Hello, Peri Darling

My first few miles on the Road to Menopause weren't very well marked. I didn't even realize I'd started the journey—I thought I was just taking a little detour from Regularly Menstruating Way. Maybe an unscheduled trip down Weird Shit Happens Postpartum Lane or You're Not Coping Well With Stress Street.

I'd get more intense ovulation cramps or feel like I was coming down with the flu right before menstruating then be totally fine once the bleeding actually started. (My doctor at the time assured me this could in no way never ever certainly not be related to my menstrual cycle. It can.) I'd get chills and go to bed wearing two pairs of socks and flannel pajamas, only to wake up having drenched the bed with sweat.

But I was still getting my period pretty regularly so I figured it couldn't be perimenopause. Then came the hives.

Before we get into my lovingly detailed experience with histamines and hives, though, let me say that I've heard some version of this story countless times. Women have told me: I didn't know that was a perimenopause symptom; I got my period so I figured it was a weird blip; my doctor said I'm too young for menopause.

I had to initiate most of these conversations, but once they got going, they got going. Women want to talk about this stage of life—about their insomnia and unpredictable sex drive and the terrifying brain fog. But it can be hard to begin the talking. Who will care? Are you abnormal? Did you work out too hard? Did you not work out enough? Are you imagining it? Are you depressed? Is it just age?

I asked myself all those questions and more. And I decided that even if no one else cared, I did. Despite my doctor's confidently expressed doubts, I got my hormone levels tested. (I had to pay for those hormone tests out of pocket, of course, because there was no insurance-approved reason to justify such wild and unreasonable demands for medical knowledge about my own body.) The results told me things were "within a normal range." The conversation, as far as my doctor was concerned, had ended.

The word perimenopause was never uttered by any medical professional during my appointments. When I tentatively murmured it, I was told it was unlikely and also had I looked at those blood tests? Normal levels.

You know where we really need to apply the word normal in women's health? When we normalize talking about women's health.

And we're not completely alone on that front, thankfully. When my doctor retired, I switched practices and started seeing a woman about my age who, for obvious reasons, had a personal investment in keeping up with the (very few) advances being made in the field of menopause.

I'm going to take a moment here to feel grateful once again that I ended up at her practice.

Because…

One summer night last year I woke up with hives covering both arms, one hip, and my entire abdominal area. As I took two Benadryl, I worriedly went through everything I'd eaten, touched, or done in the last day. No new detergent, no outside activities, no heretofore unknown foods.

Was it stress? I'd had hives before, but not for years and years. The Benadryl put me to sleep. When I woke up in the morning, there were just one or two welts lingering around my wrists. That night, though, the hives erupted again, just as intensely as they had before. I took more Benadryl and messaged my doctor.

Urticaria, also known as hives, can be a puzzling and frustrating result of…a lot of different things. Food, environmental, animal, insect, or chemical allergies; stress; anxiety; strenuous exercise; excessive sweating; being too hot; being too cold; a virus; a bacterial infection; a medication (I could go on—but suffice it to say that "hives" is a champion nonspecific symptom).

My doctor wasn't sure what was going on, but she prescribed a few antihistamines. For three nights I combated the hives with Zyrtec and hydroxyzine. I also dealt with what I thought was a separate—but unfairly and annoyingly timed—issue of mid-cycle ovulation pain and cramps.

And then, when those cramps went away, so did the hives. Like magic (or a curse?).

As someone who carefully tracks not only my menstrual cycles but any notable physical changes, I was suspicious of the timing. I talked to my doctor again. We had hormone-level blood work done, but, as my doctor acknowledged, results of the typical tests are merely a view of one specific day at one specific time and don't give anyone much in the way of plottable data points or observable trends. (Even if things look "normal.")

Warily, I marked the days leading up to my next likely ovulatory period. Like a terrible alarm clock, the hives returned. I updated my doctor and settled into what I assumed would be another four-day stretch of violent itching and the mindfuck that is being covered in an infectious-looking rash only to see it disappear an hour later with no trace then reappear in a different spot.

But this time the hives didn't go away when the ovulation cramps did. They became less predictable but never really left. I researched Mast Cell Activation Syndrome, long COVID, Alpha-gal syndrome, and "stresses of being a parent in 2023." I didn't meet the criteria for the first three, and the fourth option didn't feel fixable with medication.

