No more red tent
June 11, 2022 6:35 AM   Subscribe

A mid-40s friend recently posted something that resonated: she has no idea what to expect of menopause. I realized I don’t either.

What does someone need to know as it approaches?
Are there ways to make the most of the time before menopause? (fertility isn’t an issue)
Any advice you wish someone had shared with you?
Tips for dealing with symptoms?
What are good ways to not just manage, but actually embrace the change?
Thanks for any advice!
posted by nouvelle-personne to Health & Fitness (39 answers total) 65 users marked this as a favorite
Reading recommendation to comprehensively address thesr questions: the Menopause Manifesto, by Dr Jen Gunter
posted by chiquitita at 6:40 AM on June 11, 2022 [26 favorites]

Came here to recommend Menopause Manifesto!
posted by honeybee413 at 6:44 AM on June 11, 2022 [4 favorites]

It's my impression post-menopause that no one tells you what to expect because they don't know. I'm post-menopausal now. Medical professionals seem to be ignorant on the subject. My gyn seemed preoccupied with people who were still fertile and was dismissive when I asked for a pregnancy test to confirm that was why my periods had stopped. I haven't been prompted to go to a gyn in years by my medical practice, though they're all about breast x-rays. I had moderate hot flashes but no confusion outside the ordinary amount, and no changes in bone density, but my hair growth patterns turned weird (much less on the body and eyebrows, somewhat more on the upper lip) and my shape changed. Yet I read that other people have very different experiences. Would have liked something like The Menopause Manifesto when I was going through it.
posted by Peach at 6:47 AM on June 11, 2022 [6 favorites]

I have been talking to my relatives who have gone through menopause to find out how it went for them, and to my sister (we are close in age) to talk about things we are experiencing that might be perimenopause. I’ve also talked to my OB at the last few annual checkups about it.
posted by Lawn Beaver at 6:48 AM on June 11, 2022

I’m not quite there, possibly peri, but have been doing some work on this recently gathering and sharing resources and info for work. The two things that strike me most are:
* The huge range of symptoms that can be caused by menopause. Not everyone gets all of them, but pretty much anything that happens to you physically or mentally in your 40s or 50s, it seems like it’s worth having a “could this be related to menopause?” question at the back of your mind. Not necessarily assuming that everything is, but bearing in mind that it could be.
* Just how many medical practitioners seem oblivious to the above, or even actively resistant to considering it. I’ve lost track of the number of accounts I’ve come across of women suddenly crippled by anxiety/depression at this age for no other obvious reason, begging their doctors for HRT and being told they should have anti-depressants instead. Which… maybe is one possible solution, but always seems to come with a huge helping of gaslighting of patients’ own reports of “all these things are happening to me in a way that I strongly suspect is menopause.” So you may have to be prepared to advocate hard for yourself.
posted by penguin pie at 7:02 AM on June 11, 2022 [10 favorites]

Oh - and in terms of good things to do for yourself now - get an exercise habit if you don’t have one already, ideally involving weights as well as cardio. Both your muscle mass and bone density are starting to decrease and it’s probably easier to start now and maintain both, than try and get them for the first time later in life. Weights are important for both your muscles and bones.
posted by penguin pie at 7:05 AM on June 11, 2022 [8 favorites]

Came into say Dr. Jen Gunter as well. She has a substack. The free tier has a lot of information, and the paid tier (I'm not a subscriber) has even more articles.
posted by kathrynm at 7:05 AM on June 11, 2022 [1 favorite]

The hard part for me was perimenopause - the time during which your hormones are changing, but you still have periods. This is often the toughest time for many women.
I had Ccippling migraines every month (for almost 2 years), often accompanied by diarrhea and nausea. Periods shorter, but stronger, with the worst cramping. I never had a hot “flash” - I was hot for two years; couldn’t wear wool, sweaters, turtlenecks, scarves, even hats made me too hot!
I was so happy when my periods stopped and things settled down.
posted by dbmcd at 7:47 AM on June 11, 2022 [5 favorites]

