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My gynecologist instructed me to lie back and place my feet in the stirrups. He picked up the speculum. I swallowed. My heart rate increased, and when the tool breached my vagina I lurched in pain.

“Does this hurt?” he asked. It did hurt. It always hurt. For much of my life, I wasted time and hope on both medical and homeopathic treatment methods ranging from NuvaRing and oral birth control to cycle syncing and herbalism. Nothing worked.

After 10 years of excruciating pain during periods and pelvic exams, this doctor was the first person who believed I dealt with something more serious than “bad” menstrual cramps. Based on my symptoms, he suspected I had endometriosis and recommended I start treatment on the Lupron Depot injection, which would help with the pain.

“You’ll stop having periods. It will put you in what we call ‘chemical menopause,’ ” he said. “There are some minor side effects like hot flashes, but in six months we can evaluate your progress and prescribe hormones to take care of that.”

In other words, he wrote me a prescription for menopause. I was just 25. At the end of the appointment, he slid an information sheet across the table and suggested I take the weekend to think about it.

As soon as I got home, I Googled “lupron + endometriosis.” Lupron would stop my body from producing estrogen and progesterone, as if I were in menopause. The decrease in estrogen stops endometrial tissue from growing, and prevents periods, thus ending the pain. But each Reddit thread I found about the medication was worse than the last, with women complaining of hair falling out in clumps, gaining 20 to 30 pounds, dealing with irreversible bone density loss, nonexistent libido, and extreme mood swings, not to mention the hot flashes. Some said Lupron ruined their lives. The criticism always came back to the side effects, all of which mirrored menopause itself. Women who had used Lupron before warned against it, and even mentioned lawsuits and claimed it had done irreversible damage to their bodies (according to Lupron’s official safety materials, it can lead to “thinning of the bones” in some cases).

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But at that point in my life, I was spending the entire week of my period on the couch with a scalding-hot heating pad on my abdomen, popping as much Aleve as I could, using up my sick leave, and canceling all my plans. Only seasons of Survivor I had already seen and late-night reruns of The X-Files offered me solace. I sent my doctor a message and said I’d get the shot.

A few months after I started taking Lupron, I went bowling with my family and had a severe hot flash. My face flushed red and I started sweating, damp spots emerging under my armpits and on my chest. The room spun around me. I grasped at a plastic chair to steady myself. My mom, who was 46 at the time, helped me take off my jacket and sit down before bringing me a glass of ice water. I think about that moment often because the roles should have been reversed. My body is the site of a time collapse.

I have a friend who, when I told her about Lupron, said that I shouldn’t be putting all this “stuff” in my body. She also has endometriosis. To treat it, she went through excision surgeries and a hysterectomy, and also healed herself with herbs. I listened to her tell me these things and felt ashamed; I had taken the easy way out. But the truth is that Lupron helped me. My life isn’t put on pause for a week every month. I can now make plans to play trivia and see movies with friends without fear of canceling. I successfully trained for and ran my first marathon, only possible because I wasn’t missing weeks of training due to pelvic pain.

My gynecologist says if I stop taking Lupron, then my body will start producing hormones again. I do an add-back hormone replacement therapy, which does lessen the side effects of the chemical menopause, but doesn’t allow my body to overcome Lupron fully. If I cease treatment, my periods will return and I’ll be able to have children. I’ll go back to being young. But, I’d be in extreme pain. Barring any issues, I could be on it until sometime in my 50s.

I’ll live more years of my life in menopause or post-menopause than not. When my friends reach perimenopause, I’ll have at least 20 years on them. And that is the most difficult thing, I think.

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My spouse and friends are supportive; they sympathize with what I’m going through when I complain of low libido, vaginal dryness, and the annoyance of getting DEXA scans to check my bone density. But because I no longer have symptoms of endometriosis, it is difficult for other women with the condition to relate to me, even notwithstanding my controversial treatment choice. And I could bring my hormones back if I could withstand the trade-off, which is a difficult thing to grapple with. I’m not old in other ways—my skin is still taut and no lines sink into my face—and I don’t have the hard-earned wisdom that comes from having spent decades as an adult. I haven’t written a book, I don’t own a home, and I feel, viscerally, like time is running out.

I get the shot every three months. When I stand with the waistband of my pants pulled down exposing my hip and wait for the nurse to inject me with the menopause shot, I can only think of the years ahead. I wonder if I’ll develop osteoporosis. I wonder if my libido will ever come back. I wonder if my relapses into depression would happen anyway, or if they are a side effect of menopause. I wonder if I’m more likely to develop cardiovascular disease, as that’s a concern of menopause, too. I wonder and wonder and wonder, because that’s the only thing to do.

Some days I don’t think about it much, but in the weeks leading up to an injection, the fact of it consumes me. Here I go, into the clinic, to choose menopause. I will choose it, again and again, until there is no choice to make.

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