As I navigate this menopausal journey that has also come with fatty liver disease as well as significant liver fibrosis, I realize that I must do much of the research myself so that I may better advocate for my own health. I have been on oral HRT for several years. For me, it was a life saver and almost immediately helped resolve the incredible anxiety I was experiencing. It also helped mitigate hot flashes and improved my sleep (for as much as my sleep can improve). Since being diagnosed with fatty liver and fibrosis, I have found myself needing to explore every avenue as I try to improve my health. This led me to the discovery that oral HRT is not advised for women with liver disease as that is where it is first metabolized, forcing the liver to work that much harder. If a liver is already compromised, this can spell disaster. Here's the thing: my doctors all use the EPIC system, which is supposed to help doctors better coordinate health care. Each doctor can see all medications that are in one's chart. They can message each other, see what tests have been ordered, etc. So is it that no one realized, once I was diagnosed, that perhaps this was not a good option for me, anymore? I will give my GYN a pass since I have not seen him since being diagnosed, but as soon as I learned this and reached out to him through the portal, he confirmed that this should be stopped immediately and prescribed the gel (I had originally been on a patch, but developed dermatitis due to the adhesive). While my research revealed that transdermal estrogen bypasses the liver, he was still cautious and stressed the need for monitoring. No one else has. I cannot stress the lack of research into women's health, especially menopausal women. Yes, there are new platforms that seek to provide better care, but why are we still playing catch up? We deserve better and should demand it.

Did you know that tinnitus (new or worsened) can be part of the fun peri- and menopausal journey. You never heard of it? Well, neither had I. It was one of those weird symptoms that came up and, as I did more and more research, found that as estrogen fluctuates and decline, our inner ears become more sensitive because this destabilizes the auditory system and brain''s sensory networkds. Estrogen works to help regulate blood flow. Estrogen helps support those sensory hair cells and acts as a neuroprotectant, too. So, is this part of the reason why, since entering perimenopause all those years ago that I have had two bouts of full-on vertigo? Is this the reason why my tinnitus sounds like I'm constantly standing in the middle of a field of summer flowers with mosquitos buzzing around me? Is it also why I am hypersensitive to loud noises? Probably. While tinnitus is definitely annoying, it can also lead to anxiety, irritability, increased headaches, dizziness and vertigo. Now go ask your GYN why she never told you.

Perhaps the most surprising part of my menopause journey was the crippling anxiety that seemed to come out of nowhere, overnight. I knew about the mood swings and can recall the episode of All in the Family when Edith becomes a beast as she battles the hormonal fluctuations, but I did not realize that beyond mood swings, depression and anger, anxiety would make an appearance. Every night, like clockwork, I would wake up in the wee hours of the morning with an existential dread. A ticking clock had suddenly started sounding the alarm that my life was over. I mean, 50 was right around the corner, and then would come 60, then 70, etc., and before long, I would be dead. Anyone who knows me can appreciate this was extremely unusual for me as, up until that point, aging and death had never scared me. As a therapist, I knew this anxiety was different than my typical neurosis. My anxiety was a persistent hum of white noise in my head, making me look at myself differently, look at other women differently. It scared the hell out of me. My husband, not a general source of emotional comfort on a good day, dismissed my fears in his usual pragmatic way. Even friends could not understand why I was freaking out. It is fair to say I lost it a little bit during that time, going back and forth between dread, anxiety and sadness. As a child of the 70s, I grew up believing all of the negative stories about HRT. However, a trip to my GYN, after much research on present day HRT, made me decide to give it a try. I can only speak for myself, but HRT was a game changer. Suddenly, my anxiety was not a thing anymore. I was not waking up in the middle of the night thinking of my life being over. While I did not feel like my 40 year old self, I did feel better. At this point, I have been on HRT for about four years. While I do not intend to ever come off, more reading has me considering topical HRT as opposed to oral due to my liver issues (one thing no doctor has pointed out is that oral meds are processed through the liver first, and with a compromised liver, this can lead to further injury). I do get an occasional hot flash. But the anxiety that comes in the night is the same that keeps everyone else awake: bills, geopolitics, my daughter, etc.

If you’re reading this, you’re likely somewhere between 40 and 60. You might be dealing withhot flashes that ruin your sleep, joint pain that makes you question every movement, chronic brain fog, or a metabolism that suddenly stopped listening to you. Oh, and let's not forget the irritability that makes you consider if violence really should be an acceptable way to handle disagreements with your partner. You might also be exhausted by a world that tells women our value drops the moment we stop reproducing. I know this terrain because I’m walking it right now. I’m 53 and post-menopausal. While I knew this part of life was inevitable if I lived long enough, I did not expect it to include hypertension, high cholesterol, liver fibrosis, and tinnitus. The hypermobility I thought was cool when I was younger and showing off has suddenly resulted in random dislocations of an ankle when I was wearing heels on an uneven surface, as well as of a pinky when I hit it, reaching for something in the closet. I’m on HRT (as well as blood pressure medication).I’m redesigning my workouts so I don’t tear myself apart. I’m fighting to keep my muscle mass while my body tries to shed it. And I’m doing all of this while running a mental healthpractice, rescuing dogs, trying to get my daughter through college and completing my own doctorate in social work. I now understand the phrase: tired, but wired. I have never been a woman who must see female providers. What matters to me is that a doctor is good. However, I am rethinking that after the orthopedist who diagnosed my severe lower back and hip pain as arthritis flatly told me this is what happens at my age. While that may be true, dismissing every ache and pain to age and menopause felt rather dismissive, especially without a subsequent treatment plan and not just a referral to PT. Since perimenopause around age 47, I have steadily gained weight despite eating less and less (even becoming a vegetarian for a year), working out hard, giving up alcohol, trying to get more sleep. My weight lifting sessions are working because I am getting progressively stronger, but it is not reflected in the image I see in the mirror. I have developed bat wings and thunder thighs and, always having had a more boyish build with no curves, I suddenly have breasts that threaten to suffocate me and a butt that must be someone else's.