Read an Excerpt

ONE
 
“I’m What?!”
 
"YOUR mother has breast cancer.” Months of her complaints of terrible stomachaches and a general malaise had led me to speculate about many ailments that might afflict my eighty-four-year-old mother, but somehow breast cancer was never on the list. I had trouble concentrating on what else the doctor—six thousand miles away in Britain—was saying, my mind already racing about possible treatments and fretting over how scared my mother must be. Although the doctor kept talking, her words seemed to run together and I let the telephone slip away from my ear. I stared out the window of my San Francisco hotel room. A thick blanket of fog saturated the city and our twentieth-floor room seemed as if it were suspended in clouds. It added to the already surreal effect of getting this disturbing news, only a few years after my mother’s sister—who had helped raise me—had been diagnosed with the same cancer.
 
“What’s the matter?” asked my husband, Gerald. He put down his newspaper and walked over when he sensed that something was terribly amiss.
 
“Mum has breast cancer.”
 
“What!”
 
He had been wonderfully supportive through my mother’s recent illnesses and had helped prepare me for possible bad news, but not for this. When I finally got off the phone with the doctor, and before I called my mother, my husband gently kissed me. “She’s a survivor,” he said. “If anyone can pull through this, she will.” I nodded, wanting to believe that his confidence was not misplaced.
 
“And if there is any silver lining,” he continued, “aren’t you glad you made the choice you did last spring?”
 
For a moment I had almost forgotten. Over a year ago— in 1997—I’d had my annual physical in my doctor’s office on the Upper East Side of Manhattan. Everything had seemed fine. Cholesterol was low, blood pressure normal, and vital signs good. A week later he telephoned.
 
“Your blood test just came back.”
 
His voice seemed tense, but I thought I might be imagining it since a call from my doctor was unexpected.
 
“Anything wrong?”
 
“No, no. But I did want you to know that your FSH [follicle-stimulating hormone] serum levels came back at one hundred ten, and the normal range is between two and ten.”
 
“What does that mean?”
 
“It means you are in full-blown menopause.”
 
Different, and obviously much less frightening than hearing about my mother’s cancer, but just as startling. I was forty-six. I had read articles and seen documentaries about perimenopause—the several-year span of wildly varying hormonal levels that precedes full menopause— and had always expected that I would get some distinct signs. There were none I could immediately think of. And somehow I felt I was a little too young. My mother had passed through a moderately difficult change of life in her mid-fifties. Two maternal aunts were also in their fifties when they were in menopause. Maybe, believing it might be a decade away, I had merely put off any serious thought of it, conveniently not paying attention to any symptoms.
 
“Are you sure?” I asked my doctor.
 
“No doubt about it, Trisha,” he said, trying to be reassuring but only adding a little to my angst. “Your numbers are so high, you are well into the change. It’s time to make a quick appointment with your gynecologist.”
 
The only real concern I had about menopause was that it brought to a head my long-standing indecision regarding hormone replacement therapy. No longer was estrogen simply the subject of a heated luncheon debate with a group of girlfriends, none of us menopausal but all with strong opinions pro and con. Now I faced an imminent decision: Was estrogen right for me, or could I pass through menopause without it?
 
My gynecologist of nearly twenty years left no doubt about the choice I should make if I was—in his words—“an intelligent, well-informed woman who wanted to ensure that her health remained good and that she was vital for her later years.” It was his not very subtle way of recommending an immediate program of estrogen and progestin. If I did not start promptly, he warned, a host of virtually cataclysmic events would overtake my body.
 
“You are in complete uterine failure,” he said grimly, as though he were informing me about some fatal condition. “This isn’t good at all. Your blood test reveals that your estrogen is gone. Your bones are probably already losing mass. You have to worry about osteoporosis.” He had zeroed in on one of my major apprehensions; since I’m allergic to almost all dairy products, I’ve always resorted to supplements for my calcium.
 
He did not, however, let me think about that for very long before adding new concerns. “Your heart is no longer getting any protective effects from your hormones,” he announced. “Your memory will worsen. Your metabolism is going to get sluggish, and fat is going to start depositing as you lose muscle tissue. You have to start a program now.”
 
“But my aunt has breast cancer, and it concerns me,” I protested weakly.
 
“He waved his arm in a large dismissive arc. “Rubbish. More women die of heart disease than ever die of breast cancer. The studies that raise fear about estrogen are biased and wrong. Estrogen doesn’t increase your risk of breast cancer. If you let your fear stop you, you will be sorry for the toll your body will suffer. You really don’t have another choice. Doing nothing is negligent.”
 
Despite, or maybe because of, his persistence, I decided that day to be obstinate, and refused to immediately start a program of long-term hormone replacement, even if the odds of increased breast and uterine cancer were small. I was not willing to play Russian roulette with my health, no matter how small the risk, at least not until I had satisfied myself there was no other alternative. Moreover, my mother and her sisters had passed through menopause without hormone replacement, and they had lived on their own, healthy and mentally vibrant well into their eighties. I mentioned this to my doctor.
 
“It’s a mistake, Trisha,” he said. “The benefits of estrogen are too important to ignore. Every month you wait sets you further back.”
 
“I’ll be back in a few months,” I told him. “Let’s see what develops.”