Menopause Now

Menopause Now

This ain't your mama's menopause. Today, women are weathering the transition with hormones, bioidenticals, exercise, diet, humor, wine ... you name it. We're talking about menopause more than our foremothers did, too. Case in point: This package, which includes the most hilarious essay ever on why menopause doesn't suck, by Odd Mom Out's Jill Kargman; a detailed breakdown on what happens to your body during menopause and what you can do about it; 51 women's menopause journeys, and celebrity takes on post-PMS life. You'll laugh, you'll cry — who knows, you may even flash. It's okay, you're in good company.

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Why Menopause Doesn't Suck

Writer, actor, genius Jill Kargman shares why dreading the inevitable is a big fat waste of time.

By Jill Kargman

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I’ve been warned about menopause: I’m going to wake up in a Jill-shaped sweat stain, I won’t be able to sleep and I’ll have a dried-up box with sand falling out like it’s the Sahara. My cooter, already a wizard’s sleeve after three vaginal births, will have a Ghostbusters sign on it, and dust bunnies will form in my ute as I become as irritable as I was during my pregnancies. But there will be no birth presents, just gray pubes sprouting.

But I refuse to flip out about menopause like it’s some old-lady Grim Reaper coming with her scythe to rip away my fertility and leave me barren and crusty. By the way, bitch: Go for it. For the last 11 years, I had that copper IUD that gave me periods that left my bedsheet looking like the flag of Japan. Good fucking riddance to that monthly tsunami.

However, while it’s easy to bid adieu to the Crimson Tide, most of us aren’t psyched about getting wrinkles or having less energy. But if we dread the inevitable, we will inevitably be depressed. So, my method at 45 is to embrace whatever Mother Nature throws my way — while giving myself a little leeway to adjust if things get completely out of hand. It’s better than the alternative! Not to be cheesy, but if you frame shit with gratitude, it’s easier not to sweat the small stuff like losing hair on your head while having it reappear on your mons veneris after spending thousands of dollars to laser it off.

I had my first hot flash at my son’s super-preppy all-boys school class cocktail party in a lavish townhouse. I was conversing with the headmaster, who already saw me as some tattooed weirdo in black leather, when I felt dizzy, started to perspire and slipped out into the snowy night. The next one came, of all places, at the Met Gala, moments before Madonna was performing; my pits were legit Niagara and my husband, Harry, fashioned a fan out of a stack of napkins as I went to find a seat. It was scary and disorienting, but I popped back up when I saw Madge, because, hey, she’s sexy at 60 and didn’t let menopause stop her!

I also had a common perimenopausal affliction known as “frozen shoulder,” which was NO picnic. And while I whined about cortisone shots and physical therapy, I stopped when I remembered that there were other women going through round four of chemo. Who cares about a little pain? People can always have it worse, and only more so as we age.

I won’t surrender to the notion that menopause sucks, because I’ve found women I admire who have gone through it and still look fabulous, project strength and have something badass to express. In season two of Fleabag, I felt so liberated by Kristin Scott Thomas’s bar stool chatter about menopause being freeing; she’s someone I’ve always thought was regal and gorgeous, and now more than ever in her solidity and confidence. They can take away our vaginal moisture, but they can’t take our cheekbones!

Plus, there are so many ways to offset the cruel march of time now. There’s fitness and eating right and acupuncture and a new stretch place that pulls you into a human pretzel. There are even shots for your clit that can quintuple your orgasms! It’s true. I tried them!

Raise your hand if your desire to bone has decreased with perimenopause or menopause. Exactly. Same. Yet after I put out, I’m always glad I did because I feel connected to my husband with whom I have a great relationship. A parallel point: Last year I had a double mastectomy after my mammo revealed two precancerous lumps. Three weeks later, I found I had a breast cancer gene. Getting my cans removed didn’t bother me; they were never part of my identity to begin with. However, one bummer was that my nips were kinda like two more unresponsive clits, but up top — when they scooped out the boobage, they excised the mysterious arousal nerves behind them. 

