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. ;)
But Tamoxifen doesn't put women in medically induced menopause. I took it for five years, beginning when I was 44. I didn't go into menopause, but Tamoxifen did cause uterine growths (completely benign) that required a uterine ablation. I also gained 30 pounds that I can't get off. I'm only just now getting hot flashes (at 54), so I'm pretty sure I'm finally in menopause. (The ablation caused my periods to stop.) Tamoxifen does not cause the ovaries to stop releasing eggs or to stop producing estrogen. (I don't mean to be argumentative. I just want to be sure that information like this is correct.)
Thanks for this Tam discussion! Since I went on 2.5 years ago at 45 (as a breast cancer prophylactic--substantial family history) I've been anxiously awaiting that first hot flash. I mean, there are tragic poems written about Tam, so I was prepared for the worst. When I talk to my NP at the breast center about my lowered libido, she says it could just as easily be a product of my age. Either way, I'm bracing myself for this new phase of life. But I think this quote from the NYT Mag article only gets at half of it. "Menopause could represent a time when women feel maximum control of our bodies, free at last from the risk of being forced to carry an unwanted pregnancy." The question I ask myself is will I be able to embrace my lowered libido as a positive? I don't miss the horny 20-something I was. I don't miss working so hard to achieve a standard of beauty so my boyfriend or later husband would find me beautiful. I might throw all this aging naturally stuff in the garbage, once I'm there. But I'm thinking about it. And these conversations really help. Thank you, Sari and all!
Tiffany I appreciate you including us medically-induced menopause people, ha! I am in a state of chemical menopause for treatment of PMDD, and I have HRT as part of that. I feel very lucky that symptoms are not extreme and are mostly treatable. Because of my life threatening hyper-sensitivity to hormonal changes I’m pretty wary looking ahead to proper menopause, or to sudden menopause if I opt for surgical treatment for PMDD eventually. But hopefully the fact that HRT smoothes those changes now means they’ll do so even when the menopause is no longer chemical...
Yes. Yes. Yes. After my double mastectomy I opted for a full hysterectomy. Jabs in my stomach every month for 10 YEARS was a heck NO. Now as my body struggles with medically induced menopause, -3.2 osteoporosis, and other chronic conditions that remain a mystery, I often find our situation an * at best.
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.
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
I also had hairloss for many years. Last November I stared taking progesterone cream (Emerita pro-gest) and my hairloss stopped completely! It started to work very fast too. Maybe 2 weeks max the hairloss was stopped. I am so happy. I take it 2 weeks on, 2 weeks off. Even during the off weeks I do not have any hairloss. This cream is yam progesterone. I took progesterone on prescription before but it did not help me at all. So there is something specific about this one for me. Also it helps with sleep too. I hope that helps.
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
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. :)
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.
Its been a tough journey but I am trying really hard to love my body/vessel -- a perspective that has eluded me for most of my adult life. I am turning 60 this year and could just weep over how antagonistic I have been to myself. Our bodies deserve our love and appreciation which I know is hard and goes against the entire history of how women are treated. But if we dont start with ourselves, nothing will change in the culture... Hormones can be annoying but they have their place. Not sure name-calling parts of ourselves really serves us. FWIW -- Rosemary
Yes, amen, THANK YOU!!!! I look at my dear, sweet nieces, who I would donate my heart to if necessary. It pains me to think of them feeling 1/10th of the abuse, hatred, and criticism I subjected myself to from 11 until recently.
fair point: our bodies do deserve love and appreciation. For me, acknowledging the difficulties is empowering. My hormones have not been kind to me; I would not tolerate that from anything *outside* my body. Conscientious name-calling is the closest thing I've found to setting an impossible boundary. YMMV.
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.
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.
Thank you for NAMS! I'm 61, seeing a gynecologist for the first time in decades because my PCP said, at this week's check up (yes, I have good insurance thank the lord), would you like to see someone. I like a doc who knows her own limits. But after 8 years of hot flashes, insomnia, pain, fatigue, brain fog, etc. I figured it couldn't hurt to try. Now I know what my first question will be.
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.