The Jen Gunter book is great but I’ll also recommend the menopause-specific volume of “Our Bodies, Ourselves” and Heather Corinna’s “What Fresh Hell is This?” I’m staring down perimenopause in full “researching the shit out of it” mode and found all three books had something to offer.
posted by Stacey at 7:51 AM on June 11, 2022 [4 favorites]

Heather Corinna’s book is the most inclusive of nonbinary people and trans men, FYI.
posted by matildaben at 7:56 AM on June 11, 2022 [11 favorites]

In my late 40's I started having panic attacks while driving. I also started to have allergy problems in the spring and fall and I wish I had been told these are both signs of peri.
posted by kiwi-epitome at 8:21 AM on June 11, 2022 [4 favorites]

I also had a tough time with perimenopause - mostly very excessive bleeding - even ending up in the emergency room. I was given megace for it and unfortunately ended up with the side effect of meningiomas (benign brain tumors, but I still needed surgery). I'm not finding much on that searching now, but when I got the tumors, I found several articles listing that as a possible side effect, including a story of a woman who had 17. So I would suggest that your friend research any medications that are offered. It is probably a very rare side effect, but that doesn't always feel like it matters if you're the rare person.

I later adopted a whole foods, plant-exclusive diet, and after reading possible effects on menopause, if I were going through that now with that amount of bleeding, that is what I would do. Of course, that's not for everyone. Women in Japan seem to have a much easier time with menopause than US women, and I would not discount the effect of diet on that.

Necessary note: dietary changes can be very hard and even impossible for some people, so YMMV.

I have been past menopause for many years now, and I almost never even think about it, much to the frustration of doctors who want to know when I had my last period.
posted by FencingGal at 8:37 AM on June 11, 2022 [1 favorite]

I am also running into the issue of no one in the medical establishment seeming to want to discuss symptoms and the potential of peri/early menopause with me. It feels like a hot potato tossed from my internist to a gyno NP to an obgyn. (Neither of whom seemed to care about the symptoms of a late 30s woman who hasn't and isn't going to have children.) In general, is there one specialty that should be "responsible"? It seems premature to go to an endocrinologist.
posted by fies at 9:18 AM on June 11, 2022 [1 favorite]

Beforehand: build a habit of strength-training (weights). Regular cardiovascular exercise is good, but I discovered that I could do massive amounts of cardio in my target heart range and still gain weight. This was both extremely humbling (in a bad way, for me) and frustrating. My primary doctor recommended a weight loss medication but for a few years I refused, thinking "I knew how to manage my weight." But eventually, my weight gain caused enough secondary issues (a decreasing spiral of joint pain, less mobility, more weight, more joint pain, etc.) that I finally agreed to try a weight loss medication. I wish I had sooner. Strength training has benefits beyond weight management, so that's a more perennial skill to add.

Also, know if you're susceptible to anemia or have a vitamin D deficiency. I found that lacking in iron or vitamin D had a lot of follow-on effects I could easily minimize by paying attention.

During - Be willing to experiment with eating habits. I discovered that gluten and sugar have a direct relation to hot flashes and fatigue/brain fog for me. Also, my whole digestion pattern changed in/around menopause, so now I pay more attention to fiber and gut health. Consider taking up a new hobby that makes demands on your brain, like learning a musical instrument, language, or something "thinky."

After - Well, I really love being post-menopausal (or most of the way through). I'm more in tune with my body again, feeling like my identity and physical presence are more coherent after the destabilization of adolescence, birth control years, pregnancy, and perimenopause. Having experienced a lot of unwanted sexual attention as a young person, I absolutely relish how free I feel as an "old woman" because generalized attention has faded and I'm now in charge of how sexually expressive I want to be in any given moment.
posted by cocoagirl at 9:18 AM on June 11, 2022 [13 favorites]

I'm someone who unexpectedly went through surgical menopause (got ovaries out and went into menopause instantly) at 40. I didn't find books helpful. Talking to my mom about what she and her mom experienced was much more helpful.

I am actually feeling great and though I'd rather have waited for long-term health implications, I'm feeling good overall and actually like parts of menopause better.

