Totally 80's Perimenopause

Holding Back the Years: Then & Now

Gen X’ers, no doy, we’re the best generation! We like had the best music, the best movies, and the best slang growing up. The 80s were quite the decade. We had ice cream trucks, big hair, and were free to roam the world without seatbelts.

Okay, maybe that part wasn’t so great. My parents loved small hatchback cars, and for a family of five, this wasn’t practical. One of us was always forced to ride in the hatchback. As the middle child, you can guess who got put back there most often. I spent most of my young years lying down in the back of cars, and not for the dirty fun reasons you think.

Then:

I was in high school in the 1980s. In 1986, I was 16, and my mother was 42. I don’t remember her mentioning any unusual health complaints at this time; those would come later when I reached my early 20s.

My favorite movie at the time was Sixteen Candles. I was obsessed with it and the main character, Samantha Baker. I had watched it over 30 times (a well-worn path to Blockbuster), owned the movie script and posters (I still own them), and wanted to be Molly Ringwald. My onscreen heartthrob was, of course, Jake Ryan.

I was a studious teen. As a slow reader, it didn’t come easy. I’m not a partier, not a player; I did ballet. I had a great group of friends who supported each other and hung out together, but I didn’t mind alone time. I loved going to the library, shopping, reading, gossiping about boys with my friends, and going to the movies with my family—basically, Samantha Baker.

Now:

A few years ago, I watched Sixteen Candles as an adult, and I was horrified that I loved this movie so much. No way was I going to let my kids watch it. But then I watched it again and focused only on Samantha, and it reminded me of what I loved about the movie in the first place.

I lived with parents who could have easily forgotten my birthday (my parents once went on vacation without us during the week of my 13th birthday), so I easily identified with Samantha Baker’s family struggles. I also felt like being the “good girl” got me ignored in school, especially by boys. Spoiler alert: I felt like the world righted itself when Jake showed interest in her and pursued her. There was hope for me yet.

Perimenopause in the 80s (in the US)

As Gen X’ers, our mothers were likely going through perimenopause during the 80s and may have even reached menopause. Try to remember what those years were like for her, or if you’re lucky, you can ask her what her experience was.

The word perimenopause was first written in the early 1960s, yet it hasn’t been until recently that the term became popular. And by popular, I mean “0.07 occurrences per million words in modern written English.” But if you look at the frequency of the term in the Oxford English Dictionary, you’ll see it has increased rapidly between 2017 - 2023¹. We’re making progress!

Menopause

Then:

I wasn’t really paying much attention to menopause in the 80s, but I get the sense that it was an exciting time for research, scientific interest, and attention. This was before the Women’s Health Initiative (WHI) even started (1991, with results in 2002) and basically shut down the HRT conversation and interest in menopause research. According to a PubMed literature search, the word “menopause” appeared in 6,924 research papers/medical articles between 1980 – 1989. “HRT” was found in 103 papers.²

At the time, scientists believed that menopause only affected our reproductive capability. Consider that estrogen was only discovered in the 1930s.

Every medical diagnosis is coded at your medical appointment, and back in the 80s, the code for “menopausal disorders” was 627 and fell under the category of “genitourinary system issues.”

Atrophic vaginitis (fun name) was the medical term for vaginal dryness and thinning vaginal tissue.

Now:

We know now that menopause doesn’t just affect our reproduction; it affects our whole body. Estrogen is not “just” a reproductive hormone for us; it’s a full-body hormone. Our whole body relies on it to operate efficiently. Menopause is not a “genitourinary system issue;” it affects our neuro-endocrine system (affecting your brain and your endocrine system, which produces your hormones).

This is a very different understanding than what we believed in the 80s. This explains why some seemingly unrelated health issues like frozen shoulder and fibroids are actually connected. Estrogen is a major player in our bodies in so many ways. It also explains why conditions like heart disease pop up more frequently in post-menopausal women. Estrogen is anti-inflammatory, allows us to retain moisture, and is overall protective.

Interest in menopause is increasing rapidly. Scientists are getting funding for menopause research, and papers are being published more frequently. According to a PubMed literature search, the word “menopause” appeared in 29,604 research papers/medical articles between 2010 - 2019. “HRT” was found in 3,807 papers.

As an example, up until this past July, scientists thought our estrogen receptors shut down in menopause. Dr. Lisa Mosconi, a PhD neuroscientist, conducted a groundbreaking study that showed that they are actually very active in perimenopause and menopause. ³

The new parent code for “menopausal disorders” is N95 and still falls under the category of “genitourinary system issues.” One day this may be changed. It was last updated in October 2023.

