Shmirshky Page 5

  Here is what I learned: The FDA46 announced its statement on the WHI studies in 2002, which scared every PM&M shmirshky half to death. The agency reported that HRT increases a shmirshky’s risk of breast cancer and heart disease. It was all over the newspapers and news shows. So many shmirshkies went off their HRT cold turkey! OMG! That’s like stopping a roller coaster on a dime in the middle of the ride. You’re left hanging upside down, lucky if you don’t fall right out of your seat!

  I am not a scientist or a doctor, but let me tell you a few of the problems that I have with these studies. Some of the shmirshkies in these studies had heart disease, were obese, and had elevated cholesterol levels requiring medication. All of the shmirshkies who were studied were in Post-M and were given the same amount of HRT. This was not clear to many PM shmirshkies, who thought the studies applied directly to them. Do you think a shmirshky who is seventy-nine years old should be treated with the same dose of HRT as a shmirshky who is fifty? No, as you get older, you typically require less HRT, and shmirshkies in PM require very different treatments than shmirshkies in M and Post-M.

  It is also important to note what kind of HRT was used in the studies. Up until 2002, most shmirshkies on HRT were taking Provera or Premarin (a mixture of estrogens obtained from the urine of pregnant horses).47 Many shmirshkies were on Prempro (which is a combination of Provera and Premarin). The WHI studies were solely focused on these forms of HRT, none of which are bioidentical.

  Why didn’t they also study healthy, younger shmirshkies while they were in the beginning stages of PM&M and see how they fared with various kinds of HRT? I think we should all demand more studies on HRT and PM&M. We need more hormone specialists, please! We need to keep our scientists studying and researching this. With all the brains in this country, is this the best we can do for shmirshkies? I think NOT!

  It is so important to think inside the box and educate yourself on the issues. Be sure to read more about bioidentical hormones and, once again, brace yourself for some new vocab words, not-so-fun terms like progesterone,48 estradiol,49 estrone,50 and estriol.51 You’ll also need to familiarize yourself with the various forms that HRT comes in. You won’t believe how many options there are! (Check out the Hormone Therapy Menu on page 154.) You can wear a patch. These patches are like putting medicine on a piece of Scotch tape. Seriously, that is what it looks like. Then you have the cream version. You can use the cream topically (on your skin) or shoot it right into your shmirshky (this was news to me!). Then there are pills. You can put them under your tongue and let them dissolve, swallow them, or shoot those babies right into your shmirshky too. Then there is the ring. No, I’m not referring to a diamond one; this one does not go on your finger. Guess where it goes? Yep, in the shmirshky. There are also pellets they can shoot right under your skin. Don’t forget the sprays, but these, thank goodness, you spray on your skin (not on your hair!).

  As I was researching, I started to visualize my carry-on bag at the airport. My allowable toiletry Baggie was already bulging with all the face creams I had squeezed into tiny three-ounce bottles. I definitely could not risk putting my shmirshky creams in the same bag as all of those face creams—what if I got them mixed up? Homeland Security needs to get right on this! We may need a special line at airport security for PM&M shmirshkies.

  So many choices! I was overwhelmed!

  My mind immediately wandered to my favorite shoe store. I love buying shoes. (FYI, your shoe size is the only size that doesn’t seem to change with PM&M.) I can walk around the biggest shoe department and have no problem whatsoever picking out one pair that I love. Too bad they can’t administer HRT through a pair of heels.

  I began talking to every shmirshky I knew. No matter where I was—in a grocery store, at the cleaners, in a car wash, or at a dinner party—I would bring up the topic. I had no time to be wishy-washy, so I was very direct, asking every shmirshky young and old, “Do you take HRT?” Based on the reactions I got, you would have thought I was talking about a nasty drug habit! It seemed no one wanted to admit that they use or used HRT. It was taboo. I think the fallout over the WHI52 study made a lot of shmirshkies think that being on HRT was wrong, so they sort of went into hiding (back under the bush). But I didn’t give up.

  shmirshky party alert!

