Chapter One Discomfort Zone When I was forty-two, not long after my second baby was born, I started having strong, consistent menopause symptoms. My most significant symptom was night sweats. But I had the occasional hot flash during the day, too. I remember two of them distinctly. One time I was on a plane when a hot flash came on. In that moment, I felt like I was being suffocated. The heat was overwhelming, but the feeling was less like being in a warm climate than like being flooded with shame. I was overcome with the feeling Oh my God, I have to get out of here right now! But I was in a middle seat, and I''d already gotten up for the bathroom a couple of times--much to the chagrin of my seatmate, who''d given me plenty of side-eye looks--so I stayed hunkered down, wishing I could be anywhere else.

If there had been an eject button, I would have hit it, right after flipping the bird to the dude in the aisle seat. Another time, I was taking a fun trip with friends, and we were on a big boat in the Pacific Ocean. It was one of the first times I''d tried to take a glamorous vacation with my toddlers, and I was thrilled to be out on the water in a cute summer outfit. I was suddenly drenched. I barely had any clothes on, but I felt I had to remove even the stringy bits of fabric and dive into the ocean! Even if the boat was moving in shark-infested waters, I thought, I have to get in the cool water immediately. "This was the year the wheels came off," one woman told me about her own experience of realizing that she was entering a new phase of life. While she was having the classic symptoms related to blood vessel dilation and constriction (hot flashes, night sweats, heart palpitations), she started having symptoms in just about every area of her body: mood changes including depression, anxiety, irritability, and rage; skin changes, including somehow both dryness and oiliness; sleep trouble; hair loss on her head coupled rather cruelly with its growth on her face; vaginal dryness and associated sexual problems; loss of libido; migraines; brain fog; UTIs; GI issues; incontinence; and even ringing in the ears. It took her and her doctors a while to realize that they were all connected to menopause.

The symptom most strongly associated with menopause is the phenomenon known as "hot flashes," or "hot flushes" in the United Kingdom. (Some doctors in the United States also prefer the term "flush," because the sensation comes on more like an all-over drench than like a lightning strike, but I''m going to stick with "flash" in this book because I''ve spent the past thirty years in America, so it''s what I''m used to.) They can be among the more aggravating issues to deal with at this age, especially because they seem to come on at the least convenient times, since they can be triggered by stress. My friend Sarah described her hot flashes to me this way: "One weird obsession became shifting my body to one side or another at night and touching the sheet, marveling at how it was as if someone had just removed an electric blanket set to level ten--so incredibly hot to the touch! The biggest surprise for me about hot flashes is how different they feel than just being superhot on a summer day. They are so intense and immediate. I''m feeling fine . feeling fine . Oh my God, someone get my fan! Throw ice on me! I don''t care if I''m fully nude in public!" She said this phase of life could be summed up as "ripping one''s clothes off while on college tours.

" I can''t tell you the number of women I''ve talked to who were in an important meeting at work or having a difficult conversation with a partner and suddenly they found themselves sweating profusely, feeling as though they were in a hot yoga class while everyone else was comfortable as could be. The first time I had a hot flash I thought, Who turned up the heat? Who is to blame for this? Like when your pants won''t button and you''re sure that the machine has shrunk them in the wash. For me, night sweats were common even though I nearly have to kill myself in an exercise routine before I can work up a sweat. Even now, in spite of hormone therapy, I''ll wake with an occasional chest sweat, smelling like I''ve been flipping burgers in a fast-food joint all night. (Dermatologists have told me that middle-aged women increasingly are showing up in their offices for underarm Botox, which turns off the excessive sweating!) One of my makeup artists says the first time she ever witnessed a hot flash was at work: "An actress was sitting in my makeup chair and said, ''Oh my gosh, it''s coming. It''s coming!'' I said, ''What are you talking about? What''s coming?'' And she said, ''Look at my face.'' All of a sudden, her skin got really red, and beads of sweat started forming on her upper lip. This was a woman playing a leading lady and wearing sexy clothes.

We got her some ice water, and we put cold compresses on her face until she cooled off." Hot flashes are caused by hormone fluctuation. The body''s thermostat gets thrown out of whack by not having the usual amount of estrogen, and so it sends signals saying it''s too hot. The body responds by opening up blood vessels, causing sweating and flushing, usually for a few intense minutes. There are plenty of reasonable things to do to combat hot flashes. Some simple, obvious tips: wear layers so you can strip down quickly when a hot flash starts and use breathable cotton fabrics. Make sure you get sleep and drink water. Monitor your triggers and try not to eat or drink things that bring hot flashes on, like spicy food or alcohol or caffeine (basically everything fun).

Chug ice water or put an ice pack on the back of your neck if you feel a hot flash coming. A friend of mine swears by her portable neck fan, which looks like headphones. I know what you''re thinking: no ice pack or cute fan is going to save me when I have a hot flash. "Hot flashes are really just the tip of the iceberg," Dr. Sharon Malone told me. (This is an ironic metaphor; there is nothing cool about them!) "We treat them because we have found that severe and frequent hot flashes are harbingers of an increased risk for cardiovascular disease and can be a risk factor for Alzheimer''s Disease as well. "Women with hot flashes have disrupted sleep. Disrupted sleep can lead to more cardiovascular disease, more depression, more irritability, and even weight gain.

So while we make jokes about hot flashes and people make light of them, hot flashes are the canaries in the coal mine for other long-term health issues that surface after menopause. And women need to understand that hot flashes are not benign, and they''re not funny." Before I entered menopause myself, I hadn''t known that there were any symptoms beyond hot flashes, night sweats, and mood swings. I''d had terrible migraines for years. They would last for three days, right in the same point behind my left eye. Sometimes it would be just a dull ache, but other times it was completely debilitating, and anything could set off a migraine. It didn''t always come from an extra glass of wine or too much sugar, though those were reliable triggers. Poor hydration was often the cause, or too little sleep.

I was never able to take three days off of work and childcare to recover, but if I didn''t catch an oncoming migraine with the right meds right away, that''s how long it would last. So I would suffer through it. I found these migraines very depressing. And not once in all those years did anyone mention they might be a menopause-related symptom. Just when I felt like I was getting a handle on migraines, I started getting urinary tract infections, incessantly. The UTIs were causing me to go on antibiotics, which were then causing GI issues--blockages and bloating. I went to the doctor, who said to start using Metamucil and drink lots of water. And that was all the help I was given.

My GP never said, "Well, this is probably related to menopause, and here''s what you should do." So I threw random short-term solutions at the problem. I remembered in my twenties using Ural "urinary alkalinizer" powders from Australia, which make urine less acidic and eliminate some of the burning feeling of UTIs. Now, many years later, I''ve learned that the powders are available online, even from Amazon, in cranberry or lemon flavors, and so from time to time I order them. But no matter how many products you throw at UTIs, they''re still annoying and incredibly painful. One day during the pandemic, I was in extreme pain from a UTI, and none of the usual drugstore remedies--including cranberry juice, Azo, and Advil--were working. I got in touch with my doctor, who was at a baseball game. (No matter how many telehealth visits I''d had, I couldn''t figure out what was going on.

I felt like I was being run around in circles, and the doctor was also incredibly hard to reach.) I could barely hear him over the roar of the crowd. He said, "No, it''s fine. Just go on this antibiotic, pick it up from the pharmacy and dah, dah, dah." I put the phone down. It was the fourth course of antibiotics I''d been prescribed in a short period of time. I felt like he was brushing me off, as though I was complaining too much or being a hypochondriac. I thought, I need help.

Isn''t it your job to provide it?.