Perimenopause Is Not My Friend: The Black Magic Episode

Black Magic: Starting Menopause Hormone Therapy

First, a note on language. You've probably heard the term HRT — hormone replacement therapy. It's actually a misnomer. We're not replacing hormones. We're managing them, in the context of menopause. So the term I prefer is MHT: Menopause Hormone Therapy. 

Second, a note on my credentials. I'm not a medical doctor (whaaa???), and I want to be clear about that upfront. Everything I'm sharing here is how I understand this in lay woman's terms. It's what I've read, heard, and lived (as evidenced my episodes one, two, three, four, and five). It's not medical advice.

During my infamous IUD extraction a few weeks ago, I had a copper IUD removed and a Mirena IUD put in. That’s an IUD with progesterone. This is key. Estrogen is a growth hormone. If you take a growth hormone without something to counter it, it can get out of control and create growth everywhere — including in places you don’t want, like cancer. The progesterone is there to balance it. So inserting a Mirena IUD takes care of the progesterone and, bonus, makes my murder scene periods stop for good.

How do you actually take estrogen?

There are a few options — pills, patches, creams, gels. From everything I've read and heard, the pill form doesn't absorb well. You need to take estrogen transdermally — through the skin. I opted for a gel. Each morning, I apply one pump of gel on each of my upper arms, from elbow and shoulder. You can also apply it to the inner thigh. The key is that it needs to land on an area with enough muscle and fat to absorb it, and away from hormonal zones like your pelvic region or chest.

I started on one pump. It wasn't quite doing it. I moved to two — and now I can feel the difference. Less brain fog. More focus. Less depression and anxiety. Contained rage instead of the unbridled variety. More like myself. As my friend, Maysoun, put it: you stop feeling like an alien in your own body. Yes. That.

My British menopausal nurse told me: put the gel on, then “walk around in your knickers for about 20 minutes while it dries.” And that's exactly what I do. Every morning, around the same time. My phone alarm goes off, I pump the gel, I wander around my bedroom like a person with a treatment plan that works, and it dries.

The full picture

MHT isn't a silver bullet. Alongside the gel, I'm also downing liquid iron first thing in the morning (can’t combine it with caffeine if you want it to take!), popping zinc, vitamin D, and B complex during the day (with food or without according to when it absorbs best), and magnesium glycerate powder in a glass of water at night to help me sleep. I've been taking black cohosh and maca root, though now that I'm on the hormones, I’m phasing those out. It's a patchwork. And everyone's patchwork looks a little different.

A thought experiment:

Imagine a man wakes up one day and his body starts changing in ways no one warned him about. His sleep disintegrates. His brain goes foggy making it hard for him to work. His mood swings wildly in all directions, always ending in rage. His joints ache and muscle spasm daily. He’s unable to regulate his body temperature so in the middle of a business meeting, he finds himself frantically peeling off his suit jacket, loosening his tie, and rolling up his sleeves while patting the sweat on his brow and throwing open the nearest window. He feels, on his best days, like a stranger to himself. On his worst, like he might just jump out the window he just opened.

Now imagine that this happens to roughly half the men on the planet — not all women experience debilitating menopausal symptoms, and I simultaneously love and hate them for that. These affected men end up leaving their careers because it’s too hard to continue in the midst of the foggy brain, homicidal rage, and unwarranted stripteases in front of colleagues. The ones that don’t leave, cut back on hours or just count the days to retirement feeling like a skeleton of themselves.

And while all this is going on internally, their colleagues, acquaintances, doctors, and members of the opposite sex brush it off as just “man troubles” to be ignored, overlooked, and belittled.

Would we shrug and say that's just life? Would we leave them to comb through research on their own, experiment with supplements, piece together protocols from sidebar conversations and online forums? Would we accept that they'd have to figure it out themselves because medicine never quite got around to solving it?

No. We would not.

And yet, for women, we just... accept it.

Witches

So here we are. Doing the research. Making the decisions. Walking around in our knickers waiting for the gel to dry.

As my friend April said when I explained all of this to her: "So it's black magic."

It is. Some of it is real science — good, solid science that has simply been underfunded and under-studied for decades. And some of it is us piecing together what we can find, from whoever has actually paid attention. Just so we can live a normal life.

Black magic.