The right hormones, the wrong kinds

When I say menopause is a "hormone problem," everyone thinks estrogen. If they are really savvy, they also think progesterone. But that is very very far from all there is to the issue.

From what I know now, it's all these hormones:

• insulin
• leptin
• cortisol
• estrogen
• progesterone
• thyroid
• testosterone
• DHEA
• pregnenolone

And those are just the ones I've researched. There's plenty more.

Happy to do the wrong thing

It was only a period of a few years where I was whipsawed back and forth over my supply of female hormones, both natural and external. First they used birth control pills to control my serious endometriosis, until I reached my late thirties and they refused to give them to me any more, even though I still, you know, had the condition. This resulted in an ovary going so cystic it had to be removed, and I was plunged into menopause suddenly and unnaturally. Then they dragged their feet about giving me hormones, and when they did, it was horse hormones.

I was beginning to suspect they didn't know what they were doing.

It looks good, but you can't hammer anything with it

There's a growing body of literature about the effects of the usual Hormone Replacement Therapy, and it's tending towards the "bad" side of the curve. Yet, taking them solves many of the sleep, temperature control, and mental problems of menopause.

Make no mistake, these symptoms can be life-destroying.

Yet, with all the fuss about the heart attack, stroke, and cancer risks, no one seems to ever grasp the fact that we have a lot of evidence about HRT -- that applies to women taking horse hormones.

We don't have a lot of evidence about women taking bio-identical hormones. Though what we do have indicates it works a lot better.

If we contrast what we know about women taking horse hormones and women taking hormones more like what their own bodies manufacture, it's easy to come to a clear conclusion that it's better for women to take the bio-identical variety.

At least, it's easy for me. When I think like a scientist. To a doctor, this is distressingly ridiculous. Hormones are hormones, is what they think.

I think they are missing something very big indeed.

Adrenal Fatigue

Medical misconceptions about hormones are absolutely rampant. If they were bedbugs, the hotel would have to be nuked from space.

Take the equally widespread, and misunderstood, condition known as Adrenal Fatigue. When I got my first round of HRT, I did have immediate relief from the insomnia, mood swings, cotton-brain, and general mayhem I was constantly struggling with. But it was less than a year after that when I began having these same problems coming back at me with some new wrinkles in them, like bone-crushing fatigue and the ability to get a case of twice-as-bad of whatever bug was going around.

I found that my symptoms matched the information on the Adrenal Fatigue website of Dr. James. L. Wilson. His perspective and advice were extremely helpful.

To me this means it's at least a "syndrome" and by following his recommendations I did get better, so there's also a "treatment." But medical science is extremely scornful of this phenomenon. And so many people struggle on their own, with their doctor flourishing their "normal" lab tests.

Thyroid Scandal

Thyroid difficulties seems to be one bullet I managed to dodge, but those who do suffer from it often have no idea that all their disparate symptoms might be connected to thyroid issues. It doesn't help that thyroid and menopause issues often overlap, one aggravating the other, and the symptoms can come from either source.

Thyroid problems are extremely common, especially in women, and can be brought on by hormone disruption, pregnancy, low iodine, high estrogen, raw food diets, soy consumption, and stress.

Many blood tests use two standard deviations to define blood test norms. By definition, only the lowest or highest 2.5 % of the population is in the abnormal (treatment) range. This does not work well if over 2.5 % of the population has a problem. For example, it is estimated that as many as 20% of women over 60 are hypothyroid. --Dr. Jacob Teitelbaum on Hormonal Issues

A recent study, Thyroid Disease Is Far More Widespread Than Originally Thought, puts the number of undiagnosed, at risk, thyroid patients at thirteen million. (Yes, that's million with an "M".)

Much too much of the time a thyroid patient finally gets diagnosed by requesting the proper tests instead of the standard, unhelpful, one that most doctors look at.

The trouble with lab tests

According to Dr. Jacob Teitelbaum,  a chronic fatigue specialist in this helpful video, doctors are trained to look at lab results, not symptoms. In his practice, he addresses patients with inadequate thyroid, adrenal, and ovarian/testicular function and says he doesn't go by lab tests. He goes by what the patient feels like.

