Vanitas-Still Life by Maria van Oosterwijck, 1668, Kunsthistorisches Museum
It’s been a year since I found out I’m in menopause, which sounds so weird because I’m turning 40 in July. In a way, my early diagnosis was a gift. I spent this past year closing out my thirties by studying the biological and social impacts of a major life experience I was supposed to go through in my 40s. I guess I feel a little smug, like I know more about life than I actually do. And at the same time, the knowing has made me hopeful for the lessons my 40s will bestow upon me. I’m alive and ready to roll.
The Japanese word for menopause, 更年気 (pronounced Konenki) translates to the renewal of energy. I like this definition so much because it serves as a counterbalance to the ways that I understood menopause a year ago when I knew nothing about it except that it was a confrontation with my own mortality, the beginning of the end. Of what? Oh, I was so silly!
On the anniversary of my diagnosis, I’m sharing five things I’ve learned this year because to renew something means to both resume and extend it. Forward or share the below list with your people if you think they’d find any of it helpful, and of course I hope it helps you.
There is a Menopause Practitioner Database
A cursory Google search for menopause gynecologists will yield many virtual clinics like Midi Health, Winona, and Gennev to name a few. I have no experience with any of these systems because my insurance provider doesn’t cover out of network care. Being limited to the providers in my network was frustrating until I landed in a subreddit forum at 2AM one night last March and read that The North American Menopause Society (now The Menopause Society) has a practitioner database which lets you search by region for providers.
Once I pulled up the list of providers where I live, I did a separate search to see which of these practitioners took my insurance and immediately scheduled an appointment with a menopause-focused gynecologist who changed my life.
Menopause is different for everyone
There are actually different terms for menopause depending on when you go through it (aka: you don’t have a period for a whole year). These include: early menopause for women 40-45, menopause for anyone older than that, and POI, which is what I have. Premature Ovarian Insufficiency is the official term for women 30-40 experiencing symptoms of perimenopause and menopause.
According to The Daisy Network, a UK-based charity for women with POI:
POI is different to menopause that occurs at around the average age (52 years). Not only does it occur at a very young age, but the ovaries often don’t completely fail. This means that ovarian function can fluctuate over time, occasionally resulting in a period, ovulation or even pregnancy, several years after diagnosis.
In fact, as I write I am (apologies for the TMI) on a period(!). After a year of wearing white pants whenever my period is not something I miss. But my larger takeaway from learning these different terms is that the age at which you pass through the menopause portal may be connected to certain types of care that you need. Hormone replacement therapy (HRT, or MHT if you are over 40) isn’t for everyone, but I take it to lower my risk of cardiovascular disease, osteoporosis, and potentially Alzheimers and dementia—all of which are increased by menopause, and all of which I want to decrease the risk of for a few more years.
Get baseline data on your bone density early on
I learned this tip from the The Premature Menocast podcast, but I don’t think it’s exclusively for women under 40, and that is to get a bone density scan early on in your perimenopause/menopause journey. The goal of the scan is to have a baseline to track your postmenopausal bone density loss so that you can get any care that you may need for osteoporosis if you develop it.
My bone density scan took about 10 minutes. I had to wear leggings, and I treated myself to ice cream afterward because this is my go-to ritual for all of my medical appointments.
Beware of menopause social media
The menopause algorithms found me within weeks of my initial diagnosis. While I think that on the whole menopause influencers helped me feel less alone, not all of the advice I encountered is backed by science. For example, in menopause documentary, I learned about the benefits of taking testosterone and wondered if I should. Thankfully, Dr. Jen Gunter who writes The Vajenda wrote an excellent critical analysis.
It isn’t just medical advice I’ve become wary of; menopause is also becoming an increasingly popular marketing term that taps into our insecurities about our physical beauty. In her excellent menopause novel All Fours, Miranda July wonders if what people mean by femininity is youth.
You really do feel better in time
I’ve heard that for women who go through menopause or early menopause, that you really do feel better and balanced in time, and I know that to be true for myself. My menopause symptoms began six years ago with torrential periods that (at the time) no gynecologist saw as a clear sign of early perimenopause. Then came the anxiety (explained away by the pandemic and the demands of early motherhood). Then, just a few months before my actual perimenopause diagnosis, night sweats and sleep disturbances. All of my symptoms were alleviated by HRT, Magnesium Glycinate, and learning to take more time for myself.
Renewal happens over time, with each fact you learn and step you take. Take action where you can, ask for support when you need it, and know that the hard parts don’t have to teach you anything. They can simply be hard, and you will get through them, and eventually you’ll be on the other side.
Reading Jen Hyde's anniversary essay on her POI diagnosis at 39 — the Japanese word for menopause translates to "renewal of energy," and she's living it. A few clinical notes in the comments, but the essay itself is the thing.
Jen, thank you for writing this. The Konenki frame — renewal of energy — is one I return to often with patients, and you've articulated something I find myself trying to say in clinic all the time: that the diagnosis arriving early can be its own strange gift, because it gives you years to learn what most women only get months to absorb.
A small clinical footnote on the bone density point, because I think it deserves underlining for anyone reading: for women with POI specifically, that baseline DEXA isn't just useful — it's standard of care, and it should be repeated. The trajectory matters more than any single number. The same goes for a lipid panel and, if you can get one, a coronary artery calcium score in your mid-forties. The cardiovascular piece of POI tends to get less airtime than the bone piece, and it shouldn't.
And your instinct on the social media wariness is exactly right. The testosterone conversation is the clearest example — there's a real clinical use case for it in a narrow band of women, and there's a much larger wellness-marketing case that has gotten ahead of the evidence. Jen Gunter is the right person to read on this.
The line that stayed with me most: 'the hard parts don't have to teach you anything.' I'm going to borrow that, with credit, the next time a patient apologizes for not having found the meaning in her symptoms yet. Thank you for it. With love, Amy Maher