This is part one of a series on the biological and psychological portals of menopause.

We begin with the body . . .

This adventurous explorer would now rather be curled up in bed than just about anywhere else.

Ovaries do not go quietly into that good night. They’re too feminist punk rock for that. They’re going to smash the guitar through the speaker and burn down the theater with a lit cigarette and a smirk as their set ends.

Perimenopause is like a decade-long reverse puberty with a broad range of symptoms and severity, from uncomfortable to utterly debilitating. Estrogen and progesterone (and testosterone, to a much lesser degree) fuel so many systems of the body, maintaining a cyclical balance of optimal functioning. Those systems short circuit in response to the hormonal chaos of this transition (spikes and drops) and they can shut down in response to the eventual hormonal drought.

The symptoms of perimenopause are a bountiful cornucopia of suffering. If you’re up for it (which you likely aren’t, because fatigue), let’s play a game of symptom bingo. Which of the following common symptoms of perimenopause are you experiencing? If you have the most symptoms, you win a visit to a gynecologist who will actually see you, listen to you, believe you, and help you (just kidding, uterus-bodied people don’t get that kind of healthcare, silly).

Common Symptoms of Perimenopause

Common Treatments for Symptoms of Perimenopause

Potions from the old witch in the woods: Since women are not often studied in medical research (8% of medical research is done on women’s health, despite being 51% of the population—love the book Invisible Women: Data Bias in a World Designed for Men so hard if you’re feeling called to stoke the flames of your righteous indignation around this), women are treating each other with natural/herbal/ancestral medicine. We’re calling in the crone and I’m here for it.

Hormone Replacement Therapy (HRT): There’s a nice historical stroll through the misogynist evolution of HRT for menopause in the book What Fresh Hell is This?: Perimenopause, Menopause, Other Indignities, and You, which I really enjoyed and recommend. Suffice to say, the black box label has been rightfully removed and HRT is now a powerful and accessible treatment supporting people through menopause and beyond. Various forms, dosages, and applications are available for adjusting the hormonal dials on the moving target of our evolving needs.

Symptom Management: While HRT is a valuable line of treatment that addresses the underlying cause of the variable symptoms, we sometimes need to treat the symptoms directly too. If your blood pressure is high, you might opt for a blood pressure medication so you don’t have a heart attack (especially important since most doctors aren’t taught that heart attack symptoms are different in women, so they’re often told its anxiety and sent home from the ER to die) (Too much? The mocha frappe I had today is emboldening my audacity.) Treat whatever is ailing you in the best way available to improve your quality of life.

Healthy Lifestyle: I’m 5’5″, weigh 120 pounds, and was told to lose weight (prescribed diet and exercise) and offered an SSRI in response to my requests for help with my debilitating perimenopause symptoms of menstrual hemorrhaging and aural migraines. This is what practically every woman is told by practically every doctor in response to practically every medical concern: it’s anxiety and you need to lose weight. So please hear the deafeningly loud volume of my eye roll as I include this section. I promise not to gaslight you and that there is actually some value and validity here.

Most women, mothers especially, enter this phase of life pathologically over-functioning and perimenopause does not allow for that. We’ll cover this more in part two of this series (psychological), but the sleep, movement, nutrition, therapy, medical care, etc. that you’ve been able to ignore is now an absolute necessity for survival. The alcohol or non-ideal-for-your-digestive-system dietary choices may have been fine before but they now knock you below the line of okay. The six hours of sleep that were good enough is now ten hours of sleep that make half your worst symptoms disappear if you honor. That one walk outside each day becomes the difference between harmony and homicide.

This is an invitation to prioritize and nurture the basics as though you were a newborn. Now go drink some water, you big baby.

My Experience

It’s as though the estrogen and progesterone high cleared (maternal marijuana). The hormone fueled, all-encompassing caregiving fulfillment that served giving my offspring the absolute best chance of survival served its purpose, completed its mission, and ran its course. The fog has cleared and my needs are now centered in a way that I newly recognize everyone else’s needs have always been for each of them. The physical symptoms demand and insist on self-care to a degree that completely precludes the super human functioning I have embodied for the tenure of my motherhood. To be clear, I was always conscious of honoring my needs in harmony with my others’, declining martyrdom in favor of mutual wellness and fulfillment, but now it’s like I can see how the hormonal boost expanded my comfort-level capacity so far beyond what could ever be sustainable for the entire lifespan. My work is no longer how to meet everyone’s needs together, it’s just how to meet my own (in the most values aligned way).

