“Try taking more fish oil.” That was the suggestion my naturopath offered after many office visits over many months, and no noticeable improvement of my symptoms. I had tried nearly everything that she had suggested, fish oil, vitamins, herbal supplements, and the first tool in any naturopath’s toolbox, the elimination diet. She seemed exasperated when I asked, “is fish oil known for fixing these kinds of symptoms?” She responded, “it certainly can’t hurt.” And that was that.
Over the course of several years, I would try acupuncture, prolotherapy, podiatry, physical therapy, chiropractic, herbs and potions, and eventually another naturopath, who encouraged me to do the elimination diet again. I probably hadn’t done it right, or for long enough. My wonderful husband, who does all the cooking in our house, endured all of this without a single complaint. As I embarked on this second, more thorough, complete, and strict round of the elimination diet, I celebrated my 50th birthday. It was the only party I ever hosted where all the food was gluten, dairy, soy, nut, and egg-free.
For nearly 30 years I had maintained a weight of 125 lbs. And then suddenly in a single year I gained 15 lbs. When speaking with my primary care doc about insomnia, sweating, freezing, joint aches, muscle aches, and weight gain, he responded by suggesting that I exercise more.
In the past I had been an athlete. I raced triathlons and half marathons, ran Hood-to-Coast, lifted weights, backpacked at high altitude, and skied mountains around the world. However, at this point every trip to the gym was rewarded with pain. I understand what is meant by ‘no pain no gain,’ but wielding 2 lb. weights for 5 minutes would set me back with almost a week of soreness. Exercise had always been one of my favorite things, but I just couldn’t manage. So I starting walking… a lot. My husband and I were adamant about getting at least 10,000 steps every day, and 20,000 steps a day on the weekends. But even walking, which seemed totally benign considering that I had been quite athletic not that long ago, would send me to the couch with cold packs on my elevated legs. I sometimes wondered if this would be something that I’d have to live with for the rest of my life. My doctor’s suggestion to exercise more was more salt in the wound.
Last summer a friend invited me to join her for an evening swim in the Willamette river. I was embarrassed to tell her that I was in no shape for open water swimming, but I’d love to meet. As we floated in inflatable tubes, I described my maladies. I talked about how my feet felt like stiff wooden blocks, that the naturopath had suggested more fish oil would help, and that physical therapy seemed to be making things worse. Her eyes lit up as I spoke and she responded by sharing her recent experiences, which were similar, up to and including the painful feet. She had other issues, including brain fog and mood swings, that were particularly challenging in the context of her demanding career as a university professor. And then she pulled down the waistband of her shorts and revealed a secret. It was an estrogen patch that looked like a band aid. It was one of several hormones- estrogen, progesterone, and even testosterone- that were helping her manage her menopausal symptoms.
I found conflicting information online about the risk and efficacy of hormone treatments. Then I read a book, Estrogen Matters, that described various clinical studies and explained why the most cited study on the dangers of hormone replacement therapy (HRT) had been refuted by many experts around the world. I decided that HRT was at least worth a try.
It seemed only a matter of days before my feet no longer felt like wooden blocks and I was able to walk without pain. Within weeks I was able to lift light weights at the gym and within months I was jogging 3x a week. I did not lose an ounce of weight, but I gained much joy in being able to do things that I used to take for granted.
And so, I ask, why was HRT offered seemingly as a last-ditch resort? Why was this not considered to be the first thing to try? Why make someone feel like they are incompetent at the elimination diet or shaming them to exercise more? Why prescribe more fish oil?
People “come out” about lots of different things- sexual orientation, gender identity, mental health issues, and so on. Coming out about menopause is not something I want to be known for. I worry about what my male colleagues will think, and worse yet, I fear emboldening those people who continue to look for ways to justify women’s pay inequities and the invisible glass ceiling.
I also don’t like to complain, but menopause has been a frustrating and debilitating experience for me. It’s not a fun topic, which is why women experiencing menopause issues are ashamed to share their problems more openly. It doesn’t help that comments from other women, like “I didn’t have any issues”, can sound dismissive. Or my favorite comment from a man in the medical field- “women in China don’t have menopause issues.”
More than half of the humans on this planet are women, and though not all women experience issues related to menopause, many of them will. Yet instead of validating the experiences of many women we find ways to discount them. Why is that?
100 years ago the average life expectancy was only 53 years. Menopausal women probably felt fortunate just to be alive. Or perhaps the same societal forces that debated the existence of PMS (pre-menstrual syndrome) are still in play when it comes to other aspects of women’s lives.*
So what do we do about it? First, raise awareness among the general public. Second, do a better job providing women with the best available research** so that women can make well-informed decisions. Third, provide affordable access to menopause health resources. And fourth, we need to improve our medical research methodologies so that complex issues, like menopause, can be better studied. In the age of wearable health trackers, continuous sensing capabilities, and machine learning analytics, there is ample opportunity to apply “big data” methodologies to a wide range of problems. However, it will be tough to advance these new methodologies when people feel that their personal health data could be used against them, which is yet another can of worms.
I’m not back to where I was before menopause struck. But thanks to having the time, energy, health care resources, and a friend who opened my eyes to HRT, I’m happy for not having wooden blocks for feet, being able to sleep, and for finding joy in exercise again. I hope that in writing this blog I’m able to help other women, and their loved ones, have an easier journey.
A couple links to start with:
Estrogen Matters, Avrum Bluming, MD, and Carol Tavris, PhD, 2018
Menopause Stories, Bronwen Parker-Rhodes, NYT, Dec 15, 2020
The Gift of Menopause, Margaret Renkl, NYT, Aug 5, 2018
**Doctors seem not to be on the same page as to risks and treatments. Progesterone alone can alleviate some symptoms, without the risks associated with estrogen. After posting this I have learned about other estrogen-free treatments.
*Perhaps the topic of menopause has been taboo because because traditionally women’s greatest value to society has been in reproduction, and menopause signals the end of a woman’s childbearing years.
Additional quotes from friends, neighbors, and family:
“Thanks for sharing. I went on bioidentical hormones 2 years into my menopause. They recommended 5 years max. I stayed on 10! Such conflicting information is frustrating at best. I think I prefer to die with HRT in my medicine cabinet! I think the benefits out weigh the risks for me.”
“There is so much confusion about HRT. I had an OBGYN nurse practitioner insist I go off hormones and told me I would die an early death if I didn’t. It directly contradicted what my MD was saying.”
“The symptoms are debilitating, the hormone replacement is worrying and the implications of really being open about it at work are unknown but likely limiting.”