This is Christine's story. When Christine got married at 34, she and her new husband were so ready to get started on kids right away. But life had something else in mind. Just a few months into marriage, she was feeling super low energy, had put on some unexpected weight, was having issues sleeping but above all, her libido just plummeted.
She couldn’t understand it. She was totally into her husband and knew something was ‘off’. And because there is a history of hypothyroidism in her family, she wanted her long-time doctor to check her thyroid levels. Her doctor was highly resistant and kept saying you just got your bloodwork done a few months ago and insurance won’t cover it. To boot, she offhandedly commented, “Well, you’ve been married a year now, and the honeymoon period couldn’t last forever.” Christine was both irritated and appalled. But she knew that her lack of sexual desire, deep lethargy, weight gain was not ‘in her head’. These were real symptoms. She persisted in asking for a thyroid check and said if I have to pay for the bloodwork on my own, I will.
So finally, Christine’s doctor agrees to getting her bloodwork done. A few days later, she rings Christine up with an apology and acknowledged that the bloodwork showed something important. Her FSH (Follicle Stimulating Hormone) levels were high and because of this, Christine simply wouldn’t be able to have kids. Formally, it was diagnosed as Premature Ovarian Failure – which has since been ‘renamed’ Premature Ovarian Insufficiency – which let’s be honest here, is only a marginally better ‘name’. Ovarian Insufficiency medically means that the ovaries are not releasing eggs or producing estrogen, which essentially means a woman is infertile. Medically, the reason the FSH levels were off the charts high was that the body is trying to compensate for the fact that the ovaries are not releasing eggs. In reality, it meant that Christine was experiencing a form of Early Menopause. Christine was one of the 1 in every 100 women who experience Early Menopause.
The low libido, sleeping issues, weight gain and lethargy Christine was experiencing were actually all common symptoms or physical experiences seen in Menopause, which on average in the U.S. happens when a woman is around 50 to 51. Early onset ovarian issues, as happened to Christine, are defined as before age 40. And believe it not, some teenage girls can even experience early menopause. Christine’s doctor suggested she see a Reproductive Endocrinologist, which she did and quickly grasped that what this kind of specialist does is to focus on getting women pregnant using surrogacy and other strategies. What the specialist did not focus on were the menopausal symptoms she was experiencing so intensely. For that, she had to do a lot of hunting and pecking on the internet and searching for information for her situation. She was surprised that there were so little knowledge and what there was, seemed unclear and unsupportive.
FACT:The average age of menopause in the U.S. is 51.
1 in 100 women will experience Early Menopause, meaning before age 40.
Menopause itself is such a fundamentally important time of life - and like puberty - it happens to every single woman, yet it’s barely discussed. You’ve reached ‘Menopause’ or as the British more eloquently call it, ‘the menopause’ when periods have stopped for a full year. But here’s the complicated part. Pre-menopause, usually called perimenopause, typically starts in a woman’s forties. Female hormone production is declining and fluctuating and ratios of estrogen, progesterone, testosterone are no longer in sync. This period of change can range from 3 years to 8 years. That’s the physical change. Then there’s the psychological component.
Many women feel that our youth focused culture not only doesn’t celebrate the other side of adult female hormone change but in fact does just the opposite – women feel our collective culture from films and television to workplace and dating apps and sites send out strong signals of menopause marking the ending of sexual capability, beauty, productivity, creativity and more. There is no ‘birds and the bees’ discussion about menopause from one’s mother, never mind in high school biology or anywhere else.
The first place most women turn to – at least for physical menopausal expressions - is their OB/GYN doctor. But shockingly only 1 in 5 Obstetrics & Gynecology medical students receive menopause training. The study of menopause is considered an elective and many don't have the opportunity to take it, even if they desire to. The National Menopause Society seeks to help fill this glaring void by offering post-med school learning opportunities, and there are now about 1,000 clinicians all over the U.S. who have a deeper understanding of menopause and its specific physiological issues and hormone replacement therapy. To find a menopause trained doctor, you can go to the www.menopause.org site directly and use their Menopause Practitioner finder.
Let’s get back to Christine. Fifteen years have passed since newlywed Christine found out about her Ovarian Insufficiency. She and her husband continue to be solid together, successfully adopted and have a great homelife. Christine made it her personal mission to help other women in their personal journeys through adulthood, through menopause. She was and is always learning. In the early years, there was so little information about her menopausal symptoms and what she could do to mitigate them; it was frustrating and sometimes disheartening. Christine also found that early onset menopause or not, she had a somewhat unique symptom, which was that the very texture of her hair changed, from straight to curly! It turns out that hair and skin are one of the very first manifestations of menopause. For most women, it’s changing skin but for many women, thinning hair is very common.
