June writes, Dr Eddie, I would appreciate your insights and thoughts. Before anyone of my medical journey happened I am in a job – a caring profession – where I feel stressed, unsupported and burnt out.  It all started last May I had some bleeds. During this period between investigations and results, I convinced myself that I had cancer and that I would be saying goodbye to my two children, I didn’t really talk to anyone about this.  Thankfully it wasn’t cancerous and it turned out to be a large growing fibroid. Time rolled on and I went to see a consultant who is a genuine caring doctor and he said that surgery was required and that he had would have me in within 6 weeks.  This coincided with my youngest starting school. This really set me off.  Now here is the rub,  I am 44 all I can think about is having another child, I have so many emotions I am tearful, upset, distressed, depressed, angry regretful, and anxious all at once. I wake up at each night, anxious and profound sadness with images of a third child.  I feel I can’t cope. I struggle to get on with the simplest of things cooking, and washing. It’s not like my husband and I actively wanted a third child, I had the coil in, but this news of having to have a hysterectomy has floored me. He paradox is that I want a third child, my fibroid looks like I am pregnant and yet I will be having a hysterectomy shortly. I say to myself cop on, you have two wonderful children look at those who have none and those really struggling. Any help appreciated.      

Dr. Eddie, Thank you Mary for writing.  This year has certainly thrown serious health challenges.  A number of key issues strike me, one is the accumulation of stressful life events; Job stress and burnout; the unknown phase – thinking you had cancer; confirmation of fibroid; youngest child starting school; a desire to have another child; scheduled surgery.  Taking all these into account one could be forgiven for experiencing low mood and anxiety. Given that you talk about waking each night and the number of these significant life events I think a visit to your GP is advisable to assess. Often there is a response called an ‘Adjustment Reaction’ or more recently called ‘stress response syndrome’. This is essentially is a short-term presentation that occurs when a person has great difficulty coping with, or adjusting to, a particular source of stress and there is often some of the symptoms of  depression such as tearfulness, feelings of hopelessness, and loss of interest in work or activities. Unlike clinical depression the situation generally resolves once you adapt to the situation.

Now that’s one way of looking at it and I would be neglectful if I did not give you the advice above. However, I think there is something more profoundly happening here. Triggered and linked by your youngest child going to school and the finality of a hysterectomy, i.e. the removal of your womb I believe that this crisis is a grieving for a number of profound losses – for a third child, the potentiality of having a third child, the loss of your womb. These feeling of anxiety, sadness, anger, and regret are often associated with bereavement.  Allowing yourself to grieve this loss; only by doing so will you allow the healing process to start. It’s ok not to be ok. It’s ok to feel sad and yet have two healthy children. These are your feelings and they are valid.

When it comes to bereavement it’s important to feel the pain, go all the way in and go all the way through, avoidance will only prolong the loss. Sometimes things are said verbally and said behaviourally. The regret of not having another child yet having the coil in reflects that for many couples they can communicate non-verbally e.g. ‘we love our children, we love each other, we don’t want another child, we won’t definitively close that door to another child and maintain that ambiguity’ sometimes that non-verbal way is easier than facing up to the reality of verbalising categorically that you don’t want another child. Many times people prefer to live with ambiguity and reality is too uncomfortable.

The finality of hysterectomy can trigger many negative emotions for women and grieving the loss of childbearing is very common after a hysterectomy.  They feel a loss of possibility, a loss of choice. Your feelings mirror this, the confusion, the thoughts and images of a third child.   Now is the time to focus on compassionate self-care pre surgery and after surgery.

Talk is critical, don’t bottle it up talk to those who you trust who will give you time. Getting to a space of compassion and acceptance takes work.  One way of helping to find a compassionate voice is what advice would you give to a friend with these thoughts?  Often what we tell a friend is supportive and encouraging while on the other hand we can be so quick to be punitive with ourselves. It might be useful to find a counsellor where you can talk through some of these feelings. There are some online support groups for those undergoing hysterectomy; www.hystersisters.com.   There is no easy solution, it’s a process. Lots of minding yourself is required to nurture yourself back into a healthy place both emotionally and physically.