The start: Perimenopause, PJ’s over lingerie, and questions

Meet Jessica. Forty-three-years-old and mom to an 11-year-old boy and stepmom to two girls: an 11-year-old and 18-year-old. She’s been married to her husband for almost 12 years. They live in New York City, juggling work, parenting and a complicated blended family dynamic. Jessica has always been thin, active, energetic and able to squeeze in work as a personal chef – she prepares healthy meals for private clients – around her family commitments. She loves to cook, travel and has a wicked sense of humor along with a deep commitment to her health and her family.

Something has changed for her recently though. Signs of a change. When we talked, it was clear she was confused about the changes she’s starting to feel and that she’s trying to figure it out…on her own.

The symptoms she’s experiencing are typical of perimenopause: Lower energy, brain fog, and almost no sex drive, where there used to be a quite healthy one. Like many women in their early 40’s, she doesn’t have a clue about perimenopause or menopause. We talked and explored what she’s concerned about and about where to turn.

This conversation has been edited for length and clarity.

AfterShock: OK, so what’s going on? How are you feeling and what brought you to us to talk about it?

Jessica: Well, I just got my IUD removed last week. I’ve had it in for eight years. I’m ready to just let my body do its thing naturally. And it is – my period came today. So right now, I don’t know what to expect or what’s going to happen.

AfterShock: What do you expect from menopause?

Jessica: I don’t know. My mom doesn’t really talk about stuff like that, so I didn’t learn anything from her. She’s Dominican and very conservative about these things. Latin moms are very, very secretive about things going on with their bodies. She’s very private about her sex life and didn’t talk about her pregnancies. I’m sure she would talk to me about it if I asked her, but I’d have to find exactly the right time. She’s 65 now and I think she went through menopause around 45.

AfterShock: Tell us about what’s concerning you now? What are the symptoms you’re experiencing?

Jessica: My period is blotchy. When I had the IUD in, I had “pre period” swollen breasts a lot. Definitely the breasts aren’t as plump anymore. I feel like my sex drive is zero. Like I have no interest. If my husband talks to me about it, I just give him “the face.” I just don’t have any energy or passion for it. A couple of years ago, I was a very sexual and passionate person. I used to like foreplay, sexy lingerie. Now I look at that shit and think “I just want to put my PJ’s on.”

My energy level is zero. I used to love to go to the gym but it’s kind of like the thought of having sex – no thanks. Today when I got my period, I decided it was a good excuse to just skip it – and my period isn’t even that bad! I just feel really fatigued. My sleep is pretty good – I go to bed early on weeknights, around 9:30 and get up at 6:30.

Oh, and the brain fogginess. I have to put everything in my schedule or calendar. I used to just keep things in my head. A year ago, I could just remember it. Now everything has to go into the calendar, or I’ll forget it.

AfterShock: So, what steps are you taking, if any, to tackle the symptoms?

Jessica: My first mission was to remove my IUD and get my body back to normal. I take regular supplements. My eating habits have been off and on. Some days very healthy and others I have the mac & cheese. I definitely feel more bloated.

My doctor didn’t talk to me at all about perimenopause. She talked about using condoms for birth control and asked me if anything hurts when I have sex which is just standard stuff from an OB/GYN.

AfterShock: She didn’t mention testing your hormones or anything like that?

Jessica: No, but I was thinking about that. Testing hormones. We’re not on insurance right now so I’d need to check into that.

AfterShock: There are some good ways to start – by testing at home. You can use myLAB box or everlywell to test hormone levels in perimenopause or menopause, or LetsGetChecked for Thyroid testing. It’s a first clue for you in this unfolding mystery and something you can take into your doctor to get the conversation going. You can also test your thyroid and vitamin D levels with these companies for around $100.

AfterShock: What are you expecting about this phase of life? About aging as a woman in our culture today?

Jessica: I’m just confused. What’s going to happen? Am I going to still be a sexual person? Am I going to be a different woman? Am I going to strangle my husband?

I also think about if my husband will leave me for a younger woman. I totally had a big jealous attack the other day. My husband has a group of people that he rides motorcycles with, and he took one of the women in the group on his bike to pick up hers somewhere. I totally was reacting like a little 15-year-old! I think it’s part of me getting older and more worried – but I don’t talk to him about that.

I definitely have thoughts about what am I going to look like? I have fears of my hair falling out. I mean if it does, I’ll just wear a wig, I guess. There are some good wigs out there now. I’m interested in a little bit of Botox, but I think that women that get a lot of surgery on their faces – it doesn’t match their bodies and hands. And to me, that just looks weird.

It’s all a big surprise. 

The takeaway: The hot take after this conversation is that doctors, especially OB/GYNs, need to get their s&*t together on the topic of perimenopause and menopause. Women can’t continue to be left surprised by their symptoms and scrambling to figure it out on their own. Thankfully, there are a growing number of companies and voices trying to fill in the blanks for those of us adrift on the middle-age sea of waning hormones. But let’s be honest: Many people will only trust or try something if their doctor recommends it. And some can’t afford a solution unless it’s covered under their health insurance. There are a lot of challenges to overcome with the lack of information and n the (American) healthcare system in order to simply manage the symptoms.

There’s more to unpack from this talk with Jessica though. I was most struck by the underlying issues of this conversation – around the conflicted feelings and messages that women have about aging. Jessica’s growing inner voice about whether her husband will leave her if she “ages badly” (and this is from a stunning woman who likely has men of all ages falling at her feet!) is an all-too-familiar comment we hear when we talk to women in midlife. Particularly women in hetero-normative relationships where their male partner only “gets better with age.” As Jessica noted in our conversation, he can “go out and start an entirely new family with a younger woman.”

So, in addition to adjusting to our own new normal – new wrinkles, new ways our body and brain work or don’t work – we must push against a healthcare system that doesn’t recognize or inform us about this time of life and a culture that considers us past our prime once we’re no longer fertile. We’ll continue to do our part to help change the conversation.