I started taking twice the recommended level of Zyrtec, with Benadryl, too, on bad nights, until I was perpetually somnolent from all the antihistamines. I cut out alcohol, probiotics, and leftovers. I stopped even my periodic jogging for fear it'd lead to a histamine outbreak. I ate a lot of bread because it was one of the few foods that didn't seem to lead to swollen lips and red bumps. I gained weight and lost hope and felt like my body was a malfunctioning prison.

In desperation, I turned to our generation's version of a women's health authority: Reddit, M.D.

(As a friend once said: "We're in the darkest timeline if Reddit is where we go for medical advice. But there just isn't anyplace else to go where people with your same health problem will actually offer helpful solutions.")

A search for hives + ovulation in the menopause subreddit yielded dozens of stories about estrogen's relationship to mast cells and histamine production. It also yielded dozens upon dozens upon dozens of stories from women going through perimenopause who'd been ignored, belittled, or sneered at by the medical industry. The word "gaslighting" came up a lot.

Thankfully, my doctor is a curious and compassionate person; when I told her that even twice the recommended dose of antihistamines was failing to control the hives, she was sympathetic instead of dismissive. She listened to my (undoubtedly longwinded and possibly borderline manic) recounting of my internet deep dive on estrogen and perimenopause and hives.

Once I'd wound down, she theorized that as I entered perimenopause, my hormone levels were taking wild leaps and dives, and, thanks to estrogen wonkiness specifically, my mast cells were building up far too many histamines and then dumping that supply far too often.

Her suggestion was to try a low-dose monophasic hormonal contraceptive, so (after a tiresome journey with my health-insurance company over coverage, because all birth-control pills are the same, right, and no one should need to take a name-brand one, because one woman's body is the same as another and just take the pill that's a generic, okay?) I've started on a(n expensive) combination pill.

Things are better. Three months in, I'm still taking Zyrtec, but it's only once a day and I'm eating yogurt with the fervor of one long denied its creamy probiotic bliss. No hives to speak of as long as I'm diligent about taking both the antihistamine and the oral contraceptive. Red wine is part of my life again (though research suggests as I continue on this road that may not always been the case…but for now…shhhhhhh the Bota box of reasonably priced grocery-store wine is calling).

Many of the other symptoms continue. I recently learned, for example, that there really is a such thing as cold flashes. The part of your brain that helps regulate temperature does just that: regulate temperature. For most perimenopausal women, it means flashes of blistering heat. For me at this point, it means bone-chilling cold for brief spells. Disregulation is a common theme as the hormones sort themselves out.

In fact, it feels like every day brings changes either small or large. And that, I gather, is a hallmark of perimenopause. The last massive hormonal change most people who menstruate will go through.

I think we're okay at supporting each other through our first few years of menstruation. But we need to figure out how to normalize this journey down the Road to Menopause. It's not always a quick one.

Maybe I can't normalize important conversations about health and menopause immediately. But I can start here: If you're having a hot (or cold!) flash, unexpectedly sore breasts, brain fog, back pain, mood swings, insomnia, headaches, vaginal dryness, low sex drive, a weaker pelvic floor, seemingly inexplicable weight gain, extreme fatigue that somehow exceeds even that hellish time your kid had colic…you're not alone.

Maybe you're even getting to experience all that and still menstruating regularly. Maybe your doctor told you you're too young for perimenopause symptoms. Maybe you didn't realize those were perimenopause symptoms.

I guarantee you're not the only one. If you reach out, someone else will be there, too.

Yours in unpredictable chills,

That Hag

Two Joys to Seek in the Week Ahead:

1. Catch up with a friend who's good at give-and-take conversations. Message (or call?!) that friend whose company is warm and encouraging but also confident enough that you can both talk about your shit without anyone feeling neglected—or waking up with an overshare hangover. You don't have to talk about your estrogen levels (but you can); just soak up all those prosocial vibes and enjoy both feeling valued and valuing.

2. Do a healthy thing that gets your heart rate up for more than a couple of minutes. Or, as some might call it…exercise. If you love working out, great! I'm genuinely pleased for (and envious of) you. It takes me forever to get into an exercise schedule; I drag my feet getting started even when it's built into my day; I despise feeling out of breath and getting stitches in my sides. And yet when I'm done, I feel righteous and gleaming (could be the sweat, I guess) and I'm much more forgiving of everyone at work.