How can we feel so absolutely awful and our doctor thinks we're normal? Dr. Teitelbaum explains it this way:

Pretend your lab test uses 2 standard deviations to diagnose a “shoe problem”. If you accidentally put on someone else’s shoes and had on a size 12 when you wore a size 5, the normal range derived from 2 standard deviations (~95% of people have a shoe size between say 5 and 13) would indicate you had absolutely no problem. You would insist the shoes did not fit although your shoe size would be in the normal range. Similarly, if you lost your shoes, the doctor would pick any shoes out of the “normal range pile” and expect them to fit you.

That's how your doctor thinks you only think you are sick.

But that's only the first set of hurdles to overcome when we have a hormone issue of any kind. Even once we are diagnosed, doctors offer synthetic versions of the hormones we are lacking.

Like my experience with Premarin, such an approach can fix some problems. Then create more.

How I became a feminist when I was eight

To hear my mother tell it, I was a tomboy from birth. From the time I mastered control of my limbs, I peeled off the pretty, but itchy, girly stuff she loved to dress me in. Once I could talk, I asked to wear pants. Other girls wanted tea sets and dolls. I wanted a microscope and (though I never got them) sea monkeys.

It wasn't that I was totally hopeless at the feminine thing. Given a comfortable outfit, I could rock it. I slept on curlers for many special occasions (as long as they were sponge curlers.) I was a hopeless nurturer of stray animals and helped my mother care for my younger siblings, so it's not like I didn't have the requisite nurturing skills.

It's just that the culture my mother had been raised in, and where we still lived, had fairly rigid gender roles. I was, early on, flunking an important female social task.

Doing something I didn't like and pretending that I did.

A glimpse into the future

Even though I was surrounded by the insistence that one day I would flatten my personality like a paper doll and become a Real Girl, I managed to become aware of what truly awaited me in the current adult world. It was because of my mother's Betty Crocker cookbook.

it was domestic... science!

This was probably a wedding present, from 1956, and was a lovely deluxe version with a three ring binder and tabbed cardboard dividers. It's not that this cookbook was filled with righteous rants that were far ahead of their time. It was sincerely devoted to the glories of living every girl's dream, the loving care and maintenance of a family and home.

It wound up at my maternal grandparents house one summer I spent there. It was a great way to acquire an eclectic education. Between the local library's "two books a week" rule and my voracious reading rate, I mowed through Reader's Digests reaching back to the 1920's, several leatherbound classics that would have otherwise been undisturbed in the parlor, and finally, likely from desperation, this cookbook.

It was quite wide-ranging compared to cookbooks of today. There were sections on how to pack cookies for the men overseas so they wouldn't break in transit, and suggestions for "good travelers." Recipes would reference each other for economy, so the egg yolks left over from an angel food cake could be used for Golden Drop cookies. Those cardboard dividers were covered with tips for organizing a lady's day, illustrated with line drawings of an ecstatic housewife in heels, a poofy dress, and perfect hair.

I know I went into it with an open mind, because I still remember the dawning horror as I would leaf through it methodically, looking for more clues which fit the pattern my brain was slowly assembling.

Telling the truth is a revolutionary act

Many of the recipes were Bake-Off winners, or contributed by members of ladies' groups, with their names. I thought this was a nice touch, but as I skipped around, looking for things that sounded tasty and marveling at the impeccably crafted photographs, I noticed that everyone was listed as their married name.

How did I know? Because they were all Mrs. Norman Bates and Mrs. Humphrey Bogart and Mrs. George Jones. None of them had their own names.

I actually sat down and skimmed for every name and I found one woman's name in the whole book. She was, poor thing, Miss Fay Wray. The only one.

Stephen King, being a man, would never write a scary novel based on this discovery, but my conclusion was just as frightening to me. Getting married meant losing your name, your identity, yourself!

This was a glimpse into a world of madness

But it was those cardboard dividers which really laid it out for me.

Happy poofy-skirt lady surrounded by cups and bowls and cooking utensils: Don't clutter your kitchen and fill up your counters. Part of the cooking process is keeping up with washing your working tools. Take time between cooking steps to wash as you go along.

Happy poofy-skirt lady with a mop: Schedule time-consuming tasks like waxing the floor for parts of the day when the baby is asleep.

