Under a Red Roof

Buckle up, dear peeps, it is going to be a long one…

Well, it happened. I am a fully menopausal woman and will never say post-menopausal, because FACTS, it is till death do us part. It was made official on Christmas Eve, of all days, but let me tell you, what a Merry Christmas to me the diagnosis was! No joke. My mental and bodily frustrations crystallized on this single point. I was not losing my mind (well, not entirely!). Now Imma break it down for you, because hormonal loss is legitimately catastrophic on the body. Fear not, however! There is a fairly simple solution.

I am also going to say, right off the bat, that menopause, until recently, was NOT a natural part of life. Also, acting proactively now, to reduce symptoms, and as a measure of disease prevention, via hormone replacement therapy, is not some sort of failure on the part of women. No way, no how. Want to know why? The average life span of a woman in 1850 was 40 years, while in 1900 was 51 years (source). The average age of menopause is 53. Let that sink in — 53! Before the 1920s, the majority of women did NOT reach the age of menopause. About 23% of white women made it to 50 — zoiks! Women of color lived even shorter lives. In a nutshell, the creator put us on earth to have beautiful, plump skin, supple vaginas, procreate, and die before our lady parts shut down. Oh, the brutality.

Let us begin with the most urgent reason that sent me to the doctor. I, literally overnight, stopped sleeping regularly. I went from mostly 7-8 blissful hours to three. It was truly horrible. No matter my exhaustion level or “sleep hygiene,” I would lie awake until midnight or one, barely sleep, and wake via a fierce internal alarm. Every night. The sadness, anxiety, and frustration, the daylight weariness was horrible. I’d roam the house, toddler-like, praying for rest.

Why, you may ask? Progesterone. The gist? Progesterone is the hormone that makes our bodies cozy to make a baby. It is pro-gestation, pro-womb. Imagine it like a blanket, not just snug, but calming, giving our bodies the message to chill, to rest. Without it, we are challenged to regulate or receive the proper cues for rest. This lack also causes many women, including myself, to be more anxious in general during menopause. The first night I took my progesterone, I slept normally for the first time in months, shocked at the efficacy of a single dose. The next day, I was noticeably more “up,” too, with that progesterone cuddle energy, ready to calmly go where no woman has gone before! I will never be without it.

My tests, not surprisingly, also revealed abysmally low estrogen. The best analogy for all of this is hormones are like death. They plug along and simply disappear, a single dive off of a massive cliff. Unlike progesterone, estrogen’s benefits are even more far-reaching, which I think I’ll break down, via my personal symptoms.

The year before last, I began to have pain in my wrists. It started with push-ups, which I could previously do fairly decently, to collapsing in agony when I tried. The pain became a generalized, all-day situation. I thought I may have hurt them during a fall and had them checked. It was osteoarhritis! The doctor showed me my damaged bones, and I was agog. To later learn that estrogen, or lack of it, is a main cause for osteopenia, osteoporosis, and arthritis was bananas! It is absolutely essential for the maintenance of strong bones and connective tissues, and is why I now have a few massive knuckles, because my estrogen supplementation came a bit too late to prevent it.

Despite working out with weights four days a week (I can now lift 50 pounds over my head!), walking five days a week (Juniper!), biking two days, AND not changing my diet (save those first few months of COVID when I did a LOT of coping via sweets), I gained weight, especially around my middle, and had constantly increasing cholesterol. Well friends, we can take this all the way back to my first surgery for endometriosis in 2008. When I lost one of my ovaries to the disease, I also lost 50% of my estrogen production. From that point on, my cholesterol creeped up, my belly and weight, too. Turns out, estrogen keeps lipid counts down and our bodies trim, especially around the belly.

Here’s where the fellas, if you have a partner near or in menopause, and happen to like sex, may want to pay close attention. Estrogen is the source of our plump tissues (everywhere, literally!) and delightfully wrinkle-free skin of youth. This is especially true of our vaginas. A young woman’s has thick walls, replete with blood vessels. As our estrogen levels decrease, this is no longer the case for the entire neighborhood, which includes the labia and clitoris. With less blood flow, and increasingly dry tissue, this causes sex to become painful and decreases our ability for arousal. In my case, it felt like having sex with a giant double-bladed knife, and in what I thought might be the final case for more than two years(!), caused me to bleed horribly and have a massive hematoma. That is some dry tissue, y’all!

