Not Your Mother’s Menopause
The Menopausal Millennial
It’s still warm in Baltimore in late September — warm enough that when I arrive at my aunt’s house for dinner on Rosh Hashanah, the same day as the kickoff to football season, I can comfortably wear my lucky Ravens tee without a jacket. I brought a sweater though, because her house is always freezing, and I typically run cold.
But throughout dinner, I can’t get comfortable. With my sweater on and my arms wrapped tightly around myself, I’m so cold my teeth are chattering. I sip on some chicken soup, and 20 minutes later, the extra layer comes off and I pull my hair into a bun to get it off the back of my neck because I’m sweating. Another 20 minutes pass, and the sweater is back on.
“Are you feeling alright? Do you want me to make you some tea?” my aunt asks, looking concerned.
“No, I’m fine. Pretty soon I’ll be sweating again. It’s just the menopause.”
“Uh, I think you have a few years to go,” one of my cousins says, chuckling.
Except I don’t. I’m 30, and I’m having menopausal hot flashes.
A little over two months earlier, when I visited a GYN oncologist, I accepted his plan to put me into temporary menopause for six months; my ovaries, thoroughly freaked out by the ever-worsening endometriosis inside of me, had been overproducing estrogen for months, maybe years. My body needed a break.
Rationally, this made sense to me. It was the biological equivalent to my go-to IT trick — if a gadget isn’t working, just turn it off and turn it back on again. Tends to work well on my cracked iPhone. Why shouldn’t it work on my equally broken reproductive system?
The not-so-logical part of me was more than a little nervous.
I was relieved by this doctor’s matter-of-fact attitude and his confidence. He didn’t seem flummoxed by my body the way my primary doctors did. But I hadn’t heard of this drug before, and it seemed like an extreme thing to do to my body.
The drug is called Lupron. It’s an analog of a pituitary gland growth hormone. Because it works by suppressing sex hormones like estrogen, doctors have begun to use it to treat endometriosis and uterine fibroids. It’s also been used to treat breast and prostate cancer.
And because it isn’t itself a sex hormone, it was an ideal course of action for me since I couldn’t take birth control due to my history of having had a blood clot.
Although the specialist assured me the menopause was completely reversible, I was wary. Tricking my body into menopause seemed so extreme. The pituitary gland is in your brain; hormones that come from your brain just seem like something you shouldn’t screw around with. And the doctor also told me that if I had to have more than two doses, I would have to start taking something to protect my bones, which is scary in and of itself. But after nearly seven full months of debilitating pain, misery, and hemorrhaging, I didn’t see another choice.
Settling for the status quo was not an option.
My primary gynecologist would administer the injection, and I had to wait two weeks for the office to have the drug delivered. Meanwhile, I began going to acupuncture. Although I didn’t expect acupuncture to cure me, I am a firm believer that modern medicine and holistic methods each do their best when complemented by the other.
Still, I was nervous for my first session.
I had crowdsourced acupuncturist recommendations on Facebook, as millennials do, and my best friend Carly had a former colleague who was a massage therapist at a wellness center in the county. The center itself placed an emphasis on reproductive health, and Carly’s colleague recommended one practitioner in particular, AJ (whose name has been changed, but if you’re looking for a REALLY good acupuncturist, lemme know, I’ll send you her way).
I made the first appointment to see AJ the Saturday following my oncologist appointment. I read up on what to do before acupuncture, and everything said to relax, stay well-hydrated, and get rest. So the night before, I had big Friday night plans to order in, decompress, zone out in front of the TV, and go to bed early.
No such luck.
When I got home from work, I went to the bathroom to pee, and as I was taking off my jeans, I heard the sickening sound of something large falling into the toilet. For a split second, I was confused, until I remembered that my iPhone, keeper of ALL THE THINGS, was in my back pocket. Or at least it had been.
Now it was in the toilet.
“NOOOOOOOOOOOOOOO! Fuck, fuck, fuck, FUCK!”
With not-so-catlike reflexes, I fished it out and stupidly tried to keep it on long enough to text my brother and ask him what to do. (Pro tip: Don’t do that.) Squiggly lines of death appeared on the screen and it shut off and commenced its own little hot flash.
I immediately got on my computer and started Googling. I am not the first to drop a phone in a toilet, and the sea of tips and tricks for drying it out was contradictory and overwhelming.
So I took to Facebook and began messaging everyone I knew who seemed even halfway tech-savvy. My ex-boyfriend, who once replaced his own shattered phone screen by himself, told me to put it in a bag of rice.
“But the internet says that doesn’t work.”
“The internet also says Venus Williams looks like a man and Caitlyn Jenner is a beautiful woman,” he retorted.
