You know what happened to me during perimenopause? I lost 10 pounds, my skin looked great, and I became a much more pleasant human being.
Lesson #1: The change before the change is a thing.Less discussed than the loss of periods is the sudden onset of insanely heavy periods—the deluge before the drought. “I like to say my bathroom is the set of CSI: Perimenopause,” says Julie, from Chicago. “Sometimes I have to stay home and just sit on towels. If there were consistency, at least you could plan. There is no consistency. Superheavy flow, then nothing but spotting. Then, in lieu of PMS, 2½ weeks of breast soreness a month akin to pregnancy symptoms. Oh, joy.”
Lesson #2: Focus on the vestibule.
We whisper among ourselves about vaginal dryness, but not just for the obvious reason of, you know, ouch. We also feel guilty because our partners see it as a sign that we’re not interested. Which makes sense, because throughout our younger lives, dryness meant just that. But then things change, and you may want to make love just as much, or more. But your cooch is sending the wrong signals.
“Vaginal dryness threw me for a loop and put me off sex for a good while,” says Beth H., a mother of two in Charlotte, NC. “I actually tore once, and that does not make for a good sexual experience.” In fact, what many women don’t realize is that the issue is not really dryness so much as elasticity. The mucous membranes of the vagina lose their stretchiness, so intercourse, which requires vaginal give, causes tears in the mucous membranes. Lubes are great for dryness, but they don’t fix the elasticity problem. Prescription topical estrogen creams are the best remedy. “My gyno recommended taking a tiny squeeze of topical estrogen [Estrace] and applying just around the vaginal entrance, instead of using the plunger to eject it inside,” adds Beth. “That’s where the real trouble is—at the ‘vestibule.’ I also use lots of lubricant. And it’s true—the more sex, the better for keeping lubricated.”
Lesson #3: You will gain weight in very unexpected places.Weight gain, of course, is the almost-universal fallout of menopause, mostly because your body is using fewer calories than it used to, and most of us aren’t cutting back and/or stepping up the exercise. “My new book is going to be titled Eat Less, Weigh More,” says Nancy Levine, a management consultant in San Francisco. Less predictable is where you gain weight. “One day I was shopping and found a dress I loved, and the salesgirl whispered to me that she would hold it for 2 days because it was going on sale,” says the writer Lisa DePaulo. “I came back in 2 days, tried it back on just to accessorize, and it wouldn’t zip up. She looked at me and said, ‘You’re in perimenopause.’ I thought that was ridiculous—I was only in my mid-40s—but I went and took the blood test at my doctor’s and she was right. That’s the thing no one tells you: that your BACK will expand.” (Balance your hormones and lose up to 15 pounds in just 3 weeks with The Hormone Reset Diet!)
Many other women chimed in about the back phenomenon. “I can’t zip up a size 14 dress, but I wear a 6 in pants,” says Rachel Clark, a magazine editor in Hopewell, NJ. “I have become a very sweaty and bitchy East German swimmer.” (I personally thought these descriptions of Hulking out were a bit exaggerated, until it dawned on me recently that none of my bras fit anymore, and I had reluctantly started ordering 36D instead of 34—a ridiculously expensive proposition, as I am to bras what Imelda Marcos was to shoes.)
Lesson #4: You’ll feel like a cliché, but that’s the least of it.
Hot flashes are the most common symptom of menopause. About 75% of women experience sudden, brief increases in their body temperature—which, in one of many cruel twists, are both worsened by lack of sleep and can cause problems sleeping. “I didn’t have night sweats,” says Lisa Leonard Adler, an art gallery owner in San Diego. “I had every-20-minutes, looked-like-I-took-a-shower sweats.” If we were all just minding our own business, flashes would be annoying enough. But for many working women, they’re upsetting to everyone in the near vicinity, too. “I have to warn my patients that I’m about to have a hot flash or am having one because they become alarmed when I turn bright red and look like I’m going to pass out,” says Michele Carlon, a physician in Chicago. “I call the flashes my personal tropical holiday.”
Hormone therapy—taking supplemental estrogen and progesterone—can almost instantly end the flashes and improve mood swings, as I gratefully discovered. But unfortunately for the not-insignificant population of women who have been treated for breast cancer, HT is usually off limits. “I went through chemical, then surgical menopause—Lupron, then a complete hysterectomy—after breast cancer treatment,” notes Lisa Greim, an online content strategist in Arvada, CO. “Even plant-based remedies like black cohosh were off limits. I made do with ice water and a fan under my desk.”