Yes, in discussing the NY Times article with friends at dinner last night, one friend was very triggered by the pro-hormone talk after being on birth control in her 20s and 30s. I wanted to honor her experience and also my own - I really believe (and call me a pollyanna) that women are like fingerprints - every body/ mind/ spirit is unique and how we prioritize our own health is different. For some, life saving for others, a killer. I like the comments section because you get the panoply of experience.
In addition to my family history and my own hormone imbalances, I spent so many years on different hormones and birth control to manage my endometriosis, and the side effects were horrible. So another deterrent for me. But, yes, we are all unique, medically!
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?
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.
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.
My own OB-GYN (who was near 68) told me that he said something to his mother about her going off HRT, and she reminded him that the decision was between her and her doctor. Now, it might be that you want to make another attempt, but it is a question of what makes you feel best. I agree with you that cannabis may not be the best choice as it would make for a muggy brain (I would not like that at all).
The new products are not supposed to do that, from what I hear, but we know so little about the effect of taking cannabis over a long period. I am going to need something forever, I think. I don't want to be any more crotchety than I am already with a decent night's sleep.
I've experimented with THC and CBD gummies at very tiny level, almost micodosing, to help with meno sleep issues, especially flashes all night. It has worked but I don't do it every night because I read that there's research that THC disrupts REM sleep. It's all fraught with trade off choices, I guess.
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.
I think HRT helps prevent aging if you take it in that early window. I understand reluctance to take it. I’m a probable DES daughter so that’s another reason they would deny it as an option but if you can take biodegradable HRT for that first 5-6 years I think it might be worth it. I also think we’re conditioned to fix everything and menopause is a natural stage in human development. Instead of fixing let’s empower. With menopause WE COME INTO OUR POWER. Let’s celebrate that!
Oh and also I’ve heard Prozac might cause early menopause as well as increase loss of bone density. Yeah. At this point I’m convinced natural medicine through nutrition, diet, exercise, is our best bet. Not supplements - actual nutritious food hard to get in this industrial food nightmare we’re in. Get the right balance of nutrients in your food. Also have lost faith in the medical establishment tho will utilize conservatively when necessary to save my life.
Yes it would be helpful perhaps to know that after you transition out of this reverse puberty, there are upsides. I feel more like myself than I ever have and I feel more confident in my decisions and care a whole lot less about what other people think. My libido took a huge hit, true, but that is also a relief on some level. I would like to reclaim the idea of being wise elders and stop yearning for what we can never have back (our youth.) My menopause journey was harsh -- but partly because I knew nothing about it. So let us be the wise elders for our sisters standing at the doorway of their transition. Knowledge is power and maybe reframing this can be a saving grace...?
Wise elder--that's way better than "post-menopausal". Why isn't there a standard word besides "crone" which is being nicely reclaimed? I'm claiming wise elder status!!
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.
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
I never had hot flashes, I had warm flushes. What I remember best was a ot of screaming. As I entered early menopause, my youngest daughter became an adolescent. . The best way to describe my (brief) menopause is that eveyy emotion was dialed to eleven. We survivied.
Thank you for sharing, Abigail. It has always been interesting to me that mothers tend to go through menopause just as their daughters are going through adolescence, two hormonally volatile phases of life.
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. ;)
Yes, please write and publish those essays! And this is such an important perspective. Thank you for sharing it.
But Tamoxifen doesn't put women in medically induced menopause. I took it for five years, beginning when I was 44. I didn't go into menopause, but Tamoxifen did cause uterine growths (completely benign) that required a uterine ablation. I also gained 30 pounds that I can't get off. I'm only just now getting hot flashes (at 54), so I'm pretty sure I'm finally in menopause. (The ablation caused my periods to stop.) Tamoxifen does not cause the ovaries to stop releasing eggs or to stop producing estrogen. (I don't mean to be argumentative. I just want to be sure that information like this is correct.)