So I stuck it in a bag of race and frantically ran it over to a local repair shop that was just about to close. As soon as I pulled the rice out of my purse, the bored-looking girl behind the desk just shook her head, looking at me with pity.
“We can’t fix that. We’d have to send it away to Apple, and even then, you might have to buy a new phone.”
Dejectedly I went home and Googled the directions to the wellness center. The next day I’d have to figure out how to get there without the help of my phone’s GPS. I shuddered remembering the days of MapQuest and handwritten directions.
Conveniently, the center was right by a mall which also conveniently housed an Apple store, my least favorite place in the world.
The next morning I was frazzled. I hadn’t slept well. I had planned to meditate, but as I used an app for that — well, let’s just say, it’s not great if you can’t even meditate without your phone.
Keeping myself hydrated for acupuncture was the least of my worries now that my phone had been adequately hydrated. I got to the Apple store when it opened, hoping to get my phone checked out before acupuncture.
The hipster with the man bun and the iPad waitlist gave me an “aww, that’s cute” look and told me the wait would be three hours. It was 10 am in July, but it was so crowded, it could have been Black Friday. They could see me at 1 — when I’d be on a table with needles sticking out of me. He told me to just come in after, and it wouldn’t be too long.
I decided to start hydrating and killed some time with a bottle of water and travel magazines at Barnes & Noble. Then I headed to my appointment. Each subsequent session would be an hour, but the first was slotted to take two hours. It became immediately apparent why.
AJ asked me more questions about my health history and my current problems than any doctor ever had. When she asked questions that elicited the goriest details of my period horrors, I cringed, but she didn’t flinch. She wasn’t disgusted, and she didn’t seem all that surprised; in fact, it appeared she had heard similar tales before.
Throughout the course of our conversation, I began to relax, forgetting about the rice-swaddled phone in my bag and my worries about what acupuncture would actually be like. AJ was warm and sweet, she exuded calmness, and I felt an easy connection with her.
I’ve written before that I was skeptical of acupuncture at first. It’s not that I didn’t believe it could help; there has to be something to any method of medicine that’s been around for thousands of years. It’s more that my Western mind simply couldn’t wrap itself around the idea of my pain being eased due to the unleashing of my chi, or energy. If someone told me that the tiny acupuncture needles were somehow rebalancing my hormones, that would have made more sense to me.
But my doubt subsided after that first session due to two pieces of undeniable evidence:
- After the session, I asked AJ how she chose the points where she put the needles. She selected spots that would help my blood flow and nourish my spleen. She hadn’t asked what I did as an occupation, but after taking my pulse and examining my tongue, she said I presented like a student — someone who spent hours poring over books and therefore had stagnant blood. I’m not a student anymore, but at the time, I was a medical book editor, and my days were indeed spent hunching over books.
- When she was finished inserting the needles, she turned off the lights, turned on some music, and told me my only job was to relax. What a wonderful thought! I chilled so much that when I returned to the hellscape that is the Apple store, I didn’t lose my mind when I had to kill another hour without the aid of Candy Crush. The crowds didn’t give me my familiar Apple store anxiety. And I didn’t cry when I was told I had to shell out a few hundred dollars for a new phone, money I had been saving for an upcoming trip to Europe.
This was proof enough for me. Even if acupuncture couldn’t fix my uterus, it was worthwhile for the stress relief, and I returned every week.
I was so sold, I added AJ’s Chinese herbs to my diet. The pills weren’t so bad, but the powder that she custom-mixed for me was another story.
It looked like cinnamon, but smelled like something else. I don’t know how to describe it. It did have a faint smell of spice — but it was also mixed with the aromas of fertilizer, coffee, marijuana, and something decomposing.
AJ warned me it didn’t taste much better than it smelled. She told me to mix it with a shot of water and take it once in the morning and once in the evening. No problem.
To be honest though, shots are not a party trick I’ve ever mastered. Even so, the Chinese herb water was the first shot I’ve done that actually made me gag. That night, I stared down the shot glass of murky water, trying to brace myself, but I just couldn’t face doing another.
So the following morning, I mixed the herbs in with my breakfast smoothie. I thought bananas, peaches, and vanilla protein powder would easily mask the putrid smell and vomit-worthy flavor of the tiny bit of herbs I included.
But no. My smoothie was ruined and so was my appetite.
Next thing I knew, I was ordering empty capsules from Amazon so I could swallow the herbs without tasting them. With the capsules spread out across the table and my little herb spoon, I felt like Baltimore’s jankiest drug dealer.
Anything to feel better.
