"Hot flash!" I announced as I reached for something to fan myself with. The conversation over the coffee-shop counter stopped dead. The other customers had that get-me-out-of-here look, and the barista turned bright red, like he was having an even hotter flash himself.
I fanned away, shamelessly. And intrigued. Call it my moment of menopausal enlightenment. With just two words, I seemed to have stumbled on a whole new mode of transgression, voicing something most people would rather be left unvoiced. The menopausal woman as social transgressor? Count me in!
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That was more than 20 years ago. You'd think a whole generation of outspoken women would have moved things forward since then. But even though we no longer refer to menopause as "the change"—which, like most euphemisms, is absurd, like you're going to metamorphose into a giant insect—it's still merely whispered among women, as though there were something shameful about it.
Indeed, for some, the prospect of menopause seems to induce an almost Kierkegaardian level of fear and trembling. In which case whatever I say here about my own experience may only add to that dread. Or it may create its own kind of metamorphosis, opening up a very different perspective.
You might even end up agreeing with me that however hot those flashes, menopause is cool. And more than cool, it's freeing. Though it didn't seem that way to me when it first began.
In what I suspect was a case of feminist snobbery, I'd managed to convince myself that only wimpy women got hot flashes. I'd read somewhere that a quarter of all women never do, and that they sail through menopause with blithe nonchalance. And although blithe nonchalance had never been my thing, I fully expected to be one of them. So I was caught off guard when the flashes began. In fact, I was insulted. "You mean I'm just an ordinary biological being? I don't get a free pass?"
Hot flashes are the most obvious "symptom" of menopause. The quote marks are there because a symptom implies something medically wrong, instead of a natural process. And hot flashes are not symptoms of illness. They're withdrawal symptoms. Withdrawal, that is, from an immensely powerful drug: hormones.
You can ignore the gradual disappearance of your period. For many, that may come as a relief. But hot flashes aren't ignorable, especially since "flash" is a misnomer. Here and gone in a second? No way. These most public signs of menopause last at least a couple of minutes, and sometimes far longer. When they come during the day, they're hard to disguise. ("Is it really hot in here or what?" you say as you resist the impulse to strip, and then realize from the way people are staring at you that the answer is "or what.") But when they come at night? That's something else.
"Do you sleep warm?" a saleswoman once asked as I was shopping for a new mattress. The question came with an oddly meaningful look, but in my premenopausal innocence, I failed to interpret it. What she meant was: "Do you have night sweats?" In which case, as I'd discover a couple of years later, the foam mattress I'd decided on was not a great choice. Rubber and sweat don't mix.
Night sweats are simply nighttime hot flashes. Not such a big deal, you might think, until you start coming wide awake two or three times a night, radiating heat. And I do mean heat. Throw-off-the-covers, take-a-cold-shower, stand-naked-at-the-open-window-during-a-snowstorm kind of heat. Which goes a long way to explaining why menopausal women have a rep for "emotional volatility." When you can't get a decent night's rest for months at a time, you end up seriously sleep-deprived.
But this is far more than simply physical. It's existential. Hot flashes are the clearest possible message, not just inscribed on your body but radiating out from inside it, that you no longer have any biological reason to be alive. Your reproductive function—the continuation of the species—is over, done with. You're not producing eggs anymore. You're no longer fit for breeding. The prime Darwinian reason for your existence on this earth is hereby declared null and void.
And this is a relatively new state of being. Not so long ago, that menopausal message would have ended with "over and out," since until the early 20th century, not that many women lived long enough to experience it. Before vaccines and antibiotics, the average life span—worldwide—was in the early 40s, and it had been that way for most of recorded history. Something as seemingly minor as an infected cut or drinking the wrong water (or childbirth, or the flu, let alone the plague) could kill you.
That's not even counting war and famine. Which is another reason menopause caught me by surprise: I never expected to live long enough to go through it. As a student in England, I'd marched with the Campaign for Nuclear Disarmament in the conviction that World War III—the big one, the nuclear one—was close (as it still is, and given the current occupant of the White House, more so than ever). We were all about to die, I thought, so who needed to even consider menopause?
Yet here I was 30 years later in Seattle, hot-flashing and night-sweating like crazy. So now what?
Sure, you can fight menopause, if denial is your thing. I know because I made it mine for a while. "Screw this," I thought. "No way am I putting up with it." And headed straight for HRT—hormone replacement therapy.
