Midlife part 2

7 things I wish I would have known

For a better reader experience, go directly to the Feel Good Studio substack website thesoberglow.substack.com, or open up the browser from the button on the top right of this email, or download the app. The first part of this email is open to all subscribers, and the remaining is behind a paywall. If you would like full access to this content and more, please consider upgrading your subscription ($9 month). As always, thank you for being here. XX Mia

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Well, Midlife part 1 definitely hit a nerve. And not a touchy, stay out of my business kind of nerve, but more of a me too, thank god I’m not going crazy all by myself over here, let’s discuss more kind of nerve.

Over on IG, a kind younger woman wrote that she was going to be sending all of this information to her mother. I sent her much appreciation back as well as gently reminded her that this information is exactly ALL the stuff I wish I had known when I was in my 20s and 30s. So Midlife part 2 will be a neatly categorized list of the important things I wish someone would have told me before I was thrown into this dark-ass mystery that would have me thinking I was not only going crazy but that I was possibly dying from some undiagnosed disease.

And I’m not being hyperbolic.

I feel as if each one of the points below could be a lengthy newsletter just on its own, and most likely, they will be. But for the sake of getting you started with your own exploration and taking the conversation into your own circles, I want to keep the overview of the information as simple and accessible as possible.

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WHY THE F DIDN’T ANYONE TELL ME…..

(1) THE WIDE RANGE OF AGES & SYMPTOMS

It can happen at any age, and every woman will have her own unique journey with symptoms ranging from mild inconveniences to full-blown are you f*cking kidding me with this sh*t symptoms. And the symptoms are not what we were often led to believe from popular TV sitcoms.

Tell me that as you were growing up, your knowledge of menopause was like mine, and you believed it was something that only happened to (gasp) old women in their fifties. And, like me, probably had no idea that perimenopause was actually something that could start in your 30s with a whole bucket full of craziness just waiting for you.

Or was that just me? I doubt it.

I didn’t have anyone in my life talking about this. Of course, as I was a bit older, there was the occasional co-worker who would sit at her desk with a fan, talking about her annoying hot flashes. And I certainly will never forget the 1-2 years when my sweet mother would consistently call me up, and before I had my ear to the receiver, I could hear her yelling at me for no apparent reason. My husband and I would eventually start to understand and laugh off this behavior as her going through the change, only because his mother started doing the same. It wasn’t till several years later that my mom would even admit to this behavior as having been going through “it.”

So in my life, “menopause” (mind you, not perimenopause, because at the time and with the little knowledge I had, it was all one thing) looked like older women with hot flashes, screaming at their kids. And that was it.

I know I am not the only one who was left out of this important conversation regarding pertinent information on my body. In fact, my question here is, was there ever a conversation? I certainly didn’t have any older, wiser women in my world sharing all these symptoms. Sadly, there was never any mention of one of the most important happenings in a woman's life at the dinner table, where most big topics are discussed. The topic of…

Drugs, sex, and rock ‘n’ roll, Yes.

But (peri) menopause? F*ck no.

Just recently, I was discussing some of my symptoms with my girlfriends, all of the similar age, all stating they were not having any perimenopause symptoms, but they were all very empathetic to me and mine. (dramatic pause here). And in the same breath, they then stated they were only waking up in the middle of the night, having longer or shorter periods and night sweats the week before their period.

This is just more (anecdotal) evidence that we women truly do not have a complete grasp on what hormone imbalance looks or feels like.

It’s not the door opening to death. It doesn’t mean life is over. It certainly doesn’t mean you should be ashamed of yourself for having lived this long. If you want to give this stage of life a rebrand (which it desperately needs), simply call it what it is, hormone imbalance.

Say it with me, (peri) menopause is simply -

A HORMONE IMBALANCE.

IMAGE SOURCE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987489/

(2) THE STATISTICS

I am not alone in this. 100% of women, if they live long enough, will enter menopause and will most likely have mild to severe symptoms. But, of course, there are outliers.

It’s not that I didn’t know menopause was going to happen…it was more like I didn’t fully grasp the level of severity that was possible in the perimenopause phase that so many women deal with….in absolute silence.

