Empowered Menopause: Upholding Bodily Autonomy in the Face of External Pressures

This direct message from a new friend on Substack this week has provoked self-reflection on my part, as well as being a reminder of how disempowered and uncertain we can feel during the neurodivergent menopause transition:“I have people around me on polar opposites of the spectrum of pro/anti HRT, and I’m unsure how best to decide what's right for me.”Why are we so opposed and opinionated? I am guilty of pushing my own agenda on others, and I went too far via text message when recently advising another friend to drop the “withdrawal method” as contraception in a casual relationship. Like me, she is perimenopausal, and I was insistent that this contraceptive method cannot be reliably effective in our life stage, when our periods are unpredictable and our ovaries are forcefully making last ditch attempts at ovulation and conception. I was freaking out on her behalf, as the thought of me getting pregnant now is terrifying. I was so impassioned and preachy telling her my opinion, but it was an unwarranted projection of my own fears. I thought I was sparing her the risk of an unwanted pregnancy, and the avoidable trauma that can go along with that. My ADHD meds had worn off for the day and my interference filter was in the bin until the next day’s dose. I was letting my special interests of hormones, fertility and women’s bodily autonomy overcome my low capacity for listening to her views. Reading that back, I see how contradictory that is and how ridiculous I was being.I have since apologised to her profusely. Info dumping my special interests on others can feel so rewarding, and the dopamine that comes with it can overwhelm me. Missing my friend’s cues and discomfort - easily done over text message - only made it worse for both of us. Women and AFABs are socialised to be talked at and hold our tongue. Autistic women (me) once up on their soapbox are hard to quieten. Our friends may not tell us to STFU at the time, but they may b***h about us behind our back, which is worse. Do you have a friend like me who tells you their opinion without stopping to listen to yours?If so, I would like to apologise on both our behalf’s, and reframe our misguided interference as an offering of love and illumination. We are trying to show you that we understand your issue, and that we have the fix you need. That we have researched both sides and formed our conclusion, so that you don’t need to waste your time and energy on it. We’ve got your back!We are not looking for a fight, but we will often defend our opinion to the end, because it was hard won. I’ve said it before and I will say it again: info dumping is my love language. It is not an ideal love language… Most people would prefer to receive flowers over a barrage of texts telling them what to do for the best with their uterus.I know it is something I need to learn to control in myself, because it is pissing everyone else off. And I will come back to it when my cognition improves after this current regression. Or not. Anyway, back to the original point: “I have people around me on the polar opposites of the spectrum of pro/anti HRT, and I’m unsure how best to decide what's right for me.”💕Bodily autonomyWomen and AFABs deserve impartiality when deciding on the best way to approach managing symptoms of perimenopause. The world is polarised in every way possible, more so now than ever. Can we say anything without receiving a barrage of comments, trolls and naysayers telling us we cannot do right for doing wrong?I want to take this opportunity to say that there are many different ways of living through the inevitable, natural and unavoidable menopause transition. Yes, I am heavily medicalised, monitored and hoping to end it all as soon as possible with a total hysterectomy for the sake of my mental health. But also yes, I did once consume my newborn baby’s placenta in a smoothie after a home hypnobirth in a birthing pool in my kitchen because I then identified as a “Crunchy Mama”. But we can change our minds at any point! In fact, immediately after mooing my baby out without pain relief, I insisted on using gas and air whilst having my perineum stitched back together because I had already been through enough. 🪡Boundaries are essential when making important decisions around our own health and wellbeing. Those boundaries include telling people that you have considered all options, and have decided what feels worthwhile trialling right here, right now. Many options in women’s health treatment are reversible and temporary anyway - perhaps apart from unmedicated births after the event, and surgical menopause. Feeling empowered to make your own choices, and having them supported by trained professionals overseeing your treatment plan, is vital. Your friends offering their support rather than judgement is a nice to have. It doesn’t need to determine what you do next.We don’t have to take sidesAll good teachers, child psychiatrists and similarly esteemed professionals will should tell us that we are the experts on our children, and that they will support us, backing us up with their expertise. We are pretty good at trusting our instincts when it comes to our children’s emotional safety and best interests. Rarely do we do the same for ourselves. Please