Why care about the long-term cancer risk when I could call biology's bluff right now? Give me my estrogen fix, and I'd be fine. I could kid myself—and a few others—that I was still a sexually attractive being. Or at least a sexually available one. All of which came to a screeching halt when I developed uterine fibroids. These made menstruation a nonevent by comparison. Huge clots of blood kept slithering out of me, inducing a kind of fascinated horror. I was almost proud that I could produce that much blood and still stand upright.
"Surgery," said the doctor. "A routine procedure, nothing to worry about." But since the prospect of a sharp instrument pointed anywhere in my direction tends to induce intense worry, this failed to reassure. Surely there was a less radical option. Even—gasp—the obvious one.
I steeled myself, and bid a mournful farewell to HRT, all those lovely artificial hormones. Sure enough, the fibroids disappeared, starved of the estrogen that had been feeding them. And the hot flashes and night sweats started back up, stronger than ever for having been delayed. As though biology were saying, "Ha, knew I'd catch you sooner or later."
Okay, you think, you can deal with this. Instead of trying to pretend that hot flashes don't exist, all you need to do is go down to Uwajimaya and get a couple of paper fans, preferably ones with tassels or fringes. Open a fan up with a flick of the wrist (this takes practice) and make like a courtesan or a Southern belle or Madame Butterfly (this might not take practice). And if someone is embarrassed by your having a hot flash, politely suggest that they grow the fuck up.
But then you'll find out that once the flashes and sweats are done—a year or two on average, though I still get them occasionally—you don't end up back where you started. You look in the mirror one clear winter morning when the light is really bright and realize that your body seems to be, um, changing. Not into a giant insect, true. But what you see doesn't match your usual image of yourself.
You knew you had a wrinkle or two—but in that morning light, it's no longer possible to deny that there are a lot more of them, and that they're more pronounced. You raise your arms and realize that your skin isn't as smooth and taut as it once was. It occurs to you with a shiver of dismay that the word might be "sagging." Your waist seems to have expanded somehow, which could be why you've been complaining that they're making jeans smaller than they used to. And you might find—could it really be?—that your pubic hair looks suspiciously thinner. Your pubic hair, for chrissakes! That's getting downright personal.
And this is only what you can see in the mirror. Where the merest thought of sex was once enough to make you go all moist and lubricious, now you have to kind of concentrate to get where you want to be. Not that you're anywhere near that dread phrase "vaginal dryness," and yet the possibility of it hovers, challenging your sense of yourself as a sexual being. If you have a flair for hyperbole, you might even suspect that you're gradually being desexed.
None of this is possible, you think. You're too young for this. You're not ready for it. But your body says you are. And at some point, your mind is likely to catch up.
While some women stay lustily active long after menopause, defying sophomoric sniggers about cougars, many don't. Sexual desire often goes down along with the hormone levels, though since we're still at the whispering stage, nobody seems to know how often. In my case, however, it went way down. And while that sounds like it must have felt like the cruelest blow of all, it didn't.
One friend thinks this might be easier for me to say since I had a ball as an active sexual being. Dancing in between the pill and AIDS, I had no sense that I'd missed out on anything, so it could be that I'd had my fill. Yet I think it more likely that my increasing indifference to what's conventionally thought of as the loss of sexual desire had nothing to do with how much sex I had or hadn't "had" (that weird phrase "having sex," as though it were something to be consumed). More likely, that is, that it simply came with the territory.
A loss is only something you feel deprived of, and I didn't feel deprived. And still don't. Yet there's a whole pile of interested parties out there all too eager to convince me that my lack of a sense of lack is itself a lack. As they see it, this is not just a loss but a problem. And more than a problem, a "dysfunction," a "disorder." Which apparently means that I need to be made functional again. Or brought back to order.
This is where the big money comes in, eager to capitalize on the desire to ward off a natural process. "Loss of libido," that is, has been transformed into a marketing opportunity. Though it began not with women but with men. Specifically, with the male equivalent of menopause: the gradual process known as andropause, which is the result of decreasing levels of testosterone.
The range of "symptoms" includes declining sperm count, receding hairline, increasing body fat, and thinning pubic hair (yes, men too). But the one andropausal sign that constitutes the biggest challenge to standard ideas of male sexuality is what is now known as erectile dysfunction.
