The Bitch Is Back

Are menopausal women mad, bad, and dangerous? Yes—but they’re really just returning to normal.

During menopause, a woman can feel like the only way she can continue to exist for 10 more seconds inside her crawling, burning skin is to walk screaming into the sea—grandly, epically, and terrifyingly, like a 15-foot-tall Greek tragic figure wearing a giant, pop-eyed wooden mask. Or she may remain in the kitchen and begin hurling objects at her family: telephones, coffee cups, plates. Or, as my mother did in the 1970s, she may just eerily disappear into her bedroom, like a tide washing out—curtains drawn, door locked, dead to the world, for days, weeks, months (some moms went silent for years). Oh, for a tribal cauldron to dive into, a harvest moon to howl at, or even an online service that provides—here’s an idea!—demon gypsy lovers.

But no, this is 21st-century America, so there is no ancient womyn’s magic for us but rather, as usual for female passages, a stack of medically themed self-help books. (I ask you: Where are the vampire novels for perimenopausal women? Werewolf tales? Pirate movies?) That’s right—to fully get our crone on, we’re supposed to read, even though it may feel, what with the giant Greek chthonic headpiece, that one can barely see out the eyeholes. (Who can focus on words on a page? Who can even remember where she left her giant octagonal Medea-size reading glasses?) Rest assured, though: I’m here to help. Gentle reader, if you are a female of transitional age, which can apparently be anywhere from 35 to 65 these days, let me be your Virgil to the literature of menopause. Long have I wandered through the dry riverbeds, long have I suffered; now I’ve come back to share my wisdom.

To set the stage, here is a selection of titles from my local bookstore’s women’s section: Could It Be … Perimenopause?; Before Your Time: The Early Menopause Survival Guide; The Natural Menopause Plan; Second Spring; Menopause Reset!: Reverse Weight Gain, Speed Fat Loss, and Get Your Body Back in 3 Simple Steps; and the slightly ominously titled What Nurses Know … Menopause (two words: atrophic vaginitis). On the cover of a typical menopause book, instead of the perhaps more to-the-point fanged woman with the Medusa do, one is far more likely to see a lone flower—a poppy, perhaps a daisy. Curious choice? Well, no, because as one begins to read the war stories of the M.D., Ph.D., and R.N. (atrophic vaginitis!) authors who dominate this genre, one sees narratives that are indeed Stuart Smalley–esque. Here’s a pastiche:

Mary Anne, age 48, came into my office feeling overweight and bloated. She hadn’t been sleeping, work was stressful, her husband had just gone on disability, and he required daily care. Mary Anne complained to me of lower-back problems and gastritis, and also cramping during sex, which had become more and more infrequent. She was extremely depressed about moving her 84-year-old mother to a nursing home, and upon examination I noticed vaginal inflammation.

As unappetizing as that just was to read, be glad you saw only one such passage—I must have read a hundred. Because clearly, from the medical-professional point of view, menopause, or really the run-up to it called perimenopause, is a parade of baleful, bloated middle-aged women (“Lisa, 52,” “Carolyn, 47,” “Suzanne, 61”) trudging into their doctors’ offices complaining of lower-back pain and family care-giving issues and diminished libidos and personal dryness and corns. As they sit wanly on the tables in their paper gowns, they arduously count out their irregular periods—from 35 days to 44 days to 57, going heavy to light, light to heavy, sometimes with spotting, sometimes with flooding, sometimes flood-spotting, sometimes spot-flooding. Why this variation? So easy to understand, really. The simple science: ovarian production of the estrogens and progesterone becomes erratic during perimenopause, with unpredictable fluctuations in levels, which in turn can result in many different symptoms, including major mood swings. But sometimes not. You may never feel any of this! Because here’s the key: All women are different.

