You've Got to Be Kidding Me! (eBook)

Chapter 2:
We Are Our Own Best Hope

“I was at my annual physical. I was thirty-eight years old, and I asked my doctor what to expect from perimenopause and menopause. He said: ‘I’ll tell you when you get there.’ I felt so dismissed. Here I was trying to better understand what to expect in the same way I had done when I was pregnant and I was blown off.” — Neena

If you’re reading this guide it’s likely you or someone you love is approaching perimenopause or in it currently. I commend you for preparing yourself for the journey ahead and for doing what you can to understand what you are undergoing right now physically and emotionally. The reality is that we know our bodies better than anyone else, including our clinicians, so it’s important that we become knowledgeable and prepared for this stage of life. However, as you’ll learn in what follows, the sad truth is that we must ready ourselves for perimenopause because it’s highly unlikely anyone else will give us the information or resources we need. We are truly our own best hope when it comes to perimenopause.

Why is it important for us to be prepared for perimenopause? The bottom line is that perimenopause is a significant stage in women’s lives. During perimenopause, our bodies are under a significant amount of stress that affects us physically, emotionally and mentally. Not only are we under stress due to perimenopause but many of us go through perimenopause just as we’re hitting our peak earning years, while we’re trying to launch teenagers off to college or to their first jobs and caring for elderly or sick parents.

Not only is perimenopause a significant stage in women’s lives, but millions of women experience perimenopause every year. 1.3 million women enter menopause annually and every single one of them went through perimenopause prior to menopause.3 Keep in mind that millennials are the largest generation in the workforce and the oldest millennials at thirty-nine are entering the perimenopausal period.

Perimenopause and menopause are not just stages in a woman’s life that happen to have uncomfortable symptoms. Perimenopause and menopause, in particular, mean we are at greater risk for certain health issues. For example, hormonal changes can result in an accelerated increase in LDL cholesterol, which puts us at greater risk for heart disease. While loss of bone density occurs in both men and women as we age, for some women that loss is extreme due to plummeting levels of estrogen. This puts them at greater risk of osteoporosis and broken bones.

One 2017 study found that the more severe and longer lasting a woman’s hot flashes and night sweats are, the greater her risk for developing type 2 diabetes.4 Perimenopause and menopause are signs our bodies are aging and when we are properly treated for the symptoms we experience, we’re not just treating uncomfortable symptoms. We’re taking steps that can lower our risk for diseases in the last third of our lives, so why isn’t more information available about perimenopause? Keep reading.

I run a purpose-driven health-care consulting company called X4 Health (www.x4health.com) with two other women cofounders. I have spent twenty years in the health-care field and I have developed deep expertise in many health-care issues despite not being a clinician. Prior to founding X4 Health, I was a patient advocate and fought for many decades to make the health-care industry a place in which patients’ and families’ needs were prioritized. All of these years later, I’m very proud of that work and the changes I achieved. Yet, even with my background, my perimenopause experience was a serious wake-up call! It reminded me the health-care industry is a very, very long way from meeting women’s needs.

This may come as a shock to you, but the vast majority of clinicians receive no training in medical school or in residency focused on women’s health after their reproductive years. According to a study by researchers at Johns Hopkins, only 20 percent of residency programs have a formal menopause curriculum.5 Most family medicine, internal medicine and—get this—OB/GYN residency programs include at most one hour of instruction on menopause. Things get worse when it comes to perimenopause. My team and I did a tremendous amount of research, yet we were unable to unearth any medical curricula that address perimenopause. None.

Unfortunately, the health-care system and many practitioners themselves are way behind. Until I sought help specifically for perimenopause, not one of my doctors spoke with me about perimenopause or shared with me the symptoms for which I should be on the lookout. Even worse, when I raised my symptoms with some doctors, they waved off my concerns with blanket statements like: “Aging is hard, but it happens to the best of us,” and, “Well, I wouldn’t recommend hormone treatments. There’s lots of problems with them.”

Let me be clear: I have deep admiration for clinicians and I know the vast majority have gone into health care because they care about patients and want to make a difference in people’s lives. However, the hard truth is most clinicians are woefully lacking in training on women’s health. In 2022, women’s health is still considered puberty, pregnancy and postpartum. What about the estimated 38 million American women who are menopausal and who account for approximately 20 percent of the American workforce? What about those same women who go through perimenopause before they get to menopause? That’s a lot of women whose needs are not being met. Worse than that, many of their needs are not even acknowledged!

It’s important we have access to information before we are in perimenopause so we can be on the lookout for symptoms, prepare ourselves should we experience physical, emotional and mental changes and make sure we have support available to us. The good news is that this guide includes the most up-to-date information you need to be your own best advocate. Information alone is not enough, so here is some additional advice to help you get the best care possible.

1. Find a clinician who specializes in hormones. While most of the health-care industry still doesn’t address perimenopause, a growing number of practices and individual clinicians are focused on helping women balance their hormones and manage their symptoms. They are who you want to work with in perimenopause and ultimately menopause. I dive more deeply into this topic in Chapter 8.
2. View yourself as a central part of your care team. Please only work with clinicians who partner with you as a central part of the care team. Remember: you know your body better than anyone else ever could, including clinicians.
3. Track your well-being. Many of us are busy working, caring for our families and volunteering in our communities. We have put ourselves last, or at least near the bottom, for a long time. As a result, we may not have all the data we need to share with our clinicians. It’s very important we have information about how often we have our periods and for how long, how long and well we are sleeping, our energy levels throughout the day, if and/or how often sex is uncomfortable etc. Collecting these data will give you and your care team a full picture of your health and well-being. You can find a great and comprehensive “Well-Being Tracker” on the Periwinkle website at www.helloperiwinkle.com/tracker
4. Power through any shame or embarrassment. Many of us have grown up in cultures that avoided talking about any women’s health or reproduction issues. For some of us, those issues were not just avoided. They were also taboo or shameful. It can be difficult for many of us to talk with clinicians about personal issues, but when we hold information back, it prevents our care team from being able to help us. If you feel unable to share with your care team fully, bring your Well-Being Tracker with you to appointments and that will help you give your care team the information they need to support you.
5. Inquire about low-cost options. My perimenopause experience has been expensive and you’ll learn more about why that is in upcoming chapters, but in the meantime, keep in mind that we all deserve to feel better no matter our income or access to health insurance. Nutrition and supplements are for many of us key to improving our perimenopause experience, so make sure to explore those options with your care team as well.
6. Take care of your emotional and mental well-being, not just your body. For whatever reason, most of our health-care system separates physical well-being from emotional and mental well-being despite the fact that they’re interconnected. Talk with your care team about challenges you may be experiencing, from anxiety to depression, as they could stem from physical changes and your health-care providers may have recommendations for managing those conditions. I talk more about this in Chapter 13.

Some of you may feel excited and look forward to feeling more empowered when you’re done reading this guide. Others may feel overwhelmed. I get it. None of us need another thing on our overflowing plates! Don’t worry; stick with me. I promise the time you spend with this guide will pay off. You’ll feel...