I am going to try to describe the timeline for care/treatment I have sought for menopause transition symptoms. Most especially: heavy periods, brain fog, exhaustion.
Summer of 2022:
I am experiencing intense brain fog, horrible lethargy/exhaustion, and very heavy periods. My cycle isn’t that irregular in terms of how often it’s occurring/skipping although I am starting to see more variance. Sidenote: the covid vaccines also fucked up my cycle and made me bleed more for every cycle after a vaccine. I am tired of being tired. My primary care physician isn’t super helpful, so I go to Planned Parenthood to see what my options are. We decide to try hormonal birth control. The first one I try is pretty good except it gives me reflux, so I switch to another one that is a lower dose. It is great in that it has no side effects and suppresses my menses. Downside: still having migraines.
The thing about hormonal birth control is that you have to go back every year to get it represcribed. I decide I don’t really want to go back to PP, so I get an appointment with an ob/gyn (which takes several months to actually get in). When I see the resident, she and the attending are not thrilled I’m taking HBC given I get migraines. They want me to go off the pill and see what happens. Attending tells me, “Average age of menopause is 50, you will be fine.” I would just like to note here that apparently she has no idea what “average” means, and also I sought interventions at 51. Anyway they were also concerned that PP hadn’t ruled out any “abnormalities” that could be associated with the heavy bleeding. I agree to stop taking the pill, and if my period comes back, I will get an endometrial biopsy.
In the meantime, I have switched GPs because mine retired and was working for a boutique/concierge practice that Amazon bought. I tell new GP about rage flares. Not having vasomotor symptoms (except for one weekend after I stopped taking the Pill), i.e. no hot flashes, night sweats or disrupted sleep. She puts me on an estrogen patch, and oral progesterone (prometrium). She has me switch from Zoloft to Lexapro to see if that helps the rage. (Lexapro turns out to be a bust and I return to sertraline). Estrogen patch is lifesaving. Calms my bursts of anger like whoa. Prometrium does NOTHING to control my period.
3-4 months after I go off the Pill, I get my first real period I’ve had since I started the HBC. It is heavy. My uterus is letting me know who’s boss. I schedule the biopsy. The first try they can’t get far enough into my cervix, so they tell me come back the following week and take misoprostol to “soften my cervix.” I had horrible, horrible cramping from the misoprostol. I almost passed out and I would have vomited if I hadn’t taken zofran. I can only lie on the couch and moan for several hours. Anything else is right out. The next day they do the biopsy (thank god both times they did a cervical block) and it comes back normal. Great! Everything is great! I switch from prometrium to norethindrone and end up having to take it twice a day, every 12 hours, to keep from bleeding. It mostly works, except for incredibly light spotting and if I don’t take it exactly every 12 hours more spotting. Also seems to be giving me reflux.
Present moment:
My symptoms are 90% under control. I can think pretty clearly, I have a decent amount of energy, and I have basically stopped bleeding. My moods are more level/even.
I have decided to try the hormonal IUD. This is the latest intervention. I’m getting it at the end of January. They have told me to take misoprostol again, but they won’t prescribe anything for the pain. “Take 600 mg of ibuprofen and 1000 mg of tylenol every 6 hours.” Okay well we will see.
I also find it very telling that they are incredibly willing to give out strong benzodiazepines for these procedures but pain killers seem verboten.
Writing this up, it feels fairly straight forward, but hindsight is always that way. I am hopeful that the IUD will be the last intervention I require and I can cruise through into menopause with calmer waters.
