How did perimenopause start for you? With hot flashes! It took me a while to figure out what I was feeling. (I actually started timing them, the good labor nurse that I am.) The hot flashes were more noticeable during the change of seasons, so I thought I was just feeling the heat of spring or something, but then I put things together and realized what was going on.
I also experienced brain fog — I felt mentally slower, unable to remember things, words and names, and not being able to get my snappy comebacks out there with the speed and zing that I used to — and there was hair loss, too. It seemed like every time I ran my fingers through my hair I got a handful of hair, and there was always a big clump of hair in the shower.
Sleep has always been an issue for me, so I don’t think I noticed less good sleep, but once I started HRT I definitely noticed better sleep.
Did your nurse training include education about menopause? I don’t remember learning about menopause in school. I’m sure it was included, but it wasn’t anything that I carried with me (or is that the perimenopause brain fog?!).
How did you learn about hormone replacement therapy? A friend actually asked me what I knew about it, and/or what I was doing about it, and then shared a podcast with me. I hadn’t really thought about it before that. The possible benefits to the treatment, even in the absence of many symptoms, made sense to me, so I decided to look into it. (I also listened to a We Can Do Hard Things podcast about menopause.)
Did you have any concerns about it? Yes, cancer. That’s the only thing I’d really ever heard in relation to hormone therapy. I had a friend who was really into a lot of alternative health care who told me at one point that doing HRT would be the very worst thing I could ever do to my body. I don’t think I pushed her much further for details, but the passion with which she said it really stuck with me. However, I had also heard that HRT is beneficial to bone health and heart disease prevention, which made me want to look into it more. (My doctor says there isn’t a lot of evidence in the research to support this at this point, but there is anecdotal evidence.)
What form of HRT are you on? I’m on the estradiol patch. I started with a 0.05mg dosage, twice weekly. I did that dose for a couple of months; it wiped out my hot flashes, and I was sleeping better and had more energy, but then I also started to break out with acne, developed an increase in headaches, and I felt PMSy with a vengeance: weepy, anxious, wishy-washy. When I went back to my doctor, we cut my dosage in half and tried that for a while. After a few weeks my hot flashes started to return, mostly at night, so we landed on a 0.035mg dose, and that has been my sweet spot. No side effects, and my symptoms are very well managed.
Wait. Aren’t you also taking progesterone along with the estradiol since that’s a requirement for women who still have a uterus? (You do still have your uterus, right?) I have a Mirena IUD which is where I get the progestin.
What exactly is a Mirena IUD? How do they implant it? How long does it last? Why use it over the pill form? The procedure to insert it can happen in the office, or sometimes it is placed after having a baby in the hospital. It’s a little device that goes in your vagina, through the cervix and into the uterus, and then it stays for as long as you want. How long it lasts depends on which kind you choose, but I think most of them last at least several years. For me, the procedure felt very similar to a pelvic exam with a speculum. It was a little uncomfortable when they were inserting it, and then I felt some cramps, but it was all very tolerable.
The IUD releases the hormone in a constant dose right there in the uterus versus a pill that’s releasing hormones into your bloodstream (and that you have to remember to take at the same time every day in order to get the most constant dose). It thickens the cervical mucous which makes it harder for sperm to pass through, and it also thins the lining of the uterus.
Any idea how long you’ll be on the hormone therapy? I don’t really have a plan. I’m just going appointment to appointment, unless something changes in my body before that. My understanding is that this dosage is not intended for the rest of my life, but it should be good for me throughout my transition. I feel like I have the information I need for right now. Moving forward, I’ll continue to pay attention to my body and follow advice from my doctor.
It sounds like you have a good doctor. When I first raised the question of HRT to my GYN, she was very supportive of my questions. She could tell I was nervous about HRT, so she gave me lots of information and told me that I could think about it and just message her if I wanted to try it. She also said that if it helped for me to know, she was planning to begin HRT whenever she started with perimenopause symptoms. Knowing that did make a difference. I realized that I have trusted her to help me with health care decisions for many years now, so why wouldn’t I continue to trust her with this stage, too?
What, if anything, about this transition has surprised you, good or bad? HOW MUCH BETTER I FEEL!! Really, as far as my hot flashes go, it feels like magic. I initially really noticed an improvement in my sleep, but now I’m not so sure. I still wake up often during the night, but I don’t know the reason why, or if that would be worse if I wasn’t on HRT. I honestly don’t know whether or not HRT has helped with my brain fog, but maybe it would be worse if I wasn’t on it?
