By Carita Rizzo
I write this on a day where, once again, I don’t feel quite like myself. Like I’m hungover, but I haven’t had anything to drink. Jittery, but without the caffeine hit. I know exactly what it is. I’m in a low-estrogen phase of my cycle and there is a migraine headed my way. I even know why, because despite my gyno repeatedly telling me to skip the last two pills in the package, for some reason I think I can tough out the hormonal dip and mimic a natural cycle.
Well, I am about to get two days in a dark room to think about my decisions.
Hormonal headaches are not the only visitors my 40s have brought with them. Despite being the most health conscious I’ve ever been, there are days where my joints feel like they’re made of glass. I have sporadic back aches and hip pain, despite the fact that I haven’t dared wear a high heel since before the pandemic. And don’t get me started on my vision.
It’s not that any of this is debilitating — or even constant — but between birth control, probiotics, regular exercise, orthopedic sneakers, a goldilocks mattress, and a deep (deeeeep) armory of skin care, lately it feels like it is a full-time job just staying upright.
To get some answers about what was happening to me, I reached out to three experts: a physical therapist, a gynecologist, and a therapist.
Johanna Pentti, a physical therapist who specializes in the pelvic floor, was my first stop for figuring out why we experience pain as we age. “Many have a sedentary lifestyle, which means that often 30 to 50-year-olds already have the body compositions of 60 to 70-year-olds,” she says. “Additionally, our diets have generally gotten worse, and if the body does not get the building material for muscles and bones to maintain strength, they begin to degenerate.”
Whether we take care of our health or not, age comes for us all. “As we get older, our muscles shrink at a faster rate compared to when we are young. Bones become more brittle and the cartilage between the bones wears out more quickly, partly because we don’t move as much as we did, or should, and partly because it just wears out and doesn’t regenerate as we get older,” she explains. “Back pain is caused by people moving too little, and also because the disks between our vertebrae become thinner. Sometimes the disk fluid seeps out, and either dries out or becomes a herniated disk that puts pressure on the nerves that run next to the vertebrae.”
Well, shit.
But is this the beginning of the end? Far from it, says Pentti. Muscles can be strengthened by working out, and although cartilage does not regenerate, with the right exercise routine, you can be virtually symptom-free even if you have close to no cartilage. “Often joint replacement surgery is not even recommended until you have given exercise therapy six months, to see if you can be symptom-free,” she says.
As a woman in probable perimenopause, there is, of course, even more to this equation. Despite being on birth control, sneaky symptoms like low-grade muscle ache and headaches are likely to appear as your hormones fluctuate in preparation for menopause.
“Musculoskeletal syndrome is a symptom of menopause. 70 percent of women will experience it,” says Dr. Somi Javaid, a board-certified OB/GYN and cofounder of HerMD, a virtual platform for women’s health. “Basically, what’s happening is that due to the loss in estrogen, research has shown that women have arthralgia, which is joint pain and stiffness, loss of muscle mass, decreased bone density, and osteoarthritis. That’s why you’re feeling like your bones and joints are made of glass.”
But is there anything I can do to avoid falling apart, as I head into what Dr. Javaid calls “the chaos years” — especially considering I am already taking hormones? “Some of it’s the really boring stuff that we’ve been saying for years,” she says. “As we lose the protection of estrogen, we want to make sure that we are getting exercise. You want 150 minutes of cardiovascular exercise a week for brain health, bone health, and cardiovascular health. To prevent bone loss and sagging skin, and to protect our muscles, you need weight-bearing exercise. You need to be drinking lots of water because we get really dehydrated without estrogen. A lot of the changes we start to see in our joints, eyes, and hair is because of the loss of estrogen, so staying hydrated is important.”
Hormonal shifts also account for less well known perimenopausal symptoms. “Our gut microbiome changes with our estrogen levels and our hormone levels, meaning we can’t process foods the way that we used to. We may be more sensitive to inflammatory foods, which are processed, highly fatty foods. We do not metabolize alcohol as readily as we did when we were younger. That’s why people have really impaired sleep — and sleep is when we repair our body and it’s key for our metabolism. So, you have to be making sure you’re eating well, hydrating, sleeping, managing your stress. I mean, it’s a full-time job.”
As someone who had hoped the answer was, “Eat kelp,” or something similarly simple, this was not the response I was looking for. But, “It’s just a lifestyle change,” she says. “This is what I’m going to have to do because, even though women live longer, we live much longer in poorer health. Do you want to live longer to be sick? I don’t. I want to be climbing mountains in my seventies and eighties, like I am doing now. I want to live those years, that I have earned, in health and to their fullest. If I have to walk with a weighted vest and be mindful of junk food, to me it’s worth it.”
Two experts confirming that my life would be a little less fun if I wanted to feel good and function was just further proof that I had entered an “Is this it?” era. Hormones aside, the biggest middle-age letdown, for me, is a persistent feeling that what I was supposed to do in life I’d already accomplished. After decades of hustling, learning, failing, falling (in love), and building, I wasn’t sure what to pursue in the second half of my life. I asked Nicole Alvarez, a therapist at Serenium Therapy & Wellness, what to do with this feeling of restlessness.
“Yeah, aging is infuriating, but I also think there’s a strong component to it that is a state of mind,” she says. “The suggested thing to do in this situation is pick up things that are going to challenge you. A mentality for middle age is to always keep learning, because that does keep you young in spirit. Maybe it’s not in your career, maybe it’s a passion project you have outside of that. I think we start to feel middle aged in the sense that we’re stuck, and we start to feel that way when we stop exploring life and stop doing new things. There’s no age by which we have to stop having new experiences and new adventures.”
Another lifeline for this period, according to Alvarez, is leaning on your female friends as you constantly ask questions like, “Are the best days of my life behind me?” or “Am I dying, or am I a woman in perimenopause?”
“There’s so much comfort, validation and reassurance to be found in speaking to other women who are going through this,” says Alvarez. “If you and your girlfriends are all questioning it, immediately, it’s like, ‘I’m not crazy.’ There’s a reassurance in that. Not because it’s going to fix it, but because our problems are not so out of the realm of normal. With this, and I would say this is true for almost any mental health issue, one of the leading and most significant treatment suggestions is: don’t suffer alone.”