Let's Talk About Menopause
How outdated and sparse the information about it is...and that New York Times Magazine article. An open thread.
After my recent open thread on aging and diminishing alcohol tolerance, many of you suggested we talk next about menopause. So, here we go.
This week, the New York Times Magazine published an article by Susan Dominus with the headline: “Women Have Been Misled About Menopause,” and with the subhead: “Hot flashes, sleeplessness, pain during sex: For some of menopause’s worst symptoms, there’s an established treatment. Why aren’t more women offered it?”
I appreciate Dominus’s reporting on the dearth of menopause information available not only to women experiencing it, but to medical students as well. To wit, Dominus writes:
“Education on a stage of life that affects half the world’s population is still wildly overlooked at medical schools. A 2017 survey sent to residents across the country found that 20 percent of them had not heard a single lecture on the subject of menopause…”
I share her frustrations with the condition and with the medical establishment’s ignorance, as I’m sure do many other women. But the piece also felt to me like a bit of an advertisement for Hormone Replacement Therapy (HRT), which I have my doubts about. There are new perspectives on it, and on the apparently flawed research decades ago that perhaps falsely indicated HRT brought with it too many health risks.
One of the associated risks that appears to have been overblown after the old studies is breast cancer. But my family history, plus my own life-long hormone imbalances, put me at high risk. What’s more, I don’t know about you—and this is totally anecdotal—but I feel as if I am lately witnessing a breast cancer epidemic of previously unknown proportions. Every time I turn around, another friend or acquaintance or family member is diagnosed.
So I am personally not inclined to “fuck around and find out” about the ways in which the relief of menopause symptoms provided by HRT outweighs the cancer risk. I mostly just live with the symptoms of menopause, which began for me after I had a partial hysterectomy at 43 to deal with both adenomyosis and endometriosis. Keeping my ovaries was supposed to mean I’d hit menopause later, but weeks after surgery, the hot flashes started, followed by insomnia, worsened depression, hair loss, unwelcome chin hairs, and other symptoms.
I’m still living with all of those, although I’ve kind of gotten used to them. (The women in my family apparently keep on flashing into their 80s, by the way, so I don’t anticipate and end to that.) I take melatonin and a THC tincture to get more sleep. I don’t consume alcohol. I limit my caffeine intake and never have it after 10am. I don’t eat much sugar or saturated fat, and there’s a lot of fruit and veggies in my diet. I do yoga, walk often, and ride my shitty Sharper Image recumbent exercise bike a few days a week. I find that Egyptian Magic is a wonderful, natural moisturizer that can be used, er, everywhere, if you catch my drift. (See #10.)
I’m going through possibly the worst depression of my life, and while there are definitely some situational factors in the mix, I wonder if it isn’t in part because my hormone deficiencies might have hit a new low. Either way, I’m not sure I want to go back on anti-depressants, with which I’ve had mixed results in the past.
And with regard to this and all my other symptoms, I have an unfortunately well-earned lack of faith in both the medical establishment and alternative medicine that deters me from pursuing pretty much any kind of treatment. (Not to mention that most alternative medicine is not covered by my insurance, and anything other than my annual checkup with my general practitioner and my annual “woman care” appointment with my gynecologist is out-of-pocket for me, until I meet my $4700 deductible.)
Don’t worry. I’ll be fine! But this is a subject that’s not enough talked about. So let’s talk.
In the comments, I invite you to tell me about your own experience with menopause, how you’re treating it, books or podcasts you like. And if you’ve read the article I mention above, what you thought of it.
***It’s really important to me that no one judge anyone else for their responses, nor lecture others about what they consider the best ways to treat menopause. I’m approaching this with curiosity rather than judgement, and I hope you all will, too.
Thanks, as always, for reading and responding.
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As someone who is currently on Tamoxifen to basically prevent a reccurence from breast cancer this hits. The women who are in early medically induced menopause are often left out of the conversations as well. I have been writing a few essays about this very topic. About being the only woman who hit menopause before 40, and none of my friends could relate or talk to me about it. The feeling of going absolutely crazy. I googled and googled and nothing came up. Or HRT came up, and I am like, yeah but hormones are my enemy and actually feed my cancer, so now what? It is maddening. I could go on and on, but I guess I should just keep working on those essays. ;)
This is a topic very near and dear to the experience of my 92 year old mum, as well as my own. I have been a yoga student and teacher since age 17, and was really taken by surprise when I began to get what I call "the perfect storm" during my early 50s. No one ever told me how dramatic it would be.