This became a go-to diagnostic category when Pfizer researchers working on a new cardiovascular drug discovered that penile erection was one of the drug's side effects. The company's marketers got a hard-on at the news and set about what they call "drug repositioning." They'd restore penises to functionality and render them safe for prime-time television with sunnily crafted commercials using the abbreviation ED, which sounded kind of man-next-door friendly.
And the woman next door? "Female Viagra," of course. It debuted in 2015, packaged with an unerring instinct for stereotype in the form of little pink pills. Branded as Addyi, it made its bid for FDA approval as a treatment for HSDD, or "hypoactive sexual desire disorder"—a DSM-III diagnostic category that evidently considers me a disorderly woman and has no idea that I might take that as a compliment.
Where Viagra works on blood flow, Addyi works on neurotransmitters, an "all-in-the-brain" approach that may make sense to many women. But there's a lot about Addyi that doesn't make sense. It's expensive, to start with. It doesn't mix with alcohol. And even if you're a wealthy teetotaler, you still have to take it every day, sex or no sex. Plus, as reported in the Journal of the American Medical Association, the best you can expect from Addyi is that it "increases sexually satisfying events 0.5 times a month."
An extra half orgasm a month. For $400. Not covered by insurance.
You might not even be aware of that half orgasm, since the main effect of Addyi appears to be sedation—in fact, sedation to the point of "sudden prolonged unconsciousness," especially when combined with booze. Which makes it sound not unlike a date-rape drug. And if the prospect of really expensive, unconscious sex is not enough to turn you off, you might consider the fact that Addyi failed FDA approval twice. It only succeeded on the third try when its manufacturer, Sprout Pharmaceuticals, hired a public-relations firm to create a ginned-up consumer advocacy campaign.
The FDA doubled down on the mysteries of its approval criteria last month when it gave the go-ahead to a new "low sexual desire" drug for women. This one's called Vyleesi, due on the market in September in the form of an auto-injector pen at a mere $899 for the pen itself, plus $99 for each subsequent dose. Just jab yourself in the thigh or the belly 45 minutes before sex—ouch!—and you'll be good to go.
Except for the nausea, that is. Per the manufacturer's website, "nausea is reported in 40% of patients who receive up to 8 monthly doses"—though, with confusing vagueness, nausea "improves for most patients with the second dose." Plus, since the drug stimulates melanin receptors, it can darken the skin of your face and breasts, as well as your gums—particularly if you already have dark skin. So now you'll be able to inject, throw up, get blotchy, and feel sexy.
Your nearest drugstore is a lot cheaper, and a lot more direct. Mine boasts two whole shelves of glycerin- and silicone-based lubricants in the "feminine hygiene" aisle, placed at eye level right above the condoms and the pregnancy test kits. Astroglide and K-Y Jelly paved the way here, repositioning anal-sex standbys into an expanded array of "couples lubricants" (his and hers, blue and red) as well as specifically "feminine" ones, so that while your vagina is saying "I'd rather not," you can trick it into saying "okay."
Or you can trick your eyes instead. If your body is trying to tell you that you're really not up for sex, you can at least look like you're up for it and fake the bloom of pulchritude. Thus the $8 billion business of cosmetic surgery (sharp instruments!). And injections of a paralytic toxin (more sharp instruments!). And hundreds—maybe even thousands—of organic and not-so-organic creams, lotions, gels, infusions, balms, fillers, volumizers, plumpers, serums, super-serums, and mega-serums. Regarding which, the main organizing principle appears to be that the smaller the bottle, the higher the price.
But why do we even want to play such tricks? Why do so many of us—both women and men—find it so hard to listen to our bodies when they don't respond like they used to? Or acknowledge what should surely be self-evident, which is that we're not hormone-driven teenagers anymore. What exactly is wrong with waning libido? Why does it seem so threatening?
Or is what we're really afraid of something else? Not menopause itself, but what it signifies: age.
Ever since I went off HRT, I've looked my age. Premenopausal friends rush to insist that this isn't so and seem disturbed—even dumbfounded—when I ask what's wrong with looking my age.
I've apparently asked a very un-American question. Indeed, given the cosmetics and pharmaceutical industries, an anti-capitalist one. But I suspect what makes it so challenging for many women is the fear that without youthful sexuality, you somehow don't count. To be postmenopausal, that is, is to risk becoming the invisible middle-aged woman.
She does exist. The day I first saw her, she was all too visible—the kind of totally unremarkable woman whose presence I'd never have registered if she hadn't been staring at me while I gazed in the windows of the downtown Nordstrom.