Today, many of Christine’s friends and peers are entering Pre and Active Menopause in their late 40s and 50s; and she almost always knows when they’re in perimenopause (pre) and menopause before they do themselves. But Christine decided to step up her advocacy from friends and family. She and her smart, vibrant colleagues Donna Klassen and Samara Daly have created Let’s Talk Menopause, a non-profit organization focused on bringing the menopause conversation into the open. And making it a comfortable, constructive, fearless conversation. They and other organizations like The Menopause Foundation, led by Claire Gill, are part of a movement that started with MadameOvary.com, led by fearless Yale Professor, Dr. Mary Jane Minkin.
The fact is that there is no specific date on your calendar where you’ll get pinged and it’ll say, okay today, you start menopause! And in 12.5 months on July 15, 2023, it will stop. Some people experience ‘symptoms’. We dislike that word and would like to reframe these as manifestations or menopause expressions.
Hormone level contractions and fluctuations start in your 30s for most people, including both men and women. For most people, the decrease is hormones is relatively small on an annual basis – about 1% loss in Hyaluronic acid and collagen production annually, for example. So the loss is not particularly ‘noticeable’ until around age 40. For most women, it’s typically between 40 and 45 when we will start to experience pre-menopause (aka PERIMENOPAUSE). The timing, actual experiences, and the intensity of each menopausal expression will vary from woman to woman and from year to year.
The good news is that there is a movement out there to not only improve awareness and provide better support physically but equally to open up hearts and minds about what real-life menopause looks like emotionally. Dr. Minkin and her direct speaking, madameovary.com, for example, contains a goldmine of knowledge about menopause and ways to think about it.
What we see is that menopause is NOT a medical mystery but is an important life passage just as puberty is. That ultimately every woman is a bit like Christine, meaning every woman will have a great, good and hard time of it. And that like so many things in life, knowledge is power.
There are a range of new startups who are also actively inventing ways to make the PreMenopausal, Menopausal and ultimately Post-Menopausal experience more empowering. These nascent brands are working to empower women to manage the situation better, to make the quality of the experience better; rather than remaining silent and annoyed or worse, saddened by it all. There is much to do and there are many newbies large and small hoping to play a small part in your success.
Caire Beauty is 100% focused on skin and how women can defy the loss of skin molecules associated with hormone loss pre and post menopause. By infusing molecular nutrition through bioavailable formulas, women can improve the firmness and elasticity – the bounce factor - of skin from the inside. Others are reinventing how women will experience bladder control (incontinence) moments such as Hazel, a new company coming out with single use undies that look and feel as light as air and just like real undies. Peaceful Mountain and Pause have hot flash sprays that are designed by women who have personally experienced this extraordinarily common menopausal symptom. Bonafide has designed a vaginal suppository called Revaree with Hyaluronic Acid. They, like us, believe Hyaluronic acid really is a ‘youth’ giver and their product directly addresses the thinning epithelium in the vagina very successfully.
Many other ‘expressions’ are common and will be explored more deeply in future Caire Menopause Diaries but for now, know that you are not alone if your cholesterol readings are shooting up, you’re having Urinary Tract infections, vaginal dryness or severe dehydration. We encourage you to use reputable resources in doing research and to find a supportive and knowledgeable medical doctor.
Hormones are like the traffic light signals in our bodies – they signal the start and stop of virtually every aspect of our systems and basic bodily functions from signaling hunger and thirst, sleepiness, sexual desire. Hair growth, bone growth. And did you know that hormones affect your very mood and metabolism? Find a doctor or two who is experienced in hormone change and how it really affects adult women. Menopause or more accurately hormone decline not only impacts skin, hair and gynecological health but it also directly affects cardiovascular health, bone and muscle health, brain health and so much more.
We suggest you find one who is looking at the most recent knowledge because medical knowledge could certainly be better, deeper and more understood. In the last few years, a sea change has begun, meaning there is a complete rethinking about how menopause, perimenopause (before) and post menopause is experienced and how each women’s circumstance and situation is hers and hers alone.
Dr. Minkin tells a story about how the Women’s Health Initiative (WHI), a major study with over 150,000 women, about the health of post-menopausal women, came out in 2002 and changed the landscape for menopausal therapy seemingly overnight. The study’s suggestion that an increase in Breast Cancer could be linked to HRT (hormone replacement therapy) was featured on Good Morning America & virtually overnight, women flushed their estrogen tablets down the toilet. In fact, this is a classic example of how a sound bite can be the death knell for a person, a product or in this case a ‘clinical treatment’. Dr. Minkin tells us that from the very beginning the WHI was “misconstrued”. And so, an entire generation of women who could have benefited from HRT did not. But today, the attitude and knowledge base of doctors is evolving. And as noted earlier, cultural mores around menopause and hormone change is also rapidly evolving in the U.S. Hormone replacement therapy is becoming more accepted as a treatment option, the understanding of how HRT can even be protective against certain forms of cancer has come out into the open; and the actual using of such therapies is more nuanced and tailored to each woman.
Like all things medical, like all things with your body, it’s ultimately up to you to be your own empowered advocate. At Caire, we hope to be of some use in your own journey.
Write us with questions and ideas at firstname.lastname@example.org
To learn more about peri-menopause, read this NY Times article, Why Is Perimenopause Still Such a Mystery?
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