perimenopause: Deidre, age 46

Continuing with the perimenopause series…

What’s perimenopause been like for you?
For a long time I struggled with heavy bleeding and increased frequency of menstruation due to uterine fibroids, but in my mid-30’s they got much worse. I had one procedure which helped for a little while, and then was approved for a hysterectomy at 40. I’m single with no children, so the OB-GYN was hesitant, thinking I might want children in the future. But the main fibroid was the size of a grapefruit, and my last period had lasted nearly two weeks and was so heavy that sometimes I would stand up from my chair and just feel it gush out of me, so I was very ready to be done with that. My uterus was removed but ovaries remained; I was assured this shouldn’t necessarily mean early menopause. It has been amazingly freeing not to worry about periods anymore!!

What did the surgeries involve? 
The first surgery was a fibroid embolization: they go in through the pelvic artery to the blood vessel that is ‘feeding’ the fibroid(s) in the uterus and inject tiny beads to block off the blood supply and hopefully shrink the fibroid. For that one, I spent the night in the hospital and then went home for a couple weeks of recovery. The procedure fixed the problem for a few years, but then the bleeding picked up again — new fibroids had grown. I could have just had a myomectomy surgery to remove the large fibroid, but they could see there were several more growing along behind it.

As for the hysterectomy itself, there are several ways a hysterectomy can be done. One common way is for the uterus to be removed vaginally, but since I had never had a baby (or even sex) my vagina was too narrow. If the fibroids are small enough, the uterus can also be removed laparoscopically through a small slit in the abdomen. For larger fibroids, they are traditionally cut into small pieces and removed through that same small slit. However, even though nearly all uterine fibroids are benign, it had been discovered that if a fibroid was unexpectedly cancerous, it could spread the cancer if cut. Just before I got to the point of surgery, the FDA ruled that fibroids could no longer be cut into pieces (morcellated). Now, large fibroids are cut up within a contained bag during surgery, but my surgery happened before this procedure became the norm. That left me with the only option of a full abdominal surgery, much like a C-section. 

For my hysterectomy, my abdomen was slit across the upper ‘bikini line’ about 8 inches long, through my core abdominal muscles. I had a friend who delivered a baby by C-section around the same time, and she had a much quicker recovery time. I’m not sure why it took longer for me to heal, except that full removal of the organ must be more traumatic to the body. I was in the hospital for two days and wasn’t allowed to do steps or lift anything heavy for several weeks after the surgery. It was about 8 weeks before I was back at work full-time. 

Those are big deal procedures! Did you have a good support network?
Because of the fibroids, I was poked and prodded a lot, so I quickly had to get over the shame; one can only be embarrassed for so long about all that stuff. (I’m sure women who have had pregnancies know all about that, but it was new for me.) Plus, I wanted to know what was happening, and what my options were, so I needed to get comfortable with the topic. Once I got over my own shyness, I didn’t find there was a stigma talking about the fibroids or hysterectomy. People were happy to share from their experiences and talk through the details. My work supervisor had experienced a hysterectomy around the same age, and she was very supportive and helpful. Several women at church surrounded me to help talk it out and share their advice. 

After the hysterectomy, did you have a sense of loss?
Afterward, my abdomen felt empty, like everything had to shift around and find its new place. I was unexpectedly teary and emotional for a couple of weeks. Physically, I didn’t feel normal again for at least 6 months, and I don’t feel that I’ve ever fully recovered my core strength (though I could certainly try harder at that). Probably because I already had been sometimes made to feel “less than a woman” from not having a partner or children, being faced with a hysterectomy didn’t feel too important, identity-wise. Although it wasn’t that painful for me to let go of the possibility of having kids, during the process I started noticing all the things that might be hurtful to someone with stronger feelings about that, like having to wait for my appointments in the same spaces with happily-pregnant women, and where there were photos of mothers and babies on the wall. After struggling with my periods for all those years, being free of the mess and pain has been so amazing. Now, since I’ve already given up my fertility and my periods, menopause doesn’t feel like it will be such a big deal. 

