When Carla missed her period at 42, she happily suspected she was pregnant with her second child.
However, a pregnancy test told her otherwise. Blood tests revealed she was in early menopause, shattering her dreams of a natural conception. "I was devastated and in disbelief," Carla says. "It just came out of nowhere."
Physically, there had been no warning - in a cruel biological twist, Carla had been breastfeeding and perimenopausal at the same time. "I was told I was born with less eggs than everybody else. I was angry and felt a huge sense of loss."
Hot flushes, weight gain, mood swings, insomnia - menopause can be unpleasant at any age, but even more so when it occurs earlier than the usual age of about 50. Early menopause can have a major impact on a woman's well-being, says Melbourne psychologist Dr Mandy Deeks. "It's not uncommon for a woman to feel a sense of loss and grief. It can affect relationships and many women question their role and identity."
Around eight per cent of women experience early menopause, defined as when the final menstrual period occurs before the age of 45. In some cases, early menopause is brought on by surgery or by other medical treatments such as chemotherapy. In others, the woman's ovaries spontaneously stop producing eggs, as happened to Carla.
Loss of fertility is not the only consequence of early menopause. Kylie Gabutto of Cairns was 43 when she developed ovarian cysts that resulted in both ovaries being removed, followed by the immediate onset of surgically induced menopause.
The hot flushes were severe, hitting her several times an hour, she had trouble sleeping, and her libido disappeared. "It was like someone had turned a key and that part of me didn't exist any more," she says. "I didn't even want to look at my husband and I mourned the loss of our intimacy."
While Gabutto's physical symptoms were acute, the psychological effects were more distressing. "I lost confidence and couldn't think or communicate the same way. I felt like I wasn't functioning as a normal person." This had a knock-on effect in her professional life. "I was moody and had a bad attitude."
Her experience is not uncommon. "Women who have surgical menopause tend to have higher rates of depression and anxiety," says Deeks. "The sudden change in hormones make symptoms more severe and unpredictable."
Although her GP recommended antidepressants, Gabutto took a different approach. She found relief in hormone replacement therapy (HRT). Although it took over 12 months to take effect, HRT alleviated her symptoms and improved her quality of life considerably. "It has made a huge difference in terms of feeling myself again," Gabutto says. "HRT helped to stabilise my emotions."
This gave her back some of the control she felt she had lost. She also was open about her experience and discussed menopause publicly. "When people asked what was wrong, I told them. I wasn't ashamed about it."
Early menopause is not all bad news, though. For Melbourne sales professional Catherine Whelan, 35, who endured years of endometriosis, surgically induced menopause significantly improved her quality of life. Whelan made the choice to have a full hysterectomy at 34, knowing it would bring on early menopause. "I didn't feel like having children, being so unhealthy myself," she says. Although she felt sad for this loss, it was only brief. "I was just so relieved my long-term health battles were over."
Despite gaining 18 kilograms and experiencing crushing fatigue and hot flushes, Whelan says being free of endometriosis outweighs everything.
Every woman's experience of menopause will be different, but Deeks reminds us that it's a normal stage of life. And she encourages women to talk about it. "When you keep it a secret, you swallow it, and it's got to go somewhere. Do the best you can for your physical and emotional health and get the support you need."