Review: Before Your Time: The Early Menopause Survival Guide

Before Your Time Cover ArtBefore Your Time: The Early Menopause Survival Guide

By Evalina Weidman Sterling and Angie Best-Boss

Fireside, $16 paperback, ISBN-10 1439108455, 288 pages, original publication April 2010

Every year more than two million women enter early menopause and find themselves suddenly dealing with a host of unforeseen (and little discussed) issues. In Before Your Time, Evelina Weidman Sterling and Angie Best-Boss provide expert advice and answer all your questions, including:

  • Is it safe to start hormone therapy in your thirties rather than in your fifties?
  • What are your fertility options?
  • How can you combat the long-term effects of early menopause, such as a greater risk of osteoporosis, heart disease, and diabetes?
  • How will early menopause affect your relationships? Your sex life? Your sense of self?

Let me start off by saying no one is excused from reading about this topic on grounds of gender or age. YOU might not be affected by premature menopause or ovarian failure/insufficiency, but your sister? Your wife? Your best friend? Your sweet little four-year-old daughter who doesn’t even know what an ovary is yet? You have no idea who in your life might be affected by this condition and need resources, and I will tell you from experience that resources are few and far between on this topic at this time. With that said, ladies and gentlemen, let’s get open-minded and maybe a little too personal!

When my doctor first used the term “premature ovarian failure,” I had never heard of such a thing. I even thought it was a synonym for early menopause. I tried Internet searches and medical databases, but I did not turn up much information beyond the very basics. Searching for books seemed like the next logical step, but the search term brought up no results at my local libraries, including the Big 12 university library nearby. I searched for books on menopause instead and  found Before Your Time: The Early Menopause Survival Guide. By that time, I’d read enough to know that my doctor wasn’t telling me that I’m going into menopause, but since many of the symptoms are the same, I picked up this book.

I loved some aspects of the book and would recommend it to anyone struggling with POI or POF. First, it explains the difference between premature menopause, primary ovarian failure/insufficiency (POF or POI) and secondary ovarian failure/insufficiency. The terms are not interchangeable, and underlying causes may or may not be the same.

The book’s symptom list alone is far more exhaustive than I have found anywhere else and covered symptoms I did not even realize were related to ovarian failure. Those palpitations that I feared were an early manifestation of my family’s terrible cardiac genes? Nope, they’re common in women with ovarian failure. My sudden need to go to the bathroom ALL the time? Probably not a sign of diabetes. Reading the list made me sad and angry (how can one problem cause so many annoying or life-altering symptoms?), but realizing some of my more frightening health bugaboos were just symptoms of my hormonal problems laid some fears to rest.

Possible causes are covered to the best of the authors’ ability, though they freely admit that medical research in this subject is still in its infancy, so most women will never know why POF or POI has affected them, and there is no cure. The tone is compassionate but upbeat as the authors discuss both prescription and alternative symptom management options as well as fertility treatment possibilities.

As resources for this problem go, this book is excellent. However, I did have four complaints:

1. The title. Before Your Time? Did I die in a fiery accident and someone forgot to tell me? First of all, there is no set age at which menopause should occur, and ovarian dysfunction can happen to any woman at any age. Experiencing this change before the stereotypical time frame doesn’t mean you’re hitting some cosmic deadline too soon. Your body is unique and runs on its own schedule. Just as you didn’t hit puberty at the same exact second as every other girl you knew, you aren’t necessarily going to hit menopause on your 50th birthday. Second, menopause isn’t a death sentence for young women any more than it is for women in their 50s and 60s. While your risk of heart disease and osteoporosis among other bugaboos (dementia, anyone?) does go up, with management and treatment you can keep living  an active, healthy life. Life does not end when fertility is gone.

The subtitle is no better: while this book does touch on early menopause a couple of times, I’d estimate that 95% of it is actually about POF and POI, which again are not exactly the same thing. I suppose the authors used “early menopause” in the title because POF and POI are not well-known terms, but could they not have said “Early Menopause and Ovarian Failure Survival Guide”? Three little extra words to raise awareness and accuracy? I nearly passed this book over because I had other books on menopause already, and I am not IN menopause. If I had not read it, I would not have known it applied to me as well.

