My 20-year sticky patch

At 36 and about to be married, HRT was the last thing on her mind. But then Caroline Hawkridge found herself facing a premature menopause after losing both ovaries

The girl in the ad looks young and attractive. On her taut left buttock is a discret little patch. Take HRT, it seems to suggest, and you too can be like this. I am also young, but the patch on my bottom is four times the size of the one in the ad. Much less glamorous, and with all the eroticism of a sandwich bag. "Keep experimenting," my GP said. "HRT is a matter of trial and error, especially for women under 40. You know your own body, so listen to what you feel is normal for you." It seemed rather feeble to admit that I had forgotten how "normal" felt.

I was due to get married when it happened. I started bleeding mid-cycle, so they sent me for a scan. Two ovarian cysts floated on the screen. I had lost my right ovary several years before; this time, the cysts, about 12cm across, were growing on the left. The consultant advised a hysterectomy: the cysts had probably already destroyed the ovary. Six weeks later, the operation went ahead.

Four days later at the age of 36, I tried my first HRT patch. Without it, I faced a premature menopause and severe hot flushes due to the loss of my ovarian sex hormones. I was grateful and relieved, but shocked by my consultant's advice to stay on HRT until at least 60: 20 years seemed a long time to be on any drug.

Slowly my body healed, but I felt a freak. There were so many reminders of what I had lost: tampons left in drawers, kids playing in the street, a hairdresser's innocent chat bemoaning her periods. Even the bridal magazine that Graham, my fiance, bought to cheer me up opened to a page on traditional fertility symbols. I felt I couldn't walk down the aisle: I wasn't a woman.

I regretted the fact I would never have children. Why had I waited so long to get pregnant? Why didn't I rush out and do it after the first bout of surgery in my early twenties?

"You weren't ready," said a friend. "Besides, we were the generation who went out there to grab the opportunities our mothers never had. Remember?" I did, vaguely.

My oestrogen patches were like enormous contact lenses. Often they fell off and I would spot them glistening on the bedroom carpet, or marooned in the shower. Yet they weren't short of adhesive, judging by the fluff they collected or the grey rims I had to scrub off my skin.

Neither did the patches do anything for my vaginal dryness - a common problem of menopause. My GP suggested doubling the oestrogen dose: I could come off the patches and try tablets, or an oestrogen body gel (very popular in France) or a vaginal ring. How could such an exotic array be so uninspiring?

I tried tablets but kept forgetting to take them. This meant, when the oestrogen levels dropped, that I would feel irritable, tired and peculiar, then realise why. "It's like having PMT," I told Gillian, an older woman at work. She was on six-monthly HRT implants. Holding her fingers an inch apart, she tried to persuade me how tiny the incision was. I gave up the tablets but didn't fancy the implants and tried instead some new matrix patches which, it was claimed, were more effective. They were smaller, thinner, easier to peel and stuck painfully to the skin, but they solved the problem of vaginal dryness.

Later, Gillian was diagnosed with breast cancer. Selfishly, I worried. I dug out the leaflet in my box of patches. It spoke of evidence for a slightly higher risk of breast cancer in women who have been on HRT for more than five years. I wondered what the risks were for someone who stayed on it for 20.

The leaflet went on to suggest my doctor and I compare this risk with the benefits of treatment. I made an appointment.

"Breast cancer is common," said the locum. "It affects one in 12 women, usually when they are older, so your friend might have got it anyway, never mind her HRT. "But what about the risk to women on HRT for decades?"

"We don't really know."

I read all the books about the menopause, HRT and the alternatives I could lay my hands on. But it was difficult to work out where someone like me fitted into a debate aimed at older women experiencing the natural menopause.

The benefits of HRT is said to be stronger hearts and bones. Five years or more appear to reduce the risk of heart disease in older women by 30- 50 per cent. However, some researchers argue that women who choose HRT are more likely to have healthy lifestyles, and therefore less heart disease. Research is being done to address this question more clearly, but the answer could take 20 years. And the launch last week of the world's largest study of women's health, involving one million middle-aged British women aged 50 to 60 on HRT to settle the arguments about the risks and benefits, is encouraging.

What should I do in the meantime? When I found out about research which shows that women who lose their ovaries through surgery can double the risk of heart disease and stroke, I gave HRT the benefit of the doubt.

Studies also indicate that five years on HRT, started during the menopause, can reduce older women's risk of fractures by 60 per cent. Women, if they live long enough, can clock up several decades without oestrogen; years linked to possible bone loss, brittleness and breakage. Not a pretty picture. As a young woman without ovaries, I find the possibility of crumbling bones frightening. I am on HRT and I mind about the possibly increased risk of breast cancer. But if I stop, I will mind about the risk of osteoporosis. One thing I do know: I don't want hot flushes or a tube of KY Jelly for my next birthday. But, most of all, I don't want to worry about any of these issues. Not at my age, not when newly married.

We finally did get married - two years later than planned, after I'd got over surgery and its aftermath. It was a fantastic celebration, although I almost forgot to pack the patches for our honeymoonn

An affliction of thousands

l 250,000 women under 40, some in their teens, may suffer from early sex hormone loss.

l In one in 100 women, it is caused by premature ovarian failure (POF). Often the cause is a disorder of the immune system, but sometimes it is unknown. A few women inherit POF. It can also follow successful treatment for leukaemia.

l One in 50 women under 40 has a hysterectomy. Normally the ovaries are left, but removal can be advised for ovarian disease (cancer, cysts) or oestrogen-related problems such as endometriosis.

l At least 500 women in Britain have no ovaries because of genetic disorders such as Turner's syndrome or Androgen insensitivity syndrome.

l Early sex hormone loss is sometimes caused by pituitary problems.

l Usually, HRT is given to younger women to prevent menopausal symptoms and long-term risks associated with the menopause. Those with a womb receive combined HRT to protect against endometrial cancer.Women without a womb receive oestrogen alone, although HRT may be ruled out by oestrogen-related disease. A few women who have early menopause have children through egg donation.

For more information contact (enclosing large SAE) the Amarant Trust Premature Menopause Helpline (0891-660 632 ) or Daisy Chain (which offers support for premature ovarian failure) PO Box 2829, Blandford Forum DT11 8YT.