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Feb 3, 2023Liked by Sari Botton

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. ;)

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Feb 3, 2023Liked by Sari Botton

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.

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Feb 3, 2023Liked by Sari Botton

Thank you for starting this conversation, Sari! I talk about menopause all the time, with myself and friends who are in it, afraid of it, sort of past it. I am 57 and reached menopause a bit over 2 years ago. My biggest complaint is the hot flashes which are worse at night (have tried black cohosh and evening primrose oil but they didn't seem to work), so I feel pretty lucky. Though I did lose about 90 of my scalp hair in 2022 (way more devastating than that simple phrase conveys) and there is no known cause for what my female dermatologist, an empathic, helpful but pretty drug-happy practitioner, is deciding to call a "flash of alopecia." Enough with the flashes! But speaking of which, my favorite menopause reading has been Flash Count Diary by Darcey Steinke. A beautiful take on the whole thing. I don't read news articles or books about it, including the recent NY Times article you referenced, because it will either upset me, scare me or be totally irrelevant to me. Everyone is different. We all have to find our own way to deal with this. Like you, Sari, I have lost nearly all my faith in the medical profession and am learning to trust my own instincts more. While I am glad the conversations (and research?) around meno has been on the uptick, I fear that every single little thing just gets chalked up to our hormones and therefore written off too easily. We just have to discuss amongst ourselves, I guess. Looking forward to hearing from more of my sisters! xx

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Feb 3, 2023·edited Feb 3, 2023Liked by Sari Botton

Sari, my experience parallels yours in many ways — early hysterectomy, kept the ovaries but nevertheless went into surgically induced menopause, which caused foggy thinking, insomnia, and the worst depression I've ever had. The miracle drug I was prescribed? Estrogen. I could take it unopposed (without added progestin to counteract the risk of uterine cancer) because I didn't have a uterus. And estrogen WAS a miracle drug: my depression lifted, I could concentrate, I was juicier in my nether regions, and it helped maintain my bone density. But I was on it for ten years, way longer than is medically suggested (no doctor said to go off of it, but I guess I should have been my own keeper in this regard). And I got breast cancer. The estrogen positive kind, which means the tumor feeds on estrogen. There's no way to know whether I would have gotten it if I wasn't on estrogen, but it seems pretty clear that my HRT was a contributing factor. Post breast cancer, I'm on a drug called arimidex, which like tamoxifen dials your estrogen to almost zero. No one tells you that the aftermath of breast cancer treatment (being on estrogen-cancelling drugs for 5 -10 years) is in some ways worse than the surgery and radiation (I didn't do chemo). The drug makes me feel ten years older than I am, with stiff hands and feet, muscle cramps, and accelerated bone loss. I take it because I don't want the cancer to recur, but boy do I miss that hit of estrogen. Hard to know if the lack of estrogen worsens my already present tendency to depression, because lots of other factors may be contributing as well. Anti-depressants help, as does healthy eating and lots of exercise. Thanks for starting this conversation.

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Feb 3, 2023Liked by Sari Botton

I started HRT about 9 months ago. It's been wonderful for me, very helpful. I have no history of breast cancer in my family but I do have family history with Alzheimer's (both parents had it plus grandmother and all my aunts) and with osteoporosis which I was diagnosed with while still in my 40s. My father broke his hip and that was the beginning of the end for him. It's scary. I don't want to break my back or hip. HRT strengthens bones and lowers my dementia risk, on top of curing my insomnia, stopping hot flashes, improving my mood, and making me feel as if I'm no longer about to turn to dust and blow away. I discussed treatment with my doctor and this is what works for me. I'm glad I have this option

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Feb 3, 2023Liked by Sari Botton

Love this! I developed overwhelming anxiety and horrific heartburn as I was completing "the menopausal transition" (meaning it had been a year since my last period, can't we have better terms for this stuff? "incompetent cervix," I'm looking at you) and went to my PCP in desperation (I'm jaded about the medical establishment). He did a bunch of lab tests and said nothing was wrong with me.