"What does she think she's doing?" I thought, with what I now recognize as dismissive condescension. "What's her problem?" I tried to outstare her, but she held her ground insistently. Maybe she was someone I'd met and didn't remember? I'm not that good at recognizing faces, so that figured. Come to think of it, she did look kind of familiar...
Which is when I finally realized that this middle-aged woman was me, reflected in the store window against the background of the latest fashions.
A rude reality check? Yes, and a good one. One response would have been to head straight for the cosmetics counters, but instead I kept on walking and started thinking. Did I really place so much store in how I appeared in the eyes of others? Had I ever actually enjoyed being stared at in the street? Did I ever think a wolf whistle was a compliment? Had any of that been in any way cute, or had it felt more like harassment?
I'd come literally face-to-face with the fact that I was no longer a sexual object. Still female, obviously, but no longer conforming to feminine stereotype. And to my surprise, this felt like a relief. More than a relief—an emancipation. Whatever need I'd felt to conform to that stereotype before menopause, I no longer did.
I began to appreciate the anonymity of the middle-aged woman. I was free to look as feminine or as unfeminine as I liked. I could choose my degree of visibility and enjoy the ease of flowing smoothly, unremarked, through public space. Middle-aged women, I realized, would make excellent spies.
Not that I totally gave up on feminine signifiers. I haven't done high heels since karate messed up my knees years ago, but I'm still a sucker for long suede boots and fingerless gloves reaching up to my elbows and any color nail polish but pink. Not because I want to look attractive—attractive to whom? or for what?—but because I like them. They make me smile. And they're effortless. I may admire the way some older women rock exquisitely groomed silver hair and defiantly red lipstick, but my hair has never been anything but unruly, and I defy better without any lipstick at all.
And without sexual desire. Or any desire to reestablish it.
I realize how terrifying this sounds to a lot of women, for the simple reason that I know how terrifying it would have once sounded to me. I can practically hear my past self screaming: "What do you mean, no desire?" She might even be cowering in dismay or weeping in pity for the future me. An end to sexuality? The horror, the horror!
Yet I'm anything but horrified. And it feels like anything but an end. Because the obvious needs to be stated: The end of sex isn't the end of life.
After menopause, most of us get two or three decades more, and these decades feel to me like an unexpected gift. So what kind of ungracious idiot would I be to reject a gift this big? I could spend these years shriveled into mourning my sexual self, or I could get down with hormone-free existence (almost hormone-free, that is, since postmenopausal bodies still retain about 20 percent of what they once had, in a kind of basic maintenance level). And here's where I discovered that there was a lot to get down with.
My mind felt clearer, for a start. It was as though there'd been a very fine, gauzy film over it, a kind of barely detectable hormonal mist that had now lifted. It felt like I'd gotten back full use of my intellect, so much so that I suspect I've done my best work in the two decades since menopause.
And where I'd imagined that waning libido would mean waning energy, it didn't. Like so many others, I'd managed to conflate libido with vitality—a conflation that only demonstrates that we're all still Freudians at heart.
My sense of vitality was as strong as ever; it just no longer depended on sex. Which is why I still work out and stay in shape—not in order to attract anyone, but because it feels good to be in a smoothly working body, and I think better this way. Besides, if I do get the urge (that 20 percent maintenance level doing its thing), it's easy and surprisingly quick to satisfy it myself.
Menopause, it turns out, freed me from want—from wanting not only sex but everything we tend to associate with it. Wanting to be attractive. Wanting to please. Wanting to prove something. This is very relaxing. I'm less concerned with how others see me, and thus more at ease with myself. And with others. There's no longer any sexual subtext to my interactions with men—or with women—and that seems to allow for more meaningful conversation, more forthrightness, more honesty. In other words, sex isn't getting in the way.
Not that I'm ignoring it. If I no longer want sex myself, I find that I'm more generous about it for others. There's no sense of envy or resentment, but instead a kind of welcoming beneficence. In my more self-aggrandizing moments, it's as though I'm some kind of crone-goddess sitting cross-legged on the rim of a high mesa, watching those still in the throes of hormones pursue sex down below me as I smile and lift my hand in blessing, saying, "Go, my children, go. Enjoy!"
So hold off on the pity, and spare me the dismay. I'm not waning, and I'm not in a state of loss.
I'm post-sexual. I'm into it. And I'm thriving up here on my mesa.