A drawing of a squirrel in a tree with happy poofy-skirt lady grinning at it: Take some time from your busy day to go outside once in a while. You might see something to share with the family at dinner.

There were some inescapable conclusions coming right at me.

One is not a choice

This was the life my society was laying out for me? An endless round of the same chores over and over again with occasional breaks taken to look at a squirrel?

In my childish imaginings, it was taking away school, where I had skills which were admired, and making me a full-time Mother's Helper. Promoting me to the actual Mother did not make a bit of difference to me. I loved my little brothers and I didn't mind helping to care for them, but I had already noticed that when men came home from work their work was done. A housewife never came home from work.

I had already been taught this was the only thing women were supposed to do. That it was the only path to love and happiness. To spurn it would result in my being one of those "maiden ladies" I saw around our small town. The ones who lived in small dingy surroundings with small dingy jobs, the ones of whom my relatives whispered, "She never married."

I had not yet read Huckleberry Finn, so I was ignorant of the famous passage in which Huck decides to buck his culture's take on morality, and choose friendship instead. A choice which would result in him going to Hell. I didn't know I was struggling with a similar choice, and that I made a similar decision.

Okay then. I'll become an old maid.

What doctors see

My own doctor is an awesome guy who is willing to think outside the box. He still has some modern-doc-reflexes, but on the whole he is impressively open-minded.

This is a rare thing.

In ages past, doctors had fewer tools to reach for, and proper diagnosis became a professional goal and the focus of their training. Observation and deduction was the motto of the famous fictional detective, Sherlock Holmes, because his creator, doctor/author Sir Arthur Conan Doyle, had been trained to diagnose disease with these same methods.

Only finding what we are looking for

Now, it's a matter of running tests in the hope of showing enough deviation from the norm for them to arrive at a diagnosis. Then they prescribe a drug which often does not address the problem so much as it masks the symptoms. But when the symptoms are suppressed, the patient stops complaining.

That's a medical term, you know: "The patient complained of ..." I don't know when the medical profession's goals shifted from curing to the patient stopped complaining, but it was not progress. Because now, when the patient keeps complaining, the overwhelming tendency of doctors is to decide the patient is not physically ill, they are mentally ill. And should be taking a psychiatric drug.

There's all the difference in the world between actually having a mental health problem, and only having your medical personnel decide for you that you have a mental health problem. People absolutely should get help with any medical issue they have.

Getting help for a medical issue we don't have is a prescription for disaster.

Yet, this is exactly the position of women who go to their doctors for help with issues that doctors don't know how to help with. But they don't say that. They look at lab results and pronounce them "normal" and tell the person there isn't anything wrong with them. The woman goes away feeling dismissed and frustrated, and the more she tries to get help, the more she gets seen as A Problem.

It's not entirely the fault of the doctor; he or she is simply doing what they have been trained to do... and so often, they don't do any more than that. This is what keeps them from seeing their middle-aged woman patient as a person with a real problem who is trying to get real solutions. Because the woman's hormone dysfunction problem is not one they are trained to see.

Adjusting their lenses

When a woman's problem falls into an area that wasn't covered in their training and doesn't show up on the usual lab tests, it's like the doctor's brain (that overly busy and highly trained and not-encouraged-to-be-creative organ that it is) shifts gears. They actually look at the patient in a different way, as in the study, below, where people were distracted while evaluating what a person was saying. If they could not follow what the person was talking about, they fell back on emotional cues:

But those who were kept mentally busy came to a very different conclusion about this woman’s personality. Regardless of what situation she was in, they concluded that she was indeed an “anxious person.” For these people, acting anxious equaled being anxious.
Mixed Signals: Why People Misunderstand Each Other

As a woman journeys from doctor to doctor, vainly trying to get someone to take their symptoms seriously, they inevitably come across as somewhat less than calm, cool, and reasonable. Often, the hormone dysfunction itself prevents someone from easily keeping their grip.

this is the same woman, seen through different lenses
comparison by rpavich

Quickly exhausted, fuzzy-headed under stress, and often at the end of their rope already, it becomes even more challenging to get across a complicated concept that doesn't even have a name except "menopause," and that is a label that is shrugged away as "not much of a problem."

