I have a love-hate relationship with my hypothalamus, a region of the brain that helps control body temperature. Johns Hopkins Medicine says 75% of all women experience hot flashes in varying degrees, unique to each individual.
My “unique” perspective on hot flashes stems from having experienced upwards of 30 per day during my late 40s. Something as simple as remembering a forgotten item as I was checking out at the grocery store would, within seconds, send me from looking freshly coiffed and put together, to looking like I’d just run a marathon.
This past fall, when my friend Lisa invited me to be her plus-one at a fancy publishing party, the only answer was yes, followed by mild panic. I’m a writer looking for representation for my novel and this was the perfect opportunity to be in a room with a prospective agent or editor. The event was three days away and I was already worrying that a surprise hot flash could ruin it. I’d recently stopped taking the low-estrogen birth control pills that had held them at bay (along with other undesirable symptoms) for the past several years.
At 55, my hot-but-not alter ego (I named her Betty) was back, living just beneath the surface of my calm exterior, waiting to rear her sweaty head at any given moment. Could I trust her to be on her best behavior in uncharted social territory? This party was a potentially life-changing event.
At 55, my hot-but-not alter ego (I named her Betty) was back, living just beneath the surface of my calm exterior, waiting to rear her sweaty head at any given moment. Could I trust her to be on her best behavior?
While many books have been written on the topic, there has not been enough talk 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 beginning to emerge. Recently, Drew Barrymore experienced her first hot flash, on air, with a supportive Jennifer Aniston, and I cannot think of a more perfect perimenopausal moment.
This past 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 rebrand menopause. It is beyond refreshing to see.
Oprah talked about experiencing heart palpitations that left her fatigued and fighting brain fog, ultimately leading her to end Oprah’s Book Club. She said, in part, “I think we all get better with 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 cultural change.
In the words of Lizzo, it’s about damn time.
In hindsight, I wish I would have thought — or been taught — to start talking with my doctor sooner about what to expect, hormone replacement therapy (HRT), the options and risks. When I went to my gynecologist and explained my symptoms, he assured me that 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 had my first child at age 18 lessened that risk significantly, since research shows that women who have their first full-term pregnancy at an early age have a decreased risk of developing breast cancer later in life, according to the NIH National Cancer Institute. A belated surprise benefit to my teen pregnancy.
My doctor prescribed low-estrogen birth control pills and sent me on my way. For me, it was a good, albeit temporary fix. That was eight years ago.
Alas, at my yearly exam in early 2022, my doctor told me he could no longer prescribe the pills because he felt strongly that, at my age (then 54), the risk factors associated with continuing to take the pill (heart attack, blood clots, stroke) were high.
For the first time in our wonderful 19-year doctor-patient relationship, this very pleasant, patient man was visibly annoyed, and it was not a comfortable discussion. It felt like I’d pushed too far and that maybe I really was asking too much.
I left feeling frustrated and unsure of what to do next. With only a couple of months left of birth control pills, I could already feel the impending return of the dreaded hot flashes.
A friend suggested I try bioidentical hormones and recommended her holistic doctor. My friend had been using bioidenticals successfully for years. I felt hopeful, but after extensive blood work and urinalysis tests and ultimately applying estrogen and testosterone creams to my body daily, I realized this wasn’t going to work for me, either. It was an expensive lesson that insurance did not cover.
I resigned myself to the idea that I was just going to have to deal with the hot flashes, mood swings and the partridge in a pear tree making a nest around my midsection.
I resigned myself to the idea that I was just going to have to deal with the hot flashes, mood swings and the partridge in a pear tree making a nest around my midsection. Surely, after turning 55, I’d be officially in menopause (it’s considered official after a woman has not menstruated for 12 months consecutively) and the symptoms would disappear.
Two days before the party, I’d memorized three different book pitches and reassured myself that the chances of having an audience with an editor or agent to pitch to were low, but I was ready nonetheless.
I also bought a new outfit I didn’t need. Panic shopping and overthinking are imperative to my preparation.
I met Lisa and we mingled, took pictures with the guest-of-honor author and enjoyed hors-d’oeuvres. Before we left, Lisa, herself a successful writer/editor, wanted to meet an editor.
Before I knew it, Lisa was talking up my story. And then, to my great surprise, the (very kind) editor turned to me and smiled.
“Okay, sell me.”
I looked at Lisa and said something stupid like, “Oh, wait, this is it!”
She nodded encouragingly. Time stopped. Betty sat back and lit a cigarette.
Words spilled out, but not the ones I’d planned.
“Please don’t be nervous, I’ve been where you are,” the editor said, as cartoon-like beads of sweat sprouted from my forehead.
If this were a movie, someone might slip me a cocktail napkin, or a glass of ice water.
There is great irony in the fact that I have spoken dozens of times on live TV and never broken a sweat. As Lisa tried to come to my rescue, all I could hear was Betty laughing as she cranked up the heat.
In my peripheral vision I could see someone trying to get the editor’s attention.
“It’s OK, thank you for your time, it was so nice to meet you,” I managed.
I can laugh about it now, but the experience also made me realize that I hadn’t really looked at how much this journey through menopause has affected my quality of life. I’ve passed on vacations, avoided certain social situations based on heat and humidity and, I’m ashamed to admit, worried far too much about what others might think.
My mother prepared me for getting my period and “becoming a woman,” but I never got the memo about what happens later.
Ultimately, I found a gynecologist who specializes in menopause and was happy to discuss different HRT options. Thanks to a new hormonal medication patch, Betty has left the building and things are finally under control.
I think that situations like mine could be avoided if more doctors proactively let women approaching the age of change know that they are open to the discussion about perimenopause, the wide range of symptoms, and options available to make this natural transition a smooth one. There are so many treatments available now and finding what works for you can be challenging, especially without medical guidance.
It goes without saying that every woman is different. Some experience no hot flashes (so jealous), some experience them for up to 10 years after being in menopause.
I wish I hadn’t been too embarrassed to go to my gynecologist when I was 46 and say, “Hey, I just threw my car keys across the room and screamed so loud at my 10-year-old that I lost my voice and I’ve never done that before. I’ve never had mood swings, what do you think?”
It’s time to put aside the shame around the inevitable phenomenon referred to as, “the change,” “passages,” “reverse puberty” or, the more gentle term from Chinese medicine, “second spring,” and talk about it. These terms are cringe-worthy and outdated.
Solutions to menopause symptoms are not one-size-fits-all, which is why we need more talk on big, public platforms to reach as many women as possible. Big names, like the ones mentioned here, using their platforms to talk openly about their own experiences, is a big step in the right direction.
Let’s reframe the word itself: me-no-pause. I haven’t paused and neither should anyone else. My mid-40s was the beginning of some of the most personally productive and fulfilling years of my life. Now in my mid-50s, I’m just getting started.