The Madwoman in the Volvo: My Year of Raging Hormones

by Sandra Tsing Loh

  I find myself thinking: Is this going to be me? South Florida retirement home? Barbara Bush hair? Mustaches and bifocals? Cats and crocheting? Is this the passage I’m entering now?

  Stopping off for some emergency wine on the way home, I salve my wounds with a perusal of Vanity Fair, which always lends my grocery shopping some much-needed glamour. Slowly turning pages in the checkout line, I find myself becoming fascinated with a piece about Courtney Love, sojourning at the time in Britain. It is startling enough to consider Love’s “retirement” scheme, which seemed to encompass three main activities: drinking Pimm’s Cups, attending foxhunts, and hoping to marry somewhere, somehow, into the British nobility. Even more startling for me, though, is the revelation that the mood-swingy mother of Francis Bean Cobain will soon turn fifty. I feel better already.

  Oh my God, I think. See! This will be different! This country has aged so much even that Gen Xers are going through the change, and it’s not going to be the same for us. There won’t be Barbara Bush haircuts and Oldsmobiles. I understand in a moment of inspiration that my generation will by necessity be part of the new menopause. Ours will be as different from the old menopause as a white pleated tennis skirt is from Crocs. Or some other better, younger, hipper fashion statement. This is our time! Ready, set, menopalooza!

  This will be huge. Subsequent research confirms just how huge. Whereas in 1900, due to an average life span of forty-eight years, many females never really reached menopause, today women between the ages of forty-four and sixty-five have become America’s largest demographic group. Think of it: We are literally the largest swarm of menopausal women in history. Picture fifty million Courtney Loves running around this country making a very giant Hole, and not just in the ozone layer. By 2015 nearly one-half of American women will be menopausal.

  Good Lord, I think, this is not going to be some sideline event. Think of the celebrities alone who are menopausal or post: Madonna, Demi Moore, Oprah, Suze Orman, Katie Couric, Kathie Lee Gifford. Or politicians: possible future president Hillary Clinton, Sarah Palin (who shares my birthday, February 11), and German chancellor, Angela Merkel. Fortune magazine recently ran a cover story on the world’s one hundred most powerful women—90 percent of them are, their ages suggest, menopausal. Forget the old menopause’s image of your lovable mustached, gray-haired aunt Edna in a shower cap, saying, “Oy, I’m shvitzing,” or “Where are my glasses?” (Children in petticoats gaily shout back: “They’re on top of your head!”) In the new menopause, these steely-eyed women are driving the freeways, running businesses, doing newscasts, setting interest rates, performing dental surgery.

  Furthermore, even when one takes a look at the women in one’s own day-to-day life, one may have no idea who’s going through the change. At least in my hometown of Los Angeles, many of these ladies do not look fifty. What with the Botox, the Restylane, the Pilates, the low lights, and God knows what else, a menopausal woman may look like a thirty-four-year-old with incredible Pilates arms who hasn’t slept in a year and will tear your head off in the checkout line because she has not had a carb since 1997.

  I start to suspect, given the vastness and edginess of the demographic, that there must be a bunch of hip, great new books on menopause. Surely my enlightened “younger” generation has developed a strategy for getting this thing done in a new, enlightened way. What does Oprah have to say about it? I wonder. Suze Orman? Real Simple? Invigorated by the positive forward momentum of my research project, I go to my local bookstore. I make my way to the Women’s Health and Self-Help sections and, behind a life-size cutout of Dr. Phil, there is indeed an avalanche of menopause titles. Eagerly I place as many as will fit into my basket. These include: Could It Be . . . Perimenopause?; Before Your Time: The Early Menopause Survival Guide; The Natural Menopause Plan; Second Spring; Menopause Reset!: Reverse Weight Gain, Speed Fat Loss; Get Your Body Back in 3 Simple Steps; and the slightly ominously titled What Nurses Know . . . Menopause (two words: atrophic vaginitis). These menopause books link to more menopause books, which I troll on Amazon.com.

  After a couple of weeks of reading I start seeing some patterns.