And yet, even though we all are different, the list of prescriptions for us seems to be very much the same, and none of it’s fun. If one must tinker with hormone-replacement therapy, one may—briefly, in moderation. But from this point on, The Change is about healthy lifestyle. We’re all to get more exercise, drink more water, do yoga stretches before bed, cut out alcohol and caffeine, and yet (and how does this follow?) reduce stress. Even the flirty exhortations to have more sex feel like yet another job on life’s chore wheel (given that it’s supposed to be with your mate of 20 years rather than with Johnny Depp). And don’t forget all the deep sensory pleasures of a reduced-calorie diet. Menopause Reset! at least initially seemed to promise a nutritional miracle cure for that mysterious spare beach floaty that arrives after 40. I for one was excited to see that, instead of Black Swan–ing it until dinner, as apparently so many of us women do (in order to heap our measly 1,500 calories together into one meal a person might actually want to eat), you’re supposed to eat many tiny meals constantly. Hurray! But alas, after reading much dietary advice for menopausal women, I concluded that, in the horrible new metrics of midlife, each of the following constitutes a meal:

Meal No. 1 (8 a.m.):
2 tsp. nonfat yogurt

Meal No. 2 (10 a.m.):
3 almonds (unsalted)

Meal No. 3 (12 p.m.)
2 oz. low-fat barley soufflé (see Appendix D)

Meal No. 4 (2 p.m.)
small Bell pepper
1 tsp. flaxseed

Just staying awake all day to eat the food—while of course getting in those 15 reps an hour of sex with your 50-something husband—seems a challenge. No wine, though: best to pair vaginal dryness with buckwheat tempeh. Oh! Oh! Oh! Where is the plate-glass window to hurl phone through? Why is life worth living? Ouch, my corns!

So that’s the basic physiological landscape of menopause. Dry as the riverbeds can seem, though, one menopause book does rise like Mount Etna above the rest. Now celebrating its 10th anniversary, it is the bible of middle-aged womanhood: The Wisdom of Menopause, by Christiane Northrup, M.D. Having recently spent (20? 50? 80?) hours with it, I’ve come to believe that The Wisdom of Menopause is a masterwork. Weighing in at two pounds and 656 pages, it is an astonishingly complete, mind-bogglingly detailed orrery of the achingly complex, wheels-and-dials-filled Ptolemaic universe that is Womanhood. Featuring, arch-conventionally, its smiling doctor/author on a soothing pastel cover, the book is very much of the genre, and yet explodes it. Northrup presents both a celebration of Western medical practice and a revolt against it. Three times as big as the others, Wisdom is no less than the Jupiter in the menopause-book solar system, our Gravity’s Rainbow.

Let me now gloriously unbutton my too-tight mom jeans, wave my Hadassah arms (even more hideous term heard recently—bat wings), and wax on. Are you grasping, yet, the scope of this thing? Wisdom is a Homeric poem of modern femalehood. No stone from Western or Eastern (or Southern or Northern) medicine is left unturned, from folic acid to breast exams to personal dancing to selenium to feng shui to cosmetic surgery (Northrup allows it, while counseling discretion as a protection against judgmental friends). Woo-woo passages on Motherpeace Tarot cards and the chakra work of the astrologer Barbara Hand Clow alternate with biological analyses of an almost kidney-squeezing complexity. Which is not to say there isn’t tons of news you can use:

I highly recommend a snack at around four in the afternoon, right during the time when blood sugar, mood, and serotonin tend to plummet.

This totally hit home. Although the Hour of the Wolf is typically considered 4 o’clock in the morning, for many mothers of school-age children, how many of our inner wolves appear at afternoon carpool time?

Even Suze Orman makes a guest appearance, in a TV green room (the place where all modern witches gather):

She told me that you can see people’s ill health in their money and cash flow first because money has nowhere to hide an energy imbalance.

You either have positive cash flow or you have debt. Simple. Sooner or later, if the behavior patterns and beliefs that create money problems are not addressed, they will manifest as health problems in the body.

I couldn’t help gasping in recognition again and penciling in the margin, like Woody Allen’s “Whore of Mensa,” “Yes, very true.” You see? Wisdom is of such a multitasking, infinitely varied scope that I think few men could tolerate it, or even maintain consciousness through it. But they remain ignorant at their peril!

All of that said, even under my inspiring leadership, it is unlikely the targeted demographic of women will ever engage in Bloomsday-like readings of Wisdom, as is done with Joyce’s Ulysses. (Groused a girlfriend to whom I was manically recommending it: “Why should I bother? Every day of menopause already feels like you’re reading a 600-page book.”) So, for the bloated and tired, let me give you the CliffsNotes.

