Menopause can be boring or dramatically awful or something in between

Note: I was busy drafting this post thinking I could talk about my experiences of menopause since I haven’t had a period since the fall. Finally! I’m no longer the woman menopause forgot!  (And yes, I know it’s not officially menopause until it’s been a year. Yep.) However, between first draft and hitting “publish” I started to bleed. Of course.

Surely I can talk about peri-menopause though. And I have this to say, yawn! So far it’s pretty boring. Nothing to report here.

(Okay. There is one thing to report. I had kind of imagined the way menopause worked is that one’s periods gradually end. From 6 days a month to 4 to 2, then every second month. You know, an orderly gradually cessation of all things bloody and crampy. That’s the way it ought to be. If I ran the zoo, as Dr Seuss might say. Instead my periods went from the usual boring kind of thing to wild, extra bloody, extra crampy, and completely unpredictable. It was hard to teach and exercise was challenging and so at my doctor’s advice I got an IUD. Problem solved. Back to extra boring. And I haven’t looked back.)

Boring is not unusual for me. I remember during each pregnancy doctors rhyming off the bad symptoms associated with pregnancy: Swollen ankles? Nope. Heartburn? Nope. Backache? Nope? Basically pregnancy agreed with me and other the warm, happy, fuzzy glow there wasn’t much different about being pregnant. Other than a brief stint of morning sickness of the super convenient variety (I couldn’t cook food or do dishes. I had enough non-pukey time just to sit down and eat quickly.) I walked, biked, and exercised through pregnancy with not much to report other than obvious increase in size. Childbirth was likewise not very dramatic.

So there’s this silence around pregnancy, childbirth, and menopause–these things that some female bodies do. And sure some of it is because its “not supposed to be talked about” but some of it is also because for some of us, it’s dull. How much is there to say really?

In all of these things, it seems obvious, YOUR MILEAGE MAY VARY.

So when friends started sharing this piece last week–The Truth is Out There about Menopause— I was surprised. THE truth? Just one?

I didn’t comment. I just ignored it hoping it would go away.

I’m pretty good at avoiding ‘someone is wrong on the internet’ syndrome. I pick my battles.

The part of the piece I liked was about shame.

Jennifer Nadel writes, “There’s also this weird shame. There’s almost a conspiracy of silence around it because obviously being menopausal isn’t quite the same as being hot and young and nubile and sexy. To say out loud “I’m menopausal” feels like saying “I have lost my femaleness,” which obviously isn’t true, but as a result so few of us are really openly talking about it. We’re both in the same book group, and the moment we discovered that everyone else in the group was also going through it, it was just heaven. Whenever women of a certain age gather together, it’s not men or careers they want to talk about, it’s menopause.”

But I was less thrilled with the general tone of the piece which was about all the bad things associated with menopause. Again, the uniformity bugged me. Again, the misery.

Rebecca got it just right I think when she commented,

A post about menopause on a friend’s page this morning got me thinking. All my life I feel like people – very much centrally including other women – have been basically threatening me that my body is going to betray me because of its femaleness. I’ve been told how I will see, just wait for it, my body will get gross and unsexy and low-libido and shapeless and leaky and weak and painful and moody once I am pregnant, no, once I have a kid … no, once I hit 35, no 40, no really it’s once I hit perimenopause, no it’s menopause that will do me in.

I have just realized that I am angry about this. It’s like a constant onslaught of microaggressions designed to undermine my self-trust and my sense of at-homeness in my body. I think it is distinctively gendered … women are supposed to hate and fear our bodies and not trust them, so if we trust and like then well enough now, someone is always ready to tell us how temporary that is.

Now of course plenty of bodies leak and have pain and change shapes at these times and any other time, but there is nothing magical or universal about these changes. Personally, I am basically the same shape and size I was at 19, and my menstrual cycles are the same, and my functionality is the same or better; none of these scary threats has manifested so far. Lucky me, and obviously there is lots of variation, and eventually I will die like everyone else. But I am pissed at being told repeatedly to fear my body and its future, and I am pissed at being asked to orient myself towards inevitable decline, inevitable failure to count as a possible object of sexual desire, etc.

Every body is different. Childbirth and menopause and so on are not magical and they do not come along with any kind of universal shared experience. Let women enjoy their bodies, wherever they are at, in all their strengths and all their frailties and frustrations. Don’t create counterfactual or impending body shame and fear when you can’t manage to generate the actual kind. We are all gonna die eventually. In the meantime, YMMV and YOLO and all that.

Yes, yes, yes.

Also there is this in the news this week: How menopause affects athletic women.

(tl/dr version: The symptoms of menopause are less severe but your race times may be affected.)

Also, menopause seems to be something that only happens to white women with grey hair and scrunched up angry faces according to Google image search. Though I do like the “gun show” photo.

Image description: Google image search results for a search for "menopause." Lots of white white with grey hair, frowning.

