Perimenopause is NOT My Friend Episode 10: Going Under

It's been a while since I've given an update on perimenopause, which is a good thing. When it's loud in my head, I write about it. When it's quiet, I don't. I can't say I forget it's there. If you've experienced perimenopause with all the symptoms and indignities I have, there's no pretending it's not there. But if I haven't been writing about it, it means it's been comparatively uneventful.

Here's where it stands now.

The procedures

I got the TOT surgery to deal with stress incontinence. I still occasionally pee when I sneeze, just not nearly as much as before, and with a little pelvic floor therapy that should go away. 

The procedure to take out my firmly embedded copper IUD and insert a Mirena was successful. The Mirena is doing its job — actually, it's doing three jobs. One is to provide progesterone as the antidote to my estrogen therapy (more on that in a minute). The second is to act as birth control. I am not pregnant, so — success.

Its third job was to lighten my 360 mL periods (for reference a normal flow is about 80 mL). After four months, I can say my periods are barely existent, which in some way I mourn. A regular menstrual flow is healthy for bone density, muscle development, and other things that decline in menopause. But not bleeding out every month definitely has its benefits.

One discovery my doctor and I made during this process: I have a large uterine fibroid. So large, in fact, that when I lie down, I can feel it jutting out — a hard peach-to-orange-sized lump on the right side of my lower abdomen. Best practice with fibroids is that you don't surgically remove them unless they're causing pain or other symptoms.

Not only did my fibroid likely cause the majority of my overactive menstrual flow, but she also creates a fair amount of vaginal discharge. (Yes, my fibroid has a gender now. We're close.) Well, actually, I can't just blame her — she's in cahoots with my IUD. My uterus sees both as foreign objects, so it creates secretions out of irritation. The hope is that over time, my body gets used to the IUD and fibroid enough to lessen the blow.

What that means is, I may not pee when I sneeze as much anymore, but I generally have dampness — because that's just how my vagina is right now. I’d like to point out that even for someone as open as I am about all this, talking about my vaginal secretions and moistness on the internet is still uncomfortable. See, people. This is what I do for you.

The estrogen saga

When I started estrogen therapy, I began with the gel. I also got a prescription for a vaginal cream. Typically vaginal creams are prescribed for vaginal dryness — a common perimenopause symptom — but that wasn't my case. I was going to try using vaginal estrogen to help awaken, strengthen, or increase the elasticity of my pelvic floor muscles. I didn't love having yet another step in my perimenopausal care, so I abandoned that fairly quickly and got the surgery instead.

Note: Vaginal dryness is easily one of the most common symptoms of perimenopause so I'd like to write about it. But I have no personal experience. If this is you, I'd love to ask some questions. And I promise I'll write about it maintaining your anonymity.

If you recall, estrogen therapy isn't really available here in Jordan. So I leaned on a doctor I know outside the country, who was willing to write the prescription. Which meant I needed to do a fair amount of research myself on what I actually wanted, since I was essentially co-piloting my own care. I chose the gel because that's what I'd talked through with my lovely nurse at Carrot Fertility. If you happen to have this perk available to you, run to make an appointment. And if you want the name of my nurse, message me. She is a menopause angel.

Obtaining the MHT itself was its own production. Three bottles of estrogen gel, plus the vaginal cream, made their way to me through a chain of favors — a friend of a friend, my father-in-law picking up the package (glad he knows what's happening with my vagina), a handoff to my husband in Denmark, and finally into Jordan. Not exactly the most direct method of filling a prescription.

My second foray into MHT came when I got back to Jordan after a month in the UK. I had misheard my OBGYN (another menopause angel) and believed that although I couldn't get gel here, estrogen patches were available in Jordan. I was wrong. I can't get patches in Jordan, but you know where I can get them? The UK.

So, I contacted a Jordanian friend vacationing in London and had a prescription fast tracked to a pharmacy that would convert it to a UK prescription and fill it. She had it delivered to her in London and brought it into Jordan a few days later. I should mention that by the time I figured all this out, I had three days before she flew back into Amman. It was a scramble, but she returned with one box of estrogen patches — in the name of Darke Misham. (I think that should be my perimenopause alter ego.)

I started using the patches, and at first I really liked not having to put gel on every morning and wait fifteen minutes for it to dry while I walked around in my knickers (as my British nurse told me) — doing laundry, tidying up, putting on makeup, basically buying myself fifteen minutes of being half-naked before entering the world. At first, the patches felt like freedom. Then they started to feel like confinement.

My skin had to be very freshly clean but not damp when I put a patch on, or it wouldn't stick well. Even a few hours of oil or sweat on my skin meant the patch would come off in a day instead of the three-plus days it was supposed to last. Depending on where I put it — upper arms, thighs, or butt, as advised — it would rub against fabric or wrinkle, leaving air between the patch and my skin, which made me wonder how much estrogen was actually getting into my body. And then there was the indignity of already being in a body that doesn't feel a fraction as sexy as my younger one, now decorated with old Band-Aid-looking square marks on my butt that wouldn't come off unless I scrubbed with a loofah hard enough to turn my skin red and raw. I started to think maybe I didn't need to add that particular indignity onto the ones that are already inevitable.

I'll keep using the patches until I get through them, since they're the only estrogen therapy available to me at the moment. But when we arrive in the US in less than a month, I'll be picking up another gel prescription. Stay tuned on this front, because my GP (my third menopause angel) suggested I try the spray, which apparently only needs two minutes to dry and doesn't require a two-hour window before swimming, showering, or sweating profusely.

Yesterday, when I was telling my physical therapist about the different forms of estrogen, my husband said from across the room that he wondered why it was not available in pill form. I explained that it is, technically, but it isn't bioidentical and isn't the preferred method, because estrogen absorbs better and has fewer complications if it is taken transdermally. He said it's surprising no one's figured that out yet. My young female pelvic floor specialist, another menopause angel, and I just looked at each other. 

"If this were something men dealt with," I said, "it would've been figured out by now."