As suspicious as my doctors were of acupuncture, AJ was equally suspicious of my doctors. She (fairly) harbors qualms about the effects of long-term birth control therapy on the hordes of young women taking the pill, and she looked downright horrified when I told her about my impending Lupron injection.
“You should research that very thoroughly before you go through with it,” she said.
I knew she was right, but I couldn’t live the way I had been living. If hot flashes, mood swings, and calcium supplements were the price I had to pay, then so be it.
Before my appointment, I checked in with a close friend of my roommate’s who had endometriosis among a slew of other reproductive problems. I told her I was having this crazy menopause shot.
“Oh, Lupron?” she asked.
“You’ve heard of it?!”
“Yeah, definitely. Jake’s girlfriend Adrienne had it.”
I had only once met Adrienne (name has again been changed to protect the privacy of her already beleaguered fallopian tubes), and I didn’t know how she’d feel about a mutual friend telling an acquaintance this information. But I wanted to talk to her.
My roommate knew her better than I did, so she reached out to her on my behalf, but I wasn’t able to talk to her before I had the shot.
When I arrived for my appointment with my gynecologist, she told me about the side effects I could expect from the drug — everything I expected — hot flashes, mood swings, night sweats. In short, menopause. I wondered how it had never occurred to her during all my months of suffering to treat me with this drug. She clearly knew the drug existed, but it took another doctor suggesting it as a treatment plan.
Then she told me to take off my pants, because this was an injection you take in your butt cheek.
This was a first for me.
I bent over, mortified yet again. At what point during the course of a chronic illness do you just stop caring about the various humiliating things you have to endure?
“There’s too much muscle here,” she said from behind me. I mentally patted myself on the back for my good work at the gym while she literally grabbed different parts of my ass.
Then she found a sufficiently fatty spot and apologized as she stuck me and said she was sorry, she knew it hurt. But by now my pain tolerance was so high, I barely felt the massive syringe. I will admit though, sitting on that part of my butt was uncomfortable for two weeks following the appointment.
To preemptively offset any menopause symptoms, she gave me a prescription for a progesterone supplement. The manufacturers of Lupron also recommend taking progesterone to promote the drug’s outcomes.
“Are you sure I can take that even though I had a blood clot?”
“The World Health Organization says it’s OK for women with a history of DVT,” she said. “But if you want, you can call your hematologist just to make sure.”
As sick as I was of calling doctors’ offices, I dutifully called her anyway. The secretary who took my message asked if it would be OK if a nurse practitioner called me back instead of my doctor; she said it would be quicker. I told her I could wait; I preferred to talk to the hematologist herself.
A half hour later, the nurse practitioner called me back.
“You can’t take any birth control,” she said, as soon as I answered.
“I’m not taking it as birth control though — ”
“Absolutely no birth control.”
“It’s progesterone only,” I quickly said before she hung up on me or interrupted me again. “No estrogen. And I’d be taking it to offset menopause symptoms caused by another drug.”
“Oh. Let me check.”
Then I heard her typing. I imagine she Googled it, which I could have done myself.
“No, I’m pretty sure you shouldn’t take progesterone.”
“Do you think my doctor could call me back?”
But she didn’t, and eventually I asked my gynecologist to call the hematologist directly. I didn’t care what the answer was; I just wanted them to figure it out amongst themselves and tell me what to do. I was too tired of battling the people buffered the doctors who were ACTUALLY treating me.
When my gynecologist finally called me back, she sheepishly told me she was wrong. Progesterone wasn’t an option for me.
Glad I dodged that blood clot.
In the two weeks following the shot, I felt terrible. Bruised butt aside, I was an emotional wreck (more so than I had been, which is saying something). My skin was breaking out. And I was bleeding just as heavily as ever.
The GYN oncologist had told me it would take one to two months for the Lupron to really kick in and for my period to disappear, but I couldn’t imagine this worsening of my symptoms was normal.
A quick Google search told me it was. In fact, each injection causes a counterintuitive estrogen surge at the start — something neither doctor had warned me about.
When my gynecologist called to check in and I told her about it, she said, “Oh yeah. It’s kind of like an estrogen explosion.”
Huh. Thanks for the heads up.
About a week into this special kind of hell, I went with a few friends to a free outdoor concert a few blocks away from my house. I had been looking forward to it ever since I found out one of my favorite bands was playing.
But I was considering bailing, like I had on so many other social outings that year. Physically, I felt like a monster. Emotionally, I was sad and terrified of running into Nicky and his new girlfriend. Even though I had nothing to be ashamed of and he had everything to be ashamed of, I was on constant high alert; I dreaded seeing him, and this was something he might attend.
