I Started Hormone Replacement Therapy at 36

What is perimenopause, and how does it impact younger women?

December 07, 2024

Opening the box I felt a flood of nervousness. Chest heaving, fingers shaking, I reached in and pulled out what looked to be a fancy, square band-aid package. Taking a deep breath, I slowly began to tear the plastic wrapping where the paper was labeled “TEAR HERE”. For some reason I imagined a large flesh-toned bandage, so sticky it might rip my skin off three days later when I’d next have to replace my next patch. Shuddering at the thought, I reached inside and felt…nothing. Furrowing my brow in confusion, I attempted again, this time scraping at each side of the package with my index finger. My nail caught the edge of a small, plastic something. Pulling it out to reveal a small clear looking patch adhered to two plastic wrappings, about the size of a dime. Instead of worrying about the large band-aid ripping off my skin, I now became quite concerned about this tiny piece of flexible plastic never adhering to my large, very dry, upper buttocks. I have to choose my upper glute or one of my pronounced peri-jelly-rolls for this important mission, and figure the best place is somewhere that I won’t accidentally pull it off or obsess about its presence.

The instructions said to apply it as though you would a sterile bandage - peel one plastic wrapping off, stick that side to the skin, and then gently pull the other side off and press down for 10 seconds - and you’re good to go. Only, nothing ever happens the way it should.

As I’m attempting to do this, it becomes clear to me that my eyesight is not as good as it once was, trying to fumble around to figure out which side is even the adhesive side. I carefully peel one side away, as precision is everything. There was a warning on the box which stated, “DO NOT TOUCH PATCH WITH FINGERS DURING APPLICATION”. As a majority rule follower, especially as a patient, I do everything to comply. I gingerly place the patch on my fatty upper bottom. As I attempt to pull the last wrapping off, the sticky part which was once semi-attached, just pops right off. Desperate, I panic. I take my thumb nail and peel the sticker off. As the tiny patch is delicately adhered to my nail, something as small as a puff of breath could send this little hormone-laden dot flying into the abyss of my own blindness - I scramble like a madwoman to stick it on - except, now that it’s on my left thumb, I can’t get it on my right side as I was planning to do. Again, in a panic, I whip around quickly, slap this little sticker on my left upper ass, and pray that it’s going to stay. It looks about as secure as a toddler in an adult seat belt. Audibly both cussing and praying at the same time, I press firmly on this sticker for ten seconds. Regardless of if it sticks or not, stays or doesn’t, the deed is done.

As comically entertaining as this scene is in type, I can't help but pose the question, “Why?” Why is something which should be so easy actually so hard? Why don’t we know about menopause? Why don’t we hear about hormone replacement therapy until we are in the rooms of our doctors, talking in hushed tones as though we are talking about acquiring street drugs? Why don’t we learn about this as girls when we begin our cycles? Why didn't anyone tell me that it could happen in my 30’s, and why didn’t they tell me what happens to my body as I age? Why?

I am sure I know some of the answers to these inquiries, but none of them are ideal. The bottom line is that women’s health, nor women’s suffering, has ever been made a priority or even acknowledged. The problem is that I thought two years ago that when my symptoms became more prominent that I was legitimately dying. Let me back up for a moment:

After the covid infection I contracted in March 2020 that progressed to my long covid and POTS diagnosis, things were still not adding up. Despite having been diagnosed with POTS, I had other intermingled symptoms that didn't match. However, no one really looked into them and shoved it all under the blanket diagnosis of long covid. “We really don’t know what this virus does because it’s so new,” I would hear several times from multiple doctors. Perfect; the all-encompassing scapegoat which doctors could use in order to dismiss my persisting problems. Despite my POTS symptoms slowly getting better with intervention, I was still left with a laundry list of issues I hadn’t had before: I had my first hot flash in June 2020. I was told that it ‘can happen’ when your hormones are ‘imbalanced’ and that if it happened again, I’d need to see a doctor. It did happen again, albeit to a smaller extent. They told me I had low vitamin D and that my physical exam was great. I was given a megadose of vitamin D and sent on my way.

Months later I began noticing more bizarre symptoms that I was, quite frankly, too exhausted to deal with and shoved under the catch-all covid umbrella. Symptoms such as an increase in palpitations confirmed by a heart monitor, struggles with sleep disturbance (of which sleep apnea was ruled out), and quick hot and cold flushes. Again, I was under the assumption these transient symptoms were post-covid related.