  Gloria, now seventy-plus years old, was on Premarin and Provera for years for her PM&M symptoms (sleep disturbances and night sweats). Like so many shmirshkies, when the WHI study came out, Gloria abruptly stopped taking hormone therapy. Unfortunately, her symptoms reappeared, so she tried several bioidentical options for a couple years, but her breasts became so tender (a symptom that is often caused by estrogen dominance53) that she could no longer sleep on her stomach. The public stir about hormone therapy risks, coupled with her nagging breast tenderness, led Gloria to discontinue her HRT altogether.

  Now here is Gloria’s recurring evening forecast: sleepless with mild to heavy precipitation (those beloved night sweats are back). I feel so bad that Gloria is still suffering. I picture myself at age seventy-three, still sleepless and dripping. Yikes, thank goodness shmirshkies don’t get mildew!

  In contrast, Patty’s response to my “Do you take HRT?” survey was wholeheartedly positive. “HRT is on my list of very positive experiences,” she said. Patty explained that she always had the world’s best memory, until, suddenly, during PM&M, it vanished. She was on the verge of tears all of the time and was no longer joyful or a joy to live with. I asked her husband, Mark, what it was like to live with Patty before she went on HRT. He said it was “like a roller coaster ride,” fun when you’re five, not so much when you’re fifty. Once Patty began bioidentical creams, though, her life turned around. She describes it as an “And then there was light!” moment. She became a whole new person—no more emotional roller coaster rides or night sweats. She slept better, became less forgetful, more focused, more patient, and more present. After HRT, if she found herself in a bad mood, her daughter and son would jokingly ask, “Mom, did you use your cream today?”

  My friend Mindy is a whole other story. When she comes into town every August for a week, we like to hit the beach and catch up on shmirshky news. The young, frolicking, bikini-clad shmirshkies run around the beach while Mindy and I sit smothered in SPF 60 under a huge oversized umbrella with our towels draped over our chalky white legs. As it turns out, I envy Mindy’s PM&M experience almost as much as I envy how the younger shmirshkies’ butts stay politely tucked into their bikini bottoms.

  Mindy basically experienced “PM&M light” and never felt the need to take HRT. Her first symptom began at fifty-one when her periods became irregular and then completely stopped for one full year. She had one more “encore” period and then it was gone forever. The show was over. Mindy never had a sleepless night, a dry shmirshky, or memory loss, but she did have some problems with her internal thermometer. Sometimes her husband would find her sitting on the sofa stripped of her top and bra, but before he had a chance to get excited, she would have herself wrapped in a blanket because she was cold. Lucky for Mindy, her temperature fluctuations only lasted for about six months and never resulted in a drop of sweat. She told me, “At fifty-three I became a bitch. Of course, I blamed it on menopause, because with no period, you can’t blame it on PMS anymore!” Her PM&M symptoms faded away by age fifty-four, leaving Mindy all out of excuses!

  Ultimately every shmirshky has to make her own determination about what course of action is best for her body. For Gloria, it’s being HRT free, and for Patty and her family, it’s an HRT shrine next to the fireplace. For Mindy, she has to find a new excuse when she’s being a bitchface!

  I was hoping one of my friends would just tell me what to do, but that universal answer didn’t exist. Everyone’s case was so different and required different solutions. So how was I going to decide? If I were to use HRT, what other side effects would I have? Would I gain more weight? Oh, dear! Would I have more or less risk of cancer? Would HRT prevent osteoporosis or make me more s
usceptible to broken bones? I kept reading and educating myself so that I could make the healthiest choices. I can’t stress enough the importance of research—take responsibility for your body and arm yourself with knowledge. If you decide not to HRT, acupuncture (see chapter 22, “No Needles in My Shmirshky”) can be a tremendous help. Some shmirshkies combine HRT and acupuncture with great success.

