The occurrences started subtly: a minor leak when I chuckled too vigorously or when I had a sudden sneeze, negligible wetness that barely caught my attention. However, the reality was unsettling considering I was only 46 and facing such uncomfortable changes.
This was not my first encounter with the disconcerting symptoms of perimenopause. For several years now, sweaty night awakenings and an unexplainable propensity to weep have become common phenomena. Even the increasingly tight comfort of my trousers was something that I came to accept as a part of the midlife process. It wasn’t all bad – there were aspects of ageing I truly cherished. But, this strange leakage was alarming enough to convince me that I required professional guidance.
It’s not as if I hadn’t sought assistance before. A few earlier encounters with my general practitioner, however, had engendered hesitation. The male doctor I had consulted dismissed my concerns about bodily transformations as premature, implying that I was being impatient. Unconvinced, I decided to consult a female doctor next. Nevertheless, her lacklustre response dampened my hopes and confidence. Instead of guidance, I was met with a bleak prediction: it’s bound to get worse.
I could have been more assertive or tried again, perhaps more firmly. But these rejections, mixed with my own resistance to face the reality of my body’s evolution, made me retreat.
The turning point was a conversation with a friend. A year my senior, she was struggling with severe musculoskeletal discomfort. When she shared that hormone replacement therapy (HRT) prescribed by her GP had remarkably alleviated her pain, my resolve was instantly steeled. I was determined to seek better medical support for myself.
This time around, I took a different approach. My next step was booking an appointment with a GP practice distinct from the previous one – a place that boasted of a dedicated menopause clinic.
The receptionist handed me a questionnaire to evaluate potential menopausal symptoms prior to my doctor’s appointment. It presented a range of 30 symptoms, from which I was to select those that I related with. I chose 13 of them: hot flashes during the day, nocturnal perspiration, change in menstrual cycle, muscle pains, reduced sexual desire, difficulties in selecting appropriate words, gaining weight around the abdomen, urinary issues, emotional lability, insufficient sleep, exhaustion, nervousness, and annoyance so severe I almost marked it twice.
Upon entering the consultant’s room, I presented my completed form. The medic attentively looked at my indications and discussed each symptom with me. During that dialog, I felt at last like someone ratified my symptoms as legitimate and deserving of medical attention.
I expressed my displeasure about the urinary disturbances, clarifying that they were the primary reason I sought medical help. The doctor expressed empathetic understanding. I was under the impression that since I hadn’t given birth, I wouldn’t face such issues. The doctor rebutted my assumption with warmth, enlightening me that female body relies on oestrogen to maintain its muscles, especially those surrounding the bladder and stomach. The information that oestrogen served purposes beyond fertility, was a revelation to me.
The doctor proposed that I would benefit from Hormone Replacement Therapy (HRT), detailing its effects, side effects, dangers, and advantages. Having previously undergone breast lump excision, I was particularly apprehensive about the possible association of HRT with breast cancer. The consultant clarified that earlier research involved older ladies and outdated oral HRT drugs which carried different risks in comparison to recent therapeutic regimes. She also reassured me by arranging an appointment at the breast clinic in the hospital for further evaluation.
Despite the favourable balance between risks and benefits, I couldn’t help but hesitate. Should I really barge in or stay quiet and bear with it?
The doctor addressed my hesitation with a simple phrase that was akin to magic: “You don’t have to endure this anymore.”
The First Treatment
Several weeks later, the Breast Care unit at St James’s Hospital confirmed my all-clear, permitting me to proceed with my first HRT regimen that very afternoon. Collecting the medication from the pharmacy, I felt a sense of control over my life returning. Yet – quite predictably – I placed the medication bag on my bathroom shelf and didn’t use it for the following week.
Acknowledging the need for HRT felt akin to admitting defeat for me. It also seemed to concede the closure of my attempts to conceive. After a tormented night of sweaty restlessness, I finally applied my inaugural oestrogen patch and later took my first progesterone tablet before bedtime. To my surprise, I enjoyed the most restful sleep I’d had in a long time, seemingly due to the sedative properties of progesterone.
A month into my HRT journey, the physical discomforts started subsiding. Not only did I feel a physical respite, but an unexpected improvement elsewhere took me by surprise. For a couple of years, I’ve been dealing with debilitating anxiety. Simple tasks would send me into a whirlwind of panic. Replying to a friend’s message seemed like a monumental effort. I had unintentionally distanced some friends as I struggled to manage the stress associated with organising meet-ups. I’d attributed this to middle age and the repercussions of a global pandemic. A shrunken life seemed my new normal.
