“I Never Went Through Menopause”

About 6 months ago, while out west visiting family, I asked my mom if I could interview her about menopause for my podcast. We were sharing a bottle of nonalcoholic wine in her living room, had covered politics, family drama, and how sad it is I don’t read anything literary anymore, so we needed a safe subject. Plus, I was genuinely curious about her experience since she turned 51 the year the WHI findings were published, and I was selfishly hoping for some foreshadowing of what my own future may hold.

“Oh, I didn’t go through menopause,” she responded, sipping her NA wine. “This is actually really good!” She proclaimed, and took another swig.

Hadn’t gone through menopause? I pondered this almost impossible proclamation. At the time, my mom was 74. She had certainly gone through menopause.

“I mean I am post-menopausal,” she continued, “but I never had hot flashes. So I guess I never really went through it! Lucky!”

She went on to explain that she had a partial hysterectomy at 44, her ovaries stayed put, and her period departed with her uterus. Without a final period to mark the moment, and without a single hot flash, she concluded that menopause had simply skipped her.

This is the misperception I hear constantly in clinic and at dinner parties. We have let one symptom stand in for an entire transition. Hot flashes are the mascot of menopause. No flash, no menopause. But menopause is not one symptom. It is a full-body hormonal shift that touches skin, hair, sleep, mood, metabolism, bones, and heart. My mom went through it as every woman with ovaries does. She just went through it without a name for what was happening.

“I do remember my hair falling out,” she said. “I had NEVER had hair loss, and it scared me. No one in Macon knew what was going on, so I flew out to San Francisco to see Dr. Vera Price at UCSF, who was supposed to be THE hair expert. She was not impressed with my hair loss and told me to use Rogaine. Which I did, and it has worked. That was really it!”

I remember that trip and the distress of her shedding hair. It was traumatic for her, so much so that my parents booked an appointment with a doctor over 3,000 miles away.

“But worse than the hair,” she continued, “was the WEIGHT. I had NEVER had any fat around my stomach, and then suddenly one day it just started showing up there.” She sat up straighter in her chair and her cheeks flushed pink. “This is important, Corinne. I had no idea that menopause could make you gain weight around your waist, and I was really worried. There was no exercise I could do or diet I could go on to fix it either. Believe me, I tried.” She looked down at her glass. “It was so scary to me because I didn’t have any idea why it was happening. No one warned me, and no one understood it. That was in my 40s, and that was really hard because I remember just starting to feel like I was getting old. I felt fear, Corinne. That’s what you need to talk about. The fear that all of this brings.”

I remembered the dieting. It was the 90s, and our pantry was filled with SnackWells fat-free cookies, 40-calorie-a-slice sandwich bread, and Diet Coke. I could still hear the thump thump thud of her sneakers as she pounded out Jane Fonda’s Step Aerobic video upstairs. I never realized then that her dedication to that era’s portrayal of a healthy lifestyle was driven by fear and determination to regain control of a body that felt like it was betraying her.

She had never had hair loss, and suddenly feared she was going bald. She had never carried weight at her waist, and overnight watched fat accumulate. She was doing all of the “right things,” not sitting around letting herself go, but felt like she was losing herself all the same.

And the timing could not have been worse. The rest of her 40s and early 50s were consumed with marital stress, raising three daughters and launching us out of the house, and eventually, divorce. She didn’t have the bandwidth to think about menopause. She was watching the life she had worked so hard to build collapse, and trying to create something even better out of the rubble.

The symptoms without an explanation were terrifying. Would any of that have changed if someone had explained it was perimenopause? It would not have changed the reality of the changes her body was facing, but it may have reduced the fear born from unknowing.

As unprepared as my mom was in the early 2000s, twenty years later, I wasn’t much better. My 44th birthday seemed to bring a new physiologic first every week.

“I’ve never had trouble falling asleep,” I complained to my husband, reaching for the wine to solve the onset insomnia.

Then a few months later, “I’ve never had trouble staying asleep,” I cried one morning after lying awake from 3 to 4:30 am, covered in sweat, heart racing. Wine was putting me to sleep, but the middle-of-the-night wine wakings were wrecking me.

“I’ve never had hair loss,” I puzzled as I cleaned out the shower drain for the third time in a week, and swept strands out of my sink after every blow dry.

“I’ve never had hormonal acne,” I grumbled as I applied tretinoin to the back of my hairline and neck.

“I’ve never had facial hair!” I exclaimed as I tweezed my upper lip after grooming my eyebrows.