Screenshot of Google image search for “menopause” Image result? Lots of white white with grey hair, frowning.

What do you think? Do you think we don’t talk enough about menopause? Do you find such conversations falsely universalizing?

Tired of Losing Sleep over Menopause? HRT Could Be the Answer

insomniaxOriginally I was going to write a post about whether to try or not to try Hormone Replacement Therapy (HRT) for relief of some of my menopausal symptoms. Most notably, the symptom that was doing me in was disturbed sleep due to hot flashes and night sweats. I used to be a great sleeper, but for the past few years my sleep has gotten worse and worse with no end in sight.

When I went to Kincardine for the Kincardine Women’s Triathlon I shared a room with a lifelong friend. At night, she just put her head down and slept, then woke up in the morning. What? When I asked her about her enviable sleeping ability, she attributed it to HRT.  She just slaps on a bit of estrogen gel in the morning, pops a progestin pill at night (to counterbalance the influx of estrogen so that there is no build up in the lining of the uterus, thereby minimizing the risk of uterine cancer), and away she goes.

Bam! No more hot flashes. No more night sweats.

Besides taking care of the hot flashes, HRT has a few other benefits. According to this article, the benefits of HRT include:

 

  • less vaginal dryness, bladder leaks and recurrent urinary tract infections
  • better sex drive
  • reduced risk of bone fractures associated with osteoporosis
  • reduced risk of bowel cancer

I’ve not had all of the issues they point to, but I have lost a bit of mojo. And who wouldn’t want to reduce the risk of osteoporosis and its associated bone fractures and of bowel cancer?

But there are also some risks associated with HRT.

 

I’ve had the conversation about HRT with my doctor in the past. She did her due diligence and explained that the current state of knowledge indicates some slight increase in certain health risks. The research shows that it slightly increases your risk of the following conditions: breast cancer, ovarian cancer, blood clots (embolisms), deep vein thrombosis, and stroke. That’s not great.

In the past, I decided that rather than take on any risk for symptoms that seemed, at the time, more like inconveniences than serious health issues, I would tough it out. But the fact of the matter is that over time, poor sleep quality has become more than a minor inconvenience.

So this time when I spoke to my doctor I asked her to candidly review the risks with me again.  Given my medical history and family medical history–no breast cancer that I know of in the family–the increase in risk is akin to the health risks associated with drinking two alcoholic beverages per day. My reasoning (specious, I’m sure) was that I don’t drink at all, so there’s room to take on a bit of risk.

When the research first came out, my mother had been on HRT for 15 years. Back then, it was thought to be a magic solution that women could stay on for the rest of their lives. But when news of risk came, many women, including my mum, abandoned HRT.

The latest studies suggest that there is a safe period of time–5 years–that a woman can be on HRT for menopause and have the benefits outweigh the risks. My doctor explained all of this to me and I decided I wanted to give it a shot. So she prescribed the same thing my friend was using: estrogel in the morning and progestin at night.

I started the very same day I got the prescription, not waiting until the morning. The gel dose is measured out in pumps. The recommended amount on the package is two pumps. My doctor recommended starting with one pump a day for a week. If that did nothing, then go to two pumps.

After a week, I was experiencing no change at all, so I increased the dose. Every morning after my shower I rub two pumps of estrogen gel over a large-ish area of my body, moving to different parts on different days on my doctor’s recommendation. Sometimes it’s both arms, or my abdomen, or my inner thighs.

Two weeks went by, and still it seemed not a lot better. Then, just this past week, I’ve been seeing a change. I haven’t had a hot flash during the day in over a week. And remarkably, I haven’t had my sleep disturbed by night sweats in a few days. And despite the flood that destroyed my condo on the weekend, I’ve been sleeping peacefully, not tossing and turning nearly as much as I have been for the past couple of years.

One thing I want to make clear is this: menopause is not on its own what I would call a health issue. It’s not an illness or anything like that. It’s a change that brings with it some inconveniences. I could have put up with the occasional hot flash and for a long time that’s exactly what I intended to do. But consistently poor sleep is, as far as I’m concerned, a health issue. Things came to head for me this spring and summer when I hit a wall. If I didn’t find a solution to my disrupted sleep, I could not continue with the training I was doing. And so for the summer, I’ve really backed off on my training in favour of sleeping longer to make up for sleeping poorly.

Now that I’ve had a few days of better sleep, I’m kind of excited at the prospect that the HRT will continue to help me in that area.  I’m really glad that I roomed with my friend in Kincardine or I may never have considered revisiting the conversation about HRT with my doctor. I’m also glad to have a doctor who is willing to take the time to explain to me the pros and cons of HRT. And what a gift to be able to live the next five years with good quality sleep!

If you’ve entered menopause and are suffering because you’re not sleeping, it’s worth having the conversation with your doctor. Not every woman is a good candidate for HRT — it depends on a lot on your and your family’s medical history. But those of us who can benefit from it with only a slight increased health risk may decide, as did I, that the benefits are worth the risk.

