Considering that women comprise 50% of the population, and that we all experience (or are currently experiencing, or have already experienced) the hormonal Armageddon known as menopause, you would think this protracted state of discomfort and sometimes misery would get more airtime. We all know that men can experience erectile dysfunction as they age, because we see the commercials for the pharmaceutical treatments on television. But where are the treatments for menopause? Where is the media coverage? Why isn’t anybody talking about this?
It seems to me, from my perspective as a physician specializing in women’s health (and specifically, women’s heart health), that there is a belief that hot flashes, sleep problems, sudden weight gain, difficulty concentrating, irritability, and the extreme inconvenience of unpredictable menstruation are all considered “normal,” “natural,” and “part of life.” That may be true, but then again, so is erectile dysfunction. So are enlarged prostate glands. Where are our remedies? Where is the research? Why are we supposed to suffer in silence? For goodness sake, where are our television commercials showing sexy attractive older women looking attractively troubled, until someone hands them the pill that will make it all okay again?
Until that day comes, the symptoms of the menopausal transition are inevitable for most of us (except those very few who tend to sail through without a problem—believe me, they are few and far between). And the truth is, we don’t have to like it. Sure, there are remedies for some of those intolerable side effects. There are dermatologic products and procedure for managing aging skin (like fillers and Botox). We know more about sun damage. We know that weight-bearing exercise strengthens bones, and there are some medications for this problem, too, that could help osteoporosis. But the one major factor that gets ignored, that is barely researched, and that certainly doesn’t have a good and reliable pharmaceutical remedy, is how the menopausal transition makes us feel. Nobody talks to us about how we feel about aging, how hormones can affect how we feel, or what it’s like to morph into what very much feels like a completely different person.
Feelings are, in the cultural consciousness, the realm of the woman. Men feel, of course, but we are both famous and notorious for it, and hormonal fluctuations have a real impact on what those feelings are. Think how well you have navigated this over the course of a lifetime. The Hormone Experience is intense, and from the time we start menstruating, we have had to deal with this. It is pretty amazing, really, to live in a body that is so subject to such constant and complex hormonal changes. We have had to figure out how to conceal menstruation, manage our symptoms, control our emotions and hide the bloat, every single month of our teenage and adult lives. We have tried to explain, to others as well as to ourselves, the premenstrual emotional rants, or the welling tears inspired by television commercials while pregnant, or the menstrual migraines. But we get used to it. We fall into step, uneasy as it sometimes is, with our hormonal fluctuations Then one day, our hormonal “normal” evolves into something new and completely foreign to us.
Menopause, by definition, is when you have gone exactly one year without a period. So, if you get your period in February and it shows up again in September, you are not in menopause. What you are in is purgatory, or this limbo called peri-menopause, where your hormones are sputtering out, and every so often, waking up again to do their thing. Your hormones are swinging, and the menopausal dance has begun. Hot flashes are often the most problematic symptom, but that is not to underestimate the life-altering effects of dramatic mood swings, brain fog, forgetfulness and distraction, rising anxiety or sinking depression, and serious sleep difficulties, even in people who have never had a single night of insomnia until peri-menopause took over. Then there are the heart palpitations, the sexual dysfunction, the surprise menstrual flooding and 15-day cycles alternating with long period-free stretches that leave you constantly wondering, every day, whether your period is going to show up again. Sometimes you might even delude yourself into believing you could be pregnant. Until you remember it’s probably less likely than the dreaded reality.
In this column, I will be writing about many different aspects of this menopausal journey, so you can be informed about what to expect, but also so you can see, in what I hope will be a meaningful way, that you are not going through this alone. That may not help your symptoms much, but I hope it will at least make them a little easier to tolerate. I’ll be talking about your health, your body, your sense of self, your heart, your mind, and encouraging you to explore what it means to be a whole woman going through this hormonal experience and rite of passage. Your hormones may be conspiring against the chipper young girl you once were, but I will be here to help you transform into a just-as-chipper, healthy, and vital woman, even as your estrogen takes its final bow.
Menopause is not the beginning of the end. It is the start of a whole new phase in life. Let’s have that conversation you have always wanted to have—the one nobody has been having out loud. It’s time to start delving into the truth about hormonal shifts and what they do to us as we age. So join me on this journey. Welcome to “The Heart of Menopause.”