And that “atrophic vaginitis” condition is now called Genitourinary Syndrome of Menopause to account for all of the symptoms that can occur, like vaginal thinning, vaginal dryness, leaking urine, prolapse, and urinary tract infections.

Hormone Therapy

Then:

In the 80s, perimenopause wasn’t talked about openly or understood, but women knew they weren’t feeling right. Historically, women had to be careful talking openly about these topics or they could get locked up for lunacy.

When a woman went to her doctor and complained of hot flashes and other discomfort, she was put on hormone replacement therapy (HRT) when she reached menopause. Women wanted to feel better, and decades of women before were also taking HRT. The most popular (and only) HRT was called Premarin and had been around since 1942.⁴

HRT in the 1980s was very different than it is now. First, it was an oral pill, not a transdermal delivery method (via the skin). The active ingredient was conjugated equine estrogen (CEE). Wait, what? Gag me with a spoon. Did you say equine, as in horse? Neigh it ain’t so!

Wait for it. It gets better. Premarin, an oral tablet, is made out of pregnant horse urine.

Estrogen used to be made from pregnant human urine, but as you can imagine, that wasn’t sustainable. Go figure; I guess pregnant women didn’t want to spend time peeing into buckets. It takes A LOT of human urine to produce just a bit of hormones.

NOTE: When you’re reading studies about estrogen and its risks, it’s very important to find out if the study used CEE or 17b-estradiol (what is popularly called “bioidentical”). Risks and side effects may be different. Most of the major studies, like the Women’s Health Initiative (WHI), used CEE. 17b-estradiol hasn’t been studied as much historically.

It was CEE that was used in the WHI study along with medroxyprogesterone acetate progestin (Provera, not to be confused with Prometrium or its generic equivalent, also called micronized progesterone which wasn’t FDA approved until 1998). 17b-estradiol wasn’t available at the time of the study and wasn’t FDA-approved until later. That’s a whole different story for another day when I talk about “bioidentical,” compounding pharmacies, and FDA-approval. These are gnarly topics, but for now, I have some info in the Vagtionary - my glossary of terms.

Premarin is still available today and, according to Dr. Jen Gunter, is still useful today.⁵ Women at the time loved taking it. They were upset when they lost their prescriptions for it when the Women’s Health Initiative study results were published. According to one doctor I spoke with who practiced at this time, she said women came into her office screaming and demanding their prescriptions be refilled.

Vaginal estrogen cream, Estrace estradiol 0.01% cream, was also available and approved by the FDA in 1984.⁶ Vaginal creams are not systemic and only help the tissues of the genitourinary system (urethra, bladder, vagina, and vulva). The 0.01% is a very low dose.

So, the 80s seemed to be the heyday for HRT. This was before the Women’s Health Initiative even began in the 1990s (results released in 2002). However, two very large studies were taking place during this time.

In 1985, the Framingham Heart Study reported that women using menopausal hormone therapy were associated with a 1.76% increase in heart disease.⁷ The Nurses Health Study, which looked at post-menopausal hormone therapy and risks of breast cancer, coronary heart disease/stroke, colon cancer, cognitive function, eye disease, and hip fractures, was also ongoing.

In 1986, the FDA deemed estrogens an effective therapy for the prevention and treatment of osteoporosis.⁸ But, in 1990, the FDA did not approve it for indication for heart disease, which is where things still stand today.⁹

Estrogen and progesterone were first prescribed together in the mid-1980s.¹⁰ While speaking with a physician who has been prescribing hormones since the 1970s. She said they didn’t know back then to prescribe progesterone with estrogen to keep the uterine lining from getting too thick. When the uterine lining got dangerously thick from using estrogen-only, they performed a hysterectomy.

Now:

Firstly, HRT is now called MHT or HT. “MHT” stands for menopause hormone therapy and “HT” stands for hormone therapy. “They” changed the name because calling it replacement therapy is incorrect. Replacement makes it seem like you are restoring your hormone levels to pre-perimenopause levels, and that’s not correct.

The amount of hormones provided in hormone therapy is very small – even smaller than low-dose birth control pills. It’s just enough estrogen to keep your baseline estrogen higher than it would have been (close to 0 at menopause) and trick your brain into thinking your ovaries are still producing it.

If you’re trying to do your own research, continue using “HRT” as one of your search terms to find information because not every website or article has switched over to the new terminology.