For more about HRT, read this primer on the Mayo Clinic website.

 

I’m late to the menopause party

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Lots of people ask us to blog more about menopause since we’re at that age.

And it’s true I’m at that age. But I’m not yet menopausal. Indeed, my last period started on the first day of the bike rally. Of course it did. Perfect timing, as always.

Menopause is starting to feel like something all my friends talk about but I haven’t much to contribute. It’s a bit like back when in grade six all my friends seemed to start their periods. They talked about it a lot. I didn’t start that much later but by the time my period began it was old news. Yawn.

Some days I feel like the person perimenopause and menopause left behind. No hot flashes here.

The average age of menopause is said to be 51 so I’m not technically “late” yet. Two weeks to go!

But perimenopause is supposed to begin much sooner.

Here’s what Web MD has to say,

Perimenopause, or menopause transition, begins several years before menopause. It’s the time when the ovaries gradually begin to make less estrogen. It usually starts in a woman’s 40s, but can start in her 30s or even earlier.

Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last 1 to 2 years of perimenopause, this drop in estrogen speeds up. At this stage, many women have menopause symptoms.

So far, other than the dreaded age related metabolism slow down, I’ve had none of this. Even perimenopause seems to be passing me by.

I know there are some health risks to late menopause besides being late to the party.

So I was happy to read in the New York Times that there’s some health benefits to late menopause as well.

There’s actually some very good news for you if you went through menopause later rather than earlier: You may live longer.

True, late menopause is associated with an increased risk of breast, ovarian and endometrial cancers. But “on balance, most of it is good news: Later age at menopause is associated with better health, longer life and less cardiovascular disease,” said Ellen B. Gold, a professor emeritus in public health at the University of California, Davis, School of Medicine and principal investigator of the university’s Study of Women’s Health Across the Nation, or SWAN.

Those who go through menopause later are at lower risk for heart disease and stroke, and also tend to have stronger bones, less osteoporosis and fewer fractures than those who go through menopause earlier. The average age of menopause, when a woman has her last menstrual period, is 51, according to the National Institutes of Health.

Save a party hat and a cupcake for me! I’ll be there eventually. Just fashionably late.

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Doctor’s orders: Menopause and fitness

Not everyone shares this sentiment, I realize, but for me, menopause is great news. My menstruation was as rough at 44 as it was at 13. But for over half a year I’ve had no excruciating cramps, no backache that feels like it’s splitting me in two, no radiating pain down my thighs. It’s fantastic. Some late-night hot flashes and a little weight-gain seem a light price to pay for freedom from monthly decommissioning.

Today was my doctor’s appointment to confirm that menopause is, in fact, happening, and not something more mysterious. When my mother was my age, she developed large, benign fibroid tumors in her uterus, and I wanted official word that the same was not happening to me. The doctor agreed that an ultra-sound could be done but assured me that usually, the sorts of tumors my mother had were accompanied by more bleeding, not less.

Instead, he said, it is a greater concern that I’m a bit young for menopause, and at higher risk for osteoporosis. “Okay,” I said cheerfully, “tell me something I can do to prevent osteo.”

“Exercise,” he said promptly.

Pause. “Tell me something else I can do.”

The thing is, I have been lucky in the body lottery, getting by on regular walking and not much more, despite a sedentary job. So exercise has always seemed optional to me. I know I lack fitness, but until now fitness seemed like it would be an improvement on my current privileged situation, and not like it was required.

This doctor’s visit was taking all the joy out of menopause.

He sent me to another room for blood-work, where I had time to stare at the long list of tests the lab was to conduct. My options seem to be dwindling. I know, I know, the future should not be presumed to resemble the past. None of ours should. But it wasn’t just that my body was changing. It’s that my concept of fitness was changing. Was fitness an optional state of well-being, or had I always been wrong about what was up to me? Had it always been required from above, an edict that I’d ignored? If I didn’t have the higher risk of osteoporosis, would I reconceive fitness, do what I’m told, obey?

I teach my students about autonomy often. I tell them that autonomy is complex, that it isn’t just equivalent to getting to do whatever you want to do. I have very high-minded lectures in which I emphasize that freedom of choice requires preconditions, and so autonomy also refers to the conditions that make choosing possible. When we refer to children as developing autonomy, we’re not referring to the numbers of new choices they can imagine, but to the physical, mental, and moral powers they are gaining, the capacities to choose. So I know I could see fitness as a capacity, a source of further choices. If I want it, if I choose fitness, maybe exercise won’t seem like a punishment, like I am being told what to do.

I was drawn to feminism because it spoke to my desire for autonomy, freedom, choice. Most of the bloggers here see fitness the same way. Only today did I realize that I don’t. At least, not yet. Before I start an exercise regimen, I’m going to need a little more of a mental workout.