Ovarian cancer, the demise of a Tudor Queen?

by Dr Emma Rees, CEO and Founder of Femma

May is Ovarian Cancer awareness month.  As a women’s health practitioner, I am keen for all women to be aware of this condition.  It presents late into the course of the disease, with symptoms that could easily be explained away. It usually (but not always) presents after the age of 40, when women may expect to experience menopause. The signs of ovarian cancer include fatigue, persistent bloating or a feeling of fullness, unexpected weight gain or loss and a change in menstrual bleeding amongst many other similarly nebulous symptoms.  

There is a member of Tudor royalty who may have died as a result of ovarian cancer.  Given the fact she lived 500 years ago and her chronicles were written by men, we will never really know. Her story does however highlight some symptoms and signs that whilst in her case became incredibly advanced, at an earlier stage can represent subtle signs of gynaecological cancer.

On the 17th November 1558 in St James’ Palace, Queen Mary 1st England died.  She was just 42 years old.  Her life had been complicated.  She was born Princess of Wales of the glittering Tudor dynasty on 18th february 1516.  Her father was the renowned King Henry the VIII and mother Queen Catherine of Aragon.  During her formative years she was celebrated as princess of England until her father, under the full eyes of Europe, acrimoniously divorced her mother, a hugely divisive event of the times. Mary was 17 years old and summarily demoted to a Lady of the Court. After a period during which she was forced to serve her baby sister, the new Princess of Wales, she spent most of her time on her own estates and was often reported to suffer from menstrual problems. Records also report that she had frequent bouts of depression. 

In 1553 she ascended to the throne and was declared Queen Mary. She had experienced a difficult family life and after her mother’s death had been lacking family affection. She quickly became besotted with her husband, Philip of Spain and was desperate to have a child.  She was overjoyed when in 1554 she started to show signs of pregnancy.  Her abdomen started to swell, her periods stopped and she developed nausea. She was 38 and relatively old inn Tudor times to give birth.  A point of particular concern given the high rates of maternal mortality and the fact that she was Queen of a country mired in unrest.  It shows some insight into her mindset that her contemporaries described her as enjoying her pregnancy despite the obvious risk!  Although she was confident that she would deliver in May 1554, this assumption was questioned by some of her most senior ladies who were aware of her previous health concerns. By the following July it became clear that her symptoms had a different cause.  Her swelling subsided and she looked even thinner and more drawn than before.  Her joyous anticipation and obvious symptoms were labelled a phantom pregnancy.  A humiliation and miscalculation mocked in Europe, and said to be caused by her desperation for pregnancy.  

She descended into depression and her husband left to command his armies in Europe.  He briefly returned in 1557 and after his visit Mary once again believed herself to be pregnant, demonstrating signs of abdominal swelling, arrested periods and nausea once again.  Sadly this time her symptoms led to neither pregnancy nor recovery and sadly she died in late 1558.  

For at least the last 4 years of her life, Mary had shown signs that a modern doctor would usually investigate.  We see a collection of symptoms of periods having stopped, persistent abdominal swelling and nausea, or a change in appetite reported, all of which would flag concern today.  Of course in Tudor times doctors had to rely on physical examination and history alone.  Now we have access to scans to investigate, surgery to treat and chemo and radiotherapies to manage signs and symptoms such as those exhibited by Mary.  We might read this narrative as a tragic story but the implications of it are still very relevant.  This was a lady who could explain her symptoms by other causes and although, had she known she had gynaecological cancer, in the 1500s her treatment options were nonexistent, we can still learn from her experience.

In today’s society, where women lead incredibly busy lives, fatigue can be accepted as par for course.  During a decade of hormonal transition, women expect menstrual change and changes in their weight.  So how do we know, as women,  when to explore symptoms further?  There is no easy answer but awareness of the possible symptoms of ovarian cancer amongst both clinicians and patients is paramount to opening the conversation. I encourage women who experience new and persistent symptoms of pelvic pain, altered bleeding, bloating, unexpected weight gain or loss and changes in bowel and urinary habits to challenge these symptoms and discuss them with their clinician!