In 2022, these symptoms became difficult to ignore. Many nights I would wake up with a heart rate of 160, feeling as though I was sleeping in a fire pit. Some nights, I would never fall asleep until 4am or 5am while utterly exhausted. Temperature control became more difficult - one moment, I’d be burning up with a high heart rate and the next, I’d be freezing my tail off. Brain fog was at an all time high, and joint pain set in for the first time in my life. Severe mood swings wrecked my day to day, to the point where I was worrying my husband and children. They felt as though they were living with a stranger. I felt like a stranger to myself. I was diagnosed with PMDD at 33. Now, some of these symptoms do overlap with POTS. However, the next set of symptoms do not.

By end of 2022, I was having full on hot flashes. I remember the first time I had a big one, I panicked. My face, neck, and chest flushed lobster red, and I felt like my skin had been sunburned, radiating heat from all over. Nausea hit and I seriously contemplated running to the nearest toilet, but thankfully it subsided within a few minutes. That hot flash lasted 55 minutes. Though infrequent, I still get them.

Despite the clear telltale perimenopause symptom of hot flashes, I also experienced a change in my periods. At first, it was subtle. I began to spot at the end of my periods - for days. Every 3-4 months I would have a 10 day period. At first, I wasn’t concerned as the last 4 days were just light or spotting. It also didn’t happen every month, so I just kept waiting. They also became heavier on days 2 and 3, which I already struggled with since my second child was born. (THE REST OF THIS PARAGRAPH MAY BE TOO GRAPHIC FOR SOME READERS. PLEASE SKIP TO NEXT PARAGRAPH IF BODILY FUNCTIONS BOTHER YOU) However, more than once, I would be in the restroom on the toilet and blood would pour like a faucet, creating splashes in the water. I decided with both of these menstrual changes, I’d see my OBGYN. I told all of this to her only for her to say that it sounded consistent with my history of heavy cycles. I told her that, no, this was worse, and different. The next time it happened, I was told to send over a picture. I did, and that’s when my OB said, “That is quite a lot of blood and considered abnormal.” I scheduled another visit.

In the meantime, I started going back in my tracking app and looking for any patterns that may look strange or may be unusual. I started to realize that since 2022, I’d had multiple periods where bleeding was heavier than normal and several where I’d spotted for many days after. Once I was able to see her again, I brought all of this up, as well as the potential diagnosis of perimenopause. Perimenopause was instantaneously dismissed. “You’re too young. You’re 34. It’s not possible.” I felt dejected and dismissed. “However, there’s a chance you could have the beginning of endometrial cancer. I think we should do a biopsy and an ultrasound to rule it out.” After many questions and explanations, I left the office confused and terrified. Cancer? I’d asked what the risk factors and symptoms for this cancer were and there are only 2. “Being overweight and heavy bleeding.” That’s it?, I thought. How is cancer a real concern, but early perimenopause is impossible? I reeled over this for months.

In May of 2022, I had an endometrial biopsy (do not recommend) and a transvaginal ultrasound to rule out cancer. Thankfully, we were able to rule out cancer, but I was instead diagnosed with adenomyosis, a condition that causes the lining of the uterus to grow into the muscular wall of the uterus - very similar to endometriosis. “That’s what’s causing your heavy bleeding,” my doctor cooed proudly, as though she had figured it all out. “Does this condition explain the hot flashes, night sweats, insomnia, and other issues I’ve been having?” I asked, sincerely. Her face flattened. “No, that’s caused by a hormonal imbalance. If you’ll take this progestin birth control I’ve prescribed, you’ll be fine.” And that was that.

Every time I would come back complaining, even after starting the pill, she would dismiss it as “some sort of imbalance” in my hormones. “But, isn’t perimenopause essentially an imbalance of hormones?” I finally asked, quite annoyed. “You are too young for perimenopause,” she quipped, “and you can have hormone imbalances before perimenopause too, it can happen anytime and it is NOT perimenopause.” she said dryly. I haven’t mentioned it to her since. Instead, I found a menopause subreddit which lead me to find a menopause clinic near me - a place full of doctors that specialize in exactly what I needed.

