My story.

This may or may not apply to you YET, but as women, our voices haven’t been heard nearly loud enough through the years. So I’m talking. My parents are/were both products of the Silent Generation, both born in the 1930’s. And I was raised very firmly in those principles despite being one of the oldest Gen X’ers out there - 1967, baby. And I wear that Gen X label proudly, by the way. I LOVED growing up in the era that I did. We were so amazingly blessed to have nearly unlimited physical freedom without fear throughout our youth, and then in our young adult lives technology allowed us to literally shrink the world and hold the internet in the palm of our hands. The transformation of the entire world within our own short live span has been almost incomprehensible. But I digress.

Being raised by parents who don’t like to talk about anything uncomfortable left an awful lot of things to be discovered in other ways. Like most Gen X’ers, I learned more from older siblings, friends and experiences than we did from anywhere else. We didn’t have Google, our parents weren’t talking, so where else were we going to go? I had one older brother but he went to public school and I went to private school so we had even less in common than most. There was nowhere for me to find out anything except from books or friends and if I was lucky, their older siblings. But even that was rare for me. Call me naive, because clearly I was, but how can you find out what you need to know if you don’t know what to ask? I was that clueless. For example, I had a male co-worker’s girlfriend set me up with my first ob/gyn appointment when I was 16 because birth control for cramps wasn’t something my mother was willing to discuss. I had to just trust in the kindness of others and believe that the doctors I had would help me through whatever female life changes were on the horizon. Because that’s their job, right? They’re trained for this.

HA!

Fast Forward to 2013

In 2013, I’m 45 years old. My cycles are now about 22-24 days apart and I bleed like a stuck pig for 4-5 days of every cycle. I’m very fit, at my ideal weight, running 25 miles a week on a regular basis, cross training, strength training, running 10 milers and half marathons, and I get into the NYC Marathon. It’ll be my first full marathon and I’m super excited to run one. I’ve run a dozen or so races longer than 10 miles over the past 4-5 years but a full marathon was a bucket list item - I just wanted to do one. So I start training. Gradually I ramp up my training during the summer of 2013 for the November race, and I notice a couple of things.

• I’m running about 40 miles a week now, and i’ve grown a spare tire around my waist. Huh. I’m still strength training, but I’m absolutely exhausted. I’ve started falling asleep after my training sessions - like I can’t stay awake. My rest days, that used to be walking or cross training days, have now been literal rest - like sleep.

• I’m waking up at 3 am and I can’t get back to sleep. I eventually fall back asleep but it’s at 5 am when I’m supposed to be getting up for speedwork at the track. I’ve never had trouble getting up for a workout before but I’m really dragging.

• My nutrition is off. I’ve started paying attention to macros and it’s messing with my head, and I almost don’t know how to fuel myself anymore and my performance is lacking.

So I make an appointment with my primary care doctor. It’s not an annual visit so they make me jump through all the hoops since I’m not physically sick but she reluctantly agrees to see me in about 6 weeks. (Why is it like pulling teeth to get a doctor to see you when you know something is wrong?) I see her, she says, yes, you’ve gained about 8 pounds. The fasting bloodwork we did showed that I was pre-diabetic and my cholesterol was abnormally high - all of these markers were WAY out of line with anything from even 8 months earlier. So she said, I suggest you move more and eat less. I wanted to poke her eyes out. I told her that I’m training for a marathon and I don’t think moving more is the issue so she literally tells me to just eat less. And this, folks, is when the spiral began. Since she’s the doctor, and I’m mortified to say it, I listened to her. Trust the science, isn’t that what we’re told? So I put myself on a 1400 calorie diet. I’m sure you can imagine how that went. The marathon was a disaster of epic proportions because I was so under-fueled. I broke my foot during the race, fell apart at mile 22, but there was no way I wasn’t crossing that finish line. It took me way longer than I wanted it to, and I was nearly in shock by the time I finished. I should have been hospitalized, honestly. But the long and short of all of this is, I think my hormones STILL have not recovered from the torture that started in 2013. Yeah I got my medal, but to this day I regret that race with everything in me!

HRT

So yes, I ended up gaining about 12 pounds during 2013 despite running 40 miles a week and putting myself on a diet during the training for that marathon. I turned 46 the day before that race, and perimenopause was in full swing but I had no idea. No one had labeled it for me, and it honestly never occurred to me. Again, I figured if there was something to be concerned about, the doctor would have mentioned it. But I was becoming miserable. After the race, I couldn’t run due to the broken foot, and I was gaining weight at an alarming rate. I was still tired and irritable and my periods were ridiculous. Back to the same doctor I went. Again, she told me the same thing - well, you’re not running now so what did you expect. So it was time for a new approach.

