Guest Post: Things That The Doctor Never Tells You About Menopause

(and neither, in many cases, does the internet)

Quick note: My spouse wrote this as a rant just for my benefit, and I enjoyed it so much I made xem rewrite it as a guest post. Menopause information online is often incomplete and almost never includes trans or genderqueer experiences, unless talking about periods stopping from taking T, which is a different situation. My spouse’s menopause occurred after a full hysterectomy, which also influences menopause in different ways compared to naturally occurring; this is largely about xeir specific experiences, but still may be helpful for others. We have put some resource links at the bottom.

Content notes and warnings: This does contain multiple mentions of medical issues including surgery and chemo, as well as anxiety, and brief mentions of medical fatphobia

So as someone who has had their uterus removed for their health at the age of 39/40, I have… surprisingly little information on the subject, and not just from my gynecological surgeon, but also from my ob/gyn because apparently they just expect you to know. Unfortunately there’s a lot of stuff you need to know to survive this period! Or lack thereof.

[Image description: A bottle & cup of tea, a bottle of pills, and several homemade plush frogs, with a background of flowers.]

Hot flashes can last ages.

Your doctor, and most of the internet, will tell you that your hot flashes will last for a maximum of 2 years. Period, no exceptions, that’s just how it is. What they don’t tell you, and you can find if you scour the ‘net, is that many people who have uteruses don’t even experience them! Hot flashes can last from 6 months after the end of your last period up to TEN YEARS. That’s right. Ten.

And then if you’ve had a surgical or chemical menopause, it’s even more different, and you can’t find much without searching hard, with a lot of search terms to help. Surgical or chemical menopause can last a minimum of 3 years. My ob/gyn said “it’s been 2 years, you shouldn’t be having hot flashes anymore. How’s that going for you?” So of COURSE I said I was fine. Because well. Why wouldn’t you? Since she didn’t have the time to explain what I could potentially be going through until the year 2029, so why would I tell her that the schedule she thought I was on was skewed?

They’re called hot flashes, but…

That’s not all they are. Hot flashes, or “flushes” aren’t just a sudden burst of heat that occupy your chest, neck, head, and face. The average claim is that an individual with a uterus (or who has had a hysterectomy) will have 7 a night (more than during the day) and that they will last no more than 5 minutes max. With a lot of work and looking into uterine/reproductive “women’s” health websites, I discovered that hot flashes include:

a sudden rush of heat in the chest, upper back, neck, head, and face
a spike in blood pressure
racing heart and/or palpitations
a flood of anxiety that varies in strength
rapid or shallow breathing
racing thoughts/irrational thoughts
sudden chills in the wake of the heat dissipating
sleep disruption (due to the flashes)
insomnia
head rush/light-headedness (often in place of a hot flash, but both can exist concurrently)
difficulty falling asleep
general fatigue
inability to handle stressful situations
increased stress response
an increase in anxiety for “normal” tasks
sound sensitivity (rare)
digestive disturbance
profuse sweating

Alarmingly, these are the classic signs of anxiety, not including the hot flash itself. Generally, all of these symptoms (except head rush) are concurrent with each hot flash.

You’ll have a lot.

And when I say a lot, “an average of seven a night” is because those are what wake you. Yeah, technically speaking, you can have dozens, or even hundreds of hot flashes, and most of the time they won’t wake you, because they’re part of the natural awakenings we all have during the night. They’re called micro-awakenings, and no matter how solidly you think you sleep, they’re there. But they’re normal! Bet you didn’t know about those either. You’ll also have a lot of hot flashes when you’re awake, too, but most of those go unnoticed because unless you start sweating, because they’re easy to dismiss, especially when you’re like me and just go “oop too warm” even outside in winter when I should be at least aware of the fact that it’s 26 outside.

You’ll get a lot of repetitive information on how to “stop” them.

Among these will be such advice as “avoid alcohol, caffeine, and tobacco”. Many will tell you to avoid sugar, and others still will tell you to avoid dairy. (Others will list the same seven teas). While there may be ~some~ correlation to these, they’re the same advice that is given for literally EVERYTHING. Only a few things apparently genuinely help reduce the occurrence of hot flashes:

estrogen/progesterone treatment
progesterone only treatment (most recommended)
green tea
chocolate, esp dark chocolate
exercise (this is varied on how much daily, but at least 5-15 mins seems to be “good enough” to help)

That’s it, that’s the list. Those are the only things that give consistent, quantifiable results. And that’s it! Be wary of any lists that tell you that weight loss will help hot flashes. This is patently untrue. People of any size experience hot flashes, and no size category experiences them more than another.

Nothing’s actually wrong with you!

