It started with sex. Searing, agonizing sex—just like the very first time I tried it. But now I was 40, and unlike when I was 20, there was no reason to be optimistic that the pain detonating across my pelvis would eventually go away.
I tried shifting my hips, curling onto my side, holding my breath, but each time I had sex, the throbbing pain roared. At first I was convinced it was a cyst—a ball of cells so large that nothing, barring a tampon, could enter. I had gone through five rounds of IVF to have my daughter, so it didn’t seem far-fetched to concoct a theory that the injected hormones had transformed into a pulsating polyp blocking my cervix. (Though highly unlikely, it was possible.) But an excruciating 15-minute vaginal ultrasound turned up nothing.
With no apparent physical problem, I was told that I probably had vaginismus, a painful contraction of the muscles around the vagina that can make sex hell. According to the Cleveland Clinic, it’s considered a primarily psychological condition, the pain arising from, “fear of sex, anxiety, past sexual abuse or trauma, and negative emotions towards sex.” Treatment often involves therapy—but I was already in therapy and had been for years. Cracking open memories and dissecting grief in a psychotherapist’s office was something I grew up with. I was flummoxed. Had I been so deep in the emotional weeds that I had unintentionally sidelined a trauma that was now wreaking havoc on my sex life? I couldn’t shake the feeling that the diagnosis was a cursory reading of my pain—yet another dismissal of women’s symptoms by the medical system.
And then came the sweat.
One night I awoke to a mosaic of perspiration covering my eyes, upper lip, and chest. It became my new nocturnal norm. Shirts turned sloppy wet. Waves of searing heat radiated from my core. Pajamas were ruined. The night sweats were only made worse by my almost-two-year-old deciding to transition from her bed into ours and lovingly wrapping her arms around my torso, head, or whatever she could cling to throughout the night. I felt like a human hot-water bottle.
Finally, with a thud, my period stopped. One month turned into two, turned into eight, and I had to face facts: This looked a lot like menopause.
By this time I was only 41—a full decade younger than the average age of women in menopause. The idea that I might be entering early menopause—or even the stage before it, perimenopause—had not even been a footnote in any of the conversations I’d had with doctors up until this point. I felt stumped by my body as it convulsed with changes I thought were meant for women much older than me. Women like my mom and my grandma. Those were the women who went through menopause—not new moms like me.
I made an appointment with an endocrinologist, who asked me a battery of questions and then took several vials of blood. A week later he called and confirmed: I was in perimenopause. My ovaries were slowing down their production of estrogen until I’d never have a period again.
I thought I had years of my youth left to contemplate what this experience might mean, but my rapidly waning fertility, and even the loss of the predictable monthly routine of menstruating, forced me to face the notion that I was transitioning into the second half of my life. I felt relieved to finally have a diagnosis, but there was also a surprising feeling of shame that I had somehow hadn’t managed to hold on to those precious nubile years quite as long as most women.
Unlike most of my menopausal relatives who didn’t start dealing with this until their 50s, I was advised to take hormones—namely estrogen and progesterone, in the form of patches, pills, and vaginal inserts—to confront my prematurely aging body. “If you go into menopause earlier than 51, the priority in terms of medical issues we worry about is your bones,” says Taraneh Shirazian, M.D., a board-certified ob-gyn and founder of Mommy Matters. “That is because between 40 and 51, you have that many years left ahead where the bones won’t get as much estrogen.”
The other main consequence of estrogen loss, I soon learned, was the vaginal dryness that was ruining my sex life. “When estrogen is decreasing, you get thinness of the vaginal walls,” says Jennifer Kinder, a physical therapist and the kinesiology program director at Notre Dame de Namur University. “This decreasing can also cause vaginal dryness, which is a big one, because if a woman is dry and she wants to have sex, it can hurt.”
Out of the barrage of vexing news pouring in, this was the one symptom that actually gave me a jolt of solace. All that throbbing pain wasn’t in my head; it was likely a physiological response to the dip in hormones triggered by early menopause. Unfortunately, an estrogen patch wasn’t going to fix it. Pelvic floor muscles (there are 14 of them down there!) tend to remember pain. “Once the pain happens, the brain protects the vaginal area with what it has: muscle tightening,” says Kinder. “And when a woman attempts intercourse again, the brain remembers this and the muscles can tighten even before intercourse starts.”
So I enrolled my menopausal vagina in pelvic floor therapy, which entails a physical therapist positioning her hands in various spots inside your vagina, bringing blood flow to the area and defusing spastic muscles. At first I was nonplussed—I didn’t know whether to keep my eyes closed, stare at the ceiling, stay silent, or respond to the therapist’s chatter (which I soon came to realize brought the extremely personal work into the realm of the mundane). I never got over the embarrassment of stripping off my pants and lying on the table while she maneuvered inside me, but I started to understand the complexity of the area, which feels ridiculously underdiscussed considering how key it is to a woman during all stages of her life.
The ways women respond to menopause are just as diverse as we are—some experience nothing at all while others like yours truly undergo a torrent of transformation that can leave them feeling unrecognizable to themselves. For now, all the hormones I’m on have pushed the symptoms into a dormant state—the hot flashes have subsided, and the pain during sex has significantly waned. When I stop taking them—because the current consensus among most doctors is that hormones can work when taken in the right window but shouldn’t be taken indefinitely—it’s anyone’s guess what will happen. The hope is that by the time the ongoing rotation of patches is finished and the last pill is swallowed, I won’t be caught off guard. I’ll be able to proudly say, “I was a 41-year-old menopausal woman.”
In addition to my normal gynecologist, I now see one who specializes in menopause. During a recent visit she mentioned that because this process started at such a young age, I may experience a rogue period every now and again—a fleeting reminder of my more fertile youth. But for now I’ve grown accustomed to living without it—I never look down any more to see if I’m bleeding, and my purse no longer has the odd tampon floating around. When I think about it, what I miss most about it all is that feeling of camaraderie with my other menstruating friends—the kismet of in-sync cycles and chalking up irrational or passionate moments to “that time of the month.”
I am unsurprisingly the first of my friends to go through “the change.” Admittedly, it’s left me feeling isolated and at times wistful for the 40s I thought I’d have. But I’ve also learned that menopause, just like youth, is just a word. One we honestly don’t talk about nearly enough, especially considering every woman will eventually experience it. So as long as I’m going through menopause, I’m going to say it: It’s a chance to calm my own sense of loss, ease others when their journey begins, and fully embrace this new chapter.