Thanks for this, Andrea. Unusual though it sounds, it's a very important topic and suddenly a lot of women are talking about it. (See my friend Valerie Monroe at https://valeriemonroe.substack.com.) For so long we women, half the human race, have been kept in the dark about our "shameful" conditions, menstruation, menopause, and others. It is liberating to be open and frank about a universal female experience. I have nothing to add since my own experience was a long time ago, but I salute you for opening the discussion.
Thank you for sharing Valerie's newsletter and dispatch. I do think it's a generational shift with more women working in healthcare and more vocal women asking for relief.
In the food media space, we have such a hard time talking about aging. Cheese pulls, giant mac 'n cheese casseroles, and endless cocktail hours are plentiful and low-hanging fruit. Menopause is something worthy to spotlight. Abrazos.
It took me quite a long time to get any HRT help at all, because I'm in a rural area, and docs were still scared off by that 1990s breast cancer study. My biggest concerns were mental health. I was getting SO mean, and short tempered, and having a really hard time with light and sound sensitivity. I have a few neurodivergent traits (as does my entire family) and I did find a study pointing out that this seems to be how menopause presents in that cohort. Same as you, a little Dotti/progesterone, four months in I'm not thrilled to be reminded I have a uterus, but the mental health relief has been enormous.
The 1990s breast cancer studies were debunked but doctors are not caught up. I'm sorry! But that said, you found the patch/pill solution. Phew. High-fives!
News travels slow here in the provinces — but yes, so far so good! Thanks for writing such a lovely, balanced piece about this. (Tho “air-fryer face” is going to stick with me!)
And as always, thank you for the delicious recipes!
Thank you for sharing your experiences and opening up the discussion. At 50 I’m in the peri phase, unpredictable atrocious periods and disrupted sleep (that one could be anything). When I asked my mom about her menopause experiences, she said she didn’t recognize any because she was divorcing my father at the time and attributed everything to the stress of that. I have no siblings to ask either. I’m curious about how the management of symptoms varies in countries with less gender inequality and universal healthcare. Also, if it’s difficult for cisgender women to get help, imagine how challenging for the trans population.
Thanks for talking about this so frankly, Andrea. I wish my doctors had given useful info about perimenopausal symptoms and management, and then the different issues that came with menopause and how your body has changed (so your mgmt must change too.) A big challenge seems coordination of care, esp if you are managing other issues outside of the gynecological space. Am glad more people are talking of the importance of these issues and how overwhelming the entrance to this phase of life can be. I think if we talked more about understanding this phase of life, rather than diagnosing it a "problem" needing an acute fix, we would all be better off. Our bodies and minds change across the lifespan, and it would be terrific if our societies, foodways and care providers reflected these changes.
(On a personal note, I discovered there are also small, dissolvable vaginal estrogen tablets as a cream alternative if desired.)
So well written, Steph! Healthcare professionals can only do so much and women have to advocate for their own care to get what's needed. Half of the planet goes through this phase in life yet we often do in silence or alone.
One time, a lady said to me, "Andrea, I've been in post menopause for a long time. I'm sorry to tell you but it never fully goes away." Then we both cracked up. My mom's right in certain regards but when I told her about the night sweats that some of my friends had had, she was aghast that women put up with that for so long.
i didn’t have bad symptoms - the worse being insomnia and short term memory issues (what was I talking about?!) - started in low dose HRT dose and it’s helped somewhat. Didn’t realize either of those were menopause symptoms! I wish people had talked about all of this.
Right? All we hear about are hot flashes and night sweats but the list of menopause related symptoms is incredibly long! Women must share what we know so we can grow.
Thanks for sharing so many aspects of your experience! I’m not sure if I’m peri yet, but probably! It’s been helpful to face reality and talk to girlfriends about their own experiences.
Couple of tips. The est-ring vaginal insert for localized estrogen or the Femring vaginal insert for HRT systemic estrogen are vastly the most convenient way to get estrogen. (Swap out the ring every three months.) Insurance may cover it if you try other forms of estrogen first.