My advice is to just stay curious and don't panic!
posted by beyond_pink at 9:31 AM on June 11, 2022

I also found that my doctor and therapist never mentioned to me that many of the problems I've been having are common for people experiencing peri menopause.
Trouble sleeping, feelings of intense rage where irritation would be a more appropriate response (thank goodness that phase is over), anxiety and depression.
Having mental health issues caused (or exacerbated) by undiagnosed physical reasons like menopause is profoundly disempowering because you end up gaslighting yourself.
All of the usual advice (exercise, meditation, therapy) certainly helps, but unless you deal with the actual physical cause, you can only make so much progress.
posted by Zumbador at 10:03 AM on June 11, 2022 [6 favorites]

Nthing the recommendation for What Fresh Hell Is This? Here's a book talk with the author on Youtube.

And this thread is making me think that maybe there should be a Metafilter Menopause project? MetaPause? MetaMen seems a bit misleading...
posted by spamandkimchi at 10:22 AM on June 11, 2022 [10 favorites]

Oh! Also Darcey Steinke's book Flash Count Diary is also a great memoir and informative too.
posted by spamandkimchi at 10:24 AM on June 11, 2022 [1 favorite]

Er, a few more book recommendations. (I started reading all the ebooks on menopause and aging that the LA County Public Library system had on offer!) I remember enjoying What Would Virginia Woolf Do? by Nina Lorez Collins.
posted by spamandkimchi at 10:26 AM on June 11, 2022

Even the one GYN I've seen in years has seemed clueless about it (she prescribed me a medication that most people's insurance in my area doesn't cover and is over $400 out of pocket. My pharmacist who knows me didn't even bother to fill it because so many people have elected not to pay for it.)

I've found that my COVID vaccinations have interacted with me in a very interesting way and I presume it is due to my that-time-of-life hormones. I have had a veritable bouquet of side effects for each shot and booster and many of the people in my immediate family (males, my age and younger, and my elderly mom) had almost none. I had severe PMS-type symptoms and even got a period after many many months without one, conveniently timed to my most recent vaccination. Could it have been unrelated? Maybe!

This doesn't put me off vaccinations, it's just one more thing about menopause (not peri, actual) that no one really knows about or understands enough to be able to explain it to me.
posted by 41swans at 1:09 PM on June 11, 2022 [1 favorite]

In general, is there one specialty that should be "responsible"?
When I told my GP/internist I hadn’t had a period in X months she said that if I hadn’t in 3 more to contact my gynecologist. I was surprised my regular doctor wasn’t interested at all after being asked for my last period every doctors visit for my entire adult life. Gyno ran a bunch of blood tests and put me on thyroid medication. We’ll see if it’s that or early menopause… shrug.
posted by Bunglegirl at 1:32 PM on June 11, 2022 [1 favorite]

I had severe PMS-type symptoms and even got a period after many many months without one, conveniently timed to my most recent vaccination. Could it have been unrelated? Maybe!

It could be unrelated. I had a few widely scattered periods after I was "officially" in menopause (over a year since the last period). This was shortly pre-Covid. It was unusual enough that I had to see a gyno (my PCP is also a gyno and usually does my pap smear) and have an ultrasound to rule out any issues, but according the gyno it happens.
posted by Preserver at 1:48 PM on June 11, 2022

Just so you know it can happen, my mother had hot flashes til she was 90. I'm 20 years in and still have them. HRT was a lifesaver. I only recently went off it, and still sometimes suffer at night. A cold shower or a wash down with a dripping cold washcloth helps the worst ones.
My sister had erratic heart palpitations and anxiety attacks at night for a while. My SIL had a sudden flood of blood once that sent her to ER, and was shrugged off "it can happen". (So helpful)
Some women get a hysterectomy to stop the constant drip that makes them anemic.
At its worst it's awful, but the lack of periods is nice.
posted by Enid Lareg at 2:57 PM on June 11, 2022 [2 favorites]

I had severe PMS-type symptoms and even got a period after many many months without one, conveniently timed to my most recent vaccination. Could it have been unrelated? Maybe!

It could be unrelated. I had a few widely scattered periods after I was "officially" in menopause (over a year since the last period). This was shortly pre-Covid. It was unusual enough that I had to see a gyno (my PCP is also a gyno and usually does my pap smear) and have an ultrasound to rule out any issues, but according the gyno it happens.