As my favorite urologist, Dr. Kelly Casperson says, since the vagina and bladder are close neighbors, it isn’t surprising to have infections in both areas at once. And boy did I when I arrived at my December appointment. Everything flaming from my profound lack of estrogen.

Last year, I awoke legitimately screaming in pain, my left shoulder in utter agony. Greg hopped on his phone, and we got to work, trying to figure out what I could do in the moment to give me some relief. After about ten minutes, we found targeted exercises (and ibuprofen) to make the pain bearable enough to sleep again, and I worked daily for months to restore full movement. I didn’t think about it much until I saw a post by Dr. Mary Claire Haver, menopause doctor extraordinaire, that this is common in menopause! Yet another area of our bodies where a lack of juicy tissue from estrogen loss causes debilitating pain and a drop in mobility!

My final symptom resides in my eyes. They were growing increasingly dry, and I was looking increasingly high, despite partaking on the rarest of occasions. Yes, my friends, low estrogen can deplete the moisture in our precious eyes! The stuff is system wide. Essential.

Now, to what I take to make it all better: vaginal estrogen, transdermal estrogen (gel), and an estrogen cream applied to the labia and clitoris, all on the daily.

For anyone who might disagree with this usage based on the Women’s Healthy study released in 2002 stating it causes heart disease, breast cancer, and blood clots hear this:

That study only evaluated older women who used estrogen via pills, not transdermally. When you take a pill for estrogen, it has to pass via the liver, and thusly requires more than necessary to make up for this loss and increases the risk for blot clots (same goes for birth control pills). As a result, it can wreak all sorts of havoc (but doesn’t always! Many have taken it successfully via pill for ages). When used, as I do, via my upper thigh or my vagina, this is not the case, and especially so with vaginal estrogen. They’ve done studies proving vaginal estrogen stays in the immediate vicinity, which is why, since I started taking it, I haven’t had burning pain in that area or a UTI, which were becoming so frequent I had a constant supply of cranberry and d-mannose on hand. This is also why, Dr. Casperson and the American Association of Clinical Urologists (among other menopause experts) are demanding that the warning that vaginal estrogen can cause cancer be removed from packaging, as it unnecessarily frightens women from using it.

If you are genuinely concerned about breast cancer, the best thing you can do is stop drinking, as 56-66% of breast cancer deaths are attributable to this single cause. The gamble a small number of women from estrogen activated breast cancers will take, is, in my estimation, worth the risk, and why I will take these drugs until I die.

Finally, if treated separately, without taking menopause into mind (for a dearth of education in medical school – generally less than SIX hours spent covering something that happens to half the population!), imagine everything you’d need to take to help, when progesterone and estrogen will do: a sleep aid and anti-anxiety medication for the lack of progesterone, cortisone shots and analgesics for for joints, osteoporosis drugs, hip and knee replacements, drops for dry eyes, weight loss drugs and/or constant dieting, antibiotics for UTIs and vaginal infections, the list goes on.

If you’re old enough, bite the hormone replacement bullet! There’s so much more to be gained that no longer challenges me (hot flashes!) and can protect us from in the future, like dementia.

I’d like to say, all of the information I provided is backed by solid research. Visit the National Library of Medicine to search for answers at https://pmc.ncbi.nlm.nih.gov/. I also highly recommend Dr. Kelly Casperson’s podcast, You are Not Broken and Dr. Mary Claire Haver’s The Pause Life blog. They are both passionate, caring women who will tell it to you straight.

If you are finding it challenging to locate a doctor who is up to date on the research and importance of hormone replacement therapy (this can include testosterone, by the way, I just so happen to have enough of it, for now) go to the Menopause Society to search for a practitioner nearby. I’ve also heard that Alloy and Midi Health are helpful online options if you live in a good menopause doctor desert.

Finally, a weird aside, if you are having issues with UTI and a vaginal infection. My initial prescription for this dreaded combo was a vaginal cream antibiotic and a pill, since my problem was so severe. I didn’t bat an eye, but after a couple days on the pill awoke in the middle of the night, gasping for breath, with a racing mind and pounding heart. It was terrifying! In order to decide if I should dash to the E.R., we got out our pulse oximeter and heart rate monitor to see where I was (inexpensive to purchase, by the way). Everything was completely normal. Bananas, right?! I now inform you, via my experience, that what I was feeling was literally all in my head. That night, I learned antibiotics have a history of inducing psychosis. Yowza. The things you learn when you least expect it!