‘Dear Estrogen, We need to talk!’ My Journey through Womanhood

Congratulations, it’s a girl!”

“I like the name, Uzma,” I imagine my mother saying with joy, holding her baby girl.

Thus started a long association between us.

You and I.

A relationship decided and sealed at birth, my X chromosome, a tiny strand of DNA, picked my destiny. A daughter, a sister, a woman, a wife, a mother, all these roles woven sequentially in the microscopic double helical protein within my cells.

Dormant inside of me were two tiny organs holding within my fertility in form of finite number of eggs.

The chief conductor of the orchestra of womanhood, the maestro, “You,” the Estrogen and “I,” the human female.

After a quiet phase, you started to conduct music, slowly and gently. Your ebbs and flows, coordinated meticulously with your accomplices, the progesterone, luteinizing hormone and follicular stimulating hormones.

As I started to mature physically, my chest would feel tender and sore and I couldn’t understand why. Running through my blood, you slowly started stimulating the growth of my breasts and catalyzing numerous changes all over. Then, around my 13th birthday, you roared, you, the mighty hormone Estrogen surging through my thin and petite body. The first crescendo and decrescendo of estrogen and the event called “menarche.”

“Mummy, I have blood on my underwear!!” I yelled, scared that something awful has happened to me as I was getting ready to take a bath.

“Finish your bath, we will talk later,” my mother, failing to hide her horrified expression peeking inside the bathroom, reassured me in her usual contained manner.

I wasn’t quite prepared for “it,” neither the “periods” nor the “talk” and she didn’t seem ready either.

Raised in an Islamic conservative culture in Pakistan, where the whole society is an overt denial of sexuality, puberty is neither a welcome transition nor an exciting discussion. It usually triggers discussion about marriage, saving money for marriage and dowry and other expenditures. In summary, myriad of worries and stress for parents. Mothers don’t engage in discussion with daughters about sex and sexuality. It’s usually the older sisters or friends that enlighten the dazed young woman. Most sex education comes from foreign movies and literature.

“We didn’t even have pads, my mom washed an old cloth and cut it into pieces and we used those, you are lucky to have sanitary pads.” My mother reminisced.

I didn’t feel particularly lucky but I listened.

End of the “talk.”

My life was no longer simple as I dealt with the necessity of bleeding every month for no “real “reason. I had been delivered nature’s gift for womankind. At 13 years, it was hard to wrap my brain around the fascinating intricacies of a female body and looking back, I was a very naïve 13 year old. I didn’t have much exposure like a thirteen year would in this day and age. My ninth grade biology book however was quite helpful in understanding because it was a “foreign” edition and actually had the chapter on “Sex and Reproduction” unlike the state-censored text books.

“My periods hurt a lot, these cramps are awful!”

“I get diarrhea with my cycle!” they said.

“I can’t wait to go into menopause!” I joined in.

We all giggled, silly teenagers, finding comfort in conversing and longing for menopause. Together we celebrated our arrival into womanhood, our newly acquired bras and secretly talked about boys.

My body was changing in so many ways. My boy-like flat chest was getting curvy. I was no longer allowed to play outside with boys albeit it gets hit with a cricket ball somewhere “sensitive” (Read as “chest”).

Stepping into womanhood also meant facing stereotypes and sexism. The “PMS” jokes and misogyny of my native culture gradually was evident to me. Slowly, I understood I belong to a “minority” group being a woman. I became aware of gender based quotas in educational institutions and the limits on the sport activities available to women, the estrogen-laden female gender.

Perhaps it is you and your impact that makes a woman unpredictable, your play with the serotonin and endorphins in my brain, the highs and the lows. Scheduled yet unpredictable. No wonder you remain the topic of research for scientists all over.

It’s not just about uterus and ovaries for you, unlike most believe. Your charming presence stimulates everything from the brain to the bones, from the pelvis to the heart; you remain vital to so many body processes. You are part of the miracle of conception and procreation. You took charge and moved things forward. Just like all relationships, it was so exciting in the beginning. You transitioned me into the magical world of womanhood with femininity, intimacy, sex and love. You made possible the funny tingling feelings that one feels in love in places you don’t expect.