When my psychiatric NP saw my test results, she referred me to a menopause specialist, a NP who happened to be an old family friend, which was fun! She has devoted 30+ years of her career (she's in her 70s now) to menopause and we tried a few things, including hormones. Nothing changed for me, and they are expensive, so we quit, but I appreciated her thoughtful approach. One part of which was asking "So did anyone tell you you're in menopause?" -- which she could tell from my hormone levels, but my doctor hadn't bothered actually telling me.

She referred me to a book called "Estrogen Matters" to help me make up my mind about hormone therapy, and it was very useful in explaining the 1990s nurses study and the other nuances to hormones. All of this reminds me of when I was diagnosed with endometriosis in my 20s and I saw that some significant percentage of uterus-havers (8%? 14%?) have it, but there was basically no knowledge about it. Similar to how the NYT writes about it -- can you imagine 1 in 12 men having debilitating pain every month that caused them to miss work and have surgery, perhaps to remove reproductive organs, and nobody knows jack about it?

Also, Gen X is the invisible generation, but I hope Gens Y and Z appreciate one day that we are the ones bringing menopause into the open. :)

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Feb 3, 2023Liked by Sari Botton

I'm writing my MFA thesis on menopause--mostly personal profiles with some science woven in--and am keen to learn more here. My small, deeply slanted survey (~130 women from the U.S. and U.K., mostly white, mostly graduate degree holders) affirms my thesis title: Hormones Are Assholes.

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Feb 3, 2023·edited Feb 3, 2023Liked by Sari Botton

I recently started taking sublingual vitamin B12 drops as well as a Methyl Folate supplement, because I was pretty depressed (and though I have plenty of good reasons to be, it felt a little too oppressive), and either the phase has passed or they have helped. I had read that they could help. And basically, I know that I"m usually low on B vitamins so it wasn't going to hurt. Also, it seems to be good for hair loss, for those experiencing that (I'm not, or not that it would be noticeable to me).

As for menopause, yeah, I'm not into HRT, if only because I'm not wealthy enough to pay for it, and secondly, I don't want to go back to my youth, I only want the hot flashes to stop, and they are, gradually, stopping. After four years I can finally get out my old turtlenecks again and wear one without the threat of overheating at an inopportune moment when I can't strip it off.

And yes, I'm a big fan of Egyptian Magic. It's good for just about everything and everywhere, as you mentioned. Very handy to travel with as well. When it gets TOO dry and cold out, I add a drop of lanolin (the kind women use on nipple cracks from breastfeeding). But it's all I need.

I think I'm fine with getting old. I don't have a boyfriend/husband/significant other to complain about my lack of libido, thank god: I am certainly not complaining. I'm loving it. I guess that takes me off the market for love, eh? Because I'm not hearing about many people willing to be with a basically asexual old girl like me. But I'm not "broken," there's nothing I think I need to "fix," I'm happy, and I'm not gonna mess with it. I'd rather be alone than with someone who doesn't see me as complete. Which brings me back to HRT, which seems to be designed with the idea that a woman must be constantly sexually attractive and available to justify the space she takes up on this Earth and in our lives. The hell with that.

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Feb 3, 2023Liked by Sari Botton

I really love Dr. Jen Gunter’s work--she’s a gynecologist who has experienced menopause and treats it in her practice. Her books, The Menopause Manifesto and The Vagina Bible should be distributed to every medical resident. Thanks to her, I now know to verify that my drs are members of NAMS (the North American Menopause Society) which requires continuing ed on the latest menopause research which, in my personal experience, no doctor ever is. When they are instead compounding their own hormones and basically experimenting on their patients, for me it’s no thank you. I am also at a high risk for breast cancer so HRT, which, I completely agree, the NYT article was very much infomercial for that, isn’t really an option.

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founding

This is such a hard topic. The article read to me like an ad too. I was surprised it was so HRT gung-ho. I am deeply confused for myself. I'm 54 and do not like having hot flashes all night, plus feeling like I'm losing my hair and libido. So, recently, I wrote a FB post asking women to weigh in and about 150 women did. What I found was this: If you take HRT you are an advocate. A few women said that HRT saved their lives. But, if you don't take HRT, you are radically against it. There were few women in between.

