In an exclusive extract from her New York Times bestseller, author Ada Calhoun addresses perimenopause, menopause and insomnia. And much more. Essential reading for any midlife women. Read on for her brilliant thoughts and analysis.
Why can’t we sleep: women’s new midlife crisis
Perimenopausal women often complain of sleeplessness, painful intercourse, breast pain and cysts, changes in appetite and energy level, mood swings, bulging midriff, trouble concentrating, and so on and so forth – all symptoms connected in one way or another to hormones.
For some women, it’s not a big deal. For others, it can be crushing. In a survey by AARP, 84% of participating women said that menopausal symptoms interfered with their lives.
The effects of symptoms of menopause
“We tell people who are grieving not to make major changes for a year,” said JoAnn Pinkerton, executive director of the North American Menopause Society and professor of obstetrics and gynecology at the University of Virginia Health System. “I don’t think anybody’s ever said, ‘Don’t make a major decision when you’re perimenopausal.’”
Good idea, I think. We can just take it easy until perimenopause ends.
“How long is that, anyway?” I asked Dr. Pinkerton. A year, I thought she’d say. Maybe two.
“Anywhere from a few months to 10 to 13 years,” Dr. Pinkerton said.
“Oh my goodness,” I said.
“On average, they call it four years,” she said. But she added that what’s important for women to know is that menopause “is actually a lot easier than the perimenopausal transition.” Why? Because perimenopause “is unpredictable. It’s based on ovarian fluctuations. You might have six months of severe hot flashes, skipping periods, and then your cycles come back for three to five years before it happens again.
“How well your ovaries function depends on your cycle and your mental and emotional state,” said Dr. Pinkerton. “It’s all tied together. Women need to recognize that it’s a time of vulnerability, and there are some things that they can do to help.
“I guess what I would just say is if you’re in perimenopause, recognise that hormonal fluctuations may make the problems at work or at home seem larger. Maybe you need to calm down the hormonal fluctuations so that you can see the problems in perspective.”
How can I get better sleep during perimenopause?
Women also benefit exponentially from sleeping more, Dr. Pinkerton said. “How many women get seven hours of sleep a night? How many women keep their exercise going when they’re mentally or physically stressed? It’s often the first thing to go, but it’s absolutely one of the things that can help you navigate this time. Then, stress reduction.
“In my clinic, we draw a circle, and I turn it into a wheel. As I listen to perimenopausal women I put a dot in the center, and I draw a line, and I say, ‘Okay, now, let’s give a percentage to how much time you’re spending at work.’ And then I’ll say, ‘Okay, how about caretaking for children? You get extra credit if it’s teenagers.’ ‘How about your parents and your in-laws? How much caregiving are you providing?’”
Dr. Pinkerton said that looking at that wheel helps women understand why they might be feeling the way they are. If she hears a woman say, “Why am I irritable at work?” she says, “Well, you don’t just have work. You have work at work and work at home and work in the family and work in the community.”
Women’s health and ethnicity
Race may be a factor in the duration or intensity of menopausal symptoms. The Study of Women’s Health Across the Nation, an observational study, found that the median white woman’s experience of perimenopausal symptoms, including hot flashes and night sweats, is nearly seven years; for Japanese and Chinese women, about five years; African American women, about 10; and Hispanic women, nine.
Other research has shown that women in Japan have far fewer hot flashes and night sweats than women in the United States and Canada.
There could be both biological and cultural factors. One theory as to why Japanese women seem to experience far fewer hot flashes than other women is all the soy in their diet.
It makes sense: hormones are affected by diet, stress, exercise, and sleep. While it’s not easy for all of us to maintain a healthy weight, sleep eight hours a night, or go back in time and spend our whole lives eating a soy-rich diet, it’s nice to know that at least theoretically some of that might help.
Are we in denial of menopausal symptoms?
Here’s what I want to know: why are Gen X women arriving in their 40s knowing something is going to happen, but without a clear idea of exactly what that is?
One answer is: denial. We have had incentives for a long time to pretend we are the same as men in every way. For decades, women have had to argue that they could still work and function through those messy period-, pregnancy-, and menopause-related symptoms, and as a result we’ve minimised them, both to others and to ourselves.
So as not to call attention to ourselves as women, we pretend it’s not happening.
Boomer women arguably started this, entering the work world in shoulder-pad armour. It makes sense that they felt they had to hide the inconvenient fact of their womanhood, particularly in middle age.
Sleep Disturbances And Much More
After taking our children to see a movie, a friend and I sat at her dining room table while the kids ran around her house.
“It’s just too hard,” she said about her menopause. “I thought it was best to do it naturally, so I’ve just been riding it out. But it’s been two years and finally I thought, This has ruined my life! Two years without sleeping through the night! Two years with hot flashes! Two years with no energy.”