know that you are the expert on yourself, and that the trained professionals you trust and work with on your perimenopause transition need to be experts in their field, and working alongside you as a partner. Optimising your quality of life and mental health at all times is what counts. We both know that your friends love you and want what’s best for you, but they might be misguided and biased on what you actually need right now. There are options for treatment that are medicalised and non-medicalised. The term “holistic” gets a bad rap these days. In its truest sense, holistic means our body, mind, spirit - and anything else I haven’t thought of - are interconnected. That we are one being. But “holistic medicine” is considered by some to be pretty woo-woo by comparison. What comes to my mind regarding “holistic medicine" is herbs, tinctures, compounds, sage bundles and other stuff I clearly haven’t researched for this article (sorry). Yet I consider my own menopause treatment plan to be fairly holistic - in the more holistic sense of the word - incorporating hormonal replacement therapy AKA HRT (micronised progesterone capsules, oestrogen gel and patches, vaginal estrogen cream, testosterone gel), hormone blockers, SSRI, strength training, plant based eating, protein powders, creatine, weighted blankets, artificial tears, yoga nidras, Ragdoll cats x2, podcasts, writing, and cathartically yelling at people who push me too far. 🧘‍♂️Yesterday I even tried to learn how to knit. Because I am desperate, and it seemed therapeutic, yet cheaper than most therapies.… 🧶Why Hormone Replacement Therapy (HRT) has bad PRHave you heard of the Women’s Health Initiative (WHI) study that wrongfully associated HRT with over-inflated risks of significant health issues? Because if you haven’t, I wouldn’t advise you read up on it. It’s since been disproven due to problems around research methodology, participants’ ages, and the outdated types of HRT that were offered at the time. Yet the repercussions of the WHI study still affects us all today. When we ask our doctors about being prescribed HRT, their computer will flash up a warning. ‘HRT prescribing guidelines have not been updated with the current evidence about HRT which means that when GPs prescribe they are warned by their computers that certain HRT products should not be prescribed.’Balance website, Dr Louise Newson: Understanding your GP – Four reasons why some women might not be able to obtain certain types of HRTGeneral practitioners are not trained in menopause during medical school to the extent that serves us, and nor are they required to undertake any further training on the topic once practicing. (Please correct me if I am wrong.)Medical misogyny fails women and AFABs every day, with the notion that menopausal people are subjects of hysteria continuing to prevail. You don’t have to sufferThe good news is that societal messaging on menopause is turning a corner. No longer a taboo, we are beginning to openly talk about it. Although I can only speak from own viewpoint in Aotearoa NZ as a middle class, native English speaking, white cis woman.We have a lot to learn from each other, but we all need to remain open minded. For the neurodivergents amongst us, and for anyone who has experienced previous bouts of hormonal depression and emotional/mood dysregulation (during puberty, pregnancy, using hormonal contraceptives, during IVF treatment, postpartum, PMDD and so on), we are especially vulnerable to recurrent depression due to the extreme fluctuations in perimenopause. These are potentially volatile times in our emotional lives. Menopause does not exist in a social vacuum. It affects entire families, workplaces, communities and societies. You are not being selfish by asking for more support in your day to day life, by seeking treatments, nor by having high standards of your healthcare providers. If you have seen beneficial results from ashwaganda, sprint interval training and sitting in circles with other women, I am very happy for you. Had I not sought neuro-affirming healthcare from a doctor who specialises in women’s health, with an interest in neurodivergence, perimenopause, and how the two intersect, I would have succumbed to menopausal suicidal ideation several years ago. When we say we need help, help is exactly what we need. We are not the “worried well”. Nor are we attention seeking. We are asserting our right to appropriate health care and medical advice. I don’t know about yours, but my friends can’t offer me impartial medical advice, or monitor my responses to different types of treatments that may or may not alleviate my psychiatric symptoms caused by fluctuating hormones. Nor can they refer me to specialists as and when necessary. HRT buffers hormonal fluctuations - it does not “replace” themThat’s why in many parts of the world, the term Menopause Hormone Therapy (MHT) is preferred over HRT. HRT/MHT provides a buffer to protect you against the effects of hormone fluctuations which may affect you in different ways: mood, sleep, libido, body pain, palpitations, brain fog/cognition, memory recall, focus, vaginal atrophy, metabolic regulation (I’m still holding out for this to work for me…), tolerance of your family, capacity to remain in employment etc. HRT is not a superficial “nice to