There is now a wide variety of systemic MHT options, including pills (not to be confused with birth control pills), patches, gels, a hormonal ring, and a spray. Both estradiol and conjugated equine estrogen are available.

For local vaginal options, we now have FDA-approved creams (generic and brand), tablets, suppositories, and a hormonal ring (not to be confused with the systemic hormonal ring).

In a future article, I’ll take a deep dive into MHT options and explain everything in terms that you can understand. I know it’s confusing, but I’ll clear the air for you.

Hormone therapy is also now offered to us in perimenopause. We don’t need to wait until we reach menopause to get started, but be aware that some doctors are still operating under the old way of prescribing it only for menopause.

If you have a uterus, progesterone is always offered with estrogen. There are several FDA-approved progesterone products available.

Hysterectomy

Then:

Hysterectomies were very common in the 80s. If a woman showed up to their doctor complaining of pelvic pain or heavy bleeding or was found to have fibroids or a uterine prolapse, it was often suggested to remove the uterus/ovaries if she was done having children. Prior to the 80s, the hysterectomy rate climbed from 2.4 per 1,000 to 10.6 per 1,000 women in 1975.¹¹

The hysterectomy rate in 1980 was 7.1 women per 1,000, and then it started to drop. By 1986, the rate was 6.6. By 1995, the rate was 5.5 per 1,000.¹²

Make sure you read my comment above about when estrogen and progesterone started to be prescribed together.

Now:

The hysterectomy rate continues to drop and is expected to drop to 3.9 per 1,000.¹³

“In 2021, the age-adjusted percentage of women age 18 and older who have had a hysterectomy was 14.6%.”¹⁴

Like everything, there are a number of reasons for this:

• We understand more about the science

• There are more non-surgical options

• Doctors are prescribing estrogen with progesterone for those with a uterus to keep the lining stable

• We (patients and doctors) are more concerned about the risks of the surgery

I’d love to say that the rate is declining because we’re getting smarter, but prior authorizations required from insurance companies have something to do with it, too. Most insurance companies review hysterectomy treatment plans to make sure they are medically necessary before they will cover them. The requirements are getting stricter.

Symptoms

This section is purely speculation, and my opinion is based on what I know.

Then:

I think perimenopause symptoms weren’t as severe or intense back in the 80s, generally. It used to be said that perimenopause lasts 2 - 4 years prior to menopause. I think women back then developed symptoms much closer to menopause than we do now. I believe there are a variety of factors involved, such as our stress levels being the major one. We also weren’t as isolated as we are now. We learned from the pandemic how important community is in our lives. Life was just overall different back then.

In 1900, the average age of menopause was 48 (US) per Dr. Mary Jane Minkin, a top menopause expert at Yale.

Now:

I’ve recently seen reports that perimenopause can last 2 to 14 years. The range keeps growing wider. Stress plays a major part in how our perimenopause symptoms manifest. The US Surgeon General¹⁵ just came out this week saying that parents’ mental health is now a public health challenge.¹⁶

Isolation also plays a part because it adds to our anxiety. We’re not meant to live so disconnected from each other. I always say, “A socially awkward interaction is far better for our nervous systems than not having one at all.” One of my favorite authors and therapists, Britt Frank, LSCSW, says that “brains will tee up anxiety just to get us to connect.” She offers the example of being on a turbulent flight and reaching out to the stranger across the aisle to hold hands.

Regardless of whether you have children or not, by the time we get to perimenopause, we are burnt out, exhausted, isolated, and living with years of chronic stress. The adrenal glands take on a bigger role during perimenopause and menopause, and if they don’t have the capacity to do this because they are constantly pumping out stress hormones, things get wonky quickly and sooner.

In 2024, the average age of menopause is 52 (US). This gives us more time to develop perimenopause symptoms if hormonal shifts start in the 40s (assuming it also did in 1900, which I realize may be a crazy assumption). But clearly, something is going on that our perimenopause symptoms are more intense and longer lasting.

I wrote about the common symptoms of perimenopause if you’re curious what they are.

Back to the Future

I hope that this mega happenin’ wicked awesome article about what perimenopause was like back in the 80s, as compared to now, was helpful. We’ve come a long way. Things are changing, and we’re making significant progress in many ways. It’s just taking time.

Talking about progress - isn’t it wonderful that you don’t have to get that phone call from the doctor’s office telling you that “the rabbit died?”¹⁷

Now turn on Casey Kasem’s American Top 40 and play with your Monchhichi. What are your best memories from the 80s?

