'It's Normal' Is Not A Medical Diagnosis:
My Menopause Maze
About five years ago, during my annual pap smear, my OB/GYN recited notes for his nurse to take down, “vaginal atrophy” being one of them. He was very nonchalant about it.
“Atrophy?!” I blurted out. “Are you saying I’m drying up?”
“It’s all very normal for a woman who is as many years post menopause as you are,” he calmly replied. Perhaps I should have cut and run then.
I went through menopause early, like really early. At the age of 43, I was officially “postmenopausal,” meaning I had no more periods and my hormone levels had tanked. Currently, I am 57 years old.
Among my friends, I was the first to crossover, so I was the test case for what it’s like over here. Many of them thought I was lucky to have finished menstruating, to be done with the monthly curse, done with the dragon.
For me, it felt like mourning. In theory, at 43, I may have been able to have another child if I wanted, but somehow I had run out of eggs. I mourned the loss of my childbearing years. I felt different from the rest of my peers, and I didn’t know how to talk about it with them since they thought I was “lucky.”
Now, all of them are joining me over here, having arrived at menopause at the average age of 52. Shockingly, they don’t like it very much. Maybe it’s the dry skin they don’t like, or maybe it’s the thinning of the hair, the decrease in libido, the plummeting of your metabolism, the increased weight, the decreased energy, the interrupted sleep, the hot flashes, memory lapses, the lack of moisture everywhere. It. Just. Sucks.
Luckily, there is good news for my friends who have recently joined me.
Before I get to the good news, some context: In 2002, the Women’s Health Initiative (WHI) published a study about estrogen and progesterone use for women in menopause, which focused on long-term hormone therapy to prevent chronic disease in women over age 60. However, the study results were generalized to younger women between ages 50-59. The media sensationalized the story by emphasizing some findings that seemed to show that hormone replacement therapy (HRT) may cause breast cancer and heart disease.
Until this study was published, doctors had supported women taking hormones to help with menopausal symptoms. Within months of the release of the WHI study, the number of women using HRT dropped by almost half.
If you were an adult woman in 2002, you heard about the WHI study. You knew what the study found, which was basically HRT=Bad. At that point in my life, I was 35 years old and trying to get pregnant–menopause seemed a long way off. But I tucked that information in my back pocket, thinking, “I got it, no HRT.”
Now the good news: In the last few years, experts are finally reevaluating the results of the WHI study and finding that the study results were overblown. Basically, a closer analysis of the WHI study and numerous subsequent studies show that there is a much lower risk than was thought and that the benefits likely outweigh the risks for HRT use in healthy women younger than 60 years or within 10 years of their final menstrual period, according to a JAMA Health Forum article. Doctors should know that current clinical guidelines support the use of hormone therapy for menopausal symptom relief in younger menopausal patients, as well as for mitigation of premature estrogen loss in women who reach menopause before the age of 45 years.
The problem is that many doctors still do not know this.
Personally, I have to give my doctor a pass for not doing more to help me, given that clinical guidelines were different when I entered menopause 13 years ago. Even so, my suffering was preventable.
At my last gynecological appointment, I complained for the third time about dryness “down there.” “Come on, it feels like sandpaper just walking around. You gotta help me,” I pleaded.
His response? “Yeah, I hear that a lot from women your age.” I’m done giving out passes.
My Gen X friends and I have been gorging ourselves on the newer information and studies about HRT. It’s not hard to do, as there are even a few female doctors who have become Instagram famous by educating women about HRT and the new, updated information, as well as the real risks weighed against the benefits.
My friends who entered menopause at the “normal” age are lucky. They get to start HRT in what is now believed by some experts to be the most beneficial window for preventing or, at the very least, prolonging chronic disease. When estrogen levels begin to drop in perimenopause, women have a higher risk of developing conditions like osteoporosis and cardiovascular disease. These risks increase as estrogen levels drop throughout menopause.
According to a 2023 article published in PubMed Central, estrogen therapy prescribed for preventing cognitive decline appears to be most beneficial when prescribed for perimenopausal women under the age of 65 years. Estrogen is protective for perimenopausal women, given that they are still healthy and cognitively intact.
On top of the potential protective benefits of HRT, my friends who are currently going through menopause don’t have to experience its harrowing symptoms, such as night sweats, hot flashes, vaginal dryness, insomnia, etc., etc., etc. They get to skip the stuff I have had to put up with. I’m happy for them–and so jealous.
After my last, useless doctor’s visit, I went on a quest to figure out if HRT could be safe for me.
As someone who experienced early menopause, I am an outlier. Remember, current clinical guidelines say that HRT benefits likely outweigh the risks for use in healthy women younger than 60 years or within 10 years of their final menstrual period. I meet only one of those criteria–and I am not alone.
It took two out-of-pocket “concierge” doctor’s visits before I found a doctor who was willing to work with me. The first doctor I visited was younger with less experience and had recently opened a direct-pay, holistic practice focused on women’s health. At the end of that visit, I was in tears when she told me that the “medical field has failed you” and that my last daughter (born when I was 39) was a medical miracle. She also told me that she couldn’t take the risk of helping an outlier like me.
Half-heartedly, I tried one more time, expecting the same, but was pleasantly surprised to find that I am not the unicorn I thought I was. The next concierge practice I tried had seen others like me. The research is scarce on women’s health in general, but especially if you don’t fall on the bell curve. So, this doctor and I did all the prerequisite tests to make sure my heart was healthy and I had no risk factors before starting HRT.
Currently, I’ve been using estrogen, progesterone, and testosterone for about 4 months, and I am so very glad I kept looking for a new doctor! I have more energy, less brain fog, recover from workouts faster, have much less soreness in my muscles, and less dryness. And my doctor and I are clear that we will continue to monitor my health to make sure that there are no adverse effects from HRT.
It’s a shame how much research my friends and I have had to do on our own to figure out that women don’t have to suffer in silence because “this is normal for a woman your age.” One of my friends recently commented that if this kind of bodily upheaval happened to men, “You’d be able to go through a McDonald’s drive-through to get your hormones.”
Clearly, there are not enough studies and certainly no good long-term, longitudinal studies that would clearly show the risks and benefits of HRT use. In fact, there is virtually no research on how long women should use hormone replacement therapy and the risks for long-term use.
Menopause brings with it loss. And not just the physical losses already discussed, but a loss of what it means to be a woman. It necessitates us redefining who we are and why we matter, since Western society doesn’t hold older women up as the ideal. The complete lack of research into women’s health as they age speaks volumes.
I can tell you one thing: The women I know who have arrived over here will not be quiet about this. We are making sure to tell our daughters, our nieces, our younger friends that they need not suffer in silence. They can be their own advocates, do their own research, and find doctors who will listen to them. They are out there. Don’t give up.