However, within a few weeks into starting HRT, I could feel my spirits lift. It appeared that my anxiety stemmed from low oestrogen levels. Gradually, I began to emerge from the seclusion that perimenopause had slowly forced me into, reconnecting with life and friends.
The complexity of it unfolded over time. At my first yearly review post commencing HRT, I shared with the doctor my improved state and also raised my ongoing issues. I was still struggling with word recall and remembering ideas that occurred just shortly before. When the doctor probed if it was like a ‘brain fog’, I, being a literal person, pictured my head filled with actual mist. After some thought, however, I described that it felt more like losing my mind. She affably reassured me that this was, indeed, brain fog. I then brought up my decreased libido, which the doctor acknowledged understandingly.
Then I brought up the issue that was continuously haunting me – the terror of incontinence. I attempted to inject some humour around the topic, yet it quickly dawned upon me that I was trying to trivialise my greatest fear. I compelled myself to be louder, more assertive with my words. “The reality,” I said, “is that I am passing urine unintentionally.” Voicing these feelings was strange yet liberating.
Subsequently, the physician and I came to a consensus about raising my Hormone Replacement Therapy (HRT) dosage and incorporating testosterone into my prescription. I administer the testosterone as a gel, rubbing a tiny dollop into my skin each morning. Although diminutive in quantity, it has instigated a remarkable change in both my sexual drive and cognitive clarity. I carry a sensation of being more present in my bodily self and feeling more genuine. There are moments when I am overwhelmed with a blend of relief and sheer happiness due to such alterations.
Nonetheless, it hasn’t been a smooth journey. The increased HRT dosage didn’t sit well with me. So, during my subsequent meeting with the doctor, we returned to the prior, lower dosage. Additionally, I was prescribed vaginal oestrogen and directed to a women’s health physiotherapy professional.
Pelvic Physiotherapy
At the therapy clinic, I was anxious about both retelling the frequency of my restroom visits and the impending physical examination. However, the pragmatic attitude of the physiotherapist swiftly put me at ease. Even during the physical examination, when she inserted her gloved finger into my vagina to examine my muscle response, I felt unfazed.
The focus of the physiotherapist’s diagnosis was my overused pelvic floor muscles, leading them to tighten. I always had a lingering fear about weakening pelvic floor muscles, but the truth was the exact opposite due to my role as a lecturer, which involved standing for extended periods without restroom breaks.
My physiotherapist educated me on how strained pelvic muscles can induce pelvic discomfort or sexual pain. She recommended pelvic breathing exercises and encouraged me to relax my muscles. After leaving the clinic, I carried with me a renewed understanding of my body and a ray of hope.
On my journey back home, I shared about my experience by sending a recorded message to a close confidant. The response from my friend humorously suggested my pelvic floor was attempting to exceed its capabilities. This opinion was passed along to my sister and her boisterous laughter lightened my mood – feeling much like a burden had been lifted.
After the passing of three months and an equal number of visits, my physical therapist pronounced that my condition had fully recovered. No further incontinence issues were reported.
I recount these experiences to my sister and my circle of friends, both female and male, as hearing the stories of other women gave me the courage to seek help. The subject of menopause may still be largely brushed under the carpet, initiating conversations about it can be challenging. However, it’s a worthwhile effort since even though the term menopause is no longer taboo, numerous women continue to experience needless distress.
The Gap in Reproductive Healthcare
The lack of widespread understanding about menopause appears to be an unfortunate continuation of the embarrassment and negative perception that relates to the female anatomy, sexual behaviours and reproductive mechanisms.
It’s perplexing why knowledge and power surrounding women’s healthcare continue to be glaringly constrained.
While societal and medical arenas are going through a transformation, the snail’s pace at which this change is happening is challenging to tolerate.
Amidst these difficulties, the only approach that seems feasible for many is the softer one – discussing with our friends, seeking out reputable doctors, and bracing ourselves to reveal our deepest fears, intimate complications, and weak bladders in public.
All we’re really acknowledging, in truth, is the existence of our female forms.
Emilie Pine, the author of a narrative memoir called ‘Notes to Self’ has penned these thoughts.