“The 2010 U.S. census estimates a population of 50 million menopausal women by 2020, an average age of menopause at 51, and a life expectancy for American women of 85. Consequently, Shen notes, an enormous group of women will live one-third of their lives after menopause.” - Johns Hopkins Medicine

(3) THE SUBTLE SHIFTS

Again, back to perimenopause and ALL the subtle symptoms that can happen. I wish I knew that my body wasn’t actually falling apart. That all these completely random and weird and abnormal happenings inside me were pretty much all related to hormone imbalance. Now granted, we can’t blame everything on hormones, and we should investigate these symptoms. But for me personally, I would have been able to save a lot of time and worry had I known exactly what perimenopause symptoms can present like. And that they can be extremely subtle and sneaky, and you can be going about your business until one day, you wake up and start saying things like, “it’s like I aged overnight,” “how did I get so soft,” “why am I so anxious all of a sudden,” “why is my sweet husband so freaking irritating” “what happened to my neck,” or “I must have rheumatoid arthritis with all this bone pain,” and my all-time lowest moment, “I’m not pregnant, apparently I’m menopausal.”

(4) DON’T EXPECT YOUR PHYSICIAN TO HAVE ALL THE ANSWERS

If you are confused, there is good reason. Everyone in healthcare and beyond is seemingly confused.

IMAGE SOURCE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987489/

As per Dr. Kyrin Dunston on the Everyday Wellness podcast with NP Cynthia Thurlow (get used to this name because I am loving her and her work). Dr. Dunston states - The American College of Obstetricians and Gynecologists (ACOG) – only recognizes two symptoms of menopause – hot flashes and vaginal atrophy.

However, when I looked into this statement, I found this organization did, in fact, have other symptoms mentioned, however, nowhere near the realistic amount that is common.

This narrative was also pushed again with the super bowl commercial (see last post) by focusing on just two symptoms, hot flashes, and night sweats. Granted, the commercial was for a new drug that is supposed to help with these two symptoms….but what about all the other symptoms? To the unsuspecting female (like myself at one time), I would have noted these two symptoms to be the only issues women deal with in menopause.

Along with Dr. Kyrin Dunstons statement on what ACOG recognizes, she also mentions this: They (ACOG) only support estrogen replacement for the shortest time with the lowest dose possible.

I will cover this in more depth when I write about HRT options and how and why to use them. However, now seems like a good time to introduce Dr. Barbara Taylor to this community. Dr. Tayor is otherwise known to her one hundred thousand+ youtube followers as Menopause Taylor or Menopause Barbie. When I first came across her youtube channel, I questioned her qualifications only because her delivery is a bit….odd :) I laugh now at how I first reacted to the videos until I took the time to watch and listen to the valuable information she is actually providing. It’s pure gold. But again, she can be a bit silly in how she delivers the information, so I like to call that out beforehand. Especially if you are a very serious woman who happens to be reading this :)

For the record, I can be incredibly serious, but it’s not often, and pretty much everything I say or do is drenched in sassy, well-intentioned humor. I just have an amazing poker face that leaves most non-empaths very curious. Insert sly smile. I digress, moving on.

Below Dr. Taylor speaks to how and why we need a certain dose if we are going to use HRT (specifically estrogen) for it to help prevent “menopause diseases.” And this directly contradicts what Dr. Kyrin Dunston states about the ACOG guidelines -“lowest and shortest.”

(If you want a shorter version, skip ahead to the 12:00 minute mark)

(5) HOW TO BE MY OWN BEST HEALTH ADVOCATE

I talked about this in a prior email, but it’s worth mentioning it all again. FIRE YOUR DOCTOR if they will not listen to you, show interest in your questions, talk over you, dismiss your wants/needs, or diminish your symptoms. And I say this as a registered nurse - you hire your healthcare team, and you can fire them as well. They are working for you, not the other way around.

In the last two years, I have fired three physicians who would not work WITH me.

My first fire: PCP - I started asking my PCP about perimenopause symptoms and if hormone replacement therapy was an option. During my appointment and giving her specific reasons why I wanted specific things - she gave me this statement:

“I’ll write you a prescription for Premarin, it’s what I give all my female patients”

• First, I am not “all female patients,” nor do I believe in a one size fits all mindset. So please, please stand up to this type of prescription writing.