“I’ve never needed this much insulin to control my blood sugar,” I muttered as I changed the carb-to-insulin ratio on my pump again and read about insulin resistance in Type 1 diabetes.

And most recently: “I’ve never been anemic,” as I went for iron infusions and scheduled a uterine ablation to stop, or at least slow, my increasingly heavy periods.

Viewed as isolated, individual problems, these “I’ve never” moments would have made me feel like I was falling apart. My body felt hijacked, and the hijacking was happening in the middle of a full life: a marriage, a practice, patients, kids, aging parents. But after diligent workups and hours of studying women’s health for the first time in my medical career, I learned that the chaos was all connected. This ever-multiplying group of new symptoms shared one foundational change: perimenopause. Knowing that didn’t fix any of the issues. There isn’t one magical pill for everything that changes in perimenopause. But it gave me a framework for approaching my overall health.

What if we could all start with that framework instead of earning it symptom by terrifying symptom? Skin and hair changes are some of the earliest signs of perimenopause. What if we could look in the mirror and, instead of panicking over more hair simultaneously in the drain and on our upper lips, take it as a sign of other changes to come? We could start building a supportive team to help us through the next 2 to 10 years of perimenopausal shifts. Instead of living in a body full of landmines, we could find a safe path through.

Instead, we hand women a different framework. One of my husband’s older colleagues said to him a few years back, “Just wait, man. People do some really fucked up shit in their 40s.”

This is how we have branded midlife: a time of crisis and collapse. Of divorces and second marriages, trips to rehab, career burnout, and professional goals abandoned. We have heard the warnings and watched them come to fruition in our friends and families. Any noticeable change, from going vegan to marital infidelity, gets labeled part of a midlife crisis. I recently saw a “Choose Your Midlife Crisis Adventure” post on Instagram and felt the blood rush to my face when I spotted “Quit drinking” on the influencer’s laundry list alongside starting a supplement company in your basement and selling research peptide IVs. Even positive changes get absorbed into the crisis concept. That’s the branding we have accepted. But the branding is the crisis.

Imagine if this was the approach we took with our kids approaching puberty, and even more daunting, middle school. What if we didn’t tell them that they would start smelling funky, break out in acne, grow dark thick hairs on their genital areas and armpits, grow breasts, have deeper voices, wake up with an occasional stiffy and sticky sheets, and intermittently start bleeding for 4-7 days on a monthly basis?

We could just let them figure out that they can go from emotional war to peace and back again over the cafeteria running out of pizza. That they will literally think their life is over because of a comment someone made about their eyebrows in gym class. You’re just getting older, we could say, and your body and brain will feel like they have been hijacked for the next 3-5 years. You won’t feel like yourself, look like yourself, act like yourself, and neither will any of your friends. Just remember, kiddo, people do some really sick shit starting in 6th grade. If you see something that looks like a life raft, it’s probably a shark. But it’s all totally normal. You’ll be fine.

We would never because we treat puberty differently. Several renowned menopause experts have called perimenopause Puberty 2.0. It’s an appropriate parallel. Both are years-long hormonal transitions. Both announce themselves first on the skin. Both come with moods that arrive like a tempest and evaporate into the ether. The difference is that puberty comes with a name, a timeline, and a health class that is well characterized. It’s talked about in families, at the pediatrician’s office, and at schools. And puberty is easier to schedule around. In puberty, you have to keep track of Nintendo, a math assignment, and deodorant. In perimenopause, it’s an entire complicated life.

Last month I showed my 11-year-old son his new acne face wash and explained that the small bumps on his nose were the first sign of his hormones changing. “You mean puberty,” he said, as casually as if he were announcing he was going to eat a sandwich. He was unfazed, because in our house, hormones are dinner conversation. He will not need to be interviewed at 73 to learn the name for what happened to his body at 12.

That is what I want for women. Not a cure, because there is no face wash or serum to clear up the endless litany of perimenopausal symptoms, although marketing campaigns will try to convince us otherwise. There is no clear timeline for how long this phase will last, and many women, like my mom and hopefully me, will lose the marker of the menstrual cycle to know when menopause has officially arrived. There is more ambiguity than puberty ever had. But a name, a pattern, and a warning of what might be coming next is protective on its own.

Fear is so often born of unknowing, and knowledge is its antidote. More so than menopause-branded supplements, serums, and sleep trackers, the most powerful gift we can give women approaching midlife’s hormonal mayhem is the language to name it, discuss it, and understand it.

But in the meantime, you may want to choose a new face wash.