A Mirena IUD is another way of getting progesterone.
The list of perimenopausal symptoms is insanely long and includes anxiety, sleep issues, frozen shoulder, and itchy toes. Also bloodwork isn’t definitive because hormones are fluctuating so it depends on the day. Doctors use symptoms to manage dosage. Anxiety was my big perimenopause symptom.
Menopause.org has a “find a provider” search function to find a gynecologist near you who’s been certified to help with menopause - regular ob/gyns often don’t know much (and PCPs even less).
I loved HRT so much I had a double mastectomy to stay on it after a Stage 0 breast cancer diagnosis (DCIS). And my mom, who’s about to turn 80, started on hormones in her early 60s and never intends to go off.
Fabulous practical tips, Crystal. Thank you for nudging us to think out of the box and advocate batter for our own health.
I love Menopause.org. It’s a terrific resource that I’ll share with folks again in next week’s gems. Its guidebook is a great place to start.
And yeah, seems like 95% of the weird body things that happen in this phase of life is menopause related.
Appreciate and respect your and your mom’s decisions to go with HRT. Her going on it later in life and staying on it is definitely noteworthy. Thank you!
Being in the first wave of the baby boomers, I entered menopause in the early nineties. HRT was brand new. My issues were moderate, hot flashes but not frequently, migraines on Saturday mornings (never have been able to figure that one out), but no brain fog or irritability. My doctor suggested HRT. I read the medical literature available ( I worked part time for a pharmaceutical company) and decided no. I had had two benign breast cysts in a year, and I didn’t like the research that at that time showed possible links between estrogen and breast/reproductive cancers, especially since I had been exposed to herbicides in Vietnam. I read Susan Lark’s Menopause Self Help Book, added some vitamins and supplements, stopped eating meat (I had enough carcinogens in me already), started a serious exercise program, and soldiered through. My biggest menopause surprise was bad bones. Osteoporosis runs in my family, and exactly 5 years after my last period, I broke my foot, was diagnosed with osteoporosis and on another brand new drug, Fosamax. Oh yes, the vaginal atrophy was a surprise too. Things are a lot different now in terms of treatment, and 30 years of additional research have altered the landscape considerably. We whispered about menopause to each other. It’s inspiring to see and hear such wide open discussions now.
Saturday migraines? Oh boy. What a journey you've had, Ann. I would have decided against HRT if I were in your situation too. Why put more foreign substances in your body?
Exposure to herbicides in Vietnam during your service there. Good gawd.
The osteoporosis is real. A friend in her early 50s, a serious breast cancer survivor, was recently diagnosed with it and now gets shots every 6 months to manage it.
I so appreciate your sharing your experience because it makes me value where we are right now. Hopefully younger women will benefit from conversations like what we're having.
There always have been (and there still are) a lot of scare stories about HRT but that was mostly because of ignorance and prejudice (caused, fed and enhanced by the fact that medical research has ignored 'women issues' for as long as there has been medical research and because there's hardly any emphasis on the working of female bodies during medical studies.)
Anyway, HRT will not be the solution for everybody - and how could it be? all bodies are different to some degree - but every doctor should know enough to discuss it with all of their female patients and to do this! This should be 'GP best practice 1.0.1.'
HRT is definitely not for everyone. They may not have symptoms or be have allergies such as peanut allergies -- which on the progesterone pill label is a no-no. I don't know how long I'll be on this stuff so we'll see.
Six years ago, a friend said she wasn't going near HRT because her sister got breast cancer after taking it. Now we know there was little cause and effect between the two. Sigh.
It’s so important to have these discussions. I am 62 and although I did not have any significant symptoms other than sleep disruption (which was dreadful), I was shocked at the vaginal atrophy. Couldn’t understand why we don’t talk about this! Thank you Andrea 🙏
There, we typed it, Marion -- vaginal atrophy. When I saw the term on my health record my first thought was -- who came up with it? It further shames women.
