When I was in grade school, one of our hippie teachers told us the story of making soup out of his new baby’s placenta — a tale we third-graders found simultaneously riveting and repulsive.
Naturally, we went home and told our parents — “Did you make soup out of me, too?” — and there was muted outrage. (It was the ’70s.) Later that year, the same teacher told us in some detail about having sex with his wife, at which point the parents put down their bongs for a second and expressed some concern. Though the teacher seemed to think he was educating us about the beauty of human sexuality, he obviously got quite a talking-to, because he never broached the subject again. Nor, as I remember, did anyone else. For years — until I switched schools — I knew far more about the mating habits of salmon than those of human beings. Aside from one book I had at home, which said an orgasm was like sneezing after being tickled with a feather, I was pretty much in the dark. Even after I took a dedicated sex-ed class at my new school, I came away confused, understanding only that viewed laterally, I looked like an inverted pitcher inside.
My lack of knowledge about sex and the human body was forcefully brought home when I got my period for the first time, at age 13. “I’m dying,” I thought. “I have a vagina tumor.” These were the actual words that went through my mind. Though I’d known menstruation was in my future, no one ever said precisely what we girls needed to hear: “It’s going to be really weird. It’s going to be more blood than you’ve ever seen come from your body except for that one time you fell off the jungle gym and split your head open and needed 16 stitches. It’s going to seem scary and shocking and remind you of Carrie. But it’s okay. It’s merely the beginning of your life as a person of the female sex.”
There are other things I would have liked to learn about living with female reproductive organs and body parts — things I had to learn on the fly.
I would have been interested to know, for instance, about the existence of the clitoris, and the obligations of others in its regard.
I would have welcomed information about the care of the urinary tract beyond the admonition to drink plenty of cranberry juice.
Most of all, I would have appreciated being told the truth about the years that follow fertility: namely, that menopause is the culmination of a transition process that can take years, during which you may have symptoms that resemble illness in their severity and multiplicity and capacity to disable. Yet just as you learned, with menstruation, that blood isn’t always a signifier of illness, you may have to learn during perimenopause that symptoms that feel like illness are not what they seem. Rather, they’re just “part of the journey.”
Now that perimenopause has stalked into my life, I begin to understand why young girls aren’t taught about it in school health classes: They couldn’t handle it. “Seriously? Like, are you serious right now? After the whole period thing, and the pregnancy stuff, and what happens during childbirth, and after all that — there’s more?” They’d all jump off a cliff.
MOST AMERICAN WOMEN with functional female reproductive organs will be postmenopausal — meaning they haven’t had a period for at least 12 months — by age 52, according to C. Neill Epperson, director of the Penn Center for Women’s Behavioral Wellness. Before that happens, the body has to gradually relinquish its ability to procreate, a process that can take years.
I asked Epperson, a psychiatrist, to give me a sort of nuts-and-bolts explanation of what happens to a woman’s body during this time. “Pre-menopause, you’re having these regular menstrual cycles,” she said. “Perimenopause is when you become irregular. We have different phases of perimenopause: early transition, late transition. … People who are early in the transition will have a change of maybe around seven days one cycle out of the year — it could be seven days shorter or longer. The late perimenopause transition would be you haven’t had a period for three to 11 months.”
During perimenopause, the body’s hormonal output changes, which is what causes all the pesky symptoms — most familiarly characterized in popular culture by hot flashes and bad moods, and I guess Menopause The Musical. Colloquial language we use to describe perimenopause is imprecise; a woman will be fanning herself furiously inside a walk-in freezer, say, and will explain herself by quipping: “Don’t mind me. I’m just menopausal.” In fact, she could be at the beginning of the transition, at the end, or even postmenopausal. The word “menopause” tends to be used as shorthand for “all the crap that goes on while your ovaries gradually crinkle into useless raisins.”
A great deal of information about the menopause transition has actually been gleaned from women in Philadelphia — participants in the Penn Ovarian Aging Study, or POAS. Over 18 years, researcher Ellen Freeman and her colleagues tracked a large cohort of Caucasian and African-American women from the time they were premenopausal to the time they were postmenopausal, using their experiences to identify hormone trends; examine the transition through the lens of factors like race, BMI and age; and determine how hormonal changes affected physical and behavioral symptoms. The POAS data has served other researchers studying clinical approaches to the transition, resulting in more than 50 POAS-informed articles in medical journals.
“Sexual functioning, sleep, hot flashes, night sweats, overall sense of well-being, food, anxiety, cognition — you name it, they pretty much looked at it,” Epperson says of the research. Yet despite this wealth of information, there’s still so much we don’t know. The length of this reproductive purgatory is unpredictable, as is the à la carte menu of potential side effects. (A YouTube search for “menopause” immediately brings up a gloomy 40-second video that’s nothing more than a list of 35 symptoms, from “unexpected tears” to “dried-out vagina” — opposite sides of the coin, if you will.) The whole thing gets especially complicated if you take into account that sex doesn’t always correlate with gender. The age-related hormone experiences of transgender men, for example (assigned female at birth and living as men), differ from those of transgender women (assigned male at birth and living as women) and from cisgender women like me.
