Meno Madness
A story that pissed me off, a brilliant menoposse, plus an updated menopause cheat sheet...
Heart palpitations. Overactive bladder. Incontinence. Hair loss. Frozen shoulder. Painful sex. Dry skin. Dry eyes. UTIs. Sleep disruption. Joint pain. Migraines. Anxiety. Depression. Irritability. Low Libido. Hot Flashes. Night Sweats. Period Changes. Fatigue. Weight Gain. Brain Fog. Tinnitus. No, you have not just walked into a horror movie, although for many of us midlife women, some days it can feel like we are living in a hellscape.
I honestly had no idea what was going on when I started experiencing perimenopause symptoms around the age of 43; symptoms that raged (along with me) for years before I started to figure out what was happening. I regularly, I’ll just say it, peed myself. Not a full-on puddle, but enough leakage to make me consider inventing a cute diaper panty (it’s since been invented- yay!). At some point my vagina seemed to “break” overnight, inconveniently on vacation while staying in a romantic Florentine villa. Never an issue before, I thought something was seriously wrong. I was sent for countless ultrasounds because of my irregular periods. Once, I ended up in the emergency room after the cardiologist I was referred to for palpitations said my EKG was irregular and that I needed immediate further evaluation. What?? I was fine, except for the fact that I left that scary experience with nothing resembling a satisfying (or comforting) answer. I honestly hadn’t thought about this incident in years, until I was recently reminded while listening to a panel of experts discuss how common it is for women to be sent to multiple specialists during these peri/menopause years, chasing down answers and relief, often to no avail.
Last week I was speaking with a friend who’s been having a difficult time with symptoms after finally getting off of the pill. I’ve talked to her about my (newish) experience with hormone replacement therapy (HRT, also referred to as MHT for menopausal hormone therapy), and she went to her doctor to talk about whether it might be right for her. Her hot flashes had become debilitating, and she had some of the other life-disrupting symptoms listed above. Despite the fact that were no obvious contraindications- no history of hormone dependent cancer like breast or ovarian, no history of blood clots, no liver disease, no heart issues- he told her that he prefers that women try to go through it “naturally.”
Even though I’ve long had my rage (mostly) in check, this set me off. Maybe it was the glass of wine I was drinking, or maybe it was the fact that this statement came from a person with a penis, but I reacted strongly. Had he ever projectile perspired in the middle of a presentation? Experienced painful sex? Does he wake every night at 4am with racing thoughts, unable to get back to sleep? I mean, maybe he’s experienced hair loss, but I venture a guess he has not had to deal with much else on our very long list.
Don’t get me wrong, I’m all for optimizing lifestyle and diet, and I think it’s incredibly important that we do just that- moving our bodies every day, lifting weights (especially as we get older with bone and muscle mass decreasing), and paying special attention to what we feed our bodies and our minds. In fact, when I was going through the perimenopause madness and had no language for what was happening to me, I turned to a certified health coach/nutritional counselor (who was also an RN). Not satisfied with “this is just what happens at this age,” answers from my (female) gyno, I decided to take matters into my own hands, and was lucky to have access to someone who could shed at least some light in an area where there seemed to be an information blackout.
But we’ve come a long way over the past decade, and we know now that a 2002 Women’s Health Initiative study that linked HRT usage to breast cancer, heart disease, strokes and blood clots was both flawed in its design and widely misinterpreted, which caused mass panic. Almost overnight, what was once the most commonly prescribed treatment in the US (approximately 15 million women were on it at the time) saw a precipitous drop in usage, and unfortunately, years later the fear, confusion and misinformation lingers, keeping many women from exploring HRT’s potential health benefits .
I think the thing that bothered me most about my friend’s experience was something articulated by Rebecca Thurston, a psychiatry professor at the University of Pittsburgh who studies menopause. In this must-read 2023 article by Susan Dominus, How Women Have Been Misled About Menopause, Thurston says she believes that the underserving of women in menopause is an oversight that constitutes “one of the great blind spots medicine,” which “suggests that we have a high cultural tolerance for women’s suffering” and that “it’s not regarded as important.” This, I think, gets to the crux of my strong reaction; the idea that it's perfectly acceptable for women to suffer, expected in fact, and that it’s just not important. And when you think about the fact that women were not required to be included in government sponsored clinical trials until 1993, it’s hard to deny these feelings.
With this in mind, it’s probably not surprising to hear that most doctors have little to no menopause training. But I was a bit shocked to find out that only 20% of ob/gyn residency programs provide it as part of their regular curriculum, and disheartened to learn that 80% of medical residents in a recent survey admit to feeling “barely comfortable” even discussing menopause.
The good news is that we now have a menoposse- new wave of rockstar physicians, fierce advocates, and a generation of women who are no longer willing to tolerate being dismissed. Last weekend I had the privilege of attending a couple of events where this energy was palpable, providing a powerful melding of education, community, and connection. I listened to a panel of doctors that included Mary Claire Haver and Rachel Rubin talk about how we got here, and what we can do to greatly improve the quality of our lives so that we can continue to live fully and thrive.
Look, HRT is not for everyone (although topical, nonsystemic vaginal estrogen can be used safely by most despite the FDA black box warning, which is another article for another day), but it’s certainly an avenue worth exploring. And beyond symptom management, it can help prevent conditions like osteoporosis that can lead to things like hip fractures, which can be lethal in 50+ year olds.
It was actually a diagnosis of low bone density that finally convinced me to start HRT about 6 months ago (after much research), and so far it’s helped with night sweats and with sleep in general, which has been an ongoing struggle that definitely impacts the quality of my life. I’ve also started lifting heavier weights to help build back bone.
As for my friend, I’m not sure what she’ll decide; if natural is the route, I’m all for it, as long as she feels like she was seen and heard by her doctor, and was able to make a well-informed decision. And that’s really what this is all about- arming yourself with information, knowing the questions to ask, and getting the answers you deserve. It’s why I will talk to anyone and everyone about menopause, dry vaginas, and all of the things! Knowledge is power, and so is a supportive community!
For more information check out below updated resource guide I wrote earlier this year. In it you will find links to organizations, articles, books, podcasts, doctors, etc., to help you research and show up at your next doctor’s appointment feeling empowered to get what you need, and to make decisions that are right for YOU.
Midlife Cheat Sheet: Menopause Edition
I’ve been watching the Hulu series “Life and Beth” created by Amy Schumer, and there’s a funny scene (one of many!) where a doctor asks her character Beth if she has any preexisting conditions; she deadpans, “I’m a woman.” I laughed out loud, but sadly, there is a lot of truth in that statement.
Thank you so much for reading- I’m so grateful you are here. Pieces like this are a labor of love, and I hope you will share with the women in your life who could benefit from the information. Also, If you enjoyed please hit the ❤️ to help others discover us here so we can keep building this community and learning from each other! Have a wonderful weekend! Dina xx
Fantastic midlife cheat sheet and although I can only speaking for myself, I believe it will be a welcoming feeling for all those going through menopause who read this essay. Here's to strength training, education, midlife connectivity and finding what works for each individual woman. We've come so far in just the past two year, I can't wait to see what the next ten hold in medical research and women sharing their personal experiences.
"A menoposse" - yes! Love this term!