So now you are perimenopausal, correct? 
Yes. I noticed things were beginning to change in the last year or so, but without a menstruation cycle, it’s difficult to determine what’s happening and what it means. (Actually, until recently, I didn’t even know what perimenopause was.)  

What are your symptoms?
I have had occasional night sweats that wake me, and I have had a couple mild hot flashes during the day. I’ve had some urinary incontinence, probably because I never regained good core strength after my full abdominal hysterectomy. Also, I’ve experienced a couple night-time panic attacks (I think?) where my heart rate and blood pressure increase for no reason at night. (I didn’t know that panic attacks might be connected to hormone levels until I just now, when I looked it up.)

Any tips for dealing with the night sweats and panic attacks? 
Luckily, neither of these have been frequent. I can get by with one bout of insomnia as long as it’s not several nights in a row. If I’m working from home that day, I’ll take a short nap the next afternoon. I try to reduce my stress with exercise: getting out in nature, playing with my dog, and doing yoga. For anxiety, if I start feeling scattered and unfocused, I’ve begun the practice of laying flat on the floor for ten minutes. I set the timer on my phone, cover my eyes, and just focus on breathing. It’s amazing what a good ten minutes will do to reset your mind! If I am having something like a panic attack, which has only happened a couple of times, I can usually talk myself down by acknowledging what it is and taking deep, calming breaths. (Maybe this ability to control it means it isn’t a full-blown panic attack?) A friend and therapist also shared the tip of focusing on your senses — what do you smell? feel? taste? etc. She says to just cycle through those questions until you settle, so I’m keeping that in mind if it happens again. 

What about body image? 
I’m not sure perimenopause has directly impacted my body image since it’s hard to separate normal aging from perimenopause. Due to my hysterectomy and nulliparity, I had already dealt with my loss of fertility / “womanhood”. My hair had started to thin and grey years ago — the thinning is something I specifically struggle with, image-wise — and now there are the wrinkles, age spots, and sagging skin around my face. Weight is another issue. I believe we do ourselves and each other a favor by embracing our aging bodies, so I’m attempting to age gracefully. But it’s difficult to do in a society that fights aging so desperately. How do we care for ourselves and maintain a healthy, positive self-image while also recognizing the beauty and wisdom in our aging? I want to find a healthy balance between botoxing my hands to make them look younger (yes, people really do this!) and throwing up my (wrinkled) hands and saying “Yep, I’m just getting old!” 

Can you say more about how your nulliparity has impacted your sense of “womanhood.” 
Up until I was in my 30’s, I assumed my life would include marriage and children. However, thanks to my shyness, and perhaps because of some risidual shame surrounding sexuality from my conservative church upbringing, I never went on a date until grad school. Since then, I dated off and on, including a few months of online dating, but I just never felt the urgency to find a lifelong partner. I think a part of me just gave up at a certain point, maybe because it was too hard. But I’ve read a little about asexuality and think maybe I’m somewhere on that spectrum. I have sexual urges, but I’m able to satisfy myself and that has been enough. When I date, I mostly enjoy the companionship and the camaraderie that comes from knowing someone really well, going out to dinner and a movie, and having a deep conversation or a good laugh — all of which I can also do with good friends. 

The pressure to be in a romantic relationship comes more from societal norms. There’s this underlying feeling that something must be wrong with me because I’m single. And sometimes I feel that people perceive me as a “half” who should be focused on finding my “other half.” Well-meaning friends have made unsolicited comments like “I’m sure it will happen for you some day, hang in there,” as if I was giving off a sad and unfulfilled vibe just because I’m single. When visiting a new church, there’d often be no place for me to fit in because the only Sunday school class for people my age would be for “young families.” And I absorbed some of these messages: for example, I hesitated to buy a house on my own because that was something that was supposed to happen after marriage. These are all little things but they add up to create this feeling that I’m the weird one, the odd one out. Sometimes, it’s been painful.