Do you discuss menopause/HRT with other women? It’s incredible how little HRT is known and discussed in our culture, but my friends and I talk about it a lot — anywhere and everywhere — and we talk about it without shame. I think a lot of us were embarrassed to talk about our periods for much of our younger lives, so now we are determined to not be shamed or embarrassed about this normal transition in our bodies.
At the same time, I am very cautious about sharing my opinions about HRT; I don’t want people to just take my word because I have a medical background. HRT isn’t my field of expertise, so rather than give advice, I just share my experience about how it’s worked for me and encourage others to talk with their trusted providers. It’s important that they get their questions answered based on their own health history.
On one of those blistering hot days a couple weeks ago, one of my girlfriends and I were in belly-deep water in a backyard pool, sipping spiced cranberry mead and bobbing on floaties. “So I’ve been thinking about the meaning of life,” I said. “Do you know what it is?”
“I’ve been asking that very same question!” she said, smacking the water.
“Well, do you have an answer?” I said.
“No, I was hoping you would!”
For the first (almost) fifty years of my life, my purpose has been mostly predetermined. As a child, teen, and young adult, my purpose was to grow up, get educated, and gain my own freedom. And then for the last twenty-plus years, my family — building it and then tending it — was what gave me purpose.
But now I can do whatever I want and so I’m asking, What’s it all about? What do I reach for? How will I know they are the right things? How do I check myself? It’s not the specific choice that matters as much as the underlying motivation, so I’ve run through a list of all the things that, at first glance, appear to motivate me.
Here’s what I think the answer to life’s meaning is NOT.
It’s not fame or popularity. Whenever one of my little YouTube videos does extra well, or I get a bunch of comments on a blog post, or I get a flurry of compliments, I feel like I’m lifted, speeding along on a lovely little wave. But then the wave breaks and I’m deposited (rather indecorously, I might add) on the beach and, welp, ride’s over and that’s that. The truth is, all that good will doesn’t give me meaning. Which actually, now that I think about it, is a good thing, because the same goes for the bad will, whew! My meaning and drive and purpose needs to be internal if I’m gonna stay grounded.
It’s not money. I’ve never been driven to make money but I have toyed with the idea of devoting myself to the pursuit of it, and while it’s be an interesting diversion, I’m sure, I also know that no matter how much I’d make, it’d never be enough.
It’s not relaxation. I love my down time with the fiercest of passions (when I’m not chilling on the couch, I’m looking forward to chilling on the couch), but give me more than a couple hours of popcorn and Netflix and I begin to die inside.
It’s not freedom, simply because people who lack freedom, however you might choose to define it, are still able to have deeply meaningful lives.
For awhile I thought that maybe relationships were the answer, as in life is meaningful only in as much as we find connection with others. Or maybe it was generosity, not so much the act of giving but being invested in something beyond one’s own perspective? But no, relationships are constantly breaking, and generosity can be a selfish and draining act.
Here’s something else I’ve been thinking: If I were to die tomorrow, my death would upset a bunch of people, yes, but it would only disrail a handful of lives. And then, just a couple generations later, my very own descendents will probably not even remember my name. This is kinda depressing, of course, because I am the world (to me), but it’s also kinda grounding, or at least clarifying. My existence really doesn’t matter all that much.
So then, I ask you (myself), what’s it all for?
At long last, I’ve finally settled on the truest, simplest thing I can think of. See, I’ve noticed that the more I value what is, the less frenetic I feel. When I stop chasing projects, people, deadlines, to-do lists, and obligations and instead simply focus on appreciating the little things around me — my bare feet on the cool, leaf-strewn concrete porch, the laser focus required to get these thoughts into a Google Doc, the messily abundant pantry shelves, the bodies of my children obstructing my way around the kitchen — suddenly, it is enough. There is enough. Life is enough.
Appreciating what is has two benefits. First, it removes the pressure to achieve — boots me right out of the ratrace hamster wheel, it does — and second, it gets me outside my feelings because there’s no need to like something in order to be grateful for it.
Example: I don’t like running. It’s hard work, I can’t breathe, my thighs ache, my hair sticks to my sweaty skin, my body wants to stop. And yet, I can run! My body is strong! The air is fresh! The views are stunning! My heart beats! I am alive!
Example: I don’t like a messy kitchen. Stuff’s in the way. I run out of space. Cleaning up takes time. And yet, I can cook! I have instant running water! Look at all my tools! I can make whatever I want! We have food! I have a freaking KITCHEN!
The shift is subtle but the impact is huge.
So regarding the meaning of life, this is where I’ve ended up: gratitude. It’s so simple, it sounds stupid, but I’ve yet to land on a better, truer answer.