Absolutely. I didn't mention those aspects because those are not going to be reason enough for a doctor to prescribe HRT. It's suppose to address symptoms, not be preventative. {sigh}
I started with the creams and estrogen pills but they didn’t work. So I went with Bio-T injections. GAME CHANGER! I told my daughter about my Bio-T she went to her Dr. The doctor prescribed the usual cream, patches and pill. Didn’t work for her either but her doctor doesn’t believe in the injection pellets so she’s on nothing and she hates it. They are expensive but they make me feel like I am alive again. I love them.
Thanks for writing about this incredibly important, too little discussed topic! I wanted to pass on the Mark Cuban's https://www.costplusdrugs.com is a great way to get some expensive drugs, like the estrogen vaginal cream, that many instances won't cover. My prescription would be $300 at the local pharmacy, but was only $13 there. He just cuts out the middle man - which is owned by the big insurance companies - makes a little money and we get the savings. Pass it on!
I'm well past menopause and I started BHRT about 18 months ago to help slow down bone loss. My doctors never mentioned taking hormones when I was entering perio-menopause due to the out-dated medical study on HRT. Glad I've been educated by a wise bone health expert.
That’s wonderful to know, Karen! There’s an often stated window for HRT after you hit post-menopause but protocols are changing. Yay to your smart doctors!
So did you feel any particular effect from the BHRT?
Thanks for this, Andrea. Unusual though it sounds, it's a very important topic and suddenly a lot of women are talking about it. (See my friend Valerie Monroe at https://valeriemonroe.substack.com.) For so long we women, half the human race, have been kept in the dark about our "shameful" conditions, menstruation, menopause, and others. It is liberating to be open and frank about a universal female experience. I have nothing to add since my own experience was a long time ago, but I salute you for opening the discussion.
Thank you for sharing Valerie's newsletter and dispatch. I do think it's a generational shift with more women working in healthcare and more vocal women asking for relief.
In the food media space, we have such a hard time talking about aging. Cheese pulls, giant mac 'n cheese casseroles, and endless cocktail hours are plentiful and low-hanging fruit. Menopause is something worthy to spotlight. Abrazos.
It took me quite a long time to get any HRT help at all, because I'm in a rural area, and docs were still scared off by that 1990s breast cancer study. My biggest concerns were mental health. I was getting SO mean, and short tempered, and having a really hard time with light and sound sensitivity. I have a few neurodivergent traits (as does my entire family) and I did find a study pointing out that this seems to be how menopause presents in that cohort. Same as you, a little Dotti/progesterone, four months in I'm not thrilled to be reminded I have a uterus, but the mental health relief has been enormous.
The 1990s breast cancer studies were debunked but doctors are not caught up. I'm sorry! But that said, you found the patch/pill solution. Phew. High-fives!
News travels slow here in the provinces — but yes, so far so good! Thanks for writing such a lovely, balanced piece about this. (Tho “air-fryer face” is going to stick with me!)
And as always, thank you for the delicious recipes!
Thank you for sharing your experiences and opening up the discussion. At 50 I’m in the peri phase, unpredictable atrocious periods and disrupted sleep (that one could be anything). When I asked my mom about her menopause experiences, she said she didn’t recognize any because she was divorcing my father at the time and attributed everything to the stress of that. I have no siblings to ask either. I’m curious about how the management of symptoms varies in countries with less gender inequality and universal healthcare. Also, if it’s difficult for cisgender women to get help, imagine how challenging for the trans population.
Your mom and my mom had life challenges to distract them. Of course they prioritized accordingly.
Good question about other countries like Sweden. I looked it up and found this straightforward FAQ: https://www.swedish.org/news/uf/689137903?streamid=3129992
That said, Swedish women still feel unprepared and lacking information: https://www.sciencedirect.com/science/article/pii/S1877575622001136
I also wonder about trans people and their HRT experience. It must be extra difficult.
I really appreciate your candor and willingness to share your experience on this topic!