As a person with ADHD and anxiety, I’ve felt like something was very wrong the last year or so. I can’t watch television or movies at home as much as I’ve wanted, I can’t feel remotely comfortable doing errands even though I manage quite well, and I get panicky doing next to nothing. I can read a BOOK and a “tension building” scene can give me a panic attack! Whew. You can certainly blame some of this on Covid, because of course you can, but it’s not all of it. I’m struggling to sleep, trying to fall asleep gives me panic attacks, and I can lie awake for hours desperate to sleep and never quite catching up.

But NOTHING is wrong. I’m just suffering from hot flashes, still, even though my surgery was in 2019, and yes maybe they’ve gotten worse and I’ve been through more stress but holy hell have I been bad at dealing with it. Like, sure, I deal with it logically but I’m having full out breakdowns after getting groceries, aka locking myself in the bedroom all day. I can’t go for a drive to cruise around the local neighborhood full of horses without coming back a mess, and am much worse if I go out to the (less than local) craft store because fuck if I’m going to support Hobby Lobby. There was a point in time before all of this that I could actually drive 52 minutes to Michael’s, browse the whole store, stop for a taco, drive 52 minutes home and NOT want to die on arriving, and need 3 days to recover.

And it took a LOT of deep diving looking on uterine and reproductive health websites (official ones of ob/gyns and “women’s health” doctors), with gentle caveats that you’re not going crazy, nothing’s wrong with you, that you’re not alone, and this is completely, utterly normal.

Hormones CAN actually help!

There’s a lot of argument from people about taking “natural” supplements and not shoving your body full of drugs and chemicals. But see, those people are wrong, and not for the usual reasons. One, is because progesterone is completely natural, it occurs naturally in the body. If you’re thinking “but it’s synthesized!” you’re thinking of progestin. It’s a progesterone like substance that is synthesized, and is almost always used to alleviate issues in relation to abnormal periods. Progesterone IS synthesized, yes, however it’s called “bio-identical synthesis” which means that it is so close to real, naturally occurring progesterone that there is literally no testable difference.

Progesterone does many things, mostly taming the levels of out of control hormones in your body, because your body’s had that thing in it for most likely 35+ years, and now it needs a few to figure shit out. Why not help? I just imagine progesterone like a lion tamer of old, waving a chair and snapping a whip at my wild hormones. (Or maybe a dominatrix in leather and– y’know what, I’ll just stop)

It’s recommended that progesterone be taken before bed because it’s a very mild sedative as well as a hormone controller. But it can ease a whole host of problems, and make life a lot easier in general. I mean, in my case, I cut out wheat because of IBS-induced brain fog and stuff (and it’s always affected me I just never realized, cuz y’know. 2 and 2 and shit. I can’t do math), and I can barely enjoy it because I ALSO have brain fog due to about 4000 hot flashes.

Because, quite frankly, I’m not entirely sure I wouldn’t have like, a psychotic break or just up and die if this lasted for 7 and a half more years.

[Image description: Several plush frogs with a miniature tea set. Each plate has a progesterone tablet.]

Doctors, people need your education!

It’d be goddamned lovely if doctors would EDUCATE people, and not just go “well you can look it up”.

BECAUSE YOU CAN’T. Not without a lot of work, and most people would just give up when they get to the eighth or so article that tells you to quit sugar and caffeine and drink one of these teas, and soy milk will solve all of your problems (as long as you don’t remember that phytoestrogens can cause issues if you’re prone to certain types of cancers!).

This really just makes me think of the fact that my doctors never told me a LOT.

I have a lot of health issues that cropped up after my initial emergency surgery in 2017 that they never told me! [Ed. note: This removed a problem ovary; the later hysterectomy and chemo were in 2019] And if I self-diagnose with quantifiable stuff like digestive issues or what have you (or tell them something that leads to a diagnosis, like lymphedema) they just say “oh yeah that’s normal”.

SO WHY DIDN’T YOU TELL ME?!

Especially since most of these things require (possibly drastic) lifestyle changes!

These things that I was never told include:

The entire source of this article, re: hot flashes.
lymphedema of my legs from my cancer treatment (chemo can do some wild stuff y’all)
damage to my toenails, which may be permanently ruined by chemo
digestive disturbances which include gluten intolerance and lactose intolerance, among other things, some of which can be related to abdominal surgery, and some of which can be due to menopause and hot flashes.
vaginal disturbance which requires purchasing dilators and using them DAILY (yeah, I was never educated on this! No mention of treatment of any kind, no mention that I would need to buy dilators, or that I might need vaginal lubricant to combat dryness, or even that sex or masturbation might be painful, even if we usually know that one)

Links to sources; these are not sponsors and have no idea we exist:

Progesterone Benefits via Leigh Ann Scott, MD

Hormone Therapy for Menopause via Cleveland Clinic

A Progesterone Infographic via VeryWellHealth

Damien Fox is my super cool spouse, a writer, and an artist. For more of xeir work, check out xeir Redbubble, their Tumblr and FA page, as well as xeir Twitter, or read any of xeir other guest posts on Queer Earthling!

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