Time itself is now how the cautious doctor prefers to handle their mid-life women patients, with the disaster of previous Hormone Replacement Therapy protocols echoing in their minds.

As I discovered when I tried to get cortisol, it's easier to get what that chemistry teacher was cooking in that camper in the desert. Doctors don't want to give women hormones that aren't birth control. And forget any hormonal help after the age of thirty five. At all. Ever.

Thyroid insufficiency is one of the least treated illnesses out there. And it's so easy to fix!

Ignoring the No-Hormone Disaster

In fact, it was this very medical mindset that catapulted me into menopause -- abruptly and disastrously. My endometriosis had been making my life difficult during my teens, but upon getting birth control pills, it miraculously stopped the pain and monthly difficulties. I was happy taking birth control for years, until I got into my late thirties. And the medical profession took them away.

"What about my endometriosis?" I kept asking. And they kept dismissing me, telling me that I would be in menopause soon. Sure enough, that is just what happened. I got a terribly painful cystic ovary that had to be removed with surgery and then I was dumped into menopause like falling off a cliff.

It was something like being tied to the railroad tracks, and hearing the whistle in the distance, and everyone around me all agree the train's coming but they don't think they need to untie me.

It's now a bit difficult for me to to be calm and reasonable with doctors when I think they are screwing up.

Because I've seen the train that hit me.

The part where everything I was told was wrong

Blaming ourselves is a bizarre form of control. Whatever we tried may not have worked, but if that was because we weren't doing it right, that means it can work, if we can do it right.

It means there is a solution.

I spent decades following advice on how to eat, always thinking that it wasn't working because I just wasn't doing it right. What about that slice of birthday cake? And the day I skipped exercise? And the times I slept in and the times I was so hungry I ate the wrong things at the wrong times?

Why don't I just buckle down and do it perfectly?

Doing My Best

Twelve years ago I was at the end of everything, good and bad, that I had ever tried when it came to controlling my excess weight. In my teens it was a form of bulimia that expressed itself as binge and starve. I was going through a very stressful time and food became my drug of choice. My weight swung between normal and chubby.

In my twenties I stopped the binge part and got a grip on what I thought of as my "emotional eating" but I still relied on meal skipping to stay even with my current wardrobe. I was such a good calorie counter I could eye anything and get the calorie count plus or minus twenty five. But it was a constant mental strain and I had to get more and more extreme to make it work.

In my thirties I told myself it was time to grow up, and I got on board the low-fat/cardio train. And let me tell you, I was good at it. I worked out an hour and half every day and kept my fat grams to 25 a day. I wouldn't have made it without the invention of rice cakes coated in white cheddar powder, but it did keep my weight stable, even if I wasn't the size I wanted to be.

At the end of my thirties I lost my husband, our business, and the house. I had to sell all the furniture and adopted out almost all the pets. I was able to choke down one meal a day, and I became the slimmest I'd ever been my whole adult life. However, I cannot recommend the Utter Life Devastation Diet.

It's very hard to stick to.

Crisis Point

And when I turned forty it all completely stopped working.

I put on over seventy pounds in the course of a year or two. Now it wasn't a matter of fitting into favorite pants. Now it was high blood pressure and the threat of diabetes and difficulty waking up in the morning and getting tired way too fast. This had moved from fashion and my self-esteem right into the nightmare realm of impending doom.

Which part of this is going to kill us?

So I tried Atkins. And finally I found something that worked.

I lost those seventy pounds in six months.

Before, I'd been happy staying in my size twelve clothes. Now, without exercise or going hungry, I was fitting into size tens.

Twelve years ago low carb eating was still a fringe, fad, diet that was going to kill me. Now, it's a cutting edge concept that goes under names like Paleo and Primal and Unprocessed.

Science is discovering that, for most people, it works fantastically well at not only helping people lose weight, but also in lowering inflammation. This is a body-wide reaction to eating less than optimally, which is what seems to lead to heart disease, diabetes, high blood pressure, and a host of other illnesses.

What worked

If I hadn't been eating low carb for all these years, I would have been struggling with even more health problems than the ones menopause dumped in my lap. But at least I had taken care of the extra seventy pounds, the blood pressure and blood sugar that was creeping upward, the arthritis in my hands that was waking me up in the middle of the night, and some of my sleep and energy problems.

