right way, I was reeling. I felt like I had lost a piece of myself. It wasn’t only the idea that I could never have my biological child. It was also the idea that my body had stopped doing its "female" job -- and had suddenly jumped ahead so many years. I was old. I had turned from a 38 year old into a ancient crone. I felt that I had lost my fertility and my youth in one fell swoop. . . and there was nothing I could do about it.

Nothing I could do about it. . . This sense of powerlessness was a very large part of my depression. Premature ovarian failure wasn’t like other health problems that I could take care of. There was no magic cure. Yes, I could treat the symptoms, but the underlying cause, the huge change in my life, was completely out of my hands. And that’s where the "why me" came in. Why was I singled out? Why was I stuck with this body that wasn’t working right any more? Why was I old before my time?

All of the other women I interviewed for my book had the same reaction. It’s often even worse for women in surgical menopause, because they have not only been through major surgery, they’ve also literally lost something -- their reproductive organs.

But regardless of whether the premature ovarian failure or early menopause came naturally or through surgery, and regardless of whether we were already mothers or not, we all share similar feelings of profound loss, the same grief and shock, the same pain.

I had been telling the doctor I thought I was going through menopause and he didn’t believe me. Finally he gave me a hormone test and it proved what I had been saying all along. But even though I thought I was menopausal, when I was actually sitting there and he told me I was right, I couldn’t believe it. I thought I would be ready for the bad news, but I guess I wasn’t. I just sat there. 
          -- Diana, age 31

But, as with any life-changing event, you can cope. You can, with time, deal with the reality of loss. You can feel young again, like you again.

To a great degree, coping with the emotional realities of this situation is a step-by-step process. It doesn’t disappear overnight. .. . and, in truth, it never completely disappears. You will have constant reminders about your condition, and some of the pain and loss will never go away. But, as with dealing with death, dealing with the loss of your young womanhood is a slow process of acceptance. You will go through bad times, but you will live through them. And, after some time has passed, you can actually be stronger for the difficult transition you have gone through. While you don’t have the ability to reverse what has happened to you, you do have the power to accept the change, adjust to it and emerge intact.

There’s always change in your life -- whether it’s in your relationships, your job, your health, your family. And premature menopause is another change. It’s another aspect of life. . .. not one I had thought I’d be dealing with at this point, but there’s nothing I can do about that. All I can do is go along with the change. It’s just part of living, really.            -- Rita, age 35

 Acceptance, Coping, and Moving Onward

You can expect your period of mourning, of depression and anger to list at least six months. But, there will come a time, when you will discover that you are getting past the initial emotional fallout. You may still be depressed periodically, or still feel a pang when you see a baby with its mother. . . but these moments will be fewer. You are beginning to feel like you again -- perhaps a new you, but you all the same.

The most crucial step on the way to accepting premature ovarian failure or early menopause is finally realizing that your ovaries aren’t you. Your ovaries have failed. . . but you haven’t. Yes, the "change in life" coming so early does require readjustment -- of your life plans, your lifestyle, and your outlook. But, ultimately, you are still you. Just because you have gone through a transition usually gone through in the middle ages doesn’t mean you are suddenly middle-aged.

No transition is easy -- and premature ovarian failure or early menopause is a particularly difficult one, since it comes unexpectedly, years before you ever dreamed it would happen. Yet it is within your power to handle this transition.. . . and emerge stronger.

In some ways, the negative change of premature ovarian failure or early menopause can actually be a positive force in your life. You are going through a change you didn’t want and didn’t expect, but you can turn this change into something beneficial. Recognize that this can be a milestone that marks a new beginning. Some women find going through premature ovarian failure or early menopause has actually helped them -- because they made it through a difficult transition, they are more self-confident, more directed, and better able to accept the things they can’t change.

Perhaps this is because going through such a major change in life so early, you grow up in ways you never expected to. You have had to cope with a body that is going through major physical changes, emotions that careen all over the place, and the reality that you have moved in past your normal reproductive life. Some women say it’s like going through puberty again, only this time they’re adults, and can handle the raging hormones a little better. Others simply feel that they’ve weathered a tremendous shift in their lives and emerged into a calm after a storm. And others feel as though they’ve moved to a different place in their lives. . . and in their selves.

Going through premature menopause was in a funny way a growing experience for me. It wasn’t easy, and I definitely would have rather not had to go through it. But it has changed me in some positive ways. I’m more self-confident now. I figure if I could deal with all that, I can deal with almost anything.
          -- Marianne, age 32

Sometimes, though, being in premature ovarian failure or early menopause will get to you. You’ll think you’ve got the whole thing licked, and Bam! That familiar mood will hit you, or the questions will re-emerge in your mind. When the going gets tough, remind yourself:

• Just because your body is acting as if it’s older, you’re not. Menopause doesn’t confer instant age, no matter how it may seem sometimes. You are still a young woman -- just one who happens to be going through a transition that usually doesn’t happen for years.
  
• You are still feminine, sexy, desirable. . . and everything else! A change in reproductive ability doesn’t make you less female. You are a woman who can’t have a biological child, perhaps, but you are a woman!

Finally, remember that this, too, shall pass. . .

When you’re having your seventy-eighth hot flash of the day or when you’re feeling like you’re going to explode, remember that you will get through it. When you’re looking at a baby and ready to cry because you won’t be able to have one of your own, or when you’re looking at yourself in the mirror and wondering how this could have happened to you, remember that you are strong enough to handle this. With time, it will get easier.

I speak from experience on this one. A year ago I would never have dreamed that I could sit down and write about the emotional fallout of premature ovarian failure or early menopause without breaking down myself. Yet I have gotten to a place where I can cope. And, yes, I realize I have accepted it. Premature menopause has become just one reality in my life. It isn’t the focal point it once was, when it seemed that everything was related to POF or early menopause. Now POF is something I live with every day. It’s an unfortunate reality, to be sure, but it is something I can deal with. There are days when I don’t think about it at all; and other days, when, in truth, I do get a little down about it and wish that somehow it had never happened. But it has happened. And I do have POF. But it no longer affects my every thought.