Going to Mars: The Postmenopause Symptoms Nobody Warned You About

I did not know that I would lose words.

Not the ability to speak. The actual words. A particular word I needed (the name of a restaurant, the title of a book I had read twice, the word for the thing I was holding in my hand) simply not there. Gone. As if someone had quietly rearranged the filing system while I was sleeping, and the folders were all still there but the labels had come off.

I thought this was menopause.

It is not menopause. It is postmenopause. And before we go any further, I want to say something plainly, because nobody said it to me: those two words do not mean the same thing, and the difference matters more than anyone told us.

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We Were Given the Wrong Map and Told It Was Complete

Perimenopause is the transition. It can last a few years or more than a decade. The hormones are shifting, the periods are unpredictable, and the symptoms (hot flashes, sleep changes, mood swings) are real and often significant.

Menopause is a single point in time. Twelve consecutive months without a period. That is it. That is the whole definition. One day, one threshold, and you are through.

Postmenopause is everything that comes after. It is not a stage. It is the rest of your life.

We were handed one word, menopause, for all of it. As if the transition, the threshold, and the decades that follow were the same experience, requiring the same attention, carrying the same meaning. They are not.

What I am about to describe is postmenopause. I want you to know that going in.

The Brain

The word loss was the thing that frightened me most, which tells you something about who I am. I could manage a great deal. I was less sure I could manage losing the thing I had always trusted most.

What I eventually learned is that this is called brain fog, and it is extraordinarily common in postmenopause, and almost nobody mentions it until you are already in it looking for the word you needed. Estrogen has receptors in the brain. When estrogen levels drop and stabilize at their new lower baseline, the brain is adjusting to a different operating environment. The memory lapses, the difficulty concentrating, the sense of moving through water. These are neurological, not imaginary, and they are not permanent.

They did get better. I want to say that clearly because nobody said it to me when I needed to hear it.

The Sleep

I was not someone who had trouble sleeping. I had slept well my entire life. I went to bed, I slept, I woke up.

And then I did not.

The 3 a.m. waking is its own unique experience. Not a gentle drifting to consciousness but a full, alert, wide-awake arrival, with a brain that immediately begins reviewing everything: the conversation from last week, the item on the to-do list, the thing I said in 2011 that I still think about. The archive is open and apparently unlimited.

Cooling sheets helped. A room that was colder than my husband Bill preferred helped. A magnesium supplement, taken at night, helped more than anything else. I am not a doctor and I am not prescribing. I am simply telling you what worked for me, because I wish someone had told me.

The Mood

Nobody warned me about the mood. I assumed hot flashes and called it a day. What I was not prepared for was the flat stretches, weeks when I felt like a dimmer version of myself. Not depressed. Not sad. Just meh, if I am being honest, which I am. I did not feel like me, and I did not particularly want to do much about it. Maybe you know exactly what I am talking about. Maybe you have been calling it something else. Whether it was postmenopause or the fifteen pounds I had accumulated over five years without being consulted, I genuinely cannot tell you. Probably both.

I know now that estrogen is involved in serotonin regulation, which is involved in mood, which is why postmenopause can arrive with feelings you were not prepared for and cannot entirely account for. Knowing that did not fix it, but it helped me stop looking for the thing I had done wrong.

Exercise helped. Sunlight helped. The afternoon or morning walk with Patches, non-negotiable in any weather, helped more than I expected. Getting outside and moving, even when I did not want to, moved something in me that nothing else did.

The Body

The fifteen pounds arrived without an announcement. They simply appeared, in distribution patterns I had not previously had, and declined to leave despite everything I had previously done that worked.

Metabolism changes in postmenopause. The body is redistributing fat, including toward the abdomen, in ways that are metabolic and hormonal and not primarily about what you are eating. This does not mean food and movement are irrelevant. They are relevant. But some of what is happening is not going to respond to the same things that worked at forty. This took me a long time to accept.

There is also something called Genitourinary Syndrome of Menopause (GSM), which is the clinical term for vaginal dryness, thinning tissue, and bladder changes. It is extremely common. It is also almost never discussed, which means women suffer through symptoms unnecessarily without knowing there are effective treatments. If you are experiencing this, please talk to your doctor. It does not resolve on its own, and it gets worse without treatment. There are options.

The Identity

I did not lose myself exactly. I just did not quite recognize the woman looking back at me.

The woman on the other side of that shift was still me. But she was me recalibrated, and I did not have a manual for her either.

What I found, over time, was that I liked her. She is less interested in things that do not matter and more interested in things that do. She is slower to apologize for herself. She has fewer obligations to other people’s comfort and more clarity about her own.

I would not trade her back.

The Intimacy

I will be brief here, not because this is unimportant (it is very important) but because it is also personal. The changes in postmenopause affect intimacy. Physical changes, hormonal changes, changes in desire and in how the body responds. None of this is failure. All of it is biology. And all of it is worth talking to your partner and your doctor about honestly, because honest conversation is the only way any of it improves.

This Is the Long Game, and Nobody Said So

Here is what I also did not know: postmenopause comes with long-term health consequences that nobody volunteers. You have to ask, and then you have to push.

I asked my doctor about a DEXA scan. She told me they wait until 60. Yippee, another birthday gift this year. But I am asking anyway, and I would encourage you to do the same. Ask about exercises that support bone density. Ask whether you should be wearing a weighted vest. Ask about strength training and balance, because nobody is going to hand you that conversation. You have to start it.

Cardiovascular risk changes in postmenopause too. Estrogen was offering some protection, and its reduction is worth discussing with your physician. Know your numbers. Ask the questions.

On hormone therapy: the thinking has evolved considerably from the 2002 Women’s Health Initiative study that alarmed a generation of women and doctors. Current guidance from the North American Menopause Society (NAMS) indicates that for many healthy women under 60 who are within ten years of menopause onset, the benefits can outweigh the risks. Have the conversation with your doctor based on your own history. It is not a conversation to avoid because of a study that is now more than two decades old.

There are also non-hormonal options for many postmenopause symptoms, for sleep, for mood, for bone health, for GSM. Ask. Push. Find a doctor who is working from current evidence, not 2002 guidelines.

What I Want You to Know

I think sometimes we are all just bobbing around in an ocean of information and misinformation, trying to figure out what is true and what applies to us. And sometimes what you need is not another article. It is just someone who gets it. That is another reason I am writing this series.

We are all different, and we are all in the same boat. I do not wake up at 3 a.m. much anymore, unless I am hot or stressed, which is its own kind of progress. The brain fog comes and goes. The fifteen pounds is down to ten. Do I like it? No. Am I working on it? Yes.

I did not know what I was walking into. I did not know the word for where I was. I did not know that other women I knew were quietly going through the same things and also not talking about it.

That is what this series is for. Not to alarm you. Just to say: here is the territory. Here is what it looks like from inside it. Here is what nobody put in the handout, and what I wish they had.

Books That May Help: The Menopause Brain by Lisa Mosconi, The New Menopause by Mary Claire Haver.

Tell me in the comments what piece of postmenopause territory nobody warned you about, and that you wish someone had said out loud. This is exactly the kind of conversation I want to have.

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Monopause Series:

Is There a Manual? What Nobody Ever Told Women About the Second Half of Their Own Bodies

This Is Not So Bad: What Happened When Birth Control Had Been Hiding My Perimenopause for Years

Coming Soon: I Thought I Was Over It