Period 33: Perimenopause can perimeno-suck it
First, big news! Buttondown now has commenting functionality! You can comment on these newsletters to your heart’s content – a great way to meet like-minded folks, weigh in on my writing, and suggest topics for future newsletters.
I went too narrow with the style of this newsletter when I started it last year. I did it to try and make things easier on myself – intro, links, period fact. Instead it’s constrained me and made me feel like if I didn’t have enough to contribute to each of these three categories, I couldn’t put together a newsletter.
So my plan for this year is to mess around a bit with format – without losing the primary focus of this newsletter, which of course is the almighty uterus. There will be plenty on periods. But it’s impossible to ignore the many other issues that intersect with this sometimes annoying, sometimes awesome organ.
For today, I leave you with something akin to a period fact – a little about my recent experiences starting to reckon with my major perimenopausal symptoms.
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Perimenopause can perimeno-suck it
One of the few entry points for talking openly about the premenstrual phase, pregnancy, lactation, or menopause, it often seems, is to turn it into a joke. Only yesterday I shared a pretty funny reel on Instagram personifying perimenopause as Perry Menopause, detailing the insomnia, anxiety, mood swings, and more that come with this period of five to fifteen years.
As funny as it was, it also made me reflect on how hard it is to have more serious conversations about how awful these symptoms are. In some ways the fact that irritability in the premenstrual phase, or bleeding nipples from breastfeeding, or perimenopausal hot flashes are frequently the butts of jokes minimizes the actual horror of going through these things. They also make them seem universal and inevitable, which of course is also not the case given how variable everyone’s experiences of their bodies are.
So until I started going through perimenopause in earnest I don’t think I realized how in many ways it’s just terrible. It’s not just aging – though of course it’s partly that. It’s not just the dystopian hellscape of living in a pandemic while your government is complicit in genocide – though of course it’s partly that too. It’s not just that both my children are very high need right now and during work hours I am spending time making and attending appointments for them, and during non-work hours they require all of my attention and compassion – though of course it’s partly that too.
I recently had my estrogen, testosterone, FSH, and LH tested. FSH and LH are in the typical range which is a good sign that my ovaries are still fairly functional (these are gonadotropins produced by the brain that send signals to the ovaries – they start to get high in later perimenopause because the brain is trying harder and harder to get the ovaries to respond). Testosterone was on the low end of the lab-reported typical range (which surprised me – somehow I thought my high muscle mass suggested I had plenty?).
My estrogen was loooowwwww. Well below the typical range given where I was in my cycle. On the one hand – hormones are variable, right? That’s what so much of my work is about, that what is considered “normal” is often quite narrow. But there is a difference between understanding how we need to widen the range of “normal” and not gaslighting symptomology.
In my case, my low estrogen has been paired with some horrible symptoms, not least of which has been worsening of my pelvic prolapse symptoms, probably as a result of tissue and bowel changes that come from a decline in estrogen.
Then there’s the insomnia, which I’ve written about before. Night sweats, too. Some nights I get two hours of sleep.
Then there’s the anxiety, the panic attacks.
On the one hand I really hate sharing all of these – I worry about the ways I will be punished, lose out on job opportunities, or be taken less seriously by sharing that this has been my life the last few years. On the other hand I cannot abide another jokey post about something that makes so many of us feel bereft of the minds and bodies we were accustomed to. It doesn’t feel that funny when you’re going through it.
I fear dismissiveness around perimenopause: I fear that the response is that we should all become comfortable with change, and with aging, and with things being different. And I do not disagree. I’m not interested in getting anything “back.” I’m interested in not feeling like I’m going crazy and no longer expending so much effort not appearing so outside of my home.
I cannot tell you what it did for my mental health to begin to understand what was going on with me – that moment of finding a possible answer when so often my experience of medicine is that it is answerless. I might be able to resolve some of these symptoms, for a time at least. I have an appointment next week to consult with my gynecologist about possibly getting started on hormone replacement therapy. I’m probably going to give it a try.
There are ways in the last few years where I have felt so unlike myself that I just haven’t known what to do. I have masked these symptoms and these feelings, and I’m really tired of masking. I’m reminded of how hard it is to perform ablebodiedness – and how impossible that performance is for so many. As I wrote in PERIOD, I want a future where we all get to live in public, with dignity and support and robust inclusion, regardless of what our bodies can or cannot do. The perimenopausal transition is another one of those places where many of us suffer quietly, when a just world would instead make more room.
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Self-promote-y self-promotion section
Period continues to get great press – in addition to a bunch of best of lists at the end of last year, it just made another one at Book Riot. Check out this list of eight 2023 non-fiction books you have to read in 2024 – and maybe send it to a friend who hasn’t bought the book yet. (Also know I highly recommend giving your copy of Period to a friend – books want to be read!)
I also love love loved this review by Laura Kolbe in the New York Review of Books, which will be out in their February 8 issue. It covers my book as well as Womb and Cash Flow – two other excellent books on periods. The attention to detail! The quote pulls! The weaving of these three books into a beautiful narrative! What a lovely read and it reminded me why these other books are also very much on my TBR.
What do you wish I talked more about here? What questions do you have? Let me know via email or in the comments and I’m always happy to write specific explainers on all things menstrual!