Before the tornado of menopausal hormone changes tore my body apart.

It's turning out that all that advice to eat whole grains and avoid fats and keep our heart rate elevated for long periods of time was the wrong advice.

This was the huge realization that prepared me to "go it alone" when medical science shrugged and told me I was just another hysterical middle-aged woman with emotional problems.

Listen to ourselves

It's not that I'm urging everyone to eat exactly the way I do, because I crafted an eating plan which works well for me, but might not for you. Yes, it's turning out that modern wheat is bad for us and saturated fat is good for us, but that allows a lot of leeway for DNA differences.

A fantastic book, Death by Food Pyramid: How Shoddy Science, Sketchy Politics and Shady Special Interests Have Ruined Our Health, explains that our personal relationship with food comes from our genetic heritage of enzyme combinations. This is why I fared particularly badly with Food Authority urgings to eat low fat and lots of "complex" carbohydrates. My enzymes aren't set up to turn such a combination into useful energy.

My enzymes like lots of fat; like coconut oil (so good for the brain) and grassfed butter (full of CLA and vitamin K2.) My enzymes can't get protein from vegetable sources very well, so that's why all those slim and energetic ladies from the health food store couldn't figure out why everything they did to turn me vegetarian only made me fat and shaky and miserable. My enzymes like meat and eggs and cheese.

Non-starchy vegetables and low-sugar fruits work well for me, but so does the demonized red meat and butter. When we eat food that has been processed as little as possible, this does wonders for our bodies, and thus, our health.

All those decades, it wasn't my fault at all. I was being told the wrong things. So now, when something doesn't work after a few tries, I don't blame myself for "doing it wrong."

I figure I'm doing the wrong things.

Human sacrifice in modern times

Yes, in this case the "human sacrifice" I'm referring to is symbolic. But it's a sacrifice all the same.

In her book, Slaying the Mermaid: Women and the Culture of Sacrifice, Stephanie Golden outlines the famous fairy tale of how a mermaid fell in love with a human. She gives up her voice and her immortality for legs and the chance for life with him.

In all of the mythology of fairy tales, there isn't a male version. As the author explores, in depth, sacrifice is a female trait.

Unwitting, not unwilling

In the "siren song" myth, she has all the power. It's a myth.

It's not framed that way, of course. Women are praised for giving things up for love.

It is considered both a part of their nature and a willing expression of their devotion.

What kind of mother are you to not do your utmost for your baby?

What kind of wife are you to not let your career get put on hold for pregnancy or your husband's prospects?

What kind of daughter are you to not do anything asked of you by your aging parents?

What kind of employee are you to not agree to take on that extra work the boss needs right away?

The deceptive ease of saying "no"

The classic response is to claim that women could just say "No" to these things. No one is making them do this!

It's not a literal gunpoint situation. But in a way their life is at stake. Of course they can say "No." And buck a lifetime of social programming that says if we do, we'll be considered a selfish, uncaring, woman not worthy of love.

In the many many times I have posed this question, I have never had a woman respond with "Just say No!" Because women know it's not that simple. It is men who say such things, because they have their own social programming; the one that says, A man does whatever he wants to do.

Of course, that gets them into trouble, too. It's just not the same trouble.

When I say, "Women are expected to sacrifice," it has a starkness that prompts denial in the listener, be they man or woman. But if I phrase it as, "A mother should do everything for her baby," it's approving nods all around.

Because if we want to do it, it's not a sacrifice! Which is the very trap women fall into with their eyes wide open. Love is a very powerful emotion, and in Western culture, one that women are allowed to feel, freely and openly.

But how they can express it turns out to be full of fences.

Sacrifice and stress

At its most extreme, as in the patriarchal Quiverfull movement, women are allowed some autonomy in the domestic sphere only. She can run a home-based business, but only under the permission and "headship" of her husband, father, or other male guardian. She is responsible for child raising, but with male children being encouraged to reinforce her subservient position when still quite young. It is a highly stressful situation of low control and high responsibility.

With such a stark example, it's easy to dismiss lesser forms of coercion. Especially since 21st century fathers are far more likely to share household chores and childcare, with increasing marital satisfaction as a result.