2. The cover art. The single, discreet tulip on the cover only adds to the “let’s plan your funeral” design vibe. While the absence of the happy, active seniors commonly featured on menopause literature is certainly welcome, the art could have been more appropriate. Say, a few racially diverse women in different outfits (active wear, casual wear, a business suit) looking at their abdomens and holding up their hands as though to say, “What the fuck are you doing, ovaries? Could you get your heads in the game, please? I have a five year plan, you know!”


Tulips: For when pictures of what's really wrong are just, like, too ucky, you guys!


3. The attitude (at times). Yes, it’s a crummy situation to find yourself in: You’re 20 or 30, you should be having a great sex life and possibly some kids, but instead you’re having hot flashes, can’t remember your own name half the time, and you’re afraid you’re going to need to steal from Grandma’s stash of Depends, and that’s not even getting started on the osteoporosis risk. I’m sure for many women, it does cause a complete identity crisis, particularly those that always saw themselves as future mothers or who identify fertility with womanhood. Yes, that deserves consideration and sympathy.

I thought this book took it a little too far, though, assuming that sufferers will probably ask questions like, “Am I even still a woman?” I’m sure some women do feel that way, but when I read that question, I thought, “Now, wait a minute. I don’t feel that I’m no longer a woman… Should I? Is gender confusion going to sneak up and bite me in the butt at any moment, and I will suddenly question my entire identity, which has been created by years of education, experiences, and emotions? Should I question it just because I have to take hormone replacement therapy and probably can’t have a baby?” I decided that, no, that’s not something I’ll face. I just don’t feel that way. I am female, regardless of whether the parts work correctly or not. The book just made the self-doubt sound so inevitable that I doubted my own feelings for a moment.

4. The sex chapter. I had higher hopes for this chapter than anything in the rest of the book. More than any other symptoms, I want the low libido and pelvic area problems to GO THE HELL AWAY. Since the authors started off putting so much emphasis on “This is a physical problem with physical symptoms, so don’t let anyone tell you it’s all in your head,” I was extremely disappointed when this chapter suggested that whether or not this problem affects your sex life is indeed all in your head! The authors emphasize the old “the brain is the biggest sexual organ” and “men need a place to have sex, women need a purpose” chestnuts. They even quote an expert who says that some women find their sexual symptoms improve when they get a new partner. Rather than mention the fact that new relationships cause new chemicals to release that do indeed create more lust, the authors go on to say that making sure your relationship is secure and healthy is the most helpful thing you can do, and the rest depends on your attitude.

To me, the most frightening part of this condition is how it is affecting and will affect my relationship, and this book did nothing to allay those fears. I think my boyfriend is gorgeous, and I adore him. He rescues dogs. He helps stranded motorists. He can lift the front end of a car without assistance (although he does turn a particularly vibrant shade of red). He’s funny and smart and creative, and he respects me. Most of the time. Except for that fear of clowns thing. Anyway, I can’t think myself out of low libido. This book assumes that women with low libido have no interest in sex, as though their awareness of the sex act just vanishes and they never think about it again. Nowhere does it say what to do if your brain still thinks sex is a great idea but your body is out to lunch. I was so disappointed, I cried.

If you or someone you love is struggling with premature menopause, POI, or POF, this book is a must. However, don’t stop with this book. It has some great information, but it’s an incomplete resource. Be sure you check out other resources, such as other recent books on hormone therapy, estrogen deficiency, and menopause, as well as these websites:

The International Primary Ovarian Failure Association

The National Institute of Child Health and Human Development

Also, remember that your doctor isn’t your only resource for dealing with your symptoms. Talk to your pharmacist about your medications and alternative solutions. If your doctor and pharmacist do not seem very knowledgeable on this topic, find new ones. It can be difficult to find professionals who are well-versed in this issue, but the difference in a doctor who’s in the know and one who throws birth control pills at the problem or, worse, treats you like a hypochondriac, can be the difference in getting your symptoms under control and losing your normal life to your own body chemistry.

Above all, remember that you want others to love you for who you are as a complete person, for what you can do and what you can’t do. Love your body in the same way and do your best for its health. It’s the only one you’ve got!

Writing: 3

Content: 4

Authority: 5

Value: 4

Cover Art: 2

Overall: 3.6