  On the cover of a typical menopause book, instead of the fanged woman with the spiky Medusa-do one might expect, one is far more likely to see a lone flower—a poppy, or perhaps a daisy. This type of wan little affirmation symbol actually fits, because the war stories of the MD, PhD, and RN authors who dominate this genre contain narratives that are indeed kind of, well, Stuart Smalley–esque. Here’s a pastiche:

  Mary Anne, age forty-eight, came into my office feeling overweight and bloated. She hadn’t been sleeping, work was stressful, her husband had just gone on disability, and he required daily care. Mary Anne complained to me of lower-back problems and gastritis, and also cramping during sex, which had become more and more infrequent. She was extremely depressed about moving her eighty-four-year-old mother to a nursing home, and upon examination I noticed vaginal inflammation.

  Yikes! As unappetizing as that just was to read, be glad you saw only one such passage—I must have read a hundred. Because clearly, from the medical-professional point of view, menopause, along with the ungainly run-up to it called perimenopause—which appears to be the phase that I am in now—is a parade of baleful, bloated middle-aged women (“Lisa, fifty-two,” “Carolyn, forty-seven,” “Suzanne, sixty-one”) trudging into their doctors’ offices complaining of lower-back pain and family caregiving issues and diminished libidos and personal dryness and corns. As they sit wanly on cold metal tables in their paper gowns, they arduously count out their irregular periods—from thirty-five days to forty-four days to fifty-seven, going heavy to light, light to heavy, sometimes with spotting, sometimes with flooding, sometimes flood-spotting, sometimes spot-flooding. Our symptoms are various. They include mood swings, sudden weight gain, and the appearance of morning chin hairs that by noon are long enough to braid and twirl up into thick Princess Leia buns.

  AND SO, for these new, hip, bloated, and only perhaps sometimes frumpy Gen Xers—menopausal, yes, but in the throes of careers, raising children, caring for our elders, and . . . let me start the conversation. Let me lead you quickly and relatively painlessly through the science of your symptoms, or symptoms to come. The fact is, few perimenopausal women have the time, inclination, or stamina to wade through hundreds of pages of Eeyore stories, hormonal bar graphs, and endless treatises on vitamins and omega-3. We need our facts fast, concise, and perhaps on a key chain or zip card, the back of which can be used to quickly swipe for groceries, which may well include a coupon for emergency chocolate or wine, just because it’s Wednesday. We have a child to pick up in an hour whose fourth-grade global environment project will require not just frantic Googling but faux, wide-eyed active listening—hurling the whole (Styrofoam) thing out the window is apparently not an option. So, trek shoes on, water bottles up: Let’s do this thing. Herewith, as a public service for my suffering sisters in the new menopause, is a simple, handy menopause one-sheet and walk-through of the science.

  HANDY MENOPAUSE ONE-SHEET

  (for Perimenopausal Women with

  Frighteningly Short Attention Spans)

  TYPICAL PERIMENOPAUSE SYMPTOMS

  Irregular periods

  Hot flashes

  Night sweats

  Vaginal dryness

  Breast tenderness

  Drop in libido

  Bloating

  Weight gain around the belly

  Forgetting things/inability to concentrate

  Heart palpitations

  Sleeplessness

  Mood swings

  Depression

  Panic

  Anxiety

  Sometimes all at the same time

  Of course many women may read this list and wonder: Except for the hot flashes, how is this so terribly different than my life before menopause?

  QUICK EXPLANATION OF THE SCIENCE

  (for Perimenopausal Women Sadly Lacking a PhD in Biology)


  Perimenopause is a somewhat loosey-goosey term for the period before menopause, when your periods become less regular, which can happen as early as your late thirties or early forties (and can supposedly last from four to fifteen years!). A common rule of thumb is about forty-six.

  What’s going on hormonally? Deep breath. During the first part of a twenty-eight-day cycle, follicles in your ovaries make estrogen. During the second part, progesterone surges to make the uterine lining ready for the fertilized egg.

  But now, if you start not making an egg, your body stops making progesterone and your “unopposed estrogen” rises, resulting in many lovely perimenopausal symptoms. Eventually your estrogen levels will also drop, so your relative balances of estrogen and progesterone may start fluctuating wildly.