Uncanny timing. After almost four years (I'm mid 50s) of being period free, I suddenly had one last month. Sent me right to a gyno. She also told me it's possible that I actually had a cycle, even after several years.

(My poor other half nearly fell to the floor. I can't imagine our reactions if a pregnancy had actually resulted!)

That said - with the exception of not having periods anymore, my journey through menopause was pretty easy: occasional hot flashes is pretty much it. I get irritable, and sometimes rage, but I work with the public in a retail setting, so it could just be my job.
posted by annieb at 5:19 PM on June 11, 2022 [1 favorite]

I’m reading the Dr Gunter book now, and there is also a forum called HysterSisters, although I admit it has been very useful for me. But at the moment I have one ovary (everything else went in the hysterectomy) and after two years I think I’m starting to get some symptoms. I don’t love it, and I sweat and am too hot all the time anyway so hot flashes are really unappreciated. A small desk fan has helped but I am dreading summer heat .
posted by PussKillian at 5:44 PM on June 11, 2022

Another recent book is Next Level, Sims & Yeager, which is aimed at athletic people but the non-competition parts seem about right for my energetic-but-not-athletic self.

Lots of it is another rec for lifting weights, as heavy as you can, but interestingly not very often. Like, possibly once a week? That’s imaginable.
posted by clew at 6:17 PM on June 11, 2022 [3 favorites]

Perimenopause sucked a lot for me. My periods were so heavy and miserable. I had hot flashes for several years, and while I've always had a sweaty head, it was ridiculous during those years. If I wasn't sitting directly in front of a fan I was sweating. I was so, so happy when all that nonsense finally stopped. Being free of periods is glorious.

I never had the rage stuff or unusual irritability. I've been fat since I had my kid at age 23, but the peri/menopause period my weight actually went down a significant amount (intentionally).

The one thing I was not prepared for is how my libido just completely disappeared after menopause. I'd always heard that "many women have rich full sex lives after menopause, free from the worry of pregnancy" but I never heard it mentioned that your body might be profoundly disinterested. This is a bit distressing to me as I'm married to someone younger who would ideally still like to get laid once in a while. Currently I'm taking the supplements maca and DHEA in hopes it will spark my libido again. I think they are helping somewhat, but it sure ain't like it was. Do your research before taking any supplements, DHEA in particular can have some undesirable side effects and you'll want to make sure you know what to watch for. I haven't had any issues so far.

Another surprising thing is how quickly I'm losing strength and flexibility. It's harder to go up and down stairs, and to get up off the floor if I have to get down there for any reason. My hips are really stiff and it has become noticeably more difficult to rest my ankle on my knee. I do some stretches and weights now to try to get back in shape, but I wish I'd started much earlier.

Mentally, I've experienced some mild depression thinking about all the things I wanted to do in life, that I may never get to do. And trying to figure out what I want to do in the next few decades of my life, and experiencing anxiety over how I'm going to pay for that and who, if anyone, will be there to help me when I get feeble.
posted by Serene Empress Dork at 7:33 PM on June 11, 2022 [7 favorites]

Oh just wanted to add that it's really good you're doing your own research. I was pretty gob smacked at how little my GP knows.

My GP didn't know that it's possible to have a hysterectomy without removing the cervix, and she told me that I was in menopause without doing any of the tests or asking any of the questions (she was wrong. I'm in peri menopause. I changed to another GP for unrelated reasons) my next GP thought that being on HRT would stop me ovulating, and was very surprised when it didn't.
(I have a partial hysterectomy so I don't have periods any more, but still have ovaries. )
posted by Zumbador at 8:26 PM on June 11, 2022

I also had a tough time with perimenopause - mostly very excessive bleeding - even ending up in the emergency room.

By the way, if this happens to you, don't assume it's "just" perimenopause. Though it can have a number of causes, heavy period bleeding is a common symptom of uterine fibroids, which are incredibly common (though many aren't symptomatic). It's amazing how many women hit their forties never having been told about this.
posted by praemunire at 10:37 PM on June 11, 2022 [1 favorite]

I'm mid-to-late 40s and have been having peri symptoms that came on so slowly it was like being a frog finding itself in boiling water. Heavy periods, rage, body changes, bloating, sleep disturbance (first time ever in my life), mood swings etc.