But even the sexual side effects of menopause won’t deter me. My solution? The O-Shot, which is offered at VSPOT Medi Spa, a medical spa for your down yonders in New York City. The O-Shot uses PRP (platelet-rich plasma) derived from your blood via centrifuge. Allegedly, the dude who invented this in the 1960s later got erectile dysfunction in his advanced age. His nurse, who was his wife, injected some of his PRP into his dick, and it was rock hard ever after. Which made her want some, so he injected it in to her clit. I know what you’re thinking: no fucking thanks. And it did hurt (though I was numbed topically and via nitrous oxide). But by the time I got home, I wanted to slide down the banister and for the first time I was the one who initiated sex, not counting after Peaky Blinders, which you all must binge immediately as it makes you legit want to wring out your Hanky Pankies.

But I digress. Menopause is also a great way to connect with friends! Fuck this whispered shit in the shadows. We need to shout about our symptoms so we can laugh about them! If you’re alone in this just posting rosé on a filtered flamingo float on the ’gram pretending everything is easy-breezy, it will suck. But if you take the dread and own it, it’s weirdly empowering. Por ejemplo, to reappropriate my changing corpus, I got new tattoos to decorate my body and I’m obsessed. I also started collecting harnesses (which I wear over a J.Crew shirt). They are like armor for this shit show world, and I feel protected and strong in them. If you evolve your style and weed the friendship garden down to the real ones who will share this stuff, then the menopausal years are actually a great opportunity to  become the balsamic reduction of yourself. Go to Modena; that shit’s in barrels for decades, and with the age comes the flavor.

Dive into menopause! More time on earth means more experience and more you-ness. Think of all the billions of women before us who were pushing daisies by our age! We are here, we are badass—and we have O-Shots.

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What happens during menopause?

By Courtney Rubin

Almost every girl gets The Talk in elementary school — you know, the one where they explain what happens when you get your period. But there is no corresponding talk about what happens when your period stops. “What I find remarkable is that women are completely unprepared,” says Stephanie S. Faubion, MD, the director of the Mayo Clinic Center for Women’s Health. Consider this that Talk.

But first, keep in mind that researchers can’t always tease out what is aging-related versus what is directly because of menopause. What they do know is that if a woman loses estrogen early — like if she has her ovaries removed in her 30s — it triggers a lot of chronic diseases of aging. “That tells us a lot about how menopause impacts the aging process,” Faubion says.

Estrogen receptors are everywhere in the body, from the skin to the brain to the bones to the colon to the eyes. Not surprisingly, when there’s no more estrogen — because the ovaries have stopped making it — the absence of it affects the entire body

Here’s a tip-to-toe breakdown of, well, the way your body breaks down during menopause:

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Increased bad cholesterol

Estrogen changes proteins made in the liver, which affects cholesterol. This means that during menopause, the cholesterol profile changes to one that is richer in the bad kind: LDL, or low-density lipoprotein. “It becomes a much more neutral rather than protective ratio,” says James H. Liu, MD, chair of the Department of Reproductive Biology at Case Western Reserve University School of Medicine and president of the North American Menopause Society. This accelerates risk for cardiovascular diseases — women’s risk for heart attacks catches up with men’s, who, of course, don’t have estrogen. (It’s worth keeping in mind that lifestyle also plays a huge role here. “If you don’t smoke, if you control your stress level, if you keep your weight where it should be, if you exercise, you are going to be far less likely to develop heart disease,” Faubion says.)

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Memory Loss

Decreased estrogen contributes to short-term memory loss — though it’s possible this is caused indirectly through sleep disturbances.

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Loss of skin elasticity

In the case of skin, it’s much harder to separate what’s menopause from what’s just aging. Wrinkles and skin thinning are a function of age, but lack of estrogen exaggerates this. (This is why men often age better — they never had estrogen to begin with.)

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Joint Pain

A decrease of lubrication in the joints is another aging phenomenon exaggerated by lack of estrogen. It has not been well studied, but doctors know it because they see stiffness in hands almost immediately in young women who have estrogen eliminated during treatment for diseases such as endometriosis and breast cancer.

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Sleep Problems

Estrogen also seems to promote REM sleep; breastfeeding women have very low levels of estrogen, which researchers think may be so they can easily wake up if their babies are crying. Similarly, menopausal women may experience disturbed sleep, waking up and being unable to fall back asleep. (NOTE: It’s thought that a class of neuropeptides may modulate estrogen’s effect on the brain, and this is a huge area of interest among sleep researchers.)

