Queen Mary I of England, daughter of Henry VIII and his first wife, Katherina of Aragon, came to the end of her uncharmed life on 17 November 1558. The abdominal pain that had plagued her since menarche had revealed itself to be not the stirring of new life, but the growth of a deadly cancer.
There is some dispute as to whether or not reproductive cancer was the actual cause of Mary’s death, but I think the evidence is as solid as it can be without a time machine and an autopsy.
For one thing, Mary showed symptoms of endometriosis from her early years, and untreated endometriosis puts a woman at high risk for both ovarian and uterine cancer. Mary’s physical complaints, known as her “usual troubles” or her “old disease” by royal physicians because they were chronic and reoccurring, centered on her reproductive cycle. From the onset of menses Mary had to deal with dysmenorrhea, incredible pain and cramping during her period that was much worse than the ‘typical’ menstrual discomfort, and exceptionally heavy bleeding. Her periods also remained irregular long past adolescence, meaning the pain could strike her at any time. Added to the cramps were nausea and serious episodes of melancholy. The most consistent sign of endometriosis is irregular periods and agonizing pelvic/lower abdominal pain, especially during menstruation, and heavy bleeding. Additionally, adhesions and bleeding in the abdomen due to endometriosis can cause nausea and bowel distress, which Mary’s doctors tried various medicines to disperse to no avail. The debilitating pain and hormone irregularity accompanying endometriosis often leads to depression as well.
Stress can also lead to a worsening in endometriosis symptoms, and after 1528 poor Mary had stress in abundance. Correspondingly, her health deteriorated. Mary had a particularly severe flare up in 1531, shortly after Henry made her mother leave the court and began openly treating Anne Boleyn as the queen-to-be, and again in 1534 when she was sent to live with her infant half-sister, Elizabeth.
Although Mary wasn’t allowed the comfort of seeing her mother, neither was she treated badly by the new queen. Mary was given “a separate and more expensive diet and the freedom to take copious amount of exercise, which was believed to be good for her menstrual problems and her mental health.” Nonetheless, Mary became so ill in the summer of 1534 that rumors begin to spread that Anne Boleyn was trying to poison her. King Henry sent his own physician, Sir William Butts, to treat her, and the medical practitioner quickly discovered that her distress had been caused by a bad reaction to some medicine given to her by another doctor. No one was trying to harm the princess, although she was at risk of further “hysteria” from worry and paranoia. The king’s doctor therefore sent for Katherina of Aragon’s own medical staff to treat the princess, to reassure Mary and to help stave off malicious rumors.
Mary also showed significant symptoms of endometriosis complications in middle age as well. The ambassadors from Venice noted that Mary had no eyebrows, and that her voice was, “rough and loud, almost like a man’s.” As well as suffering the agonies of the damned on your period, endometriosis plays havoc on your hormones. One of the side effects of this havoc is frequently hair loss, and a deepening voice as a result of testosterone overproduction in the stressed ovaries (yes, ovaries make testosterone too) is certainly possible.
Interestingly, the Venetian ambassador Giovonni Michiel reported that Queen Mary’s problems were due to “la retentione da’ menstraui e suffacotione della matrice”, that her menstrual blood would build up inside her and suffocate her womb, which is a close description of what endometria’s feels like, and seems to do. Michiel also wrote that it was a disease “which from childhood she had been accustomed” and that everyone was aware of. Her doctors, in a futile attempt to drain away the endometrial blood, resorted to bloodletting, which helped the queen not at all and kept her “pale and emaciated.”
Mary’s false pregnancies after she had married Philip of Spain, are also possible indicators of endometriosis.
Many people write off Mary’s false pregnancies to pseudocyesis, a “phantom pregnancy” caused by a woman wanting to be gravid so much that her body is tricked into believing there really is a fetus in the womb. This seems too pat to me, too much like sneering that she was a hysterical woman without the character or wit of her more masculine half-sister, Elizabeth I. The excuse of phantom pregnancy is too easy, and too dismissive.
For one thing, Mary herself wasn’t sure she was pregnant at first. There were concrete physical symptoms before the unfortunate queen was convinced she was up the pole. Her menses had stopped, she had morning sickness, her breasts ached and showed signs of lactation, and her belly was swelling rapidly. It wasn’t until after Christmas of 1554 that she became convinced she could feel a baby moving, writing to Emperor Charles V that, “As for that child I carry in my belly, I declare it to be alive.”
So what could have caused these physical changes?
Our old friend, endometriosis.
Endometriosis, which is often comorbid with polycystic ovary syndrome (PCOS) and other reproductive ailments, can cause endometriosis cysts, or “chocolate cysts”, on the ovaries. (Physicians call them chocolate cysts because they are typically filled with old blood the color of chocolate syrup, and doctors like to gross people out.) As can be expected, ovarian cysts can easily cause premature ovarian failure, sending a woman into a menopausal state prior to her 40s. Mary, who was 38 when she finally married, was probably right at the stage when she would stop ovulating because of all the damage done by endometrial cells to her ovaries. In a cruel coincidence, her viciously heavy periods probably stopped soon after she was having sex and could therefore think herself pregnant.
Mary’s mother, Queen Katherina of Aragon, also stopped menstruating early. A close family member with premature ovarian failure radically increases the odds it will happen to you as well.
Moreover, women with endometriosis can easily develop “endo belly”, an abdomen so swollen and bloated with endometrial blood that she looks pregnant. The picture below is of a young woman suffering from endo belly; can you see why Queen Mary might have suspected she were pregnant if her periods also stopped during this time?
While Mary may have eventually become so sure she was pregnant that her breasts began to “distil” (lactate) psychosomatically, it could have also been nipple discharge caused by uterine cancer. Even pre-cancerous endometriosis can cause nipple discharge, a milky fluid, in some patients, as well as enlarged, tender breasts and swollen nipples. Inasmuch as Queen Mary had suffered every common symptom of the disease, why not some rarer signs as well?
Queen Mary, firm in the belief her baby was due in May, went into confinement in April 1555.
The birth chamber was prepared, as was the nursery with a beautifully carved cradle, and many women were hired to help care for the baby. Letters announcing the birth were written, with just the date and the sex of the infant to be filled in … Mary and Philip went to Hampton Court, where they wanted the birth to take place.
One of the women accompanying her was Princess Elizabeth, both to keep an eye on the Protestant lightening rod and to use her as confirmation that the baby was indeed Mary’s. Elizabeth was therefore on hand to see Mary emotionally deteriorate as May passed into June and yet no labor pains began. In desperation, the queen “issued a statement that God would not allow her child to be born until all the Protestant dissenters were punished, beginning another round of executions.” She didn’t give up all hope until the end of August, when her belly once more shrank to its normally small size yet no child had appeared.
King Philip, having other, more important places to rule as well, hared off to the Low Countries for a year or so, leaving Mary more melancholy than ever. When he returned in 1557, his queen once more suspected she was pregnant, but almost no one else believed it could be a possibility.
Alas, her courtiers and husband were correct. Mary did not have life, but death, in her womb.
The last few months of her life her belly grew, but it gave her nothing but pain and suffering. On the night of 16 November the eldest daughter of Henry VIII received the viaticum at St James’s Palace, and prepared her soul for God. In the early hours of the morning on 17 November the 42 year old Mary passed away, having done everything in her power to be the queen she believed that England needed, whether it wanted her to be or not. She was buried in Westminster Abbey, rather than by her mother as she had requested, which seems a final insult to the princess.
Requiem æternam dona ei, Domine. Et lux perpetua luceat ei.