• This is exactly what I said I was afraid of. Premarin is a CEE-conjugated equine estrogen. We will cover this CEE in depth!

• It took three emails and two office phone calls over the course of two weeks for my PCP to follow up with me after I refused to take the Premarin prescription she ordered for me, even though I said absolutely not while in her office.

• Her reason for taking her time getting back to me, even though she ordered the Premarin before we could even finish our convo, was this:

Of course, I want her to take her time and make sure that what she is ordering me (or anyone) is the best and safest option. However, if this was true, no MD worth their salt would order Premarin in a quick and hastily manner which she did. And this statement of hers was clearly backtracking from my repeated concerns that I do not consider Premarin safe.

I will circle back to why I fired the next two MDs when I cover HRT. But my main point here is to empower you to be your best advocate. No one can look out for you more than you can. MDs are not the enemy, but they are incredibly busy and, unfortunately, don’t have a lot of time to give to their patients other than the absolute basics. And it’s not because they don’t want to, but insurance just doesn’t pay for the time that is truly needed. So help them out by going into your appointments prepared. I find it helpful to have a physical piece of paper with me just so they see that I have questions that they need to answer.

“The Johns Hopkins-led study, described in today’s online version of the journal Menopause, discovered that some American ob/gyn residency programs fail to offer trainees any formal curriculum or clinical experience focused primarily on women’s pre- and post-menopausal health.” - Johns Hopkins Medicine

and

“Additional results of this study showed that approximately 70 percent of residents stressed that they wanted to obtain more knowledge and expertise in menopause physiology, hormone and non-hormone therapy, menopause-related bone health, cardiovascular disease and metabolic symptoms. Shen said it was particularly striking that 40 to 60 percent of fourth-year residents who responded to the survey — those soon to complete their postdoctoral training — reported the need to improve knowledge.” - Johns Hopkins Medicine

(6) HORMONES ARE INVOLVED IN EVERYTHING

I wish I could tell you that nursing school covered weeks and weeks of education on hormones (menopause medicine specifically), what they do, how they work, how they work together, and how if one is out of whack (medical term :), all of the hormones will be affected. But honestly, I don’t remember covering much at all. Seemingly the same goes for medical school as per the Johns Hopkins study I have mentioned several times.

It’s funny that there is this basic assumption that nurses and doctors must know everything about everything. We don’t! So question everything. And if someone is polarizing with advice, find someone else.

The more I learn, the more likely I will not speak in absolutes.

I knew the basics and what I needed to know at the time. But it’s only been in the last two years that I have truly had an education on hormones and the endocrine system. And I am still learning and cutting through the weeds of information on a daily basis.

If I were going to recommend a book to my younger self (though the benefits are ageless), it would have to be Woman Code by Alisa Vitti.

IMAGE SOURCE WOMAN CODE page ix

(7) THE REASON WHY MOST ARE FEARFUL OF HRT

Wow. I had no idea. I had absolutely no idea when I started doing my own research on HRT, the amount of damage that the infamous WHI study did to the progression of women’s health.

This will be an entire topic on its own in the coming weeks. Posted below is a short clip of the Huberman Podcast with Peter Attia, MD, so you can familiarize yourself a bit with the outcome of this study if you so desire.

“It’s hands-down the biggest screwup of the entire medical field in the last twenty-five years” - Peter Attia, MD

“I’m pretty confident that I won’t be able to think of a bigger act of incompetence than what happened with the Womens Health Initiative in the late 1990s and early 2000s, which is effectively the study that turned the entire medical field off hormone replacement therapy for women” - Peter Attia, MD

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As someone who is just getting started with truly understanding how the endocrine system works as well as how her own body is working and adapting to this new stage in life, I am positive there will be so much more that could be listed here under things I wish I knew. Until then, and always, I hope you found value here, as well as in the resources and sources provided.

XX, Mia

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SOURCES:

https://www.ncbi.nlm.nih.gov/books/NBK558960/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987489/

https://www.hopkinsmedicine.org/news/media/releases/what_do_obgyns_in_training_learn_about_menopause_not_nearly_enough_new_study_suggests