have” pseudoscientific therapy. It won’t plump up your lips (neither facial nor vulval), nor remove your crow’s feet. But it might stop vaginal atrophy progressing whilst you use other treatments to alleviate symptoms, and it might support your sleep if insomnia is part of your peri symptom mix. It could also stop your hair falling out and support new growth (on your head, I am afraid it hasn’t reversed my balding mons pubis, nor reduced the thickening of midlife onset whiskers erupting from my chin, neck and right breast). HRT doesn’t come without risks to some people, but the delicate matter of balancing your individual risk versus potential health benefits is a matter for you to weigh up and decide with your trusted doctor, and not with Janet down the local pub over the second bottle of Prosecco. Australasian Menopause Society* What is HRT/MHT and is it safe? * Risks and Benefits of MHTHRT is but one tool in the toolbox of menopause survival aids, and it is unlikely to maximise your overall wellbeing without careful titration over time.There are other lifestyle changes that can potentially alleviate your symptoms in perimenopause, but some of us need HRT to buffer the fluctuations in order to have increased energy needed to later make those changes. Who wants to do a power-based heavy lifting weight session a la Dr Stacy Sims when they’ve had no sleep for three months? To try HRT or not?There are myriad treatments to support people experiencing adverse symptoms in perimenopause. Looking at our needs holistically (i.e. as a whole) can be more beneficial than assuming holistic support is “natural”, and that HRT is not. Then picking a side and fighting to the death. HRT/MHT uses bioidentical or body-identical hormones extracted in laboratories that are the closest match to those produced in our ovaries, adrenal glands, brains and perhaps in other places that I am too tired to fact check…‘Bioidentical or ‘body-identical’ hormone therapies are terms which can be applied to pharmaceutical-registered MHT products where the hormones have the same chemical structure as those produced in the human body.Australasian Menopause Society fact sheet: Bioidentical Hormone TherapyDr Jen Gunter offers an alternative take on the terms here, so I am sharing this article for balance:When you consider that hormonal symptoms of the menopause transition may respond best to hormonal treatments because they get to the root cause, they are worth looking into. Particularly when those symptoms are preventing you from functioning, relating to others, and you have tried other alternatives. If you try HRT and you don’t respond well to it or feel any symptom alleviation after careful titration overseen by your doctor, then you can simply stop using it (under medical guidance). Breast cancer and HRTIf you are a breast cancer survivor and are in perimenopause, you can discuss the use of HRT with your medical team including your oncologist, endocrinologist and so on. Hormone receptive-positive breast cancers may prevent you from being able to use HRT to reduce your risk of recurrence. But you should still be able to discuss alternatives, since you have already suffered enough and may be in a chemical menopausal state using hormone blockers. 💕When I recently asked a friend, who is both a practicing psychiatrist and a breast cancer survivor, she advised: It depends whether they have had hormone positive breast cancer. If hormone positive, HRT is a no. There could be dormant cancer cells in the body that start growing if fed by HRT. If hormone negative like triple negative breast cancer then HRT might be okay. Best they discuss with their GP or oncologist if they are still seeing one.I hope that this is researched more so that breast cancer survivors have more options to manage sudden onset menopausal symptoms. How best to decide?In summary, hormonal fluctuations affect different people in different ways. Whilst everyone is busy bickering over what is best, people in autistic perimenopause continue to be more likely to die from suicide than non-autistics . Your quality of life is paramount at all times; what do you need to do to optimise it right now? Everyone wants to help you, but nobody has all the information. Our symptoms will not be static during this prolonged transitional life phase.You do not have to suffer from unmanageable symptoms alone. Remember that, whilst menopause is not a disease, it can cause extreme and intolerable symptoms. Treatments are available and trialling something to target troublesome symptoms may make you feel more in control, which is important. Find a doctor you can trust to explore different options best suited for your symptom management. HRT health risks need to be discussed with your doctor because your medical history is what matters. Hormonal therapies may best target the root cause of your hormonal symptoms. And finally, this won’t last forever - TFFT. Thanks for reading The Autistic Perimenopause: A Temporary Regression. If you become a paid subscriber, you’re paying me because you value what I publish here and my work in general, benefit from my work, and you want to support me and my writing and research. Get full access to Divergent Menopause at samgallowayaudhd.substack.com/subscribe

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