After chatting with the head menopause specialist, she believes I am in perimenopause - and so did an OBGYN who I’d asked in the meantime for a second opinion. However, because I am on the young side, it’s still much more difficult and tedious than treating a woman in her 40’s or 50s, when perimenopause typically occurs. “I have to test your estradiol before you start the patch,” the menopause specialist warned, just to make sure I wasn’t producing too much on my own already. “I also must tell you that the pill you’re on is new and hasn’t been studied in conjunction with estradiol patch use. We anticipate that it would respond the same way as it does to the mini-pill, but because there’s no research, I have to tell you that this usage is off label and we don’t know the extent of the risks - primarily cancer-related risks.” While this intimidated me a little, it doesn’t scare me.

What did scare me were the several nights a month where I couldn’t fall asleep, even though I was crying from such extreme exhaustion. I was terrified when I’d wake up on fire, heart racing, and wanting to wretch from the extreme discomfort. I was terrified of having a hemorrhage and bleeding out before I could get to a hospital. Not being able to recall words, forgetting my groceries numerous times in the trunk, and not being able to think clearly all made me afraid I was getting early-onset dementia. My entire life I have been incredibly detail oriented, efficient, and worked under the constraint of perfection. I rarely made mistakes; then suddenly, overnight, I’m making careless mistakes all the time. I can’t remember how many times I’ve berated myself and cried over my deteriorating mental state. I was worried I had a thyroid or some other undetected condition causing these hot and cold flashes. I was tested for a cortisol disorder due to insomnia and nightly 3am waking, all of which came back normal. With this, what seemed like barrage of never-ending intensifying symptoms, I thought surely I was on my way to being six feet underground.

Most of my peers and friends don’t understand - they’re not yet in perimenopause. In fact, several of them are just beginning their families and having children, while I already have two halfway on their way to adulthood. Not knowing what this would bring for me has lead me to feel alone and ostracized. I can no longer relate to childbirth or pregnancy, to raising little ones and having unending energy. The memory of it all just seems so far away. I’m tired. My joints crack, my muscles ache, and my body feels as though it’s tearing itself apart, pieces of me slowly floating away back into the arms of Mother Nature. The concerns of young women no longer belong to me. At first I felt a pang of poignancy. Before long I will not be able to bear children, even if I desired to do so. And yet…

With this internal physical reckoning, this battle of the hormones, emerges a new and beautiful power: the power of not giving a fuck. I feel so free, so brand new, as though the air I breathe is all crisp and fresh and infused with the knowing that I am truly ALIVE. In losing the reproductive nature of myself, I am gaining so much more - the power to embody everything that I am.

It only took one doctor to believe me, just one person to tell me I wasn’t crazy, and it wasn’t all somatic, for me to break down into tears of relief. Thank God, someone finally believed that I could be in perimenopause. I remember the second OBGYN saying, “I see women complaining of the exact symptoms you’re complaining of all of the time. 99% of them are in perimenopause, and I’m 99% sure you’re in perimenopause too.” That was all it took. After four years of symptoms, two years of being fobbed off and dismissed, and hundreds of sleepless nights begging for mercy, I received the blessing.

Writing about my experience now fills me with rage; not only for myself, but on behalf of all women. I don’t like to write just to expose you all to TMI, although I can’t say that within itself would dissuade me from sharing; but I write, in this case, to attempt to reduce our suffering as women. Why should anyone be subjected to this type of treatment? Being dismissed, even belittled, when we are simply doing what we are taught? To make sure we take care of ourselves. I didn’t mind doing all of the testing to rule out cancer, thyroid disorders, and cortisol disorders. What I did mind was that instead of saying, “I believe you - let’s investigate.” I was met with, “That’s not possible. Here’s a pill.” That is not supportive, equitable care. Dear reader, do you know how much money I wasted on unnecessary tests, multiple doctors visits, new patient appointments, and supplements and medicines? Should it take a person FOUR YEARS to get a doctor to just say the measly words, “I believe you”? The state of women’s healthcare is in shambles, and if my experience can prevent even one woman from feeling terrified, throwing away her time, and wasting her money, I am grateful.

Today, at 36.5 years old, I officially started HRT (Hormone Replacement Therapy). Am I nervous? A little. I’m trekking into the unknown for not only myself, but for the field of medicine as well. What I can say, though, is that if this patch makes me feel half as good as the vaginal estradiol cream helped me to feel, I will be on top of the world - unknown cancer risk be damned. Because I deserve better care, and compassion as a human; because all women deserve better care and compassion.

IF YOU’D LIKE TO LEARN MORE ABOUT PERIMENOPAUSE, PLEASE VISIT THE LINKS BELOW.

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