Welcome to Perimenopause (We should probably talk)
Photography by Tim Goedhart
Story by Natasha Marie
“I wish more women were comfortable with their bodies and comfortable talking about perimenopause.”
Editor’s note: Welcome to our special four-part series that gets to the root of perimenopausal pain: our pelvic floor. While it is written from a cis-gender perspective, we want to make it clear that perimenopause can also affect trans men and non-binary people and we are actively working towards being more inclusive in our language and storytelling.
In some alternative universe, women are revered for our magical biology. We are called witches and sorceresses for our ability to bleed for 5-7 days and not die. Altars are built to honor our alchemy instead of being burned on stakes. Women are united by the shared experiences of menstruation, perimenopause, menopause, and postmenopause. Through these shared experiences we receive the most precious of gifts: camaraderie.
Sadly, we don’t live in that alternate universe. In the universe we live in, the reality for women is quite contentious.
But while we don’t live on the mythological Island of Lesbos, sitting at Sappho’s feet listening to her poetry, we do share at least one collective experience: As we move through the seasons of our biology, we change.
Change isn’t inherently bad. Despite the media’s fixation on celebrating youth, aging is not a death sentence. There is life after 40. What are your 40s if not your 30s with wisdom and wealth? However, navigating the road to wisdom means navigating change. When change isn’t something you wanted or even understand, it can be an Odyssey.
Actually, it still can be an Odyssey even when you do understand it.
When people think of perimenopause, they think of symptoms like hot flashes and irritability. But what is actually happening is the complete decline of your natural hormones that previously supported the health of your body. Hormones are the regulators of your body’s internal systems. And when they change, everything changes.
So while we’ve all heard about women sticking their head in the freezer to get some relief, that isn’t the whole story. Because perimenopause is more than a list of symptoms; it’s an entirely new way of relating to your body. It’s personal, it’s emotional, and it’s accompanied by a whole new identity.
Tahirah’s Story
I met Tahirah in a Caribbean dance class. She was witty and vibrant and her energy was infectious. I admired her ability to laugh at anything, even her missteps. We all had them but unlike the rest of us, she handled them so elegantly. Over time, we became close friends. But, even with our closeness, I was surprised when she confided in me about her perimenopausal urinary leakages. This knowledge felt taboo, intimate. But I’d soon discover, it’s a common experience so many of us share.
“I get leakage. It is what it is.”
She said it just like that, in a cavalier manner. For something so stigmatized, I deeply admired her level of acceptance. She said, “You learn how to adapt or combat the changes in your body.” Then she added this practical advice, “I will say this: I never pass up a bathroom opportunity.”
Because this was a topic I didn’t know a lot about, yet knew perimenopause was on my own horizon, I had more questions. And Tahirah was kind enough to answer them. We talk about how early perimenopause can start (in your 30s!), how our doctors can do better by us (it’s not just telling us to do Kegels!), and what we need to get through it (the three E’s: education, exercise, and each other).
When did you first start experiencing urinary leakage?
I first started having urinary leakage about 26 years ago, after I had my daughter. And since I’ve been perimenopausal, the leakage has gotten worse. It usually happens with physical activity, like when I’m dancing or exercising.
Are there any preventative measures you take to avoid leakage?
When I dance or exercise, I wear either a pad or a panty-liner because it comes out of the blue, like whoops, that just happened. And if I forget to wear a pad and I leak, I just shower after I exercise. Like I said, it is what it is. Things happen. I’m at the point where I can laugh at it instead of getting upset with my body.
Did your gynecologist give you any recommendations on how to help with the leakage?
My doctor suggested that I cut back on my water intake before exercising and keep pads and liners available. She also suggested doing Kegel’s. I’ve been doing Kegels since my 30s, but she told me I should probably do them more often. I also suffer from frequent bouts of urination. I do drink over a gallon of water every day. She said that since I drink a large amount of water, frequent urination is not abnormal.
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Other than offering more Kegels, did you feel like your doctors provided you with enough information to prepare you for this transition?
My gynecologist has been telling me for years that I am perimenopausal. So, I’ve been perimenopausal since my late 30’s or mid-to-late 30s. I asked my doctor about things as they were happening in my body. She would give me bits of information here and there, but it wasn’t until this year that she gave me a full breakdown of what perimenopause is. It was an eye-opener. I knew some things, the clichés like hot flashes, but not everything. She gave me a whole list, and that’s when things clicked for me, like, Oh right, what I’m experiencing makes sense now. For instance, I didn’t know the memory lapse was related to perimenopause.
Your gyno piecemealed information to you over the years, but it wasn’t until recently that you received a comprehensive breakdown? Do you think if your doctors had been more forthcoming with this information sooner, it would have made your perimenopause experience easier to handle?
Yes. I felt like my doctors should have had that conversation with me years ago. It would have made my journey a lot easier to understand. I probably could have had it under control or more controlled a lot sooner.
Can you tell me what the experience as a perimenopausal woman has been like for you? What were the changes you noticed in your body?
There’s been a lot of changes in my body. My memory is not what it used to be. My energy levels are lower, and it’s much harder to lose weight now than ever before. I started having night sweats in my 30s. I would sweat so bad that I would have to get up in the middle of the night and change my pajamas or lay a towel in my bed. I don’t get night sweats that bad anymore; I just get warm.