Sometimes I wonder what I’m missing, like when people say that they only learned love and true unselfishness through being a parent. But listening to my married friends and their struggles, I can see that we all struggle in different ways. Except for the extreme solitude of the pandemic, I really do like living alone, managing my own schedule, budget, and decisions. As an introvert, this solitude gives me time and energy to put back into my community and volunteering. As I age, my biggest worry is the loss of that independence. I wonder, Who will care for me the way that I’m expected to care for my parents? 

If you struggle with going grey, why don’t you dye your hair?
When I was younger, I heard women complain about not knowing how to stop dyeing their hair so I decided I wasn’t going to start. Also, I’m cheap and didn’t want to spend the money, ha! I resonate with what Sarah Jessica Parker said recently when people commented on her grey roots showing: “It almost feels as if people don’t want us to be perfectly OK with where we are, as if they almost enjoy us being pained by who we are today, whether we choose to age naturally and not look perfect, or whether you do something if that makes you feel better.” 

I noticed my hair was thinning significantly when flash photos were taken of me and I could see the light reflecting off the top of my head. There didn’t seem to be a logical reason — I had tests done — so the only advice was to use Rogaine/minoxidil. I tried it for a couple of years; even though it increased my hair growth a bit, I decided that I didn’t want to do that for the rest of my life. (There are supplements, but they’re expensive.) At this point, I use good quality hair care products and try my best not to damage the hair that I do have. I blow dry or fluff the top of my scalp to try and give it as much volume as possible. (I have wear hats or bandanas outside to keep from getting sunburn on the top of my head.) I still feel self-conscious about it, particularly when I have to watch myself on Zoom these days. I just try to acknowledge that I’m aging and not obsess about it. There are so many more important things I’d rather be doing with my time. 

Emotionally, how has perimenopause affected you? 
Certainly in the last couple of years I’ve felt a bit more scattered and anxious, restless. Brain cells aren’t firing as quickly as they used to. I’m forgetting tasks and appointments that I would’ve easily remembered in the past. I’m more quick to lose patience with people, and I’m more tired. It’s difficult to untangle causation between general aging, being overweight, perimenopause, and the underlying constant stress of the past couple years of the pandemic.  

Has perimenopause impacted your relationships? 
Discussing my fibroid surgery and hysterectomy with other women has, I think, strengthened and deepened these relationships. I’ve learned much more from other women than from medical professionals. I’m glad to be in an intergenerational community through church, and I have close older friends. If women don’t have that, then who do they talk to about these things?

What’s surprised you about perimenopause? 
I’ve heard older women complain about hot flashes, weight gain, and vaginal dryness, but I’m beginning to realize that I don’t know much about the other symptoms, or how they will happen exactly, or if and when I should seek medical help. Menopause and perimenopause are all defined around having periods, just as womanhood is often tied to having children and a sexual partner, so, as usual, I’m struggling to figure out where I fit into this whole thing.

Any good resources to share?  
I haven’t really sought out resources, other than some medical websites, so I’m interested to see what other people suggest. For dealing with general aging and mortality, I got a lot from When Breath Becomes Air by Paul Kalanithi, and Being Mortal by Atul Gawande. In Being Mortal, Gawande discusses how we should take better care of our elderly, and how we should talk more openly about death and dying. It’s important to have conversations with our loved ones about what quality of life means for them, and for us, so that when it comes time to make those decisions on behalf of each other, we’re not left wondering if we made the right choice. And maybe, Gawande’s perspectives do tie into menopause: if we can accept the truths of aging and death, then we can live our best and richest lives in whatever circumstances we find ourselves. 

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This same time, years previous: the quotidian (1.18.21), homemade grainy mustard, the quotidian (1.18.16), cream cheese dip, day one, polenta and greens.