Today women between the ages of 44 and 65 are the largest demographic group. So it’s no surprise that Northrup considers menopause a major cultural event. Without going into the sometimes arduous detail other feminist texts do (the rising or falling number of women in government, the social architecture of food-sharing collectives), Northrup suggests this gigantic demographic transition will change society—somehow—for the better. All well and good, no arguments there, but now here comes the juicy core of Wisdom:

A woman once told me that when her mother was approaching the age of menopause, her father sat the whole family down and said, “Kids, your mother may be going through some changes now, and I want you to be prepared. Your Uncle Ralph told me that when your Aunt Carol went through the change, she threw a leg of lamb right out the window!” Although this story fits beautifully into the stereotype of the “crazy” menopausal woman, it should not be overlooked that throwing the leg of lamb out the window may have been Aunt Carol’s outward expression of the process going on within her soul: the reclaiming of self. Perhaps it was her way of saying how tired she was of waiting on her family, of signaling

to them that she was past the cook/chauffeur/dishwasher stage of life. For many women, if not most, part of this reclamation process includes getting in touch with anger and, perhaps, blowing up at loved ones for the first time.

Woo-woo! Duck, Uncle Ralph! Go, Aunt Carol!

In short, never mind the wavy-graph technicalities of all those estrogen/progesterone/FSH fluctuations. Opines the doctor:

I think it’s useful to get your hormone levels tested. But it’s far more useful to tune in to how you’re feeling than to focus on a lab test, which gives, after all, just a single snapshot of an ever-changing process.

What the phrase wisdom of menopause stands for, in the end, is that, as the female body’s egg-producing abilities and levels of estrogen and other reproductive hormones begin to wane, so does the hormonal cloud of our nurturing instincts. During this huge biological shift, our brain, temperament, and behaviors will begin to change—as then must, alarmingly, our relationships. As one Northrup chapter title tells it, “Menopause Puts Your Life Under a Microscope,” and the message, painful as it is, is: “Grow … or die.”

It’s intriguing to ponder this suggested reversal of what has traditionally been thought to be the woman’s hormonal cloud. A sudden influx of hormones is not what causes 50-year-old Aunt Carol to throw the leg of lamb out the window. Improperly balanced hormones were probably the culprit. Fertility’s amped-up reproductive hormones helped Aunt Carol 30 years ago to begin her mysterious automatic weekly ritual of roasting lamb just so and laying out 12 settings of silverware with an OCD-like attention to detail while cheerfully washing and folding and ironing the family laundry. No normal person would do that—look at the rest of the family: they are reading the paper and lazing about like rational, sensible people. And now that Aunt Carol’s hormonal cloud is finally wearing off, it’s not a tragedy, or an abnormality, or her going crazy—it just means she can rejoin the rest of the human race: she can be the same selfish, non-nurturing, non-bonding type of person everyone else is. (And so what if get-well casseroles won’t get baked, PTAs will collapse, and in-laws will go for decades without being sent a single greeting card? Paging Aunt Carol! The old Aunt Carol!)

One could further argue that all of these menopausal women, in fact, represent a major evolutionary shift. Owing to women’s greatly lengthened lifespan (from about 40 in 1900 to 80 in 2000 in the U.S.), even the notion of what a woman’s so-called normal state is can be questioned: Northrup notes that before this time in history, most women never reached menopause—they died before it could arrive. If, in an 80-year life span, a female is fertile for about 25 years (let’s call it ages 15 to 40), it is not menopause that triggers the mind-altering and hormone-altering variation; the hormonal “disturbance” is actually fertility. Fertility is The Change. It is during fertility that a female loses herself, and enters that cloud overly rich in estrogen. And of course, simply chronologically speaking, over the whole span of her life, the self-abnegation that fertility induces is not the norm—the more standard state of selfishness is.

Which is to say, if it comes at the right time, menopause is wisdom. For Northrup—whose own passage through menopause included a traumatic divorce, a narrative she relates with regret, but little apology—this seemed to be so. Menopause’s liberating narrative dovetails elegantly with a typical Baby Boomer female’s biological and chronological clock. When a woman gets married in her 20s, has children in her late 20s or early 30s, and begins to detach in her 40s, look where her nuclear family is by the time she reaches her menopausal wanderlust-filled 50s: her grown-up (say 18-year-old) children are leaving the nest; her perhaps slightly older (say 60-ish) husband is transitioning into gardening and fishing; her aged parents have conveniently died (let’s say back—and wouldn’t it be lovely?—when they slipped and injured a hip at, oh, 78).

