Sunday, November 24, 2013



No one really prepares you for the onslaught of the failure of estrogen in your body.

As soon as you start menstruating, you can’t WAIT for it to stop.  The mood swings. The irritability. The questioning stares of loved ones when you are on the emotional rollercoaster of hormonal insanity.  The migraines. The cramps.  The expense of “feminine hygiene products.”    I can’t tell you how many pairs of pants and panties were trashed in my lifetime by miscalculations/timing problems. 

The first thing my 12 year old said after her first period was NOT “Oh, I feel like a woman now,” or “How can I feel fresh as a daisy?”  as the TV commercials for tampons and pads imply. 

She asked, “When does this stop?” 

In case you aren’t “UP” on all of the new PC language, perimenopause is now called the MT or Menopausal Transition.  I don’t care WHAT you call it, it sucks.  It can start 6 years before your last period. The menopausal transition  can start anywhere from age 45-55 with a Bell Curve distribution with outliers of  2.5 % on either side. 

  I think we should call the whole process, “ovarian hiccups.” That’s what it’s like. Your period goes wacko, either you’re skipping and getting hot flashes and night sweats for a month or two before you bleed again, or the periods come closer together, heavier, and more debilitating. Then, suddenly, normalcy returns for a couple of months and you’re “good.” Relatively, of course.

This reinforces your belief that you can’t WAIT for it all to be over and done with. 

Cue the ominous music. When you DO stop menstruating, a whole NEW set of issues crop up affecting you and your family and friends.

The night sweats:  My husband wears layers of flannel to bed because I’m whipping the covers on and off all night while the ceiling fan is set to “Hurricane Katrina.”
The Hot flashes: 
--You start to wear waterproof makeup, or just completely give up on makeup because dripping sweat pouring down your face is not fixable even with soft focus and air brushing.  The red flush glows/shines through makeup anyway.
--You discover why they sell those stupid little “personal fans” at the grocery store. 
--You fantasize about inventing a “hot flash button” for your car dashboard that when activated would shoot freezing cold air directly into your face and neck.
--You dream of inventing a car seat butt cooler instead of a heater

Vaginal Atrophy: 
--Your vagina dries up and gets stiff-losing it’s elasticity.  There’s no pretty way to say this.  It can be itchy, painful, and cause burning with urination. 
--Sex can be painful or impossible.  Lubricants may or may not be helpful. 
--Your libido goes into the crapper.  Here you are, for the first time in decades, not worried about pregnancy or emotionally psycho for two weeks out of the month and you can’t take advantage of it. 

Arthralgias/Arthritis:  Oh, did I mention that your joints become more prone to injury because you lose the estrogen effects there too? 

Your skin and hair change:   That one came as a big shocker to me the other day.  I’ve always had fine but abundant hair, and oily skin.   I HAVE WIDOWS PEAKS NOW.  I was just combing my hair and pulled it back and saw a big area of my forehead that didn’t used to be there!!!  WTF? 

My grandmother used to say, “Golden Years, Schmolden Years.”  My patients tell me, “Getting Old is not for Sissies.”  They are NOT kidding. 

As a physician, we want to fix stuff.  But here’s the thing.

Menopause is not a disease.  This is in contrast to what the drug companies want us to believe.  That’s how Hormone Replacement Therapy became so ubiquitous before they finally did the studies showing it could cause harm.  Harm like increased breast cancer risk with combined estrogen and progesterone.  Like heart disease risk if started 9-10 years after menopause.  Like blood clots.  Like endometrial cancer with estrogen pills used without progesterone in women who still have their uterus. 

What is a girl to do? 

There is so much out there in the lay literature about things like soy, and black cohosh, and testosterone.  Movie stars purport to be experts on menopause, selling their books and wares based on unscientific information. 

Dietary supplements are not regulated by the FDA and God KNOWS what is actually in some of that stuff.  I’ve seen some Male Enhancement pills over the counter that actually have Viagra hidden in them –dangerous if you’re on medications that can kill you with Viagra and you don’t know it’s in there.  I’ve seen over the counter diet pills spiked with prescription amphetamines. You have to be so careful.

You ask, “DoctorDiva, What are YOU doing?”  Funny that you should ask. 

First, I talked to my gynecologist.  (doctors who treat themselves have a fool for a doctor.)

I discussed my concerns, my family and personal history of cancer, blood clots, my personal history of whether I smoked (I don’t). 

 I tried NON prescription fixes he suggested like personal lubricants, (glycerin and silicone based) and EXERCISE. (By the way, silicone is REALLY slippery, and the bottle will slip right out of your hands and slide across the floor if you're not careful.)

    I tried DIET and WEIGHT LOSS (a whole ‘nother column).  I discussed it with my husband too, since he is intimately  (pun intended) involved in this.
When that stuff didn’t work, my doctor and I decided on a prescription medication to try.  I elected for topical estrogen.  Not everyone can use it depending on their personal and family histories, or risk factors like smoking, hypertension, blood clots, strokes, etc.  I’m still in the trial period.  WELL, not PERIOD.  Thank God.  But you know what I mean.  So far, so good.  My Doctor and I will re-evaluate on a regular basis. 
Don’t depend on the internet for all of your information—and use reputable websites, like Mayo Clinic, emedicine/Medscape. USE YOUR DOCTOR.  Your gynecologist is an expert.   
  And Good Luck. 

Getting Old(er) is not for Sissies. 

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