Claire was 27 when she married Jeremy Tan*. The couple waited almost two years before they started planning for a family.

“I told my gynaecologist I was ready to have a baby, and he advised me on how I could prepare for it, like starting on folic acid and recording my basal temperature so I would know when I was ovulating,” says the marketing manager.

But after trying in vain for two years, Claire was desperate for answers.

“I went through several tests, including a hysterosalpingogram, which involves injecting a dye into the fallopian tubes to check for blockage. All the tests turned out clear and I did not have any abnormalities,” she says.

That prompted her gynaecologist to suggest intra-uterine insemination (IUI) or in vitro fertilisation (IVF) as the next course of action.

Following her two ovarian cystectomies, Claire was worried she wouldn’t be able to have another child, but her gynaecologist assured her it wasn’t a problem. This gave the couple the encouragement to work on baby number two.

However, when Claire turned 36, things took a turn for the worse.

“I started feeling hot flushes. My palms and face would get very warm. The sensation would build up and last for a few minutes before subsiding. This happened a few times a day. I was also getting increasingly irritable.”

After a month of this, Claire decided to visit her gynaecologist. “The hot flushes started to really bother me; that, plus the fact that I was having trouble conceiving got me worried that I might be menopausal, although I knew I was too young.” She shared her fears with her gynae, who suggested a blood test. The results showed that she was perimenopausal.

“Naturally, the news came as a shock. I was only 36 then!”

A transitional phase before menopause, perimenopause occurs when the ovaries begin to produce less oestrogen; it can last anywhere from 10 years to several months before menopause is fully reached.

As Claire was still having the occasional period, her doctor left it to her to decide whether to start hormonal replacement therapy (HRT).

“I was concerned that starting HRT could put me at a slightly higher risk for certain cancers and other conditions, so I opted not to do it. Instead, I started a gym routine to help counter bone-density loss by building muscle. It also helped regulate my menstrual cycle, which went back to normal.” HRT can increase the risk of breast cancer, stroke, heart disease and cancer of the uterus and ovaries, but doctors say you can cut your risk by not smoking, eating healthily and exercising regularly.

Credit: masharotari/Twenty20

Despite the setback, Claire and Jeremy were still hoping to conceive a second child, and consulted a fertility specialist on their chances of conceiving through IVF.

“After further testing, the prognosis was not good,” shares Claire. “I was told I had lost too much ovarian tissue from the two cystectomies and most likely didn’t have a sufficient amount of good quality eggs to try for IVF.

“Up until that point, I had held on to the hope that I could still get pregnant. My husband and I talked about adoption but in the end, we decided we were contented to have a beautiful son.” For now, Claire is focused on managing her symptoms and leading a healthy and active lifestyle. “I’ve learnt to live with the symptoms. The hot flushes are quite a pain, especially with our hot weather, but you get used to it and just wait for it to pass.

“As far as my mood swings go, I think I’m managing okay, but my husband might say otherwise! Perimenopause also affects our sex life. The drop in oestrogen levels leads to vaginal dryness and a very tight cervix, so sex is pretty unbearable. “It helps that Jeremy is very understanding, and we make an extra effort to demonstrate intimacy in other ways, such as cuddling and saying ‘I love you’ more frequently. I also use lubricant applicators, which help ease the discomfort somewhat.”

“I’m also mindful about my risk of osteoporosis – my bone-density tests show that I have osteopenia (the stage before osteoporosis), so I try to exercise regularly to maintain good bone health. Since I switched jobs, it’s been difficult keeping to my gym routine but I plan to start again. Hopefully, I won’t have other health issues and be a burden to my only child.”

While life may not have turned out the way they expected, Claire and Jeremy have maintained a positive outlook. “There is no need to look back. We are thankful for what we have. After what I’ve gone through, I always tell my married friends not to wait to start a family. If there are any issues, at least time is on your side.”

*Name has been changed

Text: Sunita Shahdadpuri
This story was first published in Feb 2017.