Thanks for this Tam discussion! Since I went on 2.5 years ago at 45 (as a breast cancer prophylactic--substantial family history) I've been anxiously awaiting that first hot flash. I mean, there are tragic poems written about Tam, so I was prepared for the worst. When I talk to my NP at the breast center about my lowered libido, she says it could just as easily be a product of my age. Either way, I'm bracing myself for this new phase of life. But I think this quote from the NYT Mag article only gets at half of it. "Menopause could represent a time when women feel maximum control of our bodies, free at last from the risk of being forced to carry an unwanted pregnancy." The question I ask myself is will I be able to embrace my lowered libido as a positive? I don't miss the horny 20-something I was. I don't miss working so hard to achieve a standard of beauty so my boyfriend or later husband would find me beautiful. I might throw all this aging naturally stuff in the garbage, once I'm there. But I'm thinking about it. And these conversations really help. Thank you, Sari and all!
Thank you, Rebecca!
Tiffany I appreciate you including us medically-induced menopause people, ha! I am in a state of chemical menopause for treatment of PMDD, and I have HRT as part of that. I feel very lucky that symptoms are not extreme and are mostly treatable. Because of my life threatening hyper-sensitivity to hormonal changes I’m pretty wary looking ahead to proper menopause, or to sudden menopause if I opt for surgical treatment for PMDD eventually. But hopefully the fact that HRT smoothes those changes now means they’ll do so even when the menopause is no longer chemical...
Yes. Yes. Yes. After my double mastectomy I opted for a full hysterectomy. Jabs in my stomach every month for 10 YEARS was a heck NO. Now as my body struggles with medically induced menopause, -3.2 osteoporosis, and other chronic conditions that remain a mystery, I often find our situation an * at best.
Thank you for bringing this to the light.
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.
Wow. Thank you for sharing. I know nothing about all of this and am sure my docs don’t either.
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
I've lost a lot of hair, too. Yes, we need to talk to each other to figure it all out. Thanks for this, Kathleen. <3
I also had hairloss for many years. Last November I stared taking progesterone cream (Emerita pro-gest) and my hairloss stopped completely! It started to work very fast too. Maybe 2 weeks max the hairloss was stopped. I am so happy. I take it 2 weeks on, 2 weeks off. Even during the off weeks I do not have any hairloss. This cream is yam progesterone. I took progesterone on prescription before but it did not help me at all. So there is something specific about this one for me. Also it helps with sleep too. I hope that helps.
What brand? Glad it's helping!
Loved Flash Count Diaries!
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
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. :)
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.
They are!!!
Its been a tough journey but I am trying really hard to love my body/vessel -- a perspective that has eluded me for most of my adult life. I am turning 60 this year and could just weep over how antagonistic I have been to myself. Our bodies deserve our love and appreciation which I know is hard and goes against the entire history of how women are treated. But if we dont start with ourselves, nothing will change in the culture... Hormones can be annoying but they have their place. Not sure name-calling parts of ourselves really serves us. FWIW -- Rosemary
Yes, amen, THANK YOU!!!! I look at my dear, sweet nieces, who I would donate my heart to if necessary. It pains me to think of them feeling 1/10th of the abuse, hatred, and criticism I subjected myself to from 11 until recently.
Well the best gift you can offer them, IMHO, is to model loving yourself — out loud!
fair point: our bodies do deserve love and appreciation. For me, acknowledging the difficulties is empowering. My hormones have not been kind to me; I would not tolerate that from anything *outside* my body. Conscientious name-calling is the closest thing I've found to setting an impossible boundary. YMMV.
omg best title ever. I'd steal it if I had less (fewer?) scruples.
Fewer, I think? Can you count scruples?
I need a tshirt with this phrase. Hormones ARE Assholes!!!! Amen! Best of luck on your MFA Thesis!
Thank you!
Spammity spam spam spam.
I'd recommend blocking the spamster, @Sari.
Turned out to be Substack-wide. They’ve dealt with it.
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.
Hear, hear, to all of this. PS You are who turned me onto Egyptian Magic! <3
Yes, i remember! I’m so glad it works as well for you as it does for me!
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.
Literally could not find a doc near me in NAMS. No surprise but truly sad.