It started with chest pain and heart palpitations, not to mention severe joint pain). After numerous ER visits (sent home with anti anxiety medication when I never had anxiety before), appointments and tests with a cardiologist, nothing showed up. One PCP looked at me when I asked if he thought my symptoms were possibly hormone related, and said "you are estrogen dominant". And that was the end of that conversation.
I eventually took matters into my own hands and ordered a saliva test from ZRT labs to check my hormone levels. A complimentary morning Cortisol to that test reflected that I had virtually none in the morning, which is when it is supposed to be at its highest. So I ordered the full Cortisol test and learned that I was Hypo Adrenal. Not only that, when I eventually retrieved the labs from the ER visits, my TSH was very high, and this had not been flagged by anyone. Even though I had informed all my doctors that autoimmune ran in my family, and that my mother had hypothyroid, no one bothered to check those biomarkers.
All that to say, menopause is complicated. There is so much more than just sex hormones, which do play an important role in bone loss, muscle loss, UTI's, dementia (just look at how high the stats are for women vs men with dementia).
Every doctor should be checking, at the very least, annually, with a full thyroid panel, HA1C, D25 Hydroxy, a comprehensive lipid panel (there is more valuable information than the standard LDL, HDL, Triglycerides). And if a menopausal woman has stress in her life (children, grandchildren, partner, aging parent - you name it), testing her Cortisol levels would be prudent. Most women, by the time they reach menopause, are burned out by taking care of everyone else, having a career, and being left with the scraps of energy that are left.
Why are BIOIDENTICAL hormones important? My mother had chronic UTIs in her older years. In fact, I learned that dementia can be a symptom of a UTI infection in an older woman, and that most "facilities", such as rehab, assisted living, dementia care - they don't bother testing for UTIs because they are quite sure that everyone has already been populated with it.
Because my mother (who had a full hysterectomy in her early 60s) had mild dementia, we asked to have a script for 1mg of Estradiol, compounded, with 1mg of Testosterone (to help with bladder prolapse which was a result of the hysterectomy). We also asked for 100mg of oral Progesterone for bedtime to assist with sleep and to COUNTER balance the Estradiol. Estradiol and Testosterone are best taken transdermally or in pellets (which I would never recommend), in terms of liver detoxification - because it is healthy liver function that can play a part with hormones and breast cancer - other than genetics.
Suffice it to say, both the UTIs and the prolapse ceased. Years later, in her late mid/late 80s, she fell on each hip, two years apart, and only broke her femur neck, rather than the entire hip/femur head. And we all know that when an elderly woman needs a hip replacement, often times, that is the beginning of the end. Her recovery was very impressive to medical staff. She was walking within three days of the procedure. This is a tiny Japanese woman who was put on Fosomax in her late 60s for Osteoporosis. She disliked the side effects and stopped taking it.
Breast cancer has occurred with my maternal aunt, but she was a heavy drinker at one time, and a heavy smoker. I discovered that my genetics reflect very poor Phase I and Phase II liver detoxification (alcohol, caffeine, drugs, smoking - these all have big impact on the liver). I have been on BIOIDENTICAL hormones (I emphasize this word because drug companies modify the molecular structure of certain hormones such as Premarin and Progestin for patent reasons) for several years (along with thyroid) and I am very grateful to have access to them. But with all drugs, even Ibuprofen, checking liver function and having liver support is critical. I have clients who have been on antidepressants and anti anxiety drugs for years whose liver markers look as though they were an alcoholic.
Most practitioners have approximately 15 minutes for appointments. For women's health , an antidepressant script is much more manageable than looking at the whole picture of a person's health profile. Insurance is the main reason for this. So for women like me - I have to search high and low for an MD who takes insurance, who will prescribe. I order my own labs and provide them, because I know that they are limited by insurance as to what labs they can order. For instance, the standard thyroid biomarkers that doctors order are TSH and a Free T4 - the storage form of thyroid hormone, rather than Free T3, the active form. Thyroid function is so much more involved than that. But Levothyroxine is an easy "go to" script. If its autoimmune thyroid, good luck with that.
It is my hope that one day, women's health will be something that is properly managed through all healthcare systems, but I am not holding my breath. In the meantime, I take an active role in my own health, knowing that no one else will.
By the way, my mother is still alive and thriving at age 92, when we were told two years ago that she only had three months to live. She now lives with my sister, at home, where she belongs. Have mercy for those of us who may one day have our health in the hands of others, not knowing what they are doing with it.