TTFN¹⁸

Be well, stay cool…

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1. “Perimenopause, N. Meanings, Etymology and More | Oxford English Dictionary.” Oed.com, 2023, www.oed.com/dictionary/perimenopause_n?tl=true#:~:text=How%20common%20is%20the%20noun, https://doi.org/10.1093//OED//1207382828. Accessed 28 Aug. 2024.

2. National Library of Medicine. “PubMed .” PubMed Labs, 2024, pubmed.ncbi.nlm.nih.gov/.

3. Mosconi, Lisa, et al. “In Vivo Brain Estrogen Receptor Density by Neuroendocrine Aging and Relationships with Cognition and Symptomatology.” Scientific Reports, vol. 14, no. 1, 20 June 2024, p. 12680, www.nature.com/articles/s41598-024-62820-7, https://doi.org/10.1038/s41598-024-62820-7.

4. “The Strange Case of Premarin.” Pubsapp.acs.org, pubsapp.acs.org/subscribe/archive/mdd/v03/i08/html/kling.html.

5. Dr. Jen Gunter - “Premarin is Extracted from Horses”

6. FDA. “Drugs@FDA: FDA Approved Drug Products.” Fda.gov, 2009, www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=BasicSearch.process.

7. Stampfer, Meir J., et al. “Postmenopausal Estrogen Therapy and Cardiovascular Disease.” New England Journal of Medicine, vol. 325, no. 11, 12 Sept. 1991, pp. 756–762, https://doi.org/10.1056/nejm199109123251102. and https://www.framinghamheartstudy.org/ accessed on 8/28/24

8. Stefanick, Marcia L. “Estrogens and Progestins: Background and History, Trends in Use, and Guidelines and Regimens Approved by the US Food and Drug Administration.” The American Journal of Medicine, vol. 118, no. 12, 19 Dec. 2005, pp. 64–73, www.amjmed.com/article/S0002-9343(05)00919-8/fulltext, https://doi.org/10.1016/j.amjmed.2005.09.059. accessed on 8/28/24

9. Stefanick, Marcia L. “Estrogens and Progestins: Background and History, Trends in Use, and Guidelines and Regimens Approved by the US Food and Drug Administration.” The American Journal of Medicine, vol. 118, no. 12, 19 Dec. 2005, pp. 64–73, www.amjmed.com/article/S0002-9343(05)00919-8/fulltext, https://doi.org/10.1016/j.amjmed.2005.09.059. accessed on 8/28/24

10. Kohn, Grace E., Rodriguez, Katherine M., and Pastuszak, MD, PhD, Alexander. “The History of Estrogen Therapy.” Sex Med Rev. 2019 July; 7(3) 416 - 421.

11. Simms, Kate T., et al. “Historical and Projected Hysterectomy Rates in the USA: Implications for Future Observed Cervical Cancer Rates and Evaluating Prevention Interventions.” Gynecologic Oncology, vol. 158, no. 3, Sept. 2020, pp. 710–718, https://doi.org/10.1016/j.ygyno.2020.05.030. Accessed 6 Nov. 2021.

12. “Hysterectomy Surveillance --- United States, 1994--1999.” Www.cdc.gov, www.cdc.gov/mmwr/preview/mmwrhtml/ss5105a1.htm.

13. “Historical and Projected Hysterectomy Rates in the USA: Implications for Future Observed Cervical Cancer Rates and Evaluating Prevention Interventions.” Gynecologic Oncology, vol. 158, no. 3, Sept. 2020, pp. 710–718, https://doi.org/10.1016/j.ygyno.2020.05.030. Accessed 6 Nov. 2021.

14. “Products - Data Briefs - Number 494 - February 2024.” Www.cdc.gov, 26 Feb. 2024, www.cdc.gov/nchs/products/databriefs/db494.htm#:~:text=The%20crude%20total%20percentage%20of.

15. There are only two US Surgeon Generals that I know their names - C. Everett Koop, who used to make public service announcements between 1981 and 1989 and was a large influence in why I went into healthcare. And Jerome Adams, who I met when he was the US Surgeon General.

16. https://www.reuters.com/business/healthcare-pharmaceuticals/us-surgeon-general-calls-parent-stress-public-health-challenge-2024-08-28/

17. By the 80s, this practice had pretty much stopped, but they used to use rabbits to test for pregnancy. FYI, all of the rabbits died regardless if you were pregnant or not so saying “the rabbit died” was inaccurate.

18. TTFN is “ta ta for now” from the 1983 movie Valley Girl