Back in the 1980’s my mom was on Premarin as she hit menopause. At the time, that’s kind of all there was in terms of treatment for hot flashes or vaginal dryness. Is was an estrogen-only treatment and lo and behold, women started getting breast cancer. Women including my mom. She was actually diagnosed in October of 2013, about 3 weeks before I ran my marathon. She caught it early, had a lumpectomy and lymph nodes removed, had a few months of radiation, and she’s been clear ever since. But it was this early form of estrogen only HRT that got a really bad rap and created an entire generation of women that went through all of later life underserved, medically. And it irritates me beyond belief.

Once my other symptoms of brain fog and unbearable hot flashes kicked in a few years later, plus the extra 30 additional pounds I had put on, I couldn’t take it any more. At my annual gyn appointment I asked about HRT options because I was absolutely miserable. My doctor was my age and she said, no we don’t offer that and we don’t recommend it. So I looked for more non-traditional sources. I found a functional medicine practice near me that would prescribe estrogen patches, progesterone tablets, and testosterone pellets. All out of pocket of course. And it was about $2000/quarter for this treatment including the blood and urine testing required to make sure that the dosage was correct. I was desperate to feel better at this point. So I did it.

Within days, my hot flashes stopped. I was sleeping better. My energy levels increased. My libido increased. I felt somewhat like myself again, which was miraculous. I still had 40 pounds of extra weight to lose but it felt like I had some hope for the first time in years. So despite the cost, I stayed on the treatment for several years. But then, in 2022, that practice changed hands and it became even more expensive. Around this time some online providers started offering similar options so I switched to that. However, they didn’t provide any of the testing, which made me a little wary. They didn’t offer any of the testosterone but I still had the estrogen patch and the progesterone tablets. I stayed with them for another 2 years and a substantially lower cost, but then in November of 2024, after being in full menopause for 4 years, I got a freaking period. Like a full blown period. Good lord, how I didn’t miss those.

So I called my gynecologist and set up an appointment. Yes, it had been a while since I had seen her - now that an annual pap smear isn’t required that’s one of the things I’m happy to put off, you know? - and the soonest she can get me in is January 2025. I see her in January and I tell her that I’ve been on HRT for about 6 years and ready for this?? She said “Why didn’t you come to me for that?” I wanted to poke HER eyes out! I said “I ASKED YOU FIRST AND YOU SAID NO!” Anyway, I told her my doses and she said I shouldn’t be bleeding of course, so I had to go have a trans-vaginal ultrasound. That showed that my uterine lining was too thick which could be from the HRT or it could be from cancer, neither of which I wanted to hear.

So now I’ve been off of all of my HRT since January. I had to have a D&C and a hysteroscopy in March and the biopsy they took from that was negative, so thankfully everything is good, and all bleeding has stopped. And my symptoms of menopause haven’t really returned since I’ve been off the HRT with the exception of the brain fog - I can’t remember the simplest of words. Yesterday I was asking Ross if he would please take the hamburgers out of the “big silver box” because I couldn’t remember the word “refrigerator.” It’s very disconcerting! At times I think I don’t need to be on it anymore, and then I’ll see a study pop up that says estrogen protects women from heart disease and heart disease is still the leading cause of death. So then I think I should go back on it… It’s a very personal decision, but I think all in all, for me, it’s worth it, and I will go back on it. My gynecologist asked me to wait until June to give my body a full 4 months off all hormones and then re-start if I wanted to. I don’t regret going on it, I did feel good on it, but I’d 100% go where the testing is available to make sure your dosing is what it should be. I won’t do an online HRT anymore.

I’m annoyed that in 2025 this is an out of pocket expense for women but viagra is covered for men - if estrogen protects my heart, then why isn’t it covered? But that’s a different rant, for a different day, I suppose. And you can rest assured that I will talk and talk and talk to anyone that wants to listen about menopause, HRT, PCOS (which my older daughter Maddie has suffered with for years) and any other hormonal issues, because women are grossly underserved in medicine. And it’s about time we stop being silent about it. My girls will probably be tired of hearing me be so bullish, but the time for being delicate is long past. Female health has suffered at the hands of discretion for centuries, and it’s our time to demand answers. Our lives literally depend on it.

Love, Karen