NOTABLE: Herding Octopi
AKA, making sense of HRT advice
The first time I ever saw an octopus was off a pier in Key West sometime back in the 1970s. What I remember most is how terrified I was that I’d pulled this incredible creature from the sea.* In an instant, a crowd formed, and off rolled the boneless beast, end over end, equal parts snake and sprite.
Putting a book into the world is like that, and my plan was to write about the romanticized notion that creativity thrives under pressure. As if the weight of the world produces the diamonds. (In short, it doesn't.)
Instead, I'm moved to write about my ongoing, of-the-moment schlepp through the muck that is menopause therapy. Which is, come to think of it, also like trying to herd octopi.
I'm not a doctor, and this isn't medical advice. This is merely how I've groped my way in the dark, talking about my experiences with others and attempting to piece together a treatment plan where this weird gap in healthcare exists. Some say you can only be on HRT for a few years, just yesterday my doctor said I could be on it “forever.”
Let’s go there.
In case you haven't been following my life's moon phases... At 38, I was hard into perimenopause, I know because by 40, I'd gone a full year without a cycle, which I know because the last time I had my period was the first time in seven years that I’d had sex with someone I wasn’t married to.
At the time, people wanted to talk about the change about as much as they wanted to discuss salaries. What was inescapable, however, were the studies showing HRT causes cancer, so don't-do-it, end-of-story, and can we please change the subject already?
Lo these many years later, we're all talking about THE MENOPAUSE (It’s gone from “the change of life” to “the menopause.” I don’t love either one. How about Advance Womanhood?)
Regardless of what you call it, thank all the gods we’re talking. First, because of this newfound visibility, I heard that HRT was helpful with loads of symptoms. (Yes, it was a Kiwi friend who told me about it, thanks, Carrie!) Maybe HRT was not the evil treatment I believed. But could that be true even years after the onset of Advanced Womanhood?
Despite the prevailing wisdom that claims symptoms go away after four years (?), my insomnia, vaginal dryness, and occasional hot flashes persisted. But when I finally screwed up the courage to ask a doc about HRT, she — no lie — Googled for answers to my questions. I know because, though at first she'd leave the office, eventually she gave up and just pulled her phone out in front of me.
I left without starting a regimen. Menopause was at least as old as periods. Far from being a sign something was wrong, it showed you’d survived Early Womanhood. Natural aging and all that.
Then I broke my leg while standing still, thus I discovered that the osteopenia I’d recently been diagnosed with was a bigger problem than I’d let myself believe. That too had been dismissed as more natural aging, as in, we all lose bone density after 50 etc. But ya know, death is natural too.
Frankly, it's not clear which symptoms go away. Or if by “go away,” they mean it like when unemployment goes down because, after a year of being unemployed you no longer count. Even if the recovering Catholic in me still considers feeling better on a daily basis something too trivial to address, broken bones were another matter. And HRT could supposedly help. Though I wanted bioidenticals.
There’s much guff about BHRT in the U.S. because they aren’t FDA-approved. But I’m a sucker for the bioidentical selling point — that they’re chemically identical to hormones your body produces. Sure, those hormones can cause cancer in your body, so that doesn’t make these treatments exactly safe, but then, neither is living.
Another big slam on bioidenticals is that they’re made in — insert gasp here! — compounding pharmacies not regulated by the FDA. That they ARE regulated by state boards gets little mention.
I made my decision in part because the lack of FDA approval felt more like another area where women’s health — and in particular that of post-menopausal women — isn’t prioritized. Plus I was still skeeved by those old studies.
Then I discovered — #notalldoctors.
It took some doing, but finally I found a guy who was more than happy to get me started on bioidentical pellets. I had more energy and less vaginal dryness, but when I started having nightly hot flashes and asked about trying a cream instead (which is easier to adjust), he refused. Sounding like a shill, Dr. Pellets went on a rant about how dangerous creams were because they were compounded. Uh, so were the pellets.
His solution for my hot flashes was to increase my estrogen dose. Okay, I guess? But then that left me feeling like I was about to get my period nonstop for a month. When I asked again about creams he blew a gasket. Finally, I undertook the dread search and found a new doctor.
She recommended I try a lozenge or troche, which I thought it sounded perfect. Another friend of mine had had a poor experience with creams, why not try this other delivery mechanism?
I’m two weeks into that and back with another doctor. The one who told me I could be on HRT “forever.” Why? The lozenges are ghastly. You stick a square gel under your tongue (and no one mentioned this but you must move it to different areas of the mouth because absorption will suffer, and this is why we’re all out here doing internet research, because we don’t get adequate info)… That square gel dissolves slowly, filling your mouth with gelatinous, foul saliva that I then worried about swallowing because one benefit of this treatment was supposedly to bypass the liver. (WRONG AGAIN! Further internet searching showed you swallow it anyway, and digestive acids prevent proper absorption so there’s a whole other issue.)
What sent me over the edge to another doc though was the breakthrough bleeding. Well, that and the fact that this doctor’s answering message first addresses callers looking to refill their supplement prescriptions. Talk about shilling. No, thanks.
Underneath all this, the conversation escalates. About a month back, I read that HRT could help prevent dementia. Then a few weeks ago, I read that delaying the start of HRT could bring on dementia, particularly for women who experienced premature menopause. Glad as I am to see my experience reflected in a study, supposedly only about one percent of women go through premature menopause. (And apparently all of them are my friends.) Which left me to question that this came to light in a study at all.
Then yesterday, the New York Times reported the new study "is a source of uncertainty and fear but doesn’t provide much helpful information."
And near as I can tell, none of this is specific to BHRT.
I’ll let you know how it goes with the creams. Have you tried them? Anything? Thoughts?
PREORDER BLISSFUL THINKING!
All preorders are eligible to join my creativity masterclass on Sept. 24, which I originally named Unf*ck Your Magic but changed because algos. (Tried to hint at it with the *). Click the image for preorder choices and to register for the workshop.
SALE!
I met Jaye Viner, author of standalone romantic suspense, through various writing groups and was thrilled when she offered her latest in a series at a discount.
*I might not have been the one to lure that octopus. Memory is a trickster.
See you soon!
PS: Think this could fool some people into thinking they’re ordering Britney Spears’ new memoir?
Oh my goodness what a pain! I am so thankful I did not experience much in the way of menopausal symptoms. I was well into my 50s, and the only thing I can recall is the usual hot flashes. But being cold natured, sometimes they were welcome!
I hate that you are going through this, but as my mother-in-law used to say, we have to be our own advocates now. You are helping so many by sharing your experiences. Keep up the good work.
Herding octopi is the new metaphor to beat. Thanks for another great (and enlightening--thank you for discussing the undiscussable) issue.