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Belly Fat

Some weight gain in middle age is purely from the inexorable march of time. After age 50, women lose almost one percent of muscle mass a year, which lowers metabolism and means that even if you’re as active as you were before (and eat exactly as you did before), you’re burning fewer calories, so you can put on weight. “It’s like someone changed the rules of your body and forgot to tell you,” Faubion says.

But the way women gain weight — around the middle — is specifically because of the absence of estrogen. Estrogen is a very mild but significant insulin sensitizer. When you no longer have it, you’re relatively more insulin resistant than before — meaning that you need more insulin to break down sugar and turn it into energy. But excess insulin can be stored in fat cells, disrupting metabolic pathways and leading to an increase in so-called visceral fat, aka the kind around the middle. And it is a vicious cycle: The more visceral adipose tissue you have, the more insulin resistant you become.

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Hot flashes

For these, you can thank your mediobasal hypothalamus, which sits at the base of the brain and governs body temperature — and becomes unstable in the absence of estrogen.

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Relief from Menopause

By Courtney Rubin

Three words: “See your doctor,” says Margaret Nachtigall, MD, a clinical associate professor in NYU Langone Health’s Department of Obstetrics and Gynecology. “Don’t assume it’s menopause until you know that’s what it is.” If you’re, say, 48 and experiencing irregular bleeding or period cessation, it could be a hormonal imbalance, a polyp or any number of health problems that might require treatment.

1. Hormone therapy

In 2002, when the Women’s Health Initiative seemed to show that women who underwent hormone therapy had an increased risk of breast cancer, heart disease, strokes and blood clots, hormone therapy went from being “the best thing since sliced bread to ‘hormone therapy is going to kill you,’ and that’s when everyone bailed,” says Stephanie S. Faubion, MD, the director of the Mayo Clinic Center for Women’s Health. But hormone therapy — it’s not called hormone replacement therapy anymore, unless it’s for a woman in her 20s or 30s — can be a safe and healthy treatment, she says.

“I think women are incredibly under treated with hormone therapy,” Faubion says. Part of this, she says, is because today’s providers aren’t educated about menopause anymore, and residents don’t feel prepared to manage hormone therapy, according to a 2019 study she co-authored in Mayo Clinic Proceedings.

Estrogen is fantastic for maintaining bone strength and bone health. It may decrease cataracts (remember, there are estrogen receptors in the eyes), and it certainly decreases hot flashes, improves moods and may help memory, Nachtigall says. (Estrogen affects short-term memory; many studies show that women who take estrogen have better cognitive functioning.) It also improves the elasticity of skin: A French study found that skin cells survived better when surrounded by estrogen, and that women taking the hormone had fewer wrinkles.

And it can help women avoid fat redistribution.  “Estrogen is not a weight-loss drug. You can’t take a pill and watch your waistline go down,” Faubion says. But women on estrogen from the time they enter menopause retain the shape they had (assuming their diet does not change drastically). However, the timing of hormone therapy is critical, researchers learned from crunching the WHI data. If women begin the estrogen within five or six years of their period stopping, there’s a decrease in heart disease. But if they wait more than nine years, there’s an 11 percent increase. Wait more than 20 and there’s about a 20 percent increase.

So, one of the big questions when considering hormone therapy is: When was my last period? “There’s a window of opportunity — early is good, and late is bad,” Faubion says. If your last period was more than five years ago, “I’m going to be wondering if it’s the right thing,” Nachtigall adds.

Who should not take estrogen? Women with estrogen-receptor-positive tumors (for example, certain types of breast cancer) or those who have been treated for them, as well as women with liver disease, because estrogen is processed in the liver. (If a woman with liver disease really needs estrogen, a patch is a better approach than an oral agent, because of the way it’s absorbed bypasses the liver.) Anyone with a genetic predisposition to blood clotting — or who has had a pulmonary embolism or deep vein thrombosis — is also not a good candidate for estrogen, which is procoagulant. Ditto smokers, because smoking itself increases blood clotting. For these groups of people, as well as those who prefer to go the non-hormonal route, bioidentical drug therapy is available, though a Harvard Women's Health Watch study debunked the idea that bioidenticals are any safer.