Compare that time line, however, with the clock of my own generation of late-Boomer/Gen X women. Putting our careers and our Selves first, we adventured and traveled in our 20s, settled down and got married in our 30s, got pregnant (or tried to—fertility problems being the first surprising biological wall we hit) in our late 30s or even early 40s … and now what scenario will we face when we hit menopause?

In my case, when it arrived at 49, perimenopause was terrifying, and like nothing I had ever before physically experienced. It was not just the hot flashes, it was the mood swings, although the phrase mood swings sounds far too cartoon-like and teen-girlish. I would describe it as the sudden onset of a crippling, unreasoning gloom. It is like resting one’s hand on the familiar wall of one’s day—helping kids with homework, some grocery shopping, hurtling along on a favorite freeway, listening to Miles Davis—and then feeling the hand suddenly push through the wall, through foam spongy as the flesh of a drowned corpse, into … nothingness.

You experience anxiety at the notion of being face-to-face with your loved ones, because they will immediately read from your dull eyes that which you can no longer hide—that you don’t love them, never will again. (And note that I had already divorced my husband of several decades and had run off with my demon gypsy lover … Now I felt repulsion upon hearing the squeaky wheels of the recycling bin he was dutifully rolling out to the curb.) At one time, the sweet smell of your baby’s head was your whole world; now you can feel the clanging chime of her 10-year-old voice, note by note, draining your will to live. Where once you coordinated 70 volunteers and thousands of dollars of fund-raising with four- and fivefold Excel spreadsheets at your kids’ school, now the mere thought of trying to figure out how to pay the United Visa bill online makes you so depressed, you can’t get out of bed. Your chemistry has changed—and that is no small thing.

Even more unsettling is how, at night, the depression and anxiety are so much stranger and more intense than the minor quotidian irritants that seem to be tipping you off into hopelessness (the overflowing laundry basket, the $530 car-repair bill, the fact that the scale says you’re up—what is it?—eight pounds). The other night, I was awake at 3:24 a.m. as usual (melatonin, Tylenol PM, Ambien, forget it—I could take them all at once, paired with a bottle of wine, and still drive an 18-wheeler). As I lay in the darkness, all at once, the name Brian Hong surfaced in my consciousness and I experienced not a passing wave of despair, but despair simply moving in as a cold, straight tide.

I have no idea who Brian Hong is—I was filled with gloom simply because of the name. Perhaps there is, in fact, a lone forgotten yellow Post-it, somewhere on my rolltop desk with its gas bills and Discover-card solicitations and Blue Cross health-insurance forms, that reads Brian Hong. Perhaps Brian Hong is the head of a small Asian nonprofit who several months ago earnestly if a bit keeningly e-mailed me, citing as a referral the name of a mutual friend, to ask if I would drive an hour down to San Pedro to give a free speech at a fund-raising benefit for a flailing youth center for depressed gay minority teens at 10 a.m. three months from now on a cloudy Wednesday.

On the one hand, as a longtime veteran of the nonprofit world, I can no longer afford to humor the endless requests to do everything for free, particularly because no one treats you worse than the penniless. On the other hand, though, for me to categorically say no seems like a kick in the teeth to all the kids in the world who are already down; the result of this discomfiting indecision being that I NEVER REPLIED TO BRIAN HONG AT ALL, and so now, like that forgotten spongy corpse, he has come after me in the middle of the night to gently (because that is Brian Hong’s passive-aggressive way) but persistently (because that is also Brian Hong’s passive-aggressive way) haunt me. Brian Hong! Brian Hong! Brian Hong!

