The family of a Co Antrim primary school teacher who died from a gynaecological cancer have published her final words urging other young women not to ignore the warning signs.
Joanne Carruthers (39) from Dunfane Park in Ballymena passed away on December 16 in Antrim Area Hospital, 10 days after the death of her beloved father John (70).
As she was being cared for in her final weeks by the staff at Antrim Hospital's Macmillan Unit, Joanne was determined to spread an important message to help save others from cancers such as the one that would claim her life so early.
Joanne had a simple message for any girl reading her story: "If things have changed for you, please talk to somebody about it - don't leave it."
Having suffered from heavy and painful periods since her mid-20s, last September Joanne was diagnosed with leiomyosarcoma, an aggressive form of vaginal cancer after attending A&E in extreme pain and experiencing severe bleeding.
Four months earlier, the teacher at Round Tower Integrated School in Antrim had collapsed in work and started to haemorrhage.
At this point she was referred by her GP as an urgent case to a gynaecological consultant.
"I couldn't hide it any more or pretend it wasn't happening. At this stage it was a relief to finally be given permission to be ill," she wrote.
"Initially the consultant thought it was a fibroid and was considering a hysterectomy, but wanted to try other treatments first because I was so young for a hysterectomy. However, as time went on I got more and more ill."
An MRI scan later detected a large tumour on her uterus with further tests revealing a rapid spread to both of her lungs and liver in just three weeks. Her condition was now inoperable and Joanne began her final nine weeks of palliative care.
"It turned out that I had a tumour for a long time, but had become so used to period pain and heavy bleeding that I didn't recognise this as an important symptom of something different.
"It was just what women had to suffer sometimes. I know from talking now to my family and friends that I wasn't alone in behaving like this.
"Many, like me, carry on with the pain and think they have to suffer with periods."
Joanne believed that young girls, parents, teaching staff and society as a whole are too embarrassed to talk about menstruation, which is a factor in cancers not being identified early.
She wrote: "I attended an all-girls school where we watched a video telling you your period could be light or heavy, last two days or nine days, and that there was no 'normal'. There was no sense that you should find what was normal for you within these limits.
"I was too embarrassed to go to the doctor. I played it down until I couldn't stand up with the pain, and my mother dragged me kicking and screaming to the GP.
"As you get older this sense of embarrassment builds up, and it makes it harder to seek professional help when something is not right."
Even when she was there, Joanne still couldn't open up.
"Despite having these heavier and more painful periods for months, I probably gave the GP the impression that I was simply fed-up with having heavy periods," she recalled. "I was given a contraceptive pill which I continued to take for over 10 years, but still suffered from these painful and heavy periods. However, I tried to carry on and play it all down. I told myself it must be normal for me!"
Joanne's older brother Simon (42) and mother Judith (71) have now honoured her final wish to release her writing.
"As a teacher she was always helping other people and in this case she hoped they would learn from what happened to her," said Simon, who is also mourning the loss of his father John on December 6.
"In recent months his health had begun to slide. He never got over the stress of Joanne's illness and had a sudden heart attack."