When you have breast cancer, especially metastatic breast cancer—where the disease has spread to other areas of your body and becomes a kind of terrible roommate—your body goes through a lot of changes. For me, some were permanent, like the surgical removal of my breasts. Others were fleeting, like when I lost 10 pounds in two weeks, or lived without eyelashes for a couple of months. Some changes are reliable for their unreliability, like feeling too tired to meet friends for drinks when yesterday I felt fine. Or, thanks to a semi-full-time chemotherapy regimen, walking a constant gastrointestinal tightrope between constipation and diarrhea. Living with this disease, I have discovered that I can tolerate, and even ignore, a whole bunch of physical discomforts. So when I decided to remove my ovaries and go through menopause at 32, I figured I could handle it.

I was diagnosed with estrogen-receptor-positive breast cancer at age 29. This is the most common type of breast cancer, and it means that the cancer is fueled, at least in part, by estrogen. I experienced a recurrence at 31, when the disease showed up in my liver. Having already undergone a mastectomy, chemo, and radiation, it was time to look into depriving the disease of its food source. I chose to surgically-induce menopause to do everything in my power to extend my life. If my ovaries were producing the bulk of my body’s estrogen, they had to go.

Women with breast cancer may experience early menopause for one of three reasons: The chemo damages the ovaries and they stop functioning. Drugs are used to temporarily shut down the ovaries, to give the body a break from high levels of estrogen. Or, the ovaries are removed.

The procedure, called an oophorectomy, was manageable (especially compared to a mastectomy), and I have two small scars, less than an inch each and fading, on my abdomen. The symptoms were expected: hot flashes, which are annoying; night sweats, which are disgusting; and low libido and pain during sex, which is maddening. These are layers of discomfort and frustration that certainly do not make life any easier. But the biggest challenge that early menopause presents for me, now 33, is the near-total elimination of the possibility of having kids.

Around the time I got married four years ago, I harvested my eggs, because we knew then all of this might happen. So IVF is an option—sort of. I can’t get pregnant (that would be an upswing of estrogen), so I’d have to use a surrogate.

Adoption is another option—sort of. Like IVF, it's expensive and time-consuming, and comes with a multitude of unknowns.

In a parallel universe, I would probably have gotten pregnant by now. Many of my friends have children already. And for those of us who don’t, kids are top of mind.

Though we have careers, friendships, and a wider scope of interests than babies, early-30s women know that the window to procreate is closing. Conversations very often touch on the subject—when we might plan to become pregnant, how we feel about the prospect of getting pregnant, what it’s like to have kids, and how that will impact our lives. It’s an embarrassing cliché, this fixation on fertility, but it’s inescapable. Acquaintances of mine who don’t know about my condition ask when my husband and I plan to start a family. Suddenly, I don’t really have an answer.

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I always thought I’d be a mom. We had names picked out (informally). We were going to wait until I was three or four years in remission before we started trying for a baby. But that's when the recurrence happened. And now that I can’t just get pregnant, I’ve had to reevaluate entirely how I feel about having kids.

Can we afford it? Even if we can, is it worth it? Is life fulfilling enough with just the two of us? Questions like these were forced on me by the circumstances of early menopause. My peers are not in this position, though I know that same-sex couples and couples with fertility issues confront many of the same challenges.

And as I think about these questions, which have no concrete answers, it can feel like everyone around me is moving forward, while my husband and I are suspended.

It’s not all bad. I’ve realized that being exempted from the world of babies means that I have energy and room for other things. Not investing in a child enables us to travel, eat dinner out, and someday buy a house. I love our life together. And of course, having cancer has caused me to focus more on the present in all aspects of my life.

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I still have doubts though, all the time. I worry about how I’ll feel when my now child-less friends start having kids. Will our relationships change when they become maddened by pre-school admissions and I am unable to relate? Will I regret my decision only when it’s too late? How will I know?

Menopause at 32 has been a bigger challenge than just hot flashes. But at the end of the day, I'm glad I went through with the oophorectomy. If the choice is my health or an imaginary kid, I choose me.

Editor's note: The writer's name has been changed to protect her privacy.