I woke up in the darkness drenched in sweat. It wasn’t unfamiliar, because I remember it happening in the past when I came home from the hospital after having a baby. My clothes were damp where the moisture had soaked through.
Earlier that day, I was carrying laundry up the stairs and had to put my hair up to let the back of my neck dry. It’s summer, I told myself. I’m just hot. Wet half moons had formed on the front of my tank top, under my breasts. I wiped the moisture off my lip, and was surprised to see, from the thermostat, it was 68 degrees in the house. But the air was suffocating. This was probably how my mom would describe menopause.
Only I was barely 31.
I brushed off my symptoms for months as still being postpartum—never mind that I was two years out from having a baby. That was also when I noticed that my anxiety was worsening and sex was different with my husband. I had a lower drive and had been feeling friction that bordered on painful. I started wondering if there was something more going on with me than I realized, and admitted that to a friend. I told her about how recently, I’d find myself sweating in shorts and a tank top, around people who were completely comfortable in jeans and a T-shirt. She suggested seeing my OB/GYN because it may be a hormonal issue. I admit, it sounded like a better alternative than my own self-diagnosis of overheating from that excess baby weight I couldn’t seem to lose. Wondering if this whole thing was an overreaction—really, what if he just tells me I need to lose weight?— I went to see my doctor the following week.
He asked me a barrage of questions about lightheadedness, dizziness, low libido, anxiety, trouble sleeping, and headaches. I confirmed that I was experiencing most of those. He wanted to run some blood tests to be sure, but diagnosed me then and there with perimenopause, the transition between child-bearing years and menopause, usually occurring in your forties.
I couldn’t say I was that surprised, because I had used an egg donor to conceive my daughter. Back in 2013, I underwent three IVF treatments, each of which ended with a small amount of embryos that were not up to snuff (definitely not what you want when you’re paying tens of thousands of dollars for the chance of a baby). I later learned there were blood tests that could show decreasing egg quality, similar to that of a woman in her 40s—but at the time I was 27. We switched clinics and my new fertility doctor, while wonderful, still had the same focus of getting me pregnant, instead of helping me figure out my health concerns. No one ever mentioned to me any long term issues linked to my poor egg quality. To be fair, I didn’t pursue it either; I was just desperate to have a baby.
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That day in the doctor’s office, hearing the diagnosis of perimenopause, I kicked myself for not realizing this all sooner—for not advocating for myself and realizing that needing to use an egg donor was only the start of the health issues I would develop. In fact, my OB told me that I’ve probably been in perimenopause since the birth of my daughter—and my symptoms are getting worse.
According to the North American Menopause Society, perimenopause is a gradual winding down of estrogen, but can fluctuate, sometimes being at higher levels than others. The reduced estrogen can result in decreased sexual desire, vaginal dryness, hot flashes, and night sweats—everything I was experiencing.
I left his office with an order for blood work and treatment plans swirling through my head: hormone replacement therapy, birth control pills, estrogen patches. I would potentially be on hormones into my fifties until I officially passed menopause—not something I was particularly excited about, because who wants to take hormones for the next twenty years?
Granted, it was better than the alternative of perpetually being low on estrogen, which could lead to fun things like osteoporosis or heart disease down the road. Thinking about it all was overwhelming and I cried all the way home. Why didn’t any of those fertility doctors say this could happen? At least I could have expected it and worked through it. But no one told me about the possibility of my reproductive system sprinting into its 50s before I even got close.
Women are born with all their eggs they’ll use and the eggs continue to age throughout life, says Lauren Streicher, clinical associate professor of obstetrics and gynecology at Northwestern University, medical director of the Center for Sexual Medicine and Menopause, and author of Sex Rx: Hormones, Health, and Your Best Sex Ever.“ The peak time for good egg quality and fertility is going to be in the early twenties,” she adds. “Certainly by the time you hit your early thirties, some women continue to be very fertile and have excellent egg quality, and other people not so much.”
It’s been about seven months since my visit to my own doctor. I tried three months of birth control pills and am now on estrogen patches to see if they help my symptoms better than the pills. I still wake some nights drenched in sweat, and I’ve learned if I use more than a top sheet, I pay for it in wet pajamas. I’ve been on medication for anxiety and it’s still not determined if that’s caused by the hormone issues or not. My husband and I have to use lubricants more and more due to vaginal dryness from the estrogen changes. And with all that, it makes me struggle to feel sexy knowing that I have the hormone levels of an older woman.
I’m still trying to decide where I want to go with treatments from a diagnosis I still don’t completely understand. Perimenopause isn’t often talked about, especially when it occurs in child-bearing years. The bottom line is, like so many other health conditions, I need to be my own advocate.
“I think that if someone is going to be diagnosed with early menopause or perimenopause, if they are not seeing someone who is a menopause expert, they should, because there’s a lot of misinformation,” Streicher advises, “If you were told [you had perimenopause] by someone and you’re concerned, or you don’t feel like you’re getting all the information, then you need to get in the hands of someone who’s truly an expert.”
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