  But listen: Note that there’s a complex relationship between these hormones and the workings of your actual brain! That’s a simplified way of saying that this whole fertility conversation is taking place among a rogues’ gallery of potentially misbehaving body parts. A short list includes the hypothalamus, the pituitary gland, the ovaries, body fat, GnRH (gonadotropin-releasing hormone), FSH (follicle-stimulating hormone), the brain’s temporal lobe and limbic areas (which regulate our moods), and the brain’s amygdala and hippocampus (related to memory, hunger, libido, and anger—let the party begin!).

  Menopause (defined as a full year without any periods) is what comes after.

  In The Silent Passage, Gail Sheehy’s celebrated book on menopause, she calls it “the calm after the storm.” Weirdly, menopausal women’s hormone levels now become not just stable but in fact the same as preadolescent girls’. Menopausal women also have not just the same amount of (free) testosterone they had in fertility—sometimes they have more! (Which may suggest I’ll grow a mustache and shout more when driving, but I’ll cross that bridge when I come to it!)

  WHAT ON EARTH TO DO ABOUT IT

  There was an infamous and popular (isn’t there always?) 1966 book called Feminine Forever, by Robert Wilson, MD. Being of the “menopause as crepey dethroned queen” school, Wilson urged women to take estrogen pills to keep themselves youthful and moist and sexy. As a result, lots of menopausal women started taking a product called Premarin. Literally made from horse urine, Premarin also seemed to have the unfortunate side effect of potentially causing breast cancer, heart attacks, blood clots, and more. (This bombshell came in a 2002 Women’s Health Initiative study that had followed 160,000 women over twenty years.)

  When the news came out everyone freaked, and the conventional wisdom became no hormones.

  Now, however, the pendulum is swinging back to center. Some HRT (hormone replacement therapy), for a limited amount of time, is considered safe. As opposed to horse urine, what seems to be in vogue now are “bioidenticals,” largely thanks to Suzanne Somers’s long-term enthusiastic endorsement of same. Bioidenticals match the hormones already in your body, although they are made from plants. While that seems more “organic,” some doctors caution that there are no long-term studies that demonstrate the safety of bioidenticals, and some even consider compounding pharmacies a kind of medical voodoo world. As my wonderful gynecologist says, “Suzanne Somers giving medical advice is as if I bought a mutual fund and said, Let me give you financial advice.” She believes straight Premarin is fine (not the Prem-pro combination that set off the scare in the Women’s Health Initiative study). Then, of course, many other people use bioidenticals and love them, with no ill effects.

  In the end there is no one magic bullet to alleviate menopausal symptoms, because women are so different. See your doctor. And try not to get a needless hysterectomy.

  Some women prefer to alleviate their symptoms without any hormones at all. Typical recommended over-the-counter menopause-symptom-soothing aids include black cohosh tea, Saint-John’s-wort, soy, chamomile, calcium, vitamin supplements (D and B-12), and phytoestrogens (plant-based forms of estrogen found in alfalfa sprouts, soybeans, chickpeas, lentils, tofu, miso, flaxseed, and spinach).

  In short, the literature on menopause confirms that perimenopause could well be a wild roller coaster of anger, depression, sleeplessness, plunging libido, bloating, and vaginal dryness. How should you deal with all of this? Through (go, team!) a healthy lifestyle! Essentially, the chorus of books all agree: We’re to get more exercise, drink more water, do yoga stretches before bed, cut out alcohol and caffeine, and yet (and how does this follow?) reduce stress. Even the flirty exhortations to have more sex feel like yet another job on life’s chore wheel (given that it’s supposed to be with your mate of twenty years rather than with Johnny Depp in his Pirates of the Caribbean garb or Hugh Jackman in any garb at all).

  ALL OF which is to say that now, having learned everything there is to know about this wacky hormone dance I’ve begun, instead of feeling free and elated I feel like I’ve just been given an odious homework assignment (what with everyone’s chipper exhortations to “Just eat more flaxseed! And soy!”). To be candid, I am extremely disappointed that there isn’t a magic bullet and that now, as in pregnancy, I am supposed to start doing yoga again and to eat kale. They didn’t help at all then, and I hardly believe they will now.

