Puberty for the Middle-Aged
Forty-five-year-old women need a version of “the talk,” because our bodies are changing in ways that are both really weird and really uncomfortable.
By Lisa Selin Davis, New York Times
If only, on your 45th birthday, a doctor would sit you down, look you squarely in the eyes and say, “Here’s what’s going to happen: Eventually, your pubic hair is going to thin out everywhere but on the bikini line, exactly the opposite of what you’ve always wanted. The fat on your body will redistribute so that each of your thighs is the shape of Grimace, the McDonald’s blob monster. You will develop those wings of loose skin below your arms. You just will, no matter what you do. Also: Everything about your periods will change. They may become shorter, more frequent, more painful. And they’ll just get weirder until they desist.”
If only, in other words, someone told you, “You need to really prepare, emotionally and physically, for middle age.”
But of course, no one does.
We put a lot of time and effort into preparing teenagers for what changes puberty will wreak, but for women, midlife brings another kind of puberty — perimenopause, a road that we in our 40s navigate blind, without enough information from our doctors or often other women, wondering in silent shame at the intensity and seeming endlessness of the changes.
What is perimenopause, you might be asking? For one thing, it’s a term so underused that Microsoft’s word-processing program is telling me it’s not a word, a term that was new to many when Gwyneth Paltrow uttered it last month in a Goop video. “Peri” is Greek for “near,” and menopause is the ceasing of menstruation. So perimenopause is all the crazy stuff that happens on the way to that cessation.
We need to have The Talk, but for 45-year-olds. Doctors should speak to their patients about the changes that could lie ahead and how to prepare for them. And we perimenopausal women need to talk to one another, and the rest of the world, about what’s happening. Because a lot of it, to me, is really weird, really surprising and really hard to sit comfortably through, from the stray chin hair — O.K., hairs — to the decreasing bone density. Some 40 percent of women have interrupted sleep during perimenopause. Between 10 percent and 20 percent have mood swings. Some have uterine bleeding or vaginal dryness and even that hallmark of actual menopause, hot flashes.
My desire to know the full story goes beyond my health: How am I going to make jokes about these symptoms if I don’t know what they are? (I will always fondly recall Joan Rivers joking about the surprising number of things that sag as you age, starting with your genitals.)
Recently I asked friends on Facebook what no one had told them about middle age. No post of mine has ever garnered so many responses, so equally divided between sad and funny. Or both.
There are the physical issues — the random acne, the skin tags, the cough that causes a little bit of pee, the long recovery time from minor injuries and how easy it is to get those injuries. “Doing something really banal like reaching for the remote can put my back out and leave me wailing like a child for a day,” one friend wrote.
And then there are the emotional issues: How will I feel differently about myself as my hormonal profile shifts, as I lose estrogen in the years just before my young children surge with it?
The Talk doesn’t have to be all bad. Among the things my Facebook friends noted was that they felt better and stronger than they did in their 20s and 30s, and that they had become much less vain. One friend wrote, “I prioritize the things that are important to me and people I care about.”
She has arrived at the still-mythical (to me) moment when people stop caring so much what others think, the beginning of the upswing of the U-shaped happiness curve, which shows that people get happier as they grow old (often the 40s are the curve’s nadir). Older people are the bearers of wisdom earned by their years, or by the sheer fatigue that has overtaken them, forcing them to pick their battles more carefully. Along with those chin hairs, solace may come.
So your doctor might also say, “You will most likely find that you no longer sweat the small stuff (except at night, when you will sweat uncontrollably), that you care less about the approval of others and feel less attached to an iteration of your life that you haven’t achieved. And invisibility is a superpower that can be used to your advantage.”
If your doctor won’t go there, you can take it from me.