May is Ovarian Cancer awareness month.  As a women’s health practitioner, I am keen for all women to be aware of this condition.  It presents late into the course of the disease, with symptoms that could easily be explained away. It usually (but not always) presents after the age of 40, when women may expect to experience menopause. The signs of ovarian cancer include fatigue, persistent bloating or a feeling of fullness, unexpected weight gain or loss and a change in menstrual bleeding amongst many other similarly nebulous symptoms.  

There is a member of Tudor royalty who may have died as a result of ovarian cancer.  Given the fact she lived 500 years ago and her chronicles were written by men, we will never really know. Her story does however highlight some symptoms and signs that whilst in her case became incredibly advanced, at an earlier stage can represent subtle signs of gynaecological cancer.

On the 17th November 1558 in St James’ Palace, Queen Mary 1st England died.  She was just 42 years old.  Her life had been complicated.  She was born Princess of Wales of the glittering Tudor dynasty on 18th february 1516.  Her father was the renowned King Henry the VIII and mother Queen Catherine of Aragon.  During her formative years she was celebrated as princess of England until her father, under the full eyes of Europe, acrimoniously divorced her mother, a hugely divisive event of the times. Mary was 17 years old and summarily demoted to a Lady of the Court. After a period during which she was forced to serve her baby sister, the new Princess of Wales, she spent most of her time on her own estates and was often reported to suffer from menstrual problems. Records also report that she had frequent bouts of depression. 

In 1553 she ascended to the throne and was declared Queen Mary. She had experienced a difficult family life and after her mother’s death had been lacking family affection. She quickly became besotted with her husband, Philip of Spain and was desperate to have a child.  She was overjoyed when in 1554 she started to show signs of pregnancy.  Her abdomen started to swell, her periods stopped and she developed nausea. She was 38 and relatively old inn Tudor times to give birth.  A point of particular concern given the high rates of maternal mortality and the fact that she was Queen of a country mired in unrest.  It shows some insight into her mindset that her contemporaries described her as enjoying her pregnancy despite the obvious risk!  Although she was confident that she would deliver in May 1554, this assumption was questioned by some of her most senior ladies who were aware of her previous health concerns. By the following July it became clear that her symptoms had a different cause.  Her swelling subsided and she looked even thinner and more drawn than before.  Her joyous anticipation and obvious symptoms were labelled a phantom pregnancy.  A humiliation and miscalculation mocked in Europe, and said to be caused by her desperation for pregnancy.  

She descended into depression and her husband left to command his armies in Europe.  He briefly returned in 1557 and after his visit Mary once again believed herself to be pregnant, demonstrating signs of abdominal swelling, arrested periods and nausea once again.  Sadly this time her symptoms led to neither pregnancy nor recovery and sadly she died in late 1558.  

For at least the last 4 years of her life, Mary had shown signs that a modern doctor would usually investigate.  We see a collection of symptoms of periods having stopped, persistent abdominal swelling and nausea, or a change in appetite reported, all of which would flag concern today.  Of course in Tudor times doctors had to rely on physical examination and history alone.  Now we have access to scans to investigate, surgery to treat and chemo and radiotherapies to manage signs and symptoms such as those exhibited by Mary.  We might read this narrative as a tragic story but the implications of it are still very relevant.  This was a lady who could explain her symptoms by other causes and although, had she known she had gynaecological cancer, in the 1500s her treatment options were nonexistent, we can still learn from her experience.

In today’s society, where women lead incredibly busy lives, fatigue can be accepted as par for course.  During a decade of hormonal transition, women expect menstrual change and changes in their weight.  So how do we know, as women,  when to explore symptoms further?  There is no easy answer but awareness of the possible symptoms of ovarian cancer amongst both clinicians and patients is paramount to opening the conversation. I encourage women who experience new and persistent symptoms of pelvic pain, altered bleeding, bloating, unexpected weight gain or loss and changes in bowel and urinary habits to challenge these symptoms and discuss them with their clinician!

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