And of course, you can only expect it to get worse. I am a member of the “sandwich” generation, that group that must simultaneously care for elderly parents and support children. Never mind that I have lost the dreamlike 40-ish haze I was in during nursing and babyhood and toddlerhood, when the peach fuzz of my daughters’ cheeks made for a heady narcotic, when my heart thrilled at all their colorful pieces of kinderart, when I honestly enjoyed—oh the novelty, for someone who had pursued abstract subjects in college and graduate school for 10 years!—baking birthday cakes. Fifty-ish now, when I squat over to pick up their little socks and snip quesadillas into little bowls and yank fine hair out of their brushes, as I have now for the thousandth time, I feel like I’m in a dream, but a very bad, very sour-scented dream. I am fast losing patience with the day job of motherhood. Worse yet, I’ll be in the full fires of menopause just when my girls are in the full fires of adolescence! (As my good friend, the family therapist Wendy Mogel, observes, in her calm Zen/Torah–like way, “What wonderful insight you’ll have into their mood swings.”)

Meanwhile, my Shanghai-born father is 90 years old, has Parkinson’s, and is in a wheelchair … But that doesn’t mean, with his eerily Jack LaLanne–like resting pulse of 38, he isn’t frighteningly willful and able. Every day, my dad wheels himself down to the bus, shouting at his Malibu neighbors and at passing Mexican day laborers to help him; three hours later (via a trip that involves several bus transfers and all the shouting for help that comes with), he arrives at the UCLA campus, where he crashes chemistry and neurobiology lectures, wheeling himself to the front row, asking loud questions, disrupting the class, then going to the bathroom, getting stuck in the stall, and ordering Ph.D. students to help him. The bewildered science departments have been calling us, as well as the UCLA campus police, asking us to remove him or at least assign him a caregiver. We have to reply that we do have a full-time caregiver, but my father is impatient to get out in the mornings, won’t wait, and indeed, just as often, enjoys the sport of evading capture. I myself have chauffeured my father around, but eventually found myself unwilling, when the men’s room was five feet away, to continue to (manually) help him urinate on the street.

In light of my father’s situation, I have to question some of the clear-seeming lines Northrup draws. As she puts it:

Learn the difference between care and overcare. True care of others, from a place of unconditional love, enhances our health … That’s one reason why volunteering and community service feel good and are associated with improved health. Overcare and burnout result from not including ourselves on the list of people who require care … The way to tell the difference between the two is to be aware of how caring for another makes you feel. You must also be 100 percent honest about what you’re getting out of excessive care giving.

Pretty easy for you to say! The problem is, “overcare” is the only thing that ensures functioning lives for the many people who depend on the average woman. Sure, I could give it up—but the police and neighbors call every single day of the week, everysingle day. Who’s going to do the caring if I don’t overcare?

How often do I feel, midlife, as though I am in a strange Island of Doctor Moreau–like science experiment? My preteen daughters are flashing more and more midriff as they cavort to the (PG or R? If I could only make out the LYRICS!) gangsta rap of Radio Disney. My ridiculously old father is a giant baby who wheels his own crib into traffic, pees into a Starbucks cup, and still wields, intact, his own power of attorney. As I grow ever more sullen about it all, I feel I should be living alone in a perimenopausal cave.

So, who will supply all the caregiving when a whole sandwich generation of 50-ish women checks out? Maybe it will be men: related and hired men. I think of a phalanx of us standing recently in my father’s dining room in Malibu, trying to figure out a schedule for his care—or at the very least, for his capture. (From their homes in Northern California, my brother and sister provide all the financial and emotional support to all the caregivers, which is considerable.) In the room at that moment were my Chinese stepmother (74), myself (49), Filipino Nurse No. 1 (female, 60), Filipino Nurse No. 2 (female, 59), and Filipino Nurse No. 3 (male, 41). Who of us were going to take care of my dad? Since all of the women in the room knew all too well the difference between care and overcare, essentially everyone has now quit except for the 41-year-old male, who alone has the strength to heft my dad’s wheelchair in traffic, needs the money to support his own family of six, and is paid accordingly (which is to say well, far better than many young college graduates I know). I think also, thank heaven, of my girls’ 50-something father, he who holds up the other end of the 50/50 custody balance beam. He is unfailingly calm and patient, buys them fashionable new jeans and tennies, braids their hair, punches new holes in their pink belts, takes them camping, cooks them baked beans, and butters their corn on the cob. By a natural chronology that doesn’t imprison him in this Island of Doctor Moreau–like time line—given that he would not have dreamed of wanting to do all this as a touring musician of 25—my ex, I think, became a father at just the right stage, which is to say older. At his age, my girls have such a wonderfully nurturing father, he might as well be a mother.

