When menopause strikes early: Jan’s story

Jan MacKay experienced her first hot flash at just 25. She found her way to Sinai Health’s Dr. Wendy Wolfman, whom she credits not just with her two beautiful children – but with her continued health and wellbeing after going through menopause at 35. Now 64, she wants women’s voices to be heard so they don’t have to go through it alone.

Jan MacKay was in the middle of class teaching Macbeth to a group of high school students when it happened: her first hot flash.

“I was in my 80s power suit when this all-encompassing wave of heat just came at me. I thought, wow, if I didn't know any better, I would have said this was a hot flash! No, I thought. I’m getting married soon. I have a job. This is just stress.”

But it didn’t stop. Jan went to her doctor for bloodwork, which showed extremely high follicle-stimulating hormone (FSH) levels, which are typically associated with menopause. Jan’s levels were so high, in fact, that her doctor thought there had to be a mistake. He reordered the tests.

Rerunning that bloodwork would be a double-edged sword: the results were the same, and there were still no answers. But this time, a young doctor named Dr. Wendy Wolfman was in the clinic. Dr. Wolfman took over Jan’s care.

Jan was able to conceive two children, both difficult births delivered by Dr. Wolfman – but the hot flashes, brain fog and trouble sleeping came back. By age 35, she was in menopause. How could this be happening?

Nearly 40 years later, Jan now knows she was experiencing premature ovarian insufficiency (POI) – a term that refers to when a woman under 40 goes through menopause. The term did not exist at the time, leaving Jan feeling alone and ashamed.

“At age 25, all my friends were getting married. I wasn’t going to tell them I was having hot flashes. I didn’t tell a single girlfriend until my 50s,” she says. “I was young, I was attractive. I felt a deep sense of shame, that this made me ugly, less sexy, less valued, deficient. It’s a loss with very little support.”

The causes of POI are largely unknown, and it remains an understudied area of medicine – which is unfortunately still the case with many health concerns affecting women, especially as they age.

“There’s a huge stigma for this group of women under the age of 40, whose care has not been prioritized by society,” says Dr. Wolfman, who is now the director of Mount Sinai’s Centre for Mature Women’s Health. “It's really a group of women who need to be addressed because there are so many aspects of their lives that are being affected.”

POI affects nearly four per cent of women worldwide, amounting to nearly 800,000 Canadian women whose adult lives are completely disrupted just when they’re getting started.

Dr. Wolfman was really the only other woman who knew what Jan was going through. Once it was clear she was in menopause, the two worked together to find the right balance of hormone replacement therapy (HRT) to help Jan live her life symptom-free – just like her peers of the same age. Jan continues to see Dr. Wolfman to monitor her therapy.

“Never once did Dr. Wolfman make me feel belittled as we worked through some initial tweaks. It was a partnership. I would not have been looked after so well anywhere other than Sinai Health and by Dr. Wolfman.”

Dr. Wolfman wants every woman to know that the symptoms of menopause, like those Jan went through, are not trivial and there is help. “Menopause affects every aspect of women’s lives. It’s critical that we listen to women and prioritize treating symptoms of menopause when they interfere with daily life.”

Jan agrees: “If I could have a wish for the women out there, regardless of their age, it’s to have their voices heard. Menopause can be overwhelming.”

Sinai Health is home to Canada’s only POI clinic, underscoring the lack of care available to women like Jan. With donor support for our $50-million campaign to establish the Centre for Mature Women’s Health, Sinai Health aims to address this gap in care and break down stigma. How? By expanding our clinic to treat more women like Jan, training more physicians in caring for menopausal women and spearheading new research into understudied conditions like POI.

Jan is excited about the idea of a Centre for Mature Women’s Health. “I think it’s revelatory. This is so unique, so overdue and so important. There are so many women who need help, who need to be heard.”

But most of all, Jan is grateful to Dr. Wolfman for her wisdom over nearly 40 years of care, guidance and friendship. “She is one of the top three most important women in my life.”