Lesson #5: Can’t…stop…scratching.But maybe the change that bothers us most—if not physically, then mentally—is the change in our skin. As estrogen levels wane with age, you get skin that’s thinner, more wrinkled, and saggier. It’s normal, but it sucks. Moreover, the hormonal roller coaster of perimenopause means that one symptom impinges on another, so women find themselves playing dermal Whack-A-Mole.
Take itchiness. Because estrogen is a moisture magnet, the lack of it dries out the skin, and dry skin can be itchy. “I’d always had dry skin, but when perimenopause started I thought I was losing my mind,” says Nancy M., a real estate agent in New York City. “I’d start to itch at night. I actually had one of those sniffing dogs come to my house because even though I didn’t have any bites, I was convinced I had bedbugs.” One fix is pretty straightforward: Use rich moisturizers that contain ingredients like lanolin and petroleum. Another fix is less obvious: Use sunscreen. Broad-spectrum protection won’t just prevent you from being wrinkly and spotty 5 years from now, it’s also the first line of defense when you’re battling dryness because sun exposure reduces the natural oils that keep your skin hydrated.
“I have patients in perimenopause coming in and complaining about skin breaking out, waists expanding, and hair thinning,” says Karyn Grossman, chief of the dermatology division at St. John’s Hospital in Santa Monica, CA. “OK, so they work out more to deal with the weight gain. This can make their skin break out more, and matted hair from hot flashes can lead to hair thinning.” And of course, hair growing, but not necessarily on your head: “I’m growing hair in places women should never have hair,” says one friend. “I’m going through a pair of tweezers every couple of months because they get worn down from all the chin-plucking.”
Grossman has a passel of treatments to deal with skin problems caused by hormonal fluctuations: collagen boosters, skin-tightening lasers, acne treatments with retinoids for heavy-duty exfoliation. But still, at 49, she is irked herself “by losing skin elasticity on the body—things are just not as snug as in the past, and we can’t do as much about this as we can with skin on the face.” She insists there are still decent results with certain laser and radiofrequency pulsing treatments like Thermage, Body FX, and Forma Plus. “I am starting on my thighs,” she says. “While my belly bothers me, thighs are more visible to most.”
I can’t vouch for these treatments, but I am happy with the image of this incredibly youthful-looking dermatologist with every tool at her disposal, still annoyed with her thighs. No one is immune.
Lesson #6: !!?#$*&*$@(*$
And then, of course, there are the sudden mood swings that come with the fluctuations in our hormone levels, which can fell even the most amiable among us (and by ‘us,’ I mean me.) Janis Mara, a reporter in Oakland, CA, had always been a patient, even-tempered person. Until perimenopause hit.
“I was driving home from work around 10 p.m. on an avenue where there had been construction for the past week or so,” she recounts. “I’d had a long day’s work and was already in a foul mood, and when I caught sight of an orange DETOUR sign, I went into a foaming rage. ‘BLANKING SON OF A BLANK ROAD!’ I screamed so loudly in my car that I doubtless woke up the hapless residents on either side of the street. Then I realized the sign was just stacked on the side of the road and I didn’t have to detour, and promptly let out a howl of anguish and started sobbing, loudly. As all this was happening, on some level, the sane part of myself was watching in total disbelief, and I began comforting myself, ‘It’s OK, it’s OK, take it easy…’ the way you would talk to a child, or perhaps a frightened hamster, to calm it down.”
I certainly can sympathize. Before I started HRT, one of my sons said to me, “You used to have a witching hour. Now you have a witching day.”
It is now quite fashionable to say that when we emerge on the other side of menopause, we will be better for it in many ways—because with the end of monthly hormonal shifts comes a time of physical and emotional calm.
Every time I pass the feminine product aisle in the drugstore, I feel a wave of nostalgia and hear the line in Joni Mitchell’s Big Yellow Taxi: Don’t it always seem to go/That you don’t know what you got til it’s gone.
Soon, my boys will be old enough to have girls visit them at home. I’ll probably keep a box of Tampax around. Kind of a good-hostess thing. Or that’s what I’m telling myself.