When my weight reached its highest point ever, I cold-turkey gave up sugar, processed food and all alcohol, and started walking after lunch every day. It was hard to do at first, but over the next few months I started feeling like myself again, pretty much all my symptoms went away and the bloat went down.

Since then I have been reading about insulin resistance as a result of changing hormones and it explained a lot. I learned about how my body reacts to various foods by wearing a continuous glucose monitor for a couple weeks. The Glucose Goddess "hacks" have helped me too. (Btw, insulin resistance happens in men too, but in a more linear progression, whereas for women it can come on quickly during perimenopause.)

Also seconding Stacy Sims's Next Level book, which is not only for athletes.
posted by miche11e at 1:26 AM on June 12, 2022 [3 favorites]

These are the things that I think everyone should know:
1) If your quality of life is being affected by symptoms of menopause such as hot flashes, etc, you don't have to put up with these symptoms or accept them as "normal" or "natural." HRT can be life-changing in dealing with these issues (it was for me) and it is safe for the vast majority of women so long as you start taking it within the first 5 to 10 years of post menopause.
2) As well as the symptoms of menopause, you also need to be aware that your risk of certain diseases (e.g. heart attack, osteoporosis and Alzheimer's disease) greatly increases after menopause, due to loss of estrogen. I think it is criminal that there is no public education about this, so most women are completely unaware of it. The only reason I found out about it is because I was suffering horrible hot flashes and so ended up doing a lot of reading on menopause and how to manage it. Even if you're lucky enough not to suffer any symptoms of menopause, you need to be aware of these diseases, assess your personal risk for them, and take steps to protect your health long-term.
3) There are many doctors who are very ignorant about menopause, plus it is not realistic to expect that we could learn everything we need to know about this topic from a doctor anyway, given how short most consultations are, so we need empower ourselves by reading up on menopause and learning what our options are. Personally I found Barbara Taylor's book "Menopause: Your Management Your Way" to be very helpful in this regard.
posted by mydonkeybenjamin at 2:12 AM on June 12, 2022 [2 favorites]

I had a surgical menopause after prophylactic ovary removal. I’d already entered perimenopause but even so, the complete drop in oestrogen so quickly was very hard to endure until I could get on hormone therapy.

I experienced an onset of allergic reactions, sometimes severe, to basic things I’d enjoyed my whole life. Eg raw red onion in salads, garlic, seeded breads, and worst of all as a chronic pain sufferer: most analgesics. My tastes and diet have changed greatly. I have a sympathetic GP and she helped me see it is menopause related to have new reactions to various things when I presented to her with hives, rashes, wheezes etc.

I’ve been a skinny gal all my life and during menopause, with no real changes to mobility or food intake, I keep putting on weight in places I’ve never previously had it - a thickening of the waist seems the common lament on nights out with my friends. With the changes around the gut, expect an increase in gas which can be really uncomfortable. I always said they could take my bread from my cold, dead hands, and uh, here I am at 53 going, ok gluten you win. Much less bread and carbs in general has meant no gas pain.

Getting into a weights routine, even just basic lunges and arm reps is a good idea. Also a regular, brisk walking practice. It’s good mentally as well as physically. It also helps with the lack of sleep that attends many menopause-ers. I can’t believe how I function on so little sleep. I’m sure the sleep changes contribute to mood changes too.

During my hot flashes stint, before I started estradiol patches, I carried a water mister and barley sugars in my bag. Lifesavers.
posted by honey-barbara at 5:15 AM on June 12, 2022 [1 favorite]

Early fifties here, and haven’t had my period for almost two years. Spent the last 5 going to multiple gps with various mysterious complaints, and was told repeatedly it was all in my head. When I suggested peri they acted like I was an alien speaking another language. I’m glad you’re asking now. Books and talking to others who’d gone thru the experience is what kept me grounded and informed.
posted by Phyllis keeps a tight rein at 5:58 AM on June 12, 2022 [3 favorites]

Your post here is a great start. A woman in my small community started a private Facebook group for us to share knowledge, and then we all invited our own networks, and it’s been really nice to connect with women who’ve been or are currently working through it, or are just starting the journey. The older women I know are so happy to share. Maybe something you can do in your community?
posted by AnOrigamiLife at 4:26 PM on June 12, 2022 [1 favorite]

Adding the disclaimer that for me, perimenopause coincided with a lot of other life upheaval, so it's a crapshoot when it comes to whether my woes were exacerbated by my health issues or vice versa. And, both my strife and my periods ended at the same time, so it's also unclear how much each element has had the greatest effect on my overall mood.