“How often do you get migraine?”

“At least once right before my periods.”

“You have premenstrual migraines. May be you can chart your migraines on a calendar” my doctor suggested.

You, thus, brought your own share of medical problems. Sometimes, I wished for menopause just so I could rid myself of those throbbing, lingering headaches. The migraines remained the bane of my existence through medical school and then residency. The night calls particularly made me vulnerable to severe episodes but as a young resident, new in the US, the land of opportunity, I didn’t care.

A different and a liberated culture where dating and male companionship is the norm. I hesitatingly adjusted and very quickly he took a liking to me.

“I love you.” He said.

“I love you too.” I replied.

A wave of funny sensations spread all over my body, in parts, known and unknown to me. We hugged. We blended into each other. Yet another aspect of womanhood, entered my life.

“So you didn’t have a period this month?”

“May be I should do a pregnancy test or see the doctor?

“Congrats, you are going to be a mom! “The doctor smiled.

Oh, the joy I experienced that day. As your levels rose within me, nurturing the tiny little being inside my body. High on hormones, I waddled along in life. The headaches disappeared for a full five months.

“He is so beautiful!”

“Look at his hands, they are so tiny, my precious little baby!”

A new mother, although with a picture perfect life, I was quite lost in the first few days . I remember how much I missed your might after I had my son. Sad and anxious, so unsure of myself. For nine months, your mighty presence propelled me. Now the high was gone, leaving me with the post partum blues. At times, I thought I am just not a good enough mother and taking care of a newborn isn’t something I can ever do. I felt inadequate. Gradually, as I found my bearing, I started to recover and life continued.

I was blessed with another child. Not so hard the second time around, I coped with the hormonal decline better.

Two years after her birth, I was told “You have breast cancer!”

Things between us changed that day. It was shocking to hear but I was told that you were in cahoots with the cancer and because of you the cancer in my breast was thriving and growing.

“The pathology report shows that your cancer is Estrogen Receptor Positive , which essentially means that estrogen in your body helps the cancer grow “

I felt betrayed.

I needed you and you took care of me. You nurtured me through two pregnancies. It was your glow on my face; it was your gloss in the thickness of my hair, it was your presence. You sustained me.

And now? You left me ambivalent and my trust shaken. I want you to stay, believe me I do. But my options are narrow.

Our relationship has run its course. It is time for me to move on.

It’s time for me to let go what is no longer meant for me.

Cancer has made me wiser. I have learned to gracefully let go what isn’t sustaining me.

You still are important to me.

I will miss you tremendously, down to my bones. As my blood robs me of my calcium, I will no longer have a trusted friend, making sure my bones stay strong.

As I sweat through every hot flash, I will think of you.

My heart will ache for you as my coronaries with thicken and stiffen without your protection.

My brain will miss the shield you hold against memory loss.

I will miss being a complete woman without you.

“So have you decided what are we going to do about your ovaries? You are too young to have a natural menopause. Your Estrogen levels are too high!” my oncologist nudged me gently.

I need to let you go. I do. If I don’t, there is a chance that I may not make it. I may not live to see my kids grow up. I may not grow old with my husband. I may not be there for my friends. I have come to believe that I have greater purpose in life. I want to write and reach out to others. I want to travel. I want to share my experiences and live life fully.

With you, it may not be possible.

It could have been that we parted ways naturally, slowly and gradually you pulling back and I accepting this with grace and grey in my hair, the natural menopause, but the time to separate came so much earlier.

When I let go, maybe I will get depressed like my mother did, during her menopause, maybe I will get osteoporosis at a young age. The risk of heart disease will be higher for me and I hear that the hot flashes will melt me every time I get one but I have to accept all of this. For the sake of surviving cancer, I must part with you.

I am so sorry.

You have helped me so much.

Reluctantly and with a heavy heart, I made the appointment.

“Uzma, here is your Zoladex shot. It’s going to hurt a little. This medication will put you in a medical menopause. By suppressing your ovaries and stopping estrogen production, there is a good chance of reducing recurrence of your breast cancer. This is a wise choice!”

Yes, un-woman me now. It’s over, Estrogen, it’s over between us!