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Feb 3, 2023Liked by Sari Botton

I am about to be 49 and fully in it. I am so grateful that I get to be going through this during a moment when it's being discussed. So grateful that I had a friend to recommended a menopause specialist when I completely unraveled from lack of sleep and crippling anxiety and panic attacks a few months ago. Taking any medication has risks. But I am grateful that I get to choose knowing what the risks truly are and not just what people "feel" like they are. For me the benefit of mental health outweighs the risk of hrt. Just like I had to decide that the benefit of being on a biologic outweighed the risk from my severe psoriasis. Would I rather take none of these meds? Sure. But we make risk assessments every day.

It is interesting to me that it's just assumed women should take the risk for oral contraception (an issue that affects men) but not for hrt. How responsible is a Dr. who pushes the pill but "feels like" our meno symptoms don't warrant hrt?

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Feb 3, 2023Liked by Sari Botton

Im 54 and been on HRT for 4+ years. My main symptoms: migraines and homicidal ideation, with minor sleep disruptions and hot flashes. At this point, I rarely have a migraine and everyone around me is still alive - I see no reason to quit.

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In more than 20 years of HRT, I’ve made two attempts to quit and both times gave up because of severe insomnia. My doctor has gently suggested that at my age, 73, I’d be wise to quit the pills for good. My mantra has always been “Everybody dies of something and I want to live well while I’m here.” Without sleep, I don’t live well. But I now understand that continued HRT will compound my risk of a blood clot after surgery (this on top of all the higher-profile risks). Some women my age are using cannabis to manage menopausal symptoms, including insomnia, on the grounds that it’s “natural,” yet we know a lot less about cannabis than we do about HRT. It’s a highly personal decision, made a less lonely when we share our experience in a forum like this one.

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Having gone thru early pause at 42 here’s my advice: this will be like adolescence only harder in the sense you didn’t realize you’d lost your mind in onset of puberty. You will change; you are changing: don’t pretend you’re the same as ever. Take HRT!!!!!!! TAKE HRT!!!!!

I was denied HRT due to that famous flawed WHI study and so now I have osteoporosis. Use HRT the first 5-6 years after your period stops. Of course if you have health reasons to avoid it discuss with your doctor. It gets real now. And you will be freed from the biological imperative that has clouded your brain and that’s the good news. It doesn’t mean no sex it just means different. And sex is a mind body spirit thing. Chances are you’ll experience a beautiful integration and wholeness once you get a decade in. Yeah expect about a decade starting at peri. Vaya con Dios.

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Three books have been my savior in menopause. I wish I had found them earlier, but I have been trying to spread the word far and wide. First is The Menopause Manifesto, by Dr. Jen Gunter, who also writes The Vajenda here on Substack. Her work is backed up by studies, not judgmental, and very feminist. Same for What Fresh Hell Is This? by Heather Corinna -- a wealth of information and perspective. Third is Flash Count Diary, by Darcey Steinke, which is part memoir part reportage about what it means to be a menopausal woman and pushing back on the messages society tells us. Very much about feeling not crazy for feeling crazy. And one book I am throwing in the trash is The Wisdom of Menopause, which I bought but found more confusing than helpful and then later learned Christiane Northrup is a leading anti-vaxxer and had pushed all kinds of bad advice. Just toss it.

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I agree that the article came across as HRT evangelical, but I appreciate that it pointed out the fact that as a population we are dramatically underserved by the medical establishment. BTW I like Dr. Jen Gunter's work a lot (her book is The Menopause Manifesto) and she has plenty to say about HRT (you can find her talking about all things meno on Instagram). Most of my friends and I are peri now and we talk about this all the time, how fucking insane it is that despite the fact that we all have reasonably good health insurance we have to struggle so hard to find the care we need during this time. One thing we've started doing for each other is checking in frequently about our mental health, because while we all have varying degrees of physical peri symptoms that are easy to spot, the mental stuff is harder. Asking each other gently, "How's your mindset doing lately?" seems to promote open dialogue and create space for suggestions and reminders to be expressed. I also want to put in a good word for Foria CBD lube, which is pretty great! https://www.foriawellness.com/products/intimacy-lubricant

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