My roommate reminded me that this was absolutely not something I should let him take away from me. And if he was there, she would have my back. She loathed him. Plus, if I did see him and it was miserable, I had acupuncture the next day to help me chill out followed by a long weekend at the beach with friends to look forward to.
I didn’t see Nicky, but I did see Adrienne. She told me my roommate had reached out to her but she hadn’t had a chance to get in touch. Then she sat down on the picnic blanket next to me and told me her story.
She had been through 11 gynecologists. Like me, she didn’t feel better after her first surgery. She was able to be on birth control. But the type the doctor kept her on while she was treated with Lupron effectively canceled out anything the Lupron was doing.
And unsurprisingly, less than a year later, the pain was just as bad as it had ever been. When she had surgery a second time, a new doctor found that her previous doctor had not excised all of the endometrial implants; the offending tissue was entwined around her ovary and was pulling it down and out of its cavity. They were waiting to see if she had to go on Lupron a second time.
I felt terrible that she had gone through so much, but at the same time, I felt a massive sense of relief wash over me. I felt the knot of tension that I had become over the course of the year start to melt. Under the influence of an estrogen jag, I began to cry.
I hadn’t realized how isolated I had been feeling all year. It wasn’t that my family and friends weren’t unfailingly there for me; they were. They were nothing short of incredible. But until I talked to Adrienne, I thought I was the only one. None of my close friends had endometriosis, and as far as I knew, everyone who I did know who had it had found simple “cures” in birth control or surgery.
I alone mystified my doctors, so I assumed I was some sort of freak.
At the time, I hadn’t yet found the resilient community of endometriosis sisters on the internet who have now found me through my writing. Padma Lakshmi hadn’t yet started talking about her own struggles with endo and the toll it took on her marriage. Lena Dunham hadn’t yet written her Lenny Letter essay which mirrored my own story — years of doctor-stumping pain, an unsuccessful surgery, and a Lupron injection. Halsey hadn’t yet tweeted about what it was like to be on tour fighting crippling menstrual pain backstage.
Adrienne, this gorgeous girl who I barely knew, was the first person who opened up to me about her own story, and she inspired me to do the same. I vowed then that once I was on the other side of the pain and misery, I would write about it — ALL of it from the surgery to the breakup to the weight loss — and hopefully reach at least one person out there like me.
I was so grateful I hadn’t bailed on that concert. Saint Motel is the shit. And more importantly, Adrienne is the shit. I knew she was my turning point.
She told me how she had discovered that there was an “endo diet” — foods that could aggravate the condition, something no doctor had told me. Soy, which mimics the effects of estrogen, was to be avoided. My Asian cuisine-loving self immediately imagined the soy sauce that was probably coursing through my veins as we spoke. I mentally cursed Starbucks for carrying soy milk but not almond milk.
She told me how she believed that gynecologists who didn’t specialize in disorders didn’t know much about endometriosis at all. They know birth control and babies, but disorders are enigmas to them.
She told me about her own personal struggles she had dealt with while she was dealing with the physical pain of endometriosis, and I told her about how stressed I was at work and how sad I was over Nicky.
“Look, I’m not going to lie to you,” she said. “Menopause isn’t easy. I cried all the time. There are just going to be some days when you’re going to be really, really sad. But you’ll get through it, and a year from now, you’ll be able to look back on it and know you got yourself through it on your own, without him, and you’re strong.”
In a way she was right. I put one foot in front of the other, and sometimes just getting through the day felt like a huge achievement. I persisted in calling doctors even when I really didn’t feel like it. I forced myself to eat when I wasn’t hungry, exercised when I could, and got as much rest as possible. I went to work every day, and gave it my all.
But most importantly, I surrounded myself with the most kick-ass people imaginable. My family, my friends, AJ, and Adrienne. So even though I was going through it without a guy by my side, Adrienne was wrong in one way — I wasn’t ever on my own.
Buoyed by the hope she gave me, the dulcet tones of Saint Motel, and the promise of a pain-free future, I went home genuinely happy for the first time in months.
This is Part 5 in my series of essays on endometriosis. I encourage everyone to start talking about endo and never shut up about it. Maybe if we’re noisy enough, one day castration, pregnancy (actual or chemical), and fake menopause won’t be our only treatment options. If you liked what you read, please Facebook it, Tumbl it, Tweet it, etc., and check out Part 6, the final installment (!). If you haven’t already read them, Part 1 is here, Part 2 is here, Part 3 is here, and Part 4 is here.
As always, thank you to the nth degree to my bestie, Jen Epstein, for the illustrations you see in my essays. DAT ASS, THO, AMIRITE?