  Ultimately, you and your doctor will need to decide what is right for you. Depending on your medical history, your options may be very different. A good starting point is to simply think inside the box. Ask yourself, on a scale of 1 to 10: How am I functioning? How is my life? Some shmirshkies are so used to being less than functioning that they find themselves accepting a 2 as normal. You don’t have to settle. Once you know your challenges, you can begin to find the right solutions. Whatever you do, don’t give up trying to be as close to 10 as possible. You deserve it!

  CHAPTER 16

  shmirshky support

  I used to have a consistently even personality, but during my PM&M storm, David and I never knew which me we were going to wake up to. Sometimes I thought I was going to have a good day, but more often than not the storm came in and I felt out of control. No way, no how could I simply talk myself down from this. I was desperate to get some sleep, have a clear head again, and stop being the primo HS.54

  Wherever I went, my mind was on PM&M. One day I was in New York taking the subway uptown during rush hour. The subway was packed. Everyone else seemed to be daydreaming or thinking about work and the challenges of their day. Not me. I gazed at all the shmirshkies on the subway and had the strongest desire to ask them about their PM&M. I sat there wondering if they were in PM, or if they had finished M. I guessed that some of the grumpy shmirshkies whose pants were so tight that their shmirshky was going to break in two (you know what I’m talking about) were smack in the middle of it.

  My ears perked up whenever I heard someone on the news or a talk show speaking about HRT or PM&M. I listened to everything I could (thank you, DVR and TiVo!). I couldn’t help but notice that many celebrity talk show hosts were going through PM&M right before my eyes. I saw them struggling, heard them explain that they turned the air conditioning way up as their internal thermostats went completely askew. Of course, all the non-PM&M hosts were freezing. This reminded me of David trying to sleep in our bedroom with the air conditioning on in the dead of winter. Poor guy.

  Ultimately, the HRT decision was mine to make. Along with my gynecologist at the time, I decided that it would be good for me to begin HRT. I was nervous at first, but the one constant comfort for me was the support of the Sisterhood. We need to be there for each other. The more I opened up to my friends and loved ones, the more comforted I became. Their support helped me to embrace my PM&M. I stopped being in such a hurry to fix me and became calmer and more accepting of where and who I was. I was learning how to be okay with not being “fine,” and I felt a little better.

  Talking with other shmirshkies who have gone through PM&M is as important as studying the most current research and conferencing with your doctor. There are all kinds of ways to get this shmirshky support. It is easy to take your morning exercise crew, book club, birthday lunch bunch, cooking club, carpool group, play group, investment club, or cocktail circle and turn it into a shmirshky support group just by talking, asking, and sharing your PM&M experience. If you aren’t in any kind of club or group, start your own—host a Shmirshky Party!

  Use the Internet to reach out to the shmirshky diaspora. Most shmirshkies’ Web sites have blogs, Webcasts, and forums where you can type in what you’re going through and get support and advice from other shmirshkies. Visit shmirshky.com and connect to other PM&M shmirshkies around the world. PM&M shmirshkies are everywhere, and we need each other, so don’t be afraid to reach out for help.

  CHAPTER 17

  period or no period?

  After months on an HRT regimen, my period went from arriving irregularly to not coming at all. I thought I had graduated from PM to M. It had been thirty-nine years since my period first showed up. Can you believe that? I’d been dealing with that damn period for thirty-nine years! You’d think I would have been relieved when my period stopped, but it was oddly sad to me. I found myself going through the grieving process. I think it was more the realization that I was getting older rather than feeling sad about not having a period. That being said, I was certainly thrilled to dispose of all my period paraphernalia. I was especially joyous to get rid of my tampons and pads with wings; they, of course, flew right out of the box. Too bad there was no party or presents to go along with my period’s departure, though I was thinking about putting a graduation cap on my shmirshky.