“Some people have symptoms that are very mild; some people have symptoms that are mild but last a long time; other people go through a couple years of difficulty; and then there are people who have symptoms for 11 years,” Epperson says. Then she adds: “There are a lot of women who sail through menopause, believe it or not, and I know women who hate those women.”
Count me in: I’m officially a hater.
In my case, this transition has been nothing but trouble — a startling array of symptoms that I initially attributed to cancer or MS. Still, I delayed going to the doctor about the sweating and the edema and the weight gain and the memory loss and the insomnia and the racing heartbeat and the increased migraines and the fatigue and the hot flashes until a few days after the Queen Lane Overflow.
In that unfortunate instance, I had to get off the train taking me to Mount Airy, where I live, at the Queen Lane station in Germantown due to what’s clinically known as “urinary urgency.” Doubled over in pain, I stumbled off the train on one of the summer’s hottest days to look for a bathroom, but I ran out of time. So I scurried behind the mid-rise apartment building next to the train tracks and squatted and peed among broken glass and bugs — all over my pants leg. Then I had to wait an hour for the next train.
(I’d like to take this moment to speak directly to middle-aged women struggling with issues of perimenopausal incontinence and urgency. Ladies, the Target yoga pants I was wearing on this day, probably made by bleary-eyed child laborers halfway across the world, were constructed from a miracle synthetic that, it turns out, repels urine. It bounced off the fabric like little balls of mercury. “Look at that!” I thought, as some ants beneath me drowned. “That’s remarkable. More people should know about this.”)
After Queen Lane, I knew I had to see a doctor, because it’s one thing to be cranky and uncomfortable all day and it’s quite another to pull your pants down in public. I thought I’d probably need a referral to an oncologist, but the physician’s assistant assured me my symptoms were all interrelated and resulting from the menopause transition. She was as blasé and unworried as could be, which is an attitude Epperson is familiar with: “There’s a high level of variability on how much emphasis and concern doctors place on something that they consider a normal part of a woman’s life,” she says.
I’ll tell you what: It feels anything but normal.
IF YOU LOOK at high-school curricula for health and sexual education, you’ll notice that most don’t talk a great deal about aging. I couldn’t find any that even mentioned menopause or perimenopause. I asked a millennial colleague if she’d been taught about menopause in school, and she said no. “I guess it’s just too far away to worry about,” she said in explaining this gap.
I think she’s right. The truth is, teenagers, women in their 20s, even women in their 30s are deeply uninterested in the experience of older women. It seems so irrelevant, and sad, and uncool. I remember reading articles when I was younger written by women in their 40s in which they complained about age discrimination and the changing body. These articles always made me roll my eyes. Why couldn’t they shut up about aging? Why were they complaining all the time? I wanted everyone to be like Isabelle Huppert and Catherine Deneuve, women who seemed gracefully indifferent to getting older. I pooh-poohed plastic surgery and fancy serums. “Why does everyone want to be younger?” I’d wonder. “Why can’t they just accept their age?”
It’s not age in the abstract that’s hard to accept, I now realize. It’s that when aging manifests, it robs you of the familiar self you’ve always taken for granted. Older people don’t want to look younger, per se; they simply want to recognize the person they see in the mirror. After 40-something years of being one version of Liz — with minor variations — it’s hard for me to adjust to inhabiting a different body, washing a different head of hair, putting makeup on a different face. I miss myself — not because I was younger biologically, but because I was me.
I think this is why my perimenopause symptoms have me so disconcerted and distressed. It’s not just that the side effects are lousy. It’s that the whole transition is an unmistakable harbinger of the retreating self. Worse than that, every errant drop of urine or soaked-through t-shirt sends a dreary reminder: The end is nearer than before, and it’s all downhill from here. No surprise they don’t convey that message in school.
Sometimes I comfort myself by looking past this transition period and into my postmenopausal future. I picture myself as I often found my grandmother in her studio apartment at the William Penn House on Chestnut Street: lying on her couch in a comfy shapeless nightgown, watching Jeopardy, happily munching on her favorite candies. She was wonderfully free of all the sex-and-romance worry of a woman’s youth — no waiting by the phone for him to call; no pregnancy scares; no negotiated settlements over whose family to visit on which holiday. As she ate handfuls of spearmint leaves and Bit-O-Honeys, she no longer fretted about getting a bikini body in time for summer, or fitting into the perfect skinny jeans. She even stopped styling her hair, preferring a functional gray bowl cut because … why not? The rigmarole of traditional womanhood was done, and from my vantage point, it looked like a relief.
Besides, these days, old age isn’t as old as it used to be. When I look at pop culture, I notice ever more diverse representations of people in their 60s, 70s and 80s, from Grace and Frankie to Transparent to Joan Didion modeling for Céline. There’s a 70-something weight lifter who keeps appearing on my Facebook newsfeed; she’s far more buff than I’ll ever be.
Thing is, Dr. Epperson told me some women continue to have hot flashes even when postmenopausal, which just seems unfair. I mean, here you are, trudging through the muck of your reproductive change in order to come out on the other side, and you learn there is no other side? There’s just more muck? It’s enough to make me long for the ignorance of my grade-school days, when I’d never even heard of menopause. I was kind of stupid then, but at least if I peed myself, it was in my own bed.
Published as “Girlhood, Interrupted” in the November 2016 issue of Philadelphia magazine.