Menopause and a "Broken Thermostat"

The other day, I googled “cold flashes.” That wasn’t a typo; I didn’t mean “hot flashes.” I meant COLD.

I’m not at menopause yet, and judging by family history I’m probably a good half-decade away. But over the past several years I’ve had even more trouble than usual staying warm. My internal thermostat went completely haywire when I got sick in January 2009 with the still-undiagnosed ailment that messed with my nerves and muscles and brain. Nothing could keep me warm. While that has improved somewhat, it hasn’t returned to my pre-illness state. Then, after a minor virus this fall, I started to notice that warm stimuli – the blessed touch of sun on skin, or the spray of hot water in the shower – could give me the chills. Goosebumps, even!

I wasn’t alone. A friend of mine, a few years younger than I, seemed equally miserable at those chilly soccer games at the end of this fall’s season. We were both hiding under blankets and nursing a thermos of tea as soon as temperatures dropped into the 50s.

I began to wonder: might freezing just be part of aging?

According to Google, yes. Women do report cold flashes, though they typically follow upon hot flashes. Somehow, the hot flashes, with their dramatic sweats and red skin, get all the press, while the chills get – well, the deep freeze in the media!

The root cause seems to be the same, though. The hypothalamus is responsible for keeping our internal temperatures running steady. In the decade or so prior to menopause (a woman’s last period), the hypothalamus stops running so steadily. Conventional wisdom holds that fluctuating estrogen levels send confusing signals the hypothalamus, but actually there’s an intricate interplay between the hypothalamus, pituitary, and ovarian hormones. Contrary to its image, estrogen does not function as the ringmaster – not on its own, anyway.

Whatever the exact mechanism, it sure feels like a broken thermostat to me. At the blog re:Cycling, Heather Dillaway objects strenuously to calling it broken, or attempting to “fix” it. She objects to any language that portrays menopause negatively or suggests that women “suffer” from it. She’s part of a noble tradition of feminist criticism that has pilloried the medicalization of women’s bodies. This critique, however, too often sets up a false opposition between how doctors tell women they should feel and women’s actual experience.

Sure, experience is partially shaped by our expectations, including biomedical ideas about women’s bodies. Menopause is indeed a natural transition, one that every cis-woman will undergo if she doesn’t die young. We should certainly oppose the idea that women’s worth is based on their youth, beauty, and fertility. We should celebrate the wisdom that can come with time.

But doggonit, my thermostat feels broken! I might fantasize about it improving if were to spend a week in St. Tropez, but realistically? It’s likely to get worse before it stabilizes or improves. And it’s not a trivial thing. When I’m unable to get warm, despite long underwear and a sweater, a heating pad, and an ambient temperature of 72, I don’t merely experience cold; I suffer it. Putting a positive spin on this merely denies my experience. To anyone intent on painting menopause in shades of rose and mauve, I ask: What color do they turn when they freeze?

For many women undergoing the menopausal transition, temperature regulation is only one challenge. Many women also report debilitating fatigue, which is also linked to a wonky hypothalamus. They wake up at night, drenched in sweat, heart racing. It’s not a panic attack; it’s “only” a night sweat.  Salon just ran an essay by Beth Aviv detailing her struggles to manage such symptoms after (admittedly foolishly) stopping hormone treatment cold turkey:

… I wake in the middle of the night, heat percolating to the surface like an underground spring — flooding between my fingers, into elbows, under my arms, onto my chest, my neck, my scalp until my straightened hair curls. If you could slide your fingers over my forehead, it would feel like you were finger-painting. Sleep does not return for hours.

The comments on Aviv’s essay are Salon’s usual mixed bag. There’s no shortage of people telling women to just “suck it up.” (This phrase appears repeatedly.) It’s mostly women piling on other women, as in this especially judgmental comment by a woman calling herself Semolina:

Most menopause symptoms are psychological. Some people enjoy making drama out of trivial events, and those are the folks who suffer mightily. I’m sixty years old and female and none of my friends has had this extreme problems — because I don’t hang out with drama queens.

Well, that Judgey McJudgey comment drew the smackdown it deserved from another commenter named Mona:

I see. Well, I am a 54-yr-old woman with a law degree from an elite university. A bit more than a decade ago, I suffered a severe emotional breakdown in the wake of the death of my oldest son via vehicular accident. Followed by that son’s father deciding to leave me for a man — that happened 6 weeks after we buried our 19 year old son.

As a consequence, I developed a crippling anxiety disorder. I’ve been in peri-menopause or menopause for about 8 years, and had been swimming right along assuming mine would be as easy as my mother’s.

It is now NOT. And it’s not in my head. It’s in the interference with my work toward recovering and living an emotionally stable life — a life with joy.

The extreme insomnia is not in my head. Nor the heart palpitations and the profuse sweating followed by cold clamminess ALL NIGHT LONG.

So, Seminola, I’m glad you don’t hang with “drama queens.” Neither do I. But some women have had, and continue to have, serious, dramatic problems that are, most decidedly, not in our heads. Or wait, they are, but not in the way you imperiously meant.

Now, obviously most menopausal women don’t undergo two personal tragedies in quick succession (though most of us do start to notice the losses piling up as we move through our forties). I’m offering Mona’s experience not to typify menopause, but to underscore its variability. She thinks she’s going to try bioidentical hormones, which I would likely try myself in her situation. (The debate on the relative safety of “bioidentical” versus synthetic and equine-derived hormones is not one I want to engage here – maybe in a future post?)

It’s great that some women sail through menopause, getting by with a sense of humor and a willingness to just suck it up. That’s their experience. I’m glad they were able to manage. I’m still early-days enough to fantasize it could be my experience, too, especially if I keep my house well heated.

But other women have other experiences. Some experience severe cognitive and mental health issues. Most face the more mudane – but still sometimes disabling – issues of body temperature regulation and insomnia. Oh, and sexual issues, but that would be a whole ‘nother post.

Point is, nobody gets to define your experiences for you. Not the perhaps well-meaning but ultimately wrong-headed doctors in the 1950s and ’60s who promised eternal femininity. Not those present-day doctors who fail to see patients as individuals, either demonizing Prempro (the most common synthetic HRT) or withholding it across the board. Not good-hearted feminists who want to put power back in women’s hands – but haven’t walked in your shoes, nor tried to sleep in your soggy sheets. Certainly not the Internet scolds who tell you to suck it up.

You. Only you get to decide what you’re experiencing, whether you’re suffering, whether something feels “broken,” and how – if at all – you might try to fix it.

Then again, maybe I’m a drama queen, and I just haven’t noticed it?

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