I’d had no idea. I asked why she hadn’t told me before.
“I hate talking about menopause,” she said. “It’s like saying you’ve closed up shop as a sexual being. It’s embarrassing.”
Behind us, the kids raced up and down stairs, laughing, oblivious.
Ultimately, her doctor put her on antidepressants, which she said helped her.
They do not help everyone. A TV news producer told me that she felt numb when taking them, and her weight shot up: “I struggled with some depression and some anxiety in my late 30s, early 40s,” she said. “You’re dealing with these feelings, and then you hear, ‘Oh, you’re a 40-year-old woman, you seem depressed. I’m going to give you medication that will make you gain weight.’”
Depression and anxiety
When I felt depressed in my 30s, I was prescribed an antidepressant. I wish that I had also done more to explore why I was depressed. Now I can see it more clearly: I was working more than full-time for people whose values I didn’t share. I had a young child at home whom I missed horribly when I was at work. I had the pressure of being the breadwinner. Dreams of doing something meaningful with my life felt out of reach.
One of my oldest friends, Asia Wong, now a clinical social worker, told me: “When I, as a clinician, talk to people about depression, we talk about how three things contribute: your biology; your inner landscape or psychology, which we can work on in therapy; and then your life circum- stances.
“If your life circumstances really suck, you are going to be sad most of the time. You’re going to feel anxious and overwhelmed. If you say, ‘I’m taking care of my ageing parents, and I’m working full-time, and I have these little kids, and my husband still has some traditional gender-role stuff,’ you’re going to be sad. Not because you ‘have depression,’ but because your life is debilitatingly difficult.”
Good news for Gen X menopausal women
Menopause Confidential author and gynaecologist Tara Allmen, also happens to be a menopausal woman. Dr. Allmen told me that there’s good news for Gen X: “Your generation will be the generation that is the most educated. Now everyone has taken a collective deep breath and really does understand who can benefit from hormone therapy. You are the hopeful generation. You should be thinking, ‘Lucky us!’ even though plenty of misinformation still persists on the internet and among the older generation of physicians or the younger ones who haven’t had the training.”
Oestrogen, Progesterone and Exercise
Dr Allmen does not believe that women should grin and bear it. Here is some of her advice for us: Get daily exercise, especially weight-bearing exercise; a good diet; and plenty of sleep.
For hot flashes, she advises layering clothes and keeping a dry set of nightclothes next to the bed so you can change quickly if you wake up in the middle of the night. She recom-mends keeping the bedroom cool and getting your partner an electric blanket if he or she complains.
Other non-pill things can make life easier, like absorbent “period-proof underwear” and period tracker apps.
She advises many women to consider estrogen-and- progesterone hormone therapy (or just estrogen, if you’ve had a hysterectomy), in the form of pills, patches, gels, or sprays.
For heavy or irregular periods, you can take a birth control pill or get a progesterone IUD called Mirena.
Alternative treatment solutions
When it comes to herbs and supplements like evening primrose oil or bee pollen, there’s no proven benefit, though some women say that those things make them feel better. There’s been some encouraging research on the effect of black cohosh, a member of the buttercup family, on hot flashes, though as with anything there are potential side effects.
For better or worse, we are undergoing a transformation. In her 2019 memoir, Deep Creek, Pam Houston gives a younger woman this advice: “I’m just saying, I guess, there’s another version, after this version, to look forward to. Because of wisdom or hormones or just enough years going by. If you live long enough you quit chasing the things that hurt you; you eventually learn to hear the sound of your own voice.”Perimenopause may last months or years; it may be more or less drastic; but one day it will be over. On the other side, we’ll be different – perhaps more focused on what’s most important to us and almost certainly calmer. Psychotherapist Amy Jordan Jones told me, “This is the time of life when we learn that we don’t have to be pleasing; the work now is just to become more ourselves.”
JOIN ADA CALHOUN FOR A MIDLIFE FUNDRAISER
Join Ada Calhoun, New York Times bestselling author of Why We Can’t Sleep: Women’s New Midlife Crisis for a special virtual event on Sunday, February 7th at 5-6pm UK time.
Tickets cost US$20, to watch the livestream talk with Ada and also receive a copy of Why We Can’t Sleep. (NB. Talk + book tickets are limited, only 10 available. If your home address differs from your billing address, please email email@example.com after purchasing.)
Tickets cost US$10 to watch the one-hour livestream. A link to view the livestream will be sent 24-hours prior to the event.
All proceeds go towards the DENIZEN Theatre, a non-profit theatre company in New Paltz, NY, which is hosting this event.