Over all, the evidence shows that the shifts within marriages — men taking on more housework and women earning more outside the home — have had a positive effect, contributing to lower divorce rates and happier unions.

But for women who are dealing with menopause now, that probably wasn't the case. Our teen years roughly coincided with the rise of second-wave feminism. The controversial fact that "women were people" clashed, sometimes roughly, with the kinds of prevailing attitudes that were so shocking when depicted on Mad Men. When I was a child, women were not allowed their own credit cards, to keep their job if they were pregnant, get a no-fault divorce, or call sexual harassment what it was.

I had to flee 1,200 miles to settle in a place that encouraged more egalitarian marriage structures. I had to make that a priority and be willing to uproot myself to find better soil for my ambitions. I was also a computer professional from the time there were computers in common office use, and so I avoided more traditional views of women in more established professions. And it still wasn't easy.

Prior to women's liberation, a woman was supposed to willingly put herself last every day in order to take care of her husband and family. Love is what drove them to do so. And it is genuine love.

I'm just not sure about the "willing" part. Because the women who signed up for this in their teens and very early adulthood didn't realize what was truly being asked of them.

The short straw

Not every woman reaches her mid-years with a sense of being cheated, just as 25% of women seem to sail through their menopause with no symptoms. Yet that leaves a very large number of women who confide the un-discussed dilemma of any woman who devoted her entire self to her family:

Now that the kids are growing up, they don't have time for me any more. And now that the kids aren't around, my husband acts like I don't have any purpose in the family, and he resents giving me any money that isn't for groceries. I don't have any job skills, I never had any time to get into a hobby, and now I just keep house for room and board?

I really liked my job, and I wanted to see what I could do. But my husband had to move to help his career, and it paid more, and so I worked part-time, and mommy tracks, and didn't keep up with my schooling. I'm twenty years out of date and he seems to resent that I'm not making nearly as much as he is. All that cleaning and cooking and child care is in the past and now it just doesn't matter?

My girls want to get married and have babies with me taking care of them while they work, and I see the whole thing starting all over again. How can I tell my daughters that they will just come home to another work shift if they don't marry with better expectations than I did? How can I tell my family that it's time for me to have my own life? I don't even know what that is.

Even acknowledging such feelings cuts sharply against the grain of how much love a woman can genuinely feel for her family. With the best intentions in the world, she devoted herself to them, creating the happy, independent, lives they now enjoy.

So it hurts very deeply to discover they don't seem to understand what she did for them. They can be alternately clueless and defensive. Didn't she want to do it?

What she wanted was to love and care for her family. But if the only way to do that is to become everyone's servant, without any outlets for her own ambitions and interests... how many women sign up for that, knowingly?

When the deal is put out there this truthfully... not many.

Women are retreating from marriage as they go into the workplace. That's partly because, for a woman, being both employed and married is tough in Asia. Women there are the primary caregivers for husbands, children and, often, for ageing parents; and even when in full-time employment, they are expected to continue to play this role. This is true elsewhere in the world, but the burden that Asian women carry is particularly heavy. Japanese women, who typically work 40 hours a week in the office, then do, on average, another 30 hours of housework. Their husbands, on average, do three hours. And Asian women who give up work to look after children find it hard to return when the offspring are grown. Not surprisingly, Asian women have an unusually pessimistic view of marriage. According to a survey carried out this year, many fewer Japanese women felt positive about their marriage than did Japanese men, or American women or men.

Unless one was there, in the late 20th century, it might be difficult to understand how women were denigrated for showing an interest in feminism and equal rights. My own circumstances pushed me out to the cutting edge.

Women without clear talents in open professions, women who had trouble finding any liberated men to date, women whose relatives and hometowns and religions were extremely negative about stepping outside of their domestic role; such women felt that if they wanted a good marriage and a happy family, they had to do so in a "traditional way."

They thought they were choosing the old order, where they were supposed to be revered for devoting themselves to family and motherhood, only to discover that by the time they hit mid-life, new expectations were in operation. These women are supposed to act as though their lives are their own responsibility now.

A whole generation of women got ground up in a giant culture shift. That wasn't supposed to be the deal.