BoomerGirl Diary

Dear Crabby,

You’re not going to believe this! Three years ago, after an intense period of lobbying, my husband finally got that vasectomy. Woo-hoo! But my excitement was short-lived. Now at 45, I’m having heavy bleeding, clots, unpredictable periods, and general menstrual mayhem. My gynecologist is recommending the pill! Mr. Man got snipped so I could get off the stinking pill — and I hate to get back on it. What do you think?

Signed,

A Bitter Pill

Dear Bit:

I feel your pain. I had a hysterectomy only a few years after a tubal ligation. Something like taking the barn out after the ponies are locked up ….I don’t know, I can’t seem to create an apt metaphor for that situation.

Your symptoms are pretty classic for perimenopause, that period leading up to the cessation of — er — your periods. You’ve got it bad, and that ain’t good. And you’re not the first woman to be in this situation — you finally get the man to pick up a little of the workload in the promoting/preventing pregnancy arena (see list below) and now you’ve come full circle to the pill.

Comparison of male/ female workload in the reproductive life of a couple *

Puberty:

• Us: Periods, cramps, sanitary napkin/tampon supplies, medication for raging PMS, extra snacks for same, possible psychotherapy.

• Them: Um … maybe a condom in the wallet?

Babymaking/Not Babymaking:

• Us: Pills, diaphragms, pap smears, IUDs, shots, yeast infections, bacterial infections, bladder infections. Invasive infertility workups if needed.

• Them: Um…maybe a condom in the wallet? Or making a “special sample” in a cup?

Childbirth:

• Us: Pregnancy and LABOR — enough said? Breastfeeding, episiotomy.

• Them: Having sex, labor coaching, passing out cigars.

The “Golden Years”:

• Us: Perimenopause, menopause. Hot flashes, night sweats, mood swings, heavy bleeding, clotting, insomnia, vaginal dryness.

• Them: Um…maybe Viagra in the wallet? Oh, and finally! — a prostate exam. But still no stirrups.

* Ok, Ok, this is slightly man-bashy, but really, can you blame me? I mean, look at the list!

In reality, the pill is a good option for many women who are approaching menopause. It stabilizes the periods, lightens bleeding, makes your period more predictable, and for those women who still need contraception, prevents those “Ooops!" babies we’ve all heard about. “Change of life baby” is an understatement. How about “Shake me to the core baby?” or “Complete disruption of my retirement plans baby?” or just “Nooooooooooooo! baby?”

Anyway, unless you are a smoker or have a blood clotting disorder or certain types of cancer, the pill, particularly the low-dose pills, 20 or 25 micrograms of estrogen, usually keep things settled down and ease your transition into menopause by keeping your hormones at an even keel. It kind of stinks, I agree, but it may really help your symptoms.

A couple of other options bear looking at as well. For women who do still need contraception, a Mirena IUD might be a good choice. It’s placed in the uterus and releases low-dose progestin, which has the benefit of being a uterine relaxant (less cramps) keeping the lining of the uterus thin (lighter flow) and preventing pregnancy (less freaking out). It lasts for 5 years, too, so all you have to do is check it once a month to see if it’s in place by feeling for the string. Progestin-only methods like Mirena are safe for women who smoke or have had blood clots.

The last method is called endometrial ablation. It is an out-patient procedure in which the lining (endometrium) of the uterus is permanently “scarred,” by sliding a small instrument into the uterus and using one of several methods — laser, heat, etc., to alter the lining. The endometrium no longer goes through its monthly thickening, so sloughing, if it occurs, is light — maybe just some spotting. The procedure permanently prevents pregnancy as well. It offers a decrease in bleeding without altering hormonal balance or losing body parts. Your gynecologist can tell you if you are a candidate for any of these methods.

It does kind of bite that just when you think you’re out of the contraceptive woods, you get sucked back in by the forces of menopause. Sigh. To paraphrase Tammy Wynette, sometimes it is hard to be a woman.