Hot flashes and perimenopause: what I wish I knew sooner

I have a love-hate relationship with my hypothalamus, a brain region that helps control body temperature. Johns Hopkins Medicine states that 75% of all women experience hot flashes in varying degrees, unique to each individual.

My unique perspective on hot flashes comes from having experienced more than 30 a day for my past 40 years. Something as simple as remembering an item I forgot while I was checking out the grocery store would, within seconds, have me looking freshly coiffed and put together, to look like I just ran a marathon.

Last fall, when my friend Lisa invited me to be her date at an elegant publishing party, the only answer was yes, followed by a mild panic. I am a writer looking for representation for my novel and this was the perfect opportunity to be in a room with a potential agent or publisher. The event was three days away, and I was already worried that a surprise hot flash might ruin it. I had recently stopped taking the low estrogen birth control pills which had kept them (along with other unwanted symptoms) at bay for the last few years.

At 55, my hot-but-not (I called her Betty) alter ego was back, living just below the surface of my calm exterior, waiting to rear her sweaty head at any given moment. Could I trust her to do her best in uncharted social territory? This party was a potentially life-changing event.

While many books have been written on the subject, not enough has been said about what millions of women suffer, often in silence. This phase of life comes with mixed feelings about letting go of youth and embracing the beauty of middle age.

Thankfully, a conversation is starting to emerge. Drew Barrymore recently experienced her first hot flash, on air, with a supportive Jennifer Aniston, and I can’t think of a more perfect perimenopause moment.

Last December, Oprah Winfrey and Maria Shriver spoke about women’s health for the Paramount+ series, The Checkup with Dr. David Agus. The two women agree that we need to rename menopause. It’s beyond refreshing to see.

Oprah has spoken of experiencing heart palpitations that left her fatigued and battling brain fog, eventually leading her to terminate Oprah’s Book Club. You said, in part, that I think we all get better as we age, the culture is set up to tell us, in our particular society, that it’s the wrong thing. Maria added, “The stigma will go away if women feel empowered and feel like there’s not something wrong with them if they talk about these issues they’re going through.” Both women agree it’s time for a culture shift.

In Lizzo’s words, the time has come.

In retrospect, I wish I’d thought or been taught to start talking to my doctor sooner about what to expect, hormone replacement therapy (HRT), options, and risks. When I went to my gynecologist and explained my symptoms, she assured me it was all very typical for a woman my age.

My maternal grandmother had died of breast cancer, and my doctor and I discussed my potential risk. Having my first child at age 18 significantly reduced that risk, as research shows that women who have their first full-term pregnancy at an early age have a reduced risk of developing breast cancer later in life. , according to the NIH National Cancer Institute. A surprise belated benefit for my teen pregnancy.

My doctor prescribed low estrogen birth control pills and sent me on my way. For me it was a good solution, albeit temporary. That was eight years ago.

Sadly, at my annual exam in early 2022, my doctor told me he could no longer prescribe the pills because he strongly felt that, at my age (then 54), the risk factors associated with continuing to take the pill ( heart attack, blood clot, stroke) were high.

For the first time in our wonderful 19 year doctor-patient relationship, this very nice and patient man was visibly annoyed and it was not a pleasant discussion. I felt like I had gone too far and that maybe I really was asking too much.

I walked away feeling frustrated and unsure of what to do next. With only a couple months left of birth control pills, I could already feel the imminent return of the dreaded hot flashes.

A friend suggested I try bioidentical hormones and she referred me to her holistic doctor. My friend had been using bioidenticals successfully for years. I felt hopeful, but after extensive blood work and urinalysis and finally applying estrogen and testosterone creams to my body daily, I realized that this wasn’t going to work for me either. It was an expensive lesson that the insurance didn’t cover.

I resigned myself to the idea that I would have to deal with hot flashes, mood swings and the partridge on a pear tree nesting around my trunk. Surely, after I turned 55, I would be officially in menopause (it is considered official after a woman has not had her period for 12 consecutive months) and the symptoms would have disappeared.

Two days before the party, I had memorized three different book submissions and reassured myself that the chances of having an audience with a publisher or agent to pitch to were slim, but I was ready nonetheless.

I also bought a new dress that I didn’t need. Panic shopping and overthinking are imperative to my preparation.

I met Lisa and we mingled, took photos with the guest of honor author, and enjoyed appetizers. Before leaving, Lisa, a successful writer/editor herself, wanted to meet with a publisher.

Before I knew it, Lisa was telling my story. And then, to my surprise, the (very nice) editor turned to me and smiled.

Okay, sell me.

I looked at Lisa and said something stupid like, Oh wait, that’s it!

She nodded encouragingly. Time has stopped. Betty sat down and lit a cigarette.

The words came out, but not the ones I had planned.

Please don’t be nervous, I’ve been where you are, said the editor, as cartoon-like beads of sweat sprouted from my forehead.

If it was a movie, someone might pass me a cocktail napkin or a glass of ice water.

There’s a great irony in the fact that I’ve spoken dozens of times on live TV and have never broken a sweat. As Lisa tried to come to my rescue, all I could hear was Betty laughing as she turned up the heat.

In my peripheral vision, I could see someone trying to get the editor’s attention.

Alright, thanks for your time, it was nice to meet you, I made it through.

Game over.

I can laugh about it now, but the experience also made me realize that I hadn’t really considered how much this journey through menopause affected my quality of life. I spent the holidays, avoided certain social situations based on heat and humidity and, I am ashamed to admit, worried too much about what other people might think.

My mother prepared me to get my period and become a woman, but I never got the reminder of what happens next.

Eventually, I found a gynecologist who specializes in menopause and was happy to discuss the different HRT options. Thanks to a new hormone patch, Betty has left the building and things are finally under control.

I think situations like mine could be avoided if more clinicians proactively let women approaching the age of change know that they are open to discussing perimenopause, the wide range of symptoms, and the options available to make this transition smooth. natural. There are so many treatments available now and finding what works for you can be difficult, especially without medical guidance.

It goes without saying that every woman is different. Some don’t experience hot flashes (so jealous), some experience them up to 10 years after going through menopause.

I wish I wasn’t too embarrassed to go to my ob-gyn when I was 46 and say, “Hey, I just threw my car keys across the room and yelled so loudly at my 10-year-old that I lost my voice and couldn’t ‘I never did”. the one before. I’ve never had mood swings, what do you think?

It’s time to put aside the shame about the inevitable phenomenon called change, transitions, reverse puberty or, more polite Chinese medicine term, second spring, and talk about it. These terms are noteworthy and obsolete.

The solutions to menopause symptoms are not one-size-fits-all, which is why we need more talks on large public platforms to reach as many women as possible. Big names, like the ones mentioned here, using their platforms to speak openly about their experiences is a big step in the right direction.

Let’s rephrase the word itself: menopause. I haven’t stopped and neither should anyone else. My mid-40s was the beginning of some of the most productive and fulfilling years of my life. Now in my mid 50’s I’m just getting started.