2. The "anti-estrogen" solution

So, back for a moment to that Women’s Health Initiative data, in which more than 25,000 women were given either estrogen or estrogen plus progesterone. When researchers broke down the findings by age, they found their initial conclusions had been wrong. Taking estrogen alone actually decreased the incidence of breast cancer by 23 percent, while taking estrogen plus progesterone slightly increased it. So why not just abandon the progesterone? Women with a uterus, meaning those who have not had a hysterectomy, need small amounts of it. They can’t take estrogen alone because it makes the lining of the uterus hyperplastic, which may lead to endometrial cancer. A more recent solution is an anti-estrogen. It’s sold as Duavee and is “an attractive option for being able to take estrogen without the need for progesterone,” Nachtigall says. (The Food and Drug Administration approved Duavee in 2013. Technically it’s called a conjugated estrogens/bazedoxifene;bazedoxifene is an estrogen receptor modulator.)

3. Topical Estrogen

Estrogen administered vaginally is a separate category and can be safely used by just about everyone (except women with certain types of breast cancer), regardless of how long it’s been since the onset of menopause. It reduces vaginal dryness and lowers the pH of the vagina, bringing it back to premenopausal levels, which improves the bacteria living there and helps prevent infections.

4. Diet and exercise

Because estrogen is an insulin sensitizer, the ideal diet in menopause is as low-glycemic as possible: low in carbs, high in protein, with three meals and two snacks to keep an even glucose level throughout the day. (This means limiting pasta, rice, bread and alcohol.)

Exercise is key — at least 30 minutes per day, Faubion says. Besides helping to maintain weight (after menopause, cutting calories is the only way to lose it), exercise can help take the sugar you eat and ferry it to the cell surface, where it can meet with insulin receptors. The more exercise you do, the more sensitive you become to insulin — meaning your need for insulin decreases, says Nachtigall. People who exercise also tend to have better moods and sleep better.

5. Health and beauty products

A whole cottage industry has sprung up around counteracting the effects (laxity, lines) of estrogen-deficient skin (as reported on by The Plum). In addition to collagen-boosting skincare, lines like Pause make cooling hot-flash sprays, which offer solid temporary relief.

6. Nothing at all!

When considering hormone therapy, it helps to keep in mind that most of the changes brought about by the absence of estrogen are slow in onset; you may not be particularly bothered by them. “There are a lot of women who opt not to be on hormone therapy and do fine,” Nachtigall says. Conversely, women who had bad PMS or postpartum blues will probably feel the effects of menopause more because they are more sensitive to hormonally related mood changes. (Estrogen won’t treat a major depression — you need an antidepressant for that — but women who take the hormone prophylactically for mood changes do well with it, Faubion says.)

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Menopause of the Rich and Famous

Everyone loves hearing what famous people have to say about their reproductive systems!

By Courtney Rubin

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Angelina Jolie

“I actually love being in menopause. I haven’t had a terrible reaction to it, so I’m very fortunate. I feel older, and I feel settled being older.”

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Gillian Anderson

“I felt like my life was falling apart around me. Friends suggested it might be hormonal. I was used to being able to balance a lot of things, and all of a sudden, I felt completely overwhelmed. How wonderful would it be if we could get to a place where we are able to have these conversations openly and without shame, so we don’t feel like we’re going mad or alone in any of the symptoms we are having.”

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Belinda Carlisle

“The worst thing for me were the hot flashes, which started off not being so bad. Then they got to be debilitating, and I would carry a change of clothes in the car.”

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Whoopi Goldberg

“Menopause can be hard to deal with because it really is a shock when it hits you. There’s no countdown. It’s just: boom. All those years bitching about my period and when it stopped, I was stunned to realize how much my womanhood was tied to it.”

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Emma Thompson

“It’s such a cold night, and it’s the only time I’ve actively been grateful for menopause. I’ve been entirely comfortable.” (Said while accepting an award on a freezing cold night.)

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Gwyneth Paltrow

“I think menopause needs a bit of rebranding. I remember when my mother went through menopause, and it was, like, such a big deal and there was grief around it for her and all of these emotions. I don’t think we have in our society a great example of an aspirational menopausal woman.”

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Julie Walters

“It was like a chimney and came from the base of my spine. Every take there’d be, ‘Stop! She’s having a flash!’ At the National, I’d come off stage for a quick change and have to shout, ‘Garth, the tray!’ and this guy would come with this big tin tray and fan me.”

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Margaret Cho

“I’m going through menopause, and it’s a gateway drug to happiness. I’m at a certain age. It’s given me perspective. I love it.”

We've told you our stories, now you tell us yours.

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