Thank you for NAMS! I'm 61, seeing a gynecologist for the first time in decades because my PCP said, at this week's check up (yes, I have good insurance thank the lord), would you like to see someone. I like a doc who knows her own limits. But after 8 years of hot flashes, insomnia, pain, fatigue, brain fog, etc. I figured it couldn't hurt to try. Now I know what my first question will be.
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.
Yes, in discussing the NY Times article with friends at dinner last night, one friend was very triggered by the pro-hormone talk after being on birth control in her 20s and 30s. I wanted to honor her experience and also my own - I really believe (and call me a pollyanna) that women are like fingerprints - every body/ mind/ spirit is unique and how we prioritize our own health is different. For some, life saving for others, a killer. I like the comments section because you get the panoply of experience.
In addition to my family history and my own hormone imbalances, I spent so many years on different hormones and birth control to manage my endometriosis, and the side effects were horrible. So another deterrent for me. But, yes, we are all unique, medically!
That sounds right to me. I don't take it but I try not to militate against it.
Yeah, it's so hard to know what to think about it!
I’m in between (and have been taking it forever).
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?
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.
I had not heard about homicidal ideation! I like your sense of humor about it.
Oh I would have such intense rages where I definitely considered homicide!!! People just PISSED me OFF. I scared myself sometimes.
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.
Rona, I'm sorry you have this dilemma! But glad you've had so many years of relief. <3
My own OB-GYN (who was near 68) told me that he said something to his mother about her going off HRT, and she reminded him that the decision was between her and her doctor. Now, it might be that you want to make another attempt, but it is a question of what makes you feel best. I agree with you that cannabis may not be the best choice as it would make for a muggy brain (I would not like that at all).
The new products are not supposed to do that, from what I hear, but we know so little about the effect of taking cannabis over a long period. I am going to need something forever, I think. I don't want to be any more crotchety than I am already with a decent night's sleep.
I've experimented with THC and CBD gummies at very tiny level, almost micodosing, to help with meno sleep issues, especially flashes all night. It has worked but I don't do it every night because I read that there's research that THC disrupts REM sleep. It's all fraught with trade off choices, I guess.
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.
I think HRT helps prevent aging if you take it in that early window. I understand reluctance to take it. I’m a probable DES daughter so that’s another reason they would deny it as an option but if you can take biodegradable HRT for that first 5-6 years I think it might be worth it. I also think we’re conditioned to fix everything and menopause is a natural stage in human development. Instead of fixing let’s empower. With menopause WE COME INTO OUR POWER. Let’s celebrate that!
Oh and also I’ve heard Prozac might cause early menopause as well as increase loss of bone density. Yeah. At this point I’m convinced natural medicine through nutrition, diet, exercise, is our best bet. Not supplements - actual nutritious food hard to get in this industrial food nightmare we’re in. Get the right balance of nutrients in your food. Also have lost faith in the medical establishment tho will utilize conservatively when necessary to save my life.
Yes it would be helpful perhaps to know that after you transition out of this reverse puberty, there are upsides. I feel more like myself than I ever have and I feel more confident in my decisions and care a whole lot less about what other people think. My libido took a huge hit, true, but that is also a relief on some level. I would like to reclaim the idea of being wise elders and stop yearning for what we can never have back (our youth.) My menopause journey was harsh -- but partly because I knew nothing about it. So let us be the wise elders for our sisters standing at the doorway of their transition. Knowledge is power and maybe reframing this can be a saving grace...?
This is the way!
Wise elder--that's way better than "post-menopausal". Why isn't there a standard word besides "crone" which is being nicely reclaimed? I'm claiming wise elder status!!
Thanks for all of this, Kelly!
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.
Wasn't it great? I wish more people knew about it.
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
I absolutely adore Jen Gunter. She's straight-forward and takes no guff. Her TikTok is very informative.
I never had hot flashes, I had warm flushes. What I remember best was a ot of screaming. As I entered early menopause, my youngest daughter became an adolescent. . The best way to describe my (brief) menopause is that eveyy emotion was dialed to eleven. We survivied.
Thank you for sharing, Abigail. It has always been interesting to me that mothers tend to go through menopause just as their daughters are going through adolescence, two hormonally volatile phases of life.
I have so much more appreciation for my mother now