Since turning forty three years ago, my periods have gradually gotten heavier, longer, closer together, and more uncomfortable (to the point that the blood loss was alarming, bleeding heavily for about two weeks, every two weeks and spotting in between).

Debilitating aural migraines also came back around, which started for me in puberty and stopped when the sun set on my childbearing years (when my hormones leveled off).

I also started having trouble falling asleep and staying asleep, my anxiety baseline was increasing, my hair was thinning, it became harder to concentrate, and I was fatigued (started drinking coffee for the first time in my life).

The Certified Nurse Midwife in the mainstream medical group’s gynecology department told me I was fine. I said that I was not fine and would eventually bleed to death if we didn’t do something. She insisted there was nothing that could be done to help me. I requested bloodwork and an ultrasound. She denied the ultrasound but begrudgingly ordered some blood work, which showed that my thyroid and red blood cell count were fine. The OB/GYN said I was fine. The PCP said I was fine. This was all normal and there was nothing that could be done.

I was telling my choir friend about my uterus woes and she said I needed to see her gynecologist, who has a private practice and specializes in menopause. She said this doctor’s mother was also a gynecologist who specialized in menopause, so this woman is steeped in all the wisdom. This doctor advertises no where and only accepts patients on a case-by-case basis with a many months long wait list. It’s like a vaginal speakeasy. 

In my first appointment she was appalled that I was told there was nothing that could be done to help me. She asked me questions. She believed me. She had all the information. She gave me options. She came up with a treatment plan with me collaboratively. Connecting with this should-be-standard-but-is-remarkable care was the lifeline I desperately needed.

All of my symptoms pointed clearly to low progesterone. A period starts when progesterone drops (which it’s supposed to do monthly). My progesterone can’t keep it up, so to speak. Progesterone is the hormone that makes us feel calm and sleepy, so that explains my trouble sleeping and increasing physical sense of anxiety. My estrogen still seems high, as estrogen builds up the lining of uterus and my heavy bleeding shows that I still have plenty of that (also, I don’t have any of the low-estrogen symptoms of perimenopause, like hot flashes). She also insisted that I needed an ultrasound to check for structural/anatomical changes in the uterus that can cause my period symptoms and bloodwork to check for some other things like my iron storage level.

She started by putting me on a low-dose progesterone birth control pill. She gave me low-dose progesterone to take before bed. She also suggested some supplements that she believed would be helpful given my situation (vitamin D, Magnesium, Iron, and a liquid Collagen peptide protein with Biotin).

She ran bloodwork that showed my ferritin (iron) level at 10, while it should be between 50 and 150 (duh fatigue!), so she referred me for a series of iron infusions. She conducted an ultrasound that indicated fibroids and polyps (a polyp is caused by imbalanced estrogen-progesterone hormones, causes frequent, heavy bleeding, and has to be surgically removed). She referred me for higher resolution imaging that confirmed three fibroids, two polyps, and one uterine cyst (and a partridge in a pear tree).

I continued to bleed through the birth control pills. Though they reduced the intensity of the previously cyclical heavy bleeding (and the frequency of the migraines), they left me feeling unmoored, spotting all the time with no emotional or energetic rhythm, so she added a low dose estrogen to see if that would help me to feel more grounded. The hemorrhaging has finally stopped and I’m now awaiting my appointment with the referred gynecological surgeon.

While I need the support of the birth control pill right now, it does feel like it has doused my sparkle. The natural energetic highs and lows that I rode harmoniously to my advantage have dulled to a flat consistency. I miss the balanced gifts of each season of the unbridled menstrual cycle. I miss the burst of fizzy creative energy, the quiet introspection, the “hell yes” or “absolutely not” sex drive. It’s fine. But I want to name this to acknowledge, honor, and commemorate that sparkle.

So, while I am still very much in the midst of this biological flux, I’m feeling supported in actually getting the care I need (and feeling grateful for the female friendship and community that led to this care). I’ll keep you posted on how my journey continues to unfold (I’m sure I’ll learn many more lessons along the way), but know that if I do bleed to death (she says glibly), I went with the peace of a life well lived, flipping the bird to misogyny in the medical system on my way out.