“I’m so fat and old,” wailed an old friend theatrically when I saw her for the first time in a while last week. She was joking but also she wasn’t. In the way women so quickly do in this life stage, we cut straight to the chase. My 52-year-old friend didn’t want to have sex with her husband or in fact anyone else, ever again. She could barely remember what it felt like to want sex and it had become strangely unimportant to her despite it once being a driving force in her life. No longer did she even care that she didn't want sex.
Because on the list of things about herself she no longer recognised, her non-existent sex life and forgotten sex drive were nowhere near the top.
It was a long list. “I always used to be skinny and now I’m so fat,” she said. “It’s not like I want to fit into skinny jeans but I just....I just don’t recognise my own body anymore.”
“Oh welcome,” I replied. “Obviously it’s peri. Are you taking HRT?”
Her face sagged with resignation and she waved her hand in front of her face dismissively. “No, I just have to wait until it passes.”
I hear this a lot. Women say it out loud and we say it to ourselves. Suck it up, sweetheart. It’s not that bad. Every woman goes through it.
I subscribed to this idea for a long time until my friend who is a doctor told me I was an idiot. “Why suffer when you don’t have to?” she said. She wasn't angry, she was just disappointed. And I'm glad she was because being a martyr doesn't suit me and I needed someone to snap me out of my resigned apathy.
This is the same friend who ‘gave me permission’ to stop breast feeding my second child after eight bouts of mastitis in seven months. When she gives me advice, I listen.
Here's a thing I've noticed: as women, we internalise the idea that our pain or discomfort is something we must endure and that to seek relief is a cop-out. For pussies. Weak. Whiney. Whether it’s the valorising of a drug-free birth or the idea that the chronically debilitating and often distressing symptoms of peri-menopause are just part of life, we are encouraged to be martyrs for reasons I’ve never been able to understand. Probably because it's easier for everyone if women just suffer silently instead of demanding better living conditions inside our own bodies.
HRT may not be the answer for everyone but what every woman should do is find out what her options are. I felt sad after seeing my friend. She no longer recognised herself in the mirror, her marriage was under huge strain and the joy had been sucked out of her life at a time when she should have been leaning into the freedom of being in her early 50s.
A few weeks later, a friend in her early forties told me she'd just had a blood test to ‘check her hormones’. She thinks she might be peri-menopausal but her GP looked at the results and declared she’s not.
This isn’t necessarily true.
There is no blood test that can tell you if you’re peri, a period of time that can last for 10 years when your ovaries begin to wind down. Pack it in. Shut up shop.
This is because they don’t switch off like a light.
Remember puberty? Remember how it took a while? It’s not like you woke up one morning with boobs, your period and pubes.
The time in your life leading up to menopause is like that but longer. A blood test will simply measure your hormone levels on that particular day. The next day, they could be wildly different. And it’s that fluctuation that’s the signature of peri-menopause and why it feels so disorienting.
Menopause is easier to diagnose and can be measured by a blood test because it’s when your ovaries have stopped spluttering and decide to officially call it a day – and have stayed that way for one year.
Welcome to menopause.
Peri, though? Well, that’s a whole other bag of tricks.
I know this because for a long time, I thought I was going a bit nuts. I was forgetting things. I felt intense bouts of rage. I cried most days. I gained weight around my middle. My boobs grew enormous. I didn’t recognise my body in the mirror. I didn’t recognise my thoughts or my emotions. And because I hadn’t had my period in years thanks to my IUD, my period (or lack of it) was no barometer of where I was at with my cycle.
When I first saw an endocrinologist (hormone doctor) who specialises in menopause, he told me I was the first of his patients that week who hadn’t cried during her appointment.
His office was full of women in despair at the unrecognisable person they’d become, not just physically but emotionally and mentally. I suspect many of them were crying in relief when he told them why they were feeling so unhinged and gave them some options for ways to help.
The main option he gave me was HRT (hormone replacement therapy – now called menopausal hormonal therapy, or MHT), which I immediately rejected because I thought it caused cancer.
“It doesn’t cause cancer,” he told me without me even having to say it out loud.
Most women think it does. Many GPs think it does. And that’s due to one discredited study from decades ago which grabbed lots of headlines and prevented generations of women from accessing a treatment that could help them.
What struck me back then was how misunderstood this phase of life was – and how unfortunate that was since every woman will go through it. No matter how young you look on the outside, no matter how many anti-wrinkle injectables you get or retinol you use or on-trend trainers you wear, you cannot change your biology or the expiry date of your ovaries.
And if you don’t know what it is and you don’t know how to treat it, perimenopause can put extreme pressure and stress on relationships on families and on careers.
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Over the next year, I talked of little else as I hyper-focused on identifying the best experts in the world on peri and interviewing them for the Very Peri Summit (you can now listen to an updated version as an audio series here).
Now, almost two years after that initial doctor’s appointment, what’s changed for me and is my life better or worse?
Well, it took another six months or so for me to decide to start HRT to put back some of the oestrogen my body was no longer producing.
“It’s not too bad,” I thought. “I can suck up these symptoms.”
Until I couldn’t. It’s not that the symptoms – the weight gain, the rage, the insomnia, the hot flushes, the night sweats, the constant weepiness – got worse. It’s that I realised I didn’t have to suck them up. This was a revelation even though it sounds stupidly obvious.
I was prescribed patches, which I was to put on my lower stomach twice a week. That’s it. When you take oestrogen you also need to take progesterone, but I was already getting that through my IUD, so I didn’t have to take an extra pill.
And I should say that the reason I got the IUD in the first place wasn’t for contraception so much as to treat the ‘flooding’ I was experiencing, another fun peri symptom. Having had a lifetime of normal periods that were neither heavy nor painful, in my 40s, the floodgates opened and some days I couldn’t get off the toilet because I was bleeding so much. My iron got critically low because of all the blood I was losing and I would have had to have a hysterectomy if I was from the previous generation of women who didn’t yet have access to hormone-based IUDs.
That was actually the first and most notable peri symptom, my periods turning into tsunamis. The others were so much more insidious.
A few weeks after I started HRT, my brain fog lifted, my night sweats stopped and so did my hot flushes. My rage subsided, and I went back to crying just when things were sad – and for the first time in a long time, not everything was sad. My boobs are still huge, which I don’t love, and at 51, I’m definitely not the same shape I was in my 30s, but neither is any man I know.
This is not to say that HRT is the answer for you necessarily. That’s a question best discussed with your doctor. But what I learned by putting together and then listening to the Very Peri Audio Series is that not all GPs are created equal when it comes to being informed about perimenopause and treatments for it.
The reason we created this series – with 12 experts – is to empower women with credible, expert information about their own bodies. For me, it’s been incredibly positive.
Until I went to get my script for patches filled a month ago and the chemist told me there was a worldwide shortage of HRT and she had none of what I needed in stock.
This is good news and bad news. The bad news is that she had none of what I needed in stock. The good news, though, is that the shortage is because a generation of women like me have finally been able to learn about and talk about perimenopause.
While the factories making HRT patches crank up production, my doctor has given me a new script for oestrogen gel, which is just a different delivery method to patches and is in plentiful supply.
This is good news because I feared that a worldwide HRT shortage could lead to the breakdown of society as Gen Xers like me rampaged through the streets. Crisis averted. Bring me my gel.
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Feature image: Supplied.
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