  All the medical advice in these books has gotten me down.

  I’m very bad at cutting things out.

  I would like to bring things back in. I’m an action-oriented gal.

  I’m not going to make it through this thing unless there is a completely other way. Otherwise I’ll just have to resort to what my mother did at the end of every day: smoking.

  Life in the (Happiness) Projects

  THE THINGS WE TRIED IN OUR JOURNEY TOWARD HAPPINESS

  Singing

  Dancing

  Sculpting

  Crocheting

  Giving up Solitaire

  (Extreme!) couponing

  Exercising

  Painting our bedrooms mad different colors like Burnt Tangiers

  Writing “gratitude” notes to everyone in our lives

  If not that, at least buying a bunch of “gratitude” stationery

  Weeping

  Throwing in the towel and just buying ourselves some damn colorful plateware

  Frantic late-night fressing

  Xanax

  OF COURSE THE PROBLEM with perimenopause is forgetfulness. When you’re in perimenopause—even after you’ve been told you are—you keep forgetting who you are. I would advise all women who’ve begun the change to write a note: “REMEMBER! I AM IN PERIMENOPAUSE! THIS COULD TAKE FOUR TO FIFTEEN YEARS!” and stick it on your bathroom mirror so you can see it every morning.

  The forgetfulness is why, after I got that first attack of the “darkies” in the car, read all those menopause books, and became disappointed that there was no magic bullet—I totally forget about the whole thing. That’s right, I just totally forget about it. All I notice is that I am just sort of depressed. Every morning, I wake up feeling as though something—this nameless weight—is sitting on my chest and neck, gradually pressing the breath out of me. It’s less hat full of rain than a kind of handbag, or purse, full of anxiety. My body is also sometimes suffused with sudden tingling, uncomfortable warmth, but it doesn’t occur to me at this time to call it anything exciting like a hot flash.

  On my parenting days off, when I’m not pounding around town with my kids, I find myself becoming weirdly listless. I have a vague memory that there is something I could take for this, like Saint-John’s-wort or black cohosh tea, but I have no idea what black cohosh tea is, and even the notion of getting into the car to drive to where some perky health-food-store employee is going to explain it to me (why are health-food explanations always so long?) fills me with exhaustion. In point of fact, daily activities like “going to the store,” “taking a walk,” or even “getting dressed” have come to seem oddly daunting. I feel like some lady staring flatly out the window in a Cymbalta commercial—but of course I never make the connection that maybe what I actually need is Cymbalta—whatever that is. I
’m too embarrassed at the end of the day to report to anyone but Mr. Y (who sees it) how pathetic I’ve been. What did I do today? I stayed in bed until noon. I perused a home decor magazine. I played computer Solitaire. I Q-tipped my ears. The Q-tipping—that was arguably my happiest moment, as well as my most productive.

  “I think it’s because you’re not writing some big new project,” Mr. Y says. “The magazine articles are one thing. But you’ll feel much better when you get a new book going.”

  “Do you know how hostile that is?” I flash back, stung. “Telling a person they’ll cheer up if they just get a book going only makes them feel worse! Coming up with a great creative project is a hard thing to do, and if one’s happiness depends on that, one should contemplate quitting life entirely. ‘Be creative!’ Gee thanks! It’s another impossible chore, next to the sink full of dishes and the basket of laundry.”

  “Why don’t you call Clare,” Mr. Y pushes on, “from your writers’ group? She’s always got ten things going. You always seem to stimulate each other.”

  Not wanting to be accused of ignoring his advice, although ignoring his advice is exactly my instinct, I call Clare, who is indeed a beloved sister-in-arms. She is a middle-aged mother of two who also has three well-reviewed novels to her credit. Like me, she is doing the mothering/writing balancing act, although on her this always seems a lot more fun.

  When I ask her what she’s up to, and if she wants to get our group going again, she delivers a grand announcement: “I’ve given up writing.”