Thank you! Boo to menopause being taboo! We must and can change the situation.
Thanks for talking about this so frankly, Andrea. I wish my doctors had given useful info about perimenopausal symptoms and management, and then the different issues that came with menopause and how your body has changed (so your mgmt must change too.) A big challenge seems coordination of care, esp if you are managing other issues outside of the gynecological space. Am glad more people are talking of the importance of these issues and how overwhelming the entrance to this phase of life can be. I think if we talked more about understanding this phase of life, rather than diagnosing it a "problem" needing an acute fix, we would all be better off. Our bodies and minds change across the lifespan, and it would be terrific if our societies, foodways and care providers reflected these changes.
(On a personal note, I discovered there are also small, dissolvable vaginal estrogen tablets as a cream alternative if desired.)
So well written, Steph! Healthcare professionals can only do so much and women have to advocate for their own care to get what's needed. Half of the planet goes through this phase in life yet we often do in silence or alone.
One time, a lady said to me, "Andrea, I've been in post menopause for a long time. I'm sorry to tell you but it never fully goes away." Then we both cracked up. My mom's right in certain regards but when I told her about the night sweats that some of my friends had had, she was aghast that women put up with that for so long.
i didn’t have bad symptoms - the worse being insomnia and short term memory issues (what was I talking about?!) - started in low dose HRT dose and it’s helped somewhat. Didn’t realize either of those were menopause symptoms! I wish people had talked about all of this.
Right? All we hear about are hot flashes and night sweats but the list of menopause related symptoms is incredibly long! Women must share what we know so we can grow.
Thanks for sharing so many aspects of your experience! I’m not sure if I’m peri yet, but probably! It’s been helpful to face reality and talk to girlfriends about their own experiences.
I was ill prepared for perimenopause and hope our conversations here help you and others just a smidgen.
Couple of tips. The est-ring vaginal insert for localized estrogen or the Femring vaginal insert for HRT systemic estrogen are vastly the most convenient way to get estrogen. (Swap out the ring every three months.) Insurance may cover it if you try other forms of estrogen first.
A Mirena IUD is another way of getting progesterone.
The list of perimenopausal symptoms is insanely long and includes anxiety, sleep issues, frozen shoulder, and itchy toes. Also bloodwork isn’t definitive because hormones are fluctuating so it depends on the day. Doctors use symptoms to manage dosage. Anxiety was my big perimenopause symptom.
Menopause.org has a “find a provider” search function to find a gynecologist near you who’s been certified to help with menopause - regular ob/gyns often don’t know much (and PCPs even less).
I loved HRT so much I had a double mastectomy to stay on it after a Stage 0 breast cancer diagnosis (DCIS). And my mom, who’s about to turn 80, started on hormones in her early 60s and never intends to go off.
Fabulous practical tips, Crystal. Thank you for nudging us to think out of the box and advocate batter for our own health.
I love Menopause.org. It’s a terrific resource that I’ll share with folks again in next week’s gems. Its guidebook is a great place to start.
And yeah, seems like 95% of the weird body things that happen in this phase of life is menopause related.
Appreciate and respect your and your mom’s decisions to go with HRT. Her going on it later in life and staying on it is definitely noteworthy. Thank you!
Being in the first wave of the baby boomers, I entered menopause in the early nineties. HRT was brand new. My issues were moderate, hot flashes but not frequently, migraines on Saturday mornings (never have been able to figure that one out), but no brain fog or irritability. My doctor suggested HRT. I read the medical literature available ( I worked part time for a pharmaceutical company) and decided no. I had had two benign breast cysts in a year, and I didn’t like the research that at that time showed possible links between estrogen and breast/reproductive cancers, especially since I had been exposed to herbicides in Vietnam. I read Susan Lark’s Menopause Self Help Book, added some vitamins and supplements, stopped eating meat (I had enough carcinogens in me already), started a serious exercise program, and soldiered through. My biggest menopause surprise was bad bones. Osteoporosis runs in my family, and exactly 5 years after my last period, I broke my foot, was diagnosed with osteoporosis and on another brand new drug, Fosamax. Oh yes, the vaginal atrophy was a surprise too. Things are a lot different now in terms of treatment, and 30 years of additional research have altered the landscape considerably. We whispered about menopause to each other. It’s inspiring to see and hear such wide open discussions now.