But - I am surprised how content I now am. One of the things menopause did was to completely tank my libido - that was my biggest symptom, in fact, but since I'm single I decided not to do anything about that unless I happen to meet someone. And when the libido was gone....then the urgency to "find someone" also vanished, and the patience with dating bullshit also ran out and I cut that out of my life, and it felt like the whole entire rest of my life rushed in all "FINALLY, we've been waiting for you" and I suddenly had the brainspace to do all kinds of fun little things to please myself and I was so much happier.

Granted that I also got a sufficient income that could supplement that at long last, but I've also been in a financial upswing when I was sexually active - even once when I was coupled - and the kind of contentment I'm talking about is different. There was a big thing that was influencing my life and my decisionmaking and my thought processes which is no longer there, and in my case that big thing was talking a good deal louder than everything else - and for me, that big thing going away is letting all these other parts of myself step back into my consciousness, and I'm excited about exploring them.
posted by EmpressCallipygos at 7:53 AM on June 13, 2022 [5 favorites]

i am 42 and apparently "too young for menopause" according to my doctors. i am positive i am in peri, but what do i know.

i have read these books over the last year:
The M Word: How to Thrive in Menopause
Hormone Repair Manual: Every Woman's Guide to Healthy Hormones After 40 (this is my fave of the bunch)
What Fresh Hell Is This?: Perimenopause, Menopause, Other Indignities, and You
Our Bodies, Ourselves: Menopause (least favorite)
posted by misanthropicsarah at 9:14 AM on June 13, 2022 [1 favorite]

I'm 45 and this question is relevant to my interests.

I've bought some books about perimenopause, and am finding it interesting (well, that's one word for it, anyway) how many of the physical changes I've dealt with in the last three years are mentioned in them. So that would be my suggestion: books, whatever books are available to you and are written in a style that appeals. They might not answer all of your questions, but they should certainly help fill in some of the gaps.

One thing though: because part of the picture is what medical help is available to you and where/how to get it, this is one subject where it's worth prioritising books tailored to your own part of the world.

Resist the temptation to look through the index first. Some revelations are better presented in context.
posted by ManyLeggedCreature at 9:33 AM on June 13, 2022

i am 42 and apparently "too young for menopause" according to my doctors. i am positive i am in peri, but what do i know.

The doctors are technically right, actually. "Menopause" refers to the time when your periods are completely finished - and the definition of "finished" is "it has been at least a year since you had a period".

"Perimenopause" refers to the period before full-on menopause when your system is going bugnuts because it's shutting down. Your periods may swing between being a few months apart to being two weeks apart or may swing from being only one day long to being two full weeks of bleeding, and you may be getting the occasional hot flash or vaginal dryness or pain on penetration, but that's all still "perimenopause" unless you can count at least a year since your last period. The fun part is that perimenopause can last a few years - I started sensing some signs of perimenopause when I was 42, and I didn't hit full-on "oh shit, I haven't had a period in a full year now" until I was 49.

So you maybe don't have menopause proper, but perimenopause is different and absolutely worth investigating.
posted by EmpressCallipygos at 11:00 AM on June 13, 2022 [2 favorites]

I had severe PMS-type symptoms and even got a period after many many months without one, conveniently timed to my most recent vaccination.

There were many reports of people with uteruses who no longer menstruated (including people who had been through menopause and trans men on hormone therapy) finding their cycles restarting after getting vaccinated. (Happened to me. Was also brutal on the depression front.)

Unsurprisingly, there doesn't seem to be a lot of research on it. Since most people weren't aware that it might be vaccine-related, they didn't report it to their doctors, which means few people are aware it might be vaccine-related, so...
posted by Lexica at 1:23 PM on June 14, 2022 [2 favorites]

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