The hot flashes started about two years ago. Ugh, I was just miserable. Burning up hot, but from the inside out. It’s a terrible feeling. I take herbs for my hot flashes, which helps a lot. My hot flashes are minor now.
My menstrual cycle is crazy. I don’t always have a cycle. For example, I had a cycle in December, none from Jan to May, then it came back in June like BAD: horrible cramps, heavy flow, emotional rollercoaster. Sometimes I skip my cycle altogether for months. Other times I would have two cycles a month. Like, literally two complete cycles per month, one right behind the other one.
Then there’s the lack of sleep. I suffer from insomnia or not sleeping for long periods like I used to. Part of the lack of sleep is due to having to urinate during the night. I wake up, and I have to urinate like two to three times a night. Even if I stop drinking water at 6 pm the night before, I still wake up to use the bathroom several times a night. It’s also much harder for me to use the bathroom. I don’t know if my vaginal muscles are weak, I mean, I started doing Kegels in my 30s and never stopped, but I still get leakage.
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How have the changes in your body affected your emotional wellbeing?
I am stressed way more. As women, once a month, our hormones go crazy, but I feel even more hormonal with being perimenopausal. It’s such an emotional rollercoaster, like, if I’m not gonna have a consistent cycle, can I not have this hormonal imbalance? What contributes to my stress the most is being tired all the time from the lack of sleep or sleep disturbances. When I’m tired is when I’m most emotional and when my moods fluctuate.
Jeez, that’s a lot to deal with, and that’s not even taking into account everyday life, career, family, friends, etc. How do you cope with the additional emotional stress?
Exercise. Movement calms my mind and body. When I’m active, dancing, lifting weights, it puts me in a better headspace and I feel better physically. This is why I like to exercise so much. A few friends recommended progesterone or other medical supplements to help with the symptoms, but I’ve never cared for medicine. I do a woman’s health holistic remedy. I take supplements like sea moss to help with the symptoms of perimenopause. Breathing techniques are very effective. I give myself distractions if I get too overwhelmed. I go outside, take a walk, listen to music, call someone to chat or vent. I’m guilty of eating and online shopping too much! They are horrible coping mechanisms, but they served me when I needed a distraction.
Did you feel like you had a supportive community of friends or family that you could speak freely to about this life transition?
Thankfully, I have a lot of girlfriends my age who are currently experiencing perimenopause with me. I have a few friends who have had hysterectomies, so they aren’t experiencing the same symptoms as me, but I am thankful that I can speak openly with them. But, I wish more women were comfortable with their bodies and comfortable talking about perimenopause. I mean, look, we are who we are. Who cares about what someone else thinks? It’s just their opinion. It’s your life; you have to learn to deal with it and laugh at it. A lot of times, I laugh just to keep from crying.
Between the comedy in Tahirah’s words about her purse becoming a pharmacy, there was something else I noticed; something unspoken: grief. Grief from experiences she lost to perimenopause. Grief from losing control over her bodily functions. Grief from losing the capacity to change whatever was happening in her body.
I thought about some of the freedoms enjoyed in youth. The freedom to come and go with little to no planning, to take someone home on a whim and rip each other’s clothes off in frenzied passion.
We live in a society that rewards instant gratification. Certain freedoms of choice and agency are lost to those who have aged into perimenopause. And I can’t help but think that our culture’s lack of patience and compassion for different life stages feeds our obsession with youth.
Tahirah didn’t lose her ability to have or enjoy sex; she lost the freedom of impulse and choice when she lost her agency over her bladder. Panty liners and urine don’t exactly inspire eroticism (*with the exception of certain fetishes or kinks). The logistics of hygiene and comfort require planning and communication. Communicating an intimate detail like urinary leakage to another person is exposing. The vulnerability of trusting someone with that knowledge and asking someone for compassion to understand is heavy.
There is a real reason to grieve the loss of experiences and the loss of choice. It’s a freedom, while perhaps never exercised, was still within your power. Maybe Tahirah was never interested in taking a stranger home, but it’s a loss that resonates differently when the choice is taken from you. When your internal power dynamic changes, when a piece of power is removed, a piece you’ve had your entire life, it has impact. This power dynamic changes how you identify yourself and how you interact with the world. And accompanying that ambiguous loss is the added loss of compassion and tolerance from society.
That said, Tahirah’s smile reminded me that even though she had to deal with the symptoms of perimenopause, she also gained wisdom and a sense of freedom that only a lived experience can yield. It’s the power to choose how she responds to her situation. I was envious of her ability to laugh at things that would make me cry. That was true power.
Another true power is education. And we’ll explore that more in my next interview with Dr. Rachael Gelman. Dr. Gelman is a clinician, writer, educator, and the owner of Pelvic Wellness & Physical Therapy. We talk about what pelvic health is and the hype around the over-prescribed and frankly, over-hyped Kegels.
Natasha Marie is a writer making technology less nebulous and sexual health more accessible by dismantling taboos one word at a time. She’s currently a staff writer for sexual technology company, MysteryVibe, and manages media and public relations for global sextech conference, Sx Tech Eu. photo: Alex Oley