I finally went for some estrogen replacement to the woman who would turn out to be my fabulous new gynecologist, Valerie—who is not in my Anthem Blue Cross PPO plan, but whom my demon lover insisted I go to anyway because that was our lesbian neighbors’ recommendation.

With kind blue eyes and a comfortingly patterned knit cardigan, exuding an air that you might expect from a Scandinavian maiden aunt, Valerie gently interviewed me—while continually handing me tissues—as I sat on the archetypal metal table in my own paper gown, weeping for what seemed like an hour. And I must tell you—as a middle-aged woman who labors mightily every day to wear the mask of being sane, admitting to experiencing only the narrowest spectrum of emotions, from good-humored cheer to only the lightest irritation, a mood soothed easily with a good chuckle thanks to NPR—that it is beyond delicious to ramble aloud about the infinite varieties, colors, and shades of one’s depressions and to discuss, ad nauseam, a month’s worth of various panic attacks (going heavy to light, light to heavy). Valerie, listening quietly, wrote down the dates of my periods on a tablet, lending my ravings a reassuring scientific structure, then she gave me one of the most deeply comforting speeches I have ever heard (who from central casting would you get to do it? Streep? Mirren? Lansbury?):

“Sandra,” she said, “I have this theory. Let me see if I can describe it for you. I think some girls are paper-plate girls, and some are Chinets. Paper plates collapse even if they have nothing on them; Chinets can take a lot heaped on them and never break. Yes, right now things feel very unstable, and you’re having an emotional response to what is a purely physiological phenomenon. But I think, at heart”—and here she leaned forward—“you’re a Chinet girl. What we’d like to do now is take some of the stressors off your plate, while at the same time temporarily strengthening its foundation.” And with that, she gently smeared the tiniest dot of clear estrogen gel on the inside of my wrist, and even though she said it would take a few weeks to take effect, I instantly felt high!

In conclusion, gentle reader, here are some handy tips, from women who have survived The Change. (These come after the project of draining your parents’ savings so Medicare can pay Filipino male orderlies to do everything.)

The first is a fantastically freeing gambit called “Now That I’m 50.” As my friend Denise puts it, “Now that I’m 50, I don’t visit my fighting in-laws in Cleveland anymore. My husband can go off and see them if he wants to, but I’ve been doing it for 20 years, and you know what? Never again.” (Beat.) “I’m 50!”

Another is one of my own invention that I call “Stuff It, Barbara Ehrenreich.” For years, I was afraid to hire domestic help, because Barbara Ehrenreich wrote in Nickel and Dimed that to have a Third World woman scrub your toilets is to oppress a fellow sister. But now that I can afford it, and I’ve come out of denial over the fact that to have a house cleaned professionally is unbelievably fantastic, once every three weeks, I bring in Marta—whom I refer to sometimes as Marta, and sometimes, baldly, as “the maid”—and when I do so, I silently flip Barbara Ehrenreich the finger. I’m (just about) 50!

A third, related, survival tip is to have no shame. The middle-aged women I know, clawing their way one day at a time through this passage, have no rules—they glue themselves together with absolutely anything they can get their hands on. They do estrogen cream, progesterone biocompounds, vaginal salves, coffee in the morning, big sandwiches at lunch. They drink water all day, they work out twice a week, hard, with personal trainers. They take Xanax to get over the dread of seeing their personal trainers, they take Valium to settle themselves before the first Chardonnay of happy hour. They may do with just a half a line of coke before a very small martini, while knitting and doing some crosswords. If there are cigarettes and skin dryness, there are also collagen and Botox, and the exhilaration of flaming an ex on Facebook. And finally, as another woman friend of mine counseled with perfect sincerity and cheer: “Just gain the 25 pounds. I really think I would not have survived menopause—AND the death of my mother—without having gained these 25 pounds.”

Sure, we’re supposed to take calcium pills to avoid brittle bones and hip injuries at 90, but who worries about living long when we’re just trying to get through the day? In the end, the real wisdom of menopause may be in questioning how fun or even sane this chore wheel called modern life actually is. And if what works is black-cohosh tea with a vodka chaser, and an overturned Greek chthonic head as a chocolate-fondue fountain, then bottoms up! Avast, ye vampires and werewolves and pirates! Arrrr!

By Christiane Northrup, M.D.

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