  I was convinced the period and I were done until one Sunday afternoon at a summer BBQ at my house with twenty-two friends. I was wearing this wonderful white sundress and felt relaxed and carefree, until I stood up to get someone another drink and saw the horror on my guests’ faces. There I was with my period soaked through my dress and the sofa I was sitting on. My face all of a sudden matched my dress. Where are those pads with wings when you need them, flying to the rescue? I left the party and ran to my room, showered, and put my white dress in a sink full of stain remover. The stains disappeared before my eyes. Was there a way to drink that stuff and make my period disappear?

  The funny thing was, after this period I felt really good. Go figure. Still, I wanted so desperately to skip past all this PM&M madness and go right to the big finale when the heroine is dancing and smiling and living happily ever after in a beautiful dress with a chorus of singers carrying her off into the sunset. I was so exasperated with this whole process. I kept thinking that I would like to exchange my shmirshky for an erlick (good thing my mom kept the receipt in her purse!).

  CHAPTER 18

  erlicks are people too

  I know they say the grass is always greener on the other side, but it just seemed to me that erlicks have it easy. All they have to do is decide if their erlicks should dangle to the left or to the right. I could do that, no problem. I’ve been wearing earrings and necklaces all my life, and they all dangle. How hard could this be?

  From the moment erlicks are born, someone is caring for their erlick. Our son, Jack, found his when he was a baby, and after that, he never wanted to let it go. When he was a toddler, he even answered the door holding it. My mom was appalled. I explained to her that it was natural and we shouldn’t mention it, as that would bring attention to it. I thought he would outgrow it. But do erlicks ever outgrow it? Not really. Someone (if not themselves) is always holding the erlick.

  In all seriousness, I know you erlicks have your share of health issues as well. There is, in fact, such a thing as male menopause, although that term is a bit flimsy, since erlicks don’t menstruate. While a shmirshky’s PM&M is all about the slowdown and eventual shutdown of her reproductive system, erlicks can typically produce sperm well into their eighties (I think there is a story about Moses making use of this feature). Still, some erlicks do experience hormone fluctuations that may cause symptoms similar to PM&M, like fatigue, depression, physical weakness, and a lower libido.

  Menopause-like symptoms in erlicks are not to be ignored or laughed off—they may be the result of dropping testosterone levels or a thyroid condition. If you’re an erlick who is struggling, don’t suffer in silence. Reach out to your internist, endocrinologist, and the people you love to get the help you need.

  I must admit, when I first heard about male menopause, it reminded me of the first time I was pregnant, when I started to get these ravenous cravings for strange food combinations. That was probably my favorite part of being pregnant—I ate everything in sight! Being the ever-supportive husband that he was, it didn’t take long before David started to get cravings of his own. He gained ten pounds during both of my pregnancies. I guess he just really wanted to get in on the experience (or the pickles and ice cream).

  With David’s sympathy cravings in full swing, I was thrilled to
have an eating partner in crime. Years later, his hormones began to fluctuate around the same time as my PM&M. Of course, menopause isn’t contagious, it was just a coincidence of age, but the thought of two hormonally imbalanced people living side by side was downright frightening.55

  It began with the thyroid for David, just like me. All of a sudden, he was lethargic. I thought, well, maybe he’s just so exhausted from dealing with me, it’s finally catching up to him! In addition to being tired, he was getting forgetful and his libido was dropping. We talked about how he was feeling and he decided to go to the doctor. David got his thyroid and hormone levels checked and found out that he had a minor thyroid condition and his testosterone levels were taking a nosedive. What a great husband—if it wasn’t pickles and ice cream, it was testosterone and synthroid.56

  While you’re at it, don’t forget to check the rearview mirror. Shmirshkies and erlicks have the same next-door neighbor, which we all have to get checked out with a colonoscopy,57 usually when we hit our fifties. Don’t forget to do this; it’s very important for everyone. In addition to prostate cancer and all the other health issues erlicks have, you really do go through PM&M along with us shmirshkies. At least there isn’t an “erlickogram,” where you have to put your balls between two flat, cold metal slabs to be smashed together as tightly as possible while you hold your breath!