The Silent Passage

Well, this isn’t exactly a book review – I think it’s sort of SOP to finish the book before you review it – but it is a recommendation.

A couple of months ago, I picked up a copy of “Menopause: The Silent Passage” by Gail Sheehy.   I’ve been slowly starting to educate myself about menopause and perimenopause, for a few reasons.

First, in the latter part of last year I started having a number of different physical symptoms that were honestly scaring the crap out of me.  The worst was the heart rhythm abnormalities, but there were some others – chronic insomnia, fatigue, major mood swings, an inexplicable inability to lose weight or even to keep from gaining at times, and the ever-popular erratic periods.  I put a great deal of it down to stress and ignored it for as long as I could, but eventually the heart issue got too severe to ignore and I went to the doctor.

Several rounds of tests and about $3,000 in medical bills later (thank God all but about $700 covered by insurance) I still don’t know anything except that (a) I didn’t need any of the medications I was taking, and am thankfully now prescription-free; and (b) my heart seems to be fine.  I ended up being referred to a psychologist for CBT (cognitive behavioral therapy) to manage the anxiety that my doctor said is causing every single symptom I have.

I have nothing against CBT.  It’s a very valid therapy and I think just about everyone on the planet, including me, can benefit from it in some way.  But I know anxiety – I have lived with anxiety disorders for 20 years, thank you very much – and this isn’t it. Stress, sure.  Anxiety?  Not really.  And what anxiety I did have was primarily due to the symptoms I was having – it was the effect, not the cause.

So, even at the beginning of all this, I suspected ‘early menopause’ because of the erratic periods, the fact that I’ve had a tubal ligation, and the fact that my mother started experiencing symptoms of menopause in her late thirties.  I’m now 36, so the timing seems about right.  My doctor admitted that this could be ‘part of’ my problem, but was evasive and unwilling to discuss treatment options as he feels that hormones aren’t the way to treat me.  And evidently, synthetic hormones are the only treatment of which he is aware.  (To be fair, he is a GP, not an OB/GYN.  But still.)  Also, I did have hormone levels tested by my gynecologist a couple of years ago when I had similar symptoms, and they came back as normal, so I thought that was that.

Well.  It’s not nearly so simple as all that, as it turns out.  According to Sheehy, the hormone levels of women experiencing perimenopause can spike and drop four to six times in the course of a single day.  Add to that, the fact that when I actually had the hormone levels taken, my cycle was evidently normalizing, because I finally started my period a couple of days later.

Anyway.  It’s taken me a couple of months to get around to actually reading the book, for reasons I wasn’t actually able to articulate until Sheehy did it for me – the ‘need to know and the fear of knowing’.  Yes, I want to know if this is what’s happening to me, or if I’m just nuts, the way my doctor seems to think I am.  But part of me is just so afraid to admit that my body is undergoing a massive and radical change that is going to turn the way I look at myself upside down…

I finally started readiing it, and my God, am I glad I did.  I’m about halfway through, and already she’s made so many things make sense, and put so many of my fears to rest.  A lot of it is stuff that I already knew, though I’d never strung it all together into a coherent picture of what menopause will mean for me – but a lot of it I didn’t know.  Most of all, it gives me hope.

For instance, while women who have suffered from depression in the past are far more likely to do so during perimenopause and menopause, it’s also true that postmenopausal women exhibit the lowest rates of depression of any population group.  Do you know how that makes me feel?  Once I’m through this roller-coaster ride, I may actually be consistently sane for the rest of my life!

The book also discusses the reality of perimenopause, which seems to be one of the biggest things we end up fighting with our doctors about.  If you haven’t stopped having periods, you’re not menopausal, they will say.  If you’re under forty – or, heck, under fifty in some cases – you’re too young, and it’s not menopause.  So they won’t treat you, they won’t talk about it with you, they essentially…well, treat you for anxiety.

I’m very excited about this book, because it’s giving me hope for the future, and peace about the present.  Yes, my body is going through some bizarre stuff – but it’s normal.  It’s okay.  And it can be handled in a number of ways.  Being me, I am leaning toward a homeopathic approach, but I will tell you right now, I am not ruling out HRT should it become necessary.  However, rest assured that, being me, I will do the most complete and exhaustive research possible about all the alternatives, and will try the least extreme first.  But at least I know I’m not crazy, I know that this isn’t something I just have to ‘live with’ and I know that when I’m through the process, I’ll be settling into the best years of my life.  And hey, if I’m starting early, there’s at least a chance I’ll be finished early, right?  So maybe I’ll have more ‘best years’ than most.    This is all very reassuring for me – my mother is one of those people who did have a pretty turbulent menopause; I know, because I remember some of it, because I was a child when she went through it.  But she doesn’t really talk about it; she dismisses it as “well, sure, I had that.  It goes away.”  After all, when she went through it, there weren’t a lot of options other than just waiting it out.

In any event, I think the book is a must-read for anyone over thirty.  Since I haven’t finished it, I can’t tell you how much science it presents, though there is definitely some, and it is somewhat dated – this edition is copyright 1998 – but it presents the topic in a very calm, reassuring and comfortable way.  For me,  it’s the first source of many, because I will go on to do a great deal more reading and Internet research; that’s how I roll.  But it was a great first source, because it is doing what I needed the most – dispelling the panic and frustration and confusion, so my mind is clear and lucid for the  more in-depth research I’ll want to do.  [And when I've done it, and armed myself with all the information I can find, I'll go talk to my gynecologist about it.  If she's not interested, I'll find one who is.]

Knowledge is power – and finding that you’re not alone is enormously comforting.