Saturday migraines? Oh boy. What a journey you've had, Ann. I would have decided against HRT if I were in your situation too. Why put more foreign substances in your body?
Exposure to herbicides in Vietnam during your service there. Good gawd.
The osteoporosis is real. A friend in her early 50s, a serious breast cancer survivor, was recently diagnosed with it and now gets shots every 6 months to manage it.
I so appreciate your sharing your experience because it makes me value where we are right now. Hopefully younger women will benefit from conversations like what we're having.
There always have been (and there still are) a lot of scare stories about HRT but that was mostly because of ignorance and prejudice (caused, fed and enhanced by the fact that medical research has ignored 'women issues' for as long as there has been medical research and because there's hardly any emphasis on the working of female bodies during medical studies.)
Anyway, HRT will not be the solution for everybody - and how could it be? all bodies are different to some degree - but every doctor should know enough to discuss it with all of their female patients and to do this! This should be 'GP best practice 1.0.1.'
HRT is definitely not for everyone. They may not have symptoms or be have allergies such as peanut allergies -- which on the progesterone pill label is a no-no. I don't know how long I'll be on this stuff so we'll see.
Six years ago, a friend said she wasn't going near HRT because her sister got breast cancer after taking it. Now we know there was little cause and effect between the two. Sigh.
It’s so important to have these discussions. I am 62 and although I did not have any significant symptoms other than sleep disruption (which was dreadful), I was shocked at the vaginal atrophy. Couldn’t understand why we don’t talk about this! Thank you Andrea 🙏
There, we typed it, Marion -- vaginal atrophy. When I saw the term on my health record my first thought was -- who came up with it? It further shames women.
We're not alone, Marion!
What about the benefits to bone and brain health that my friends gave told me about? That’s why I’m on it…
Absolutely. I didn't mention those aspects because those are not going to be reason enough for a doctor to prescribe HRT. It's suppose to address symptoms, not be preventative. {sigh}
Those were the main benefits my doctor cited. Interesting. I'm at Kaiser Permanente. Thank you for your work!
I started with the creams and estrogen pills but they didn’t work. So I went with Bio-T injections. GAME CHANGER! I told my daughter about my Bio-T she went to her Dr. The doctor prescribed the usual cream, patches and pill. Didn’t work for her either but her doctor doesn’t believe in the injection pellets so she’s on nothing and she hates it. They are expensive but they make me feel like I am alive again. I love them.
Bio-T injections? I'd never heard of them. And your daughter is lacking options. These remedies are not about vanity.
Doctors have prescribed anti-depressants for menopause. Why not try something like the injections to help your daughter?
I agree. The injections I get are pellets. They dissolve slowly.
That’s good to know. Thanks for the follow up.
Thanks for writing about this incredibly important, too little discussed topic! I wanted to pass on the Mark Cuban's https://www.costplusdrugs.com is a great way to get some expensive drugs, like the estrogen vaginal cream, that many instances won't cover. My prescription would be $300 at the local pharmacy, but was only $13 there. He just cuts out the middle man - which is owned by the big insurance companies - makes a little money and we get the savings. Pass it on!
Cindi, thank you for the CostPlusDrugs tip! Wow.
I'm grateful for this ..thank you for your unpretentious but informative writing!
I'm well past menopause and I started BHRT about 18 months ago to help slow down bone loss. My doctors never mentioned taking hormones when I was entering perio-menopause due to the out-dated medical study on HRT. Glad I've been educated by a wise bone health expert.
That’s wonderful to know, Karen! There’s an often stated window for HRT after you hit post-menopause but protocols are changing. Yay to your smart doctors!
So did you feel any particular effect from the BHRT?