Love and Marriage and Menopause

My hormones turned sex with my husband into a labor of love. Emphasis on the labor part.

Photo-Illustration: by The Cut; Photo: Getty Images
Photo-Illustration: by The Cut; Photo: Getty Images

My husband, Rob, and I had a healthy sex life. A mutual friend set us up on a blind date and the chemistry was obvious right away. I loved that he didn’t play games — a rarity in Los Angeles — and how he showed up for me in a way that no partner ever had. Having both been married once before, we had five kids between us, so we’d regularly plan lusty weekends away to Palm Desert whenever we could to “luxuriate in each other’s company,” as Rob liked to say.

Then I turned 44 and started having hot flashes.

The first time my body felt like it’d caught fire was at a birthday dinner. Drenched with sweat, even my thighs were sticky. I was seated closely between two men and was mortified that they could feel this heat radiating off me. I was squirming in my chair when one of them asked, “Are you okay?”

Forty-four felt unfairly premature for this. A conversation with my gynecologist was less reassuring, more like a dead end. “Are you saying I’m just supposed to live like this?” I asked her. Only when I pressed her for options did she give me a prescription for a bioidentical estrogen cream. I was cautious and applied it to my upper arms, as directed, sparingly. After six weeks, nothing had improved.

Between the hot flashes and the ensuing brain fog and mood swings I was a mess. My ability to cope with normal stresses evaporated. I was melting down, physically and emotionally, and it was accompanied by a profound sense of loss. My body was acting years older than it was, and I was shocked by how much grief I felt over this. It felt like it marked the end of everything. I also didn’t want to be touched.
Perimenopause is sneaky; I didn’t even know it was a thing until I was deep in it. Nobody I knew had ever talked about their symptoms, at least when I was around. I decided I needed a specialist to help me navigate this, which is how I wound up in the office of a pricey “anti-aging” expert in Beverly Hills. He looked at my blood tests and loaded me up with bioidentical estrogen and testosterone creams (which would be used to supplement my crashing hormones and return them to where they had been before), plus progesterone (which is necessary to oppose the estrogen and would also help me sleep). I was to take the progesterone pills for half of the month and apply the creams to my arms and thighs daily. I could add extra if I felt I needed it.

“I decide if I need more?”

“Yes. Who knows your body better than you?” he said.

I was surprised to be handed the keys, but at the same time, it sounded reasonable.

“And have sex with your husband every day,” he added matter-of-factly.

“Does that help balance hormones?”

“No,” he said. “But you’ll both feel better.”

He was right. Orgasms and a surplus of feel-good hormones can smooth over many cracks in a marriage. The more sex I had, the more I wanted it. Bringing an awareness to my pelvic area seemed to turn a switch on. We were much more playful about it, sneaking in a quick session when we could. For the next six months, we were in our own little sex bubble and it fortified us.

The tricky thing about hormones is that they fluctuate constantly. The dosage would work for a while and then it would not. It required tweaking to keep on the “happy” frequency. Sometimes that meant more “clicks” of the estradiol cream, sometimes fewer. It was about trying to maintain a zone in which I felt good — felt “normal.”

That hormonal roller coaster had a physical effect on me: I was getting rounder and curvier. Not necessarily a bad thing, until my underwear got so tight it ruined my day. Whose body is this? I demanded, while I squeezed handfuls of extra flesh in the mirror. I didn’t know if it was the creams or if it was what my body was naturally wanting to do. Ten pounds materialized on my small frame overnight. At the highest point, it was 20. I was eating the same amount and exercising, but my jeans no longer fit. I bought larger bras and panties.

Back in the doctor’s office, I asked if I should be having less of his prescriptions. He peered at me over his distinctive glasses and smiled. “You’ve been given this gift of femininity, this attractiveness. You must preserve it! Estrogen helps to improve your moods — and your relationship.” The advice was always the same: More creams! More sex!

The hot flashes were gone, but I was exhausted and had trouble with insomnia. The sex plan slowed to about three times a week. I added herbs and supplements to my regimen to help me sleep, but it was hard to tell if anything was making a difference. After a couple of years, I began to have issues with uterine fibroids, leaving me with excruciating periods — just like when I was a teenager. I’d dealt with fibroids for years, but now there seemed to be a lot more of them and they were wreaking havoc every month. The insanely heavy periods were draining, and I was sick of having to toss out underwear that couldn’t be salvaged. I would eventually require an ablation procedure.

“Forget the witch-potion bioidentical hormones,” my new gynecologist insisted at my annual exam. (My first doctor’s practice was mostly women having babies, and I was underwhelmed by her knowledge of menopause.) “Someone could have made them in their kitchen — you have no idea what’s in them. You need to be on the good old-fashioned birth-control pill. That’ll straighten you out.”

I’d never done well on the pill, but he seemed certain about it. He forgot to mention, though, that going on a low-dose pill would plunge me into withdrawal. Within a month, the hot flashes returned and I was crawling out of my skin again. Being in a rush and trying to navigate a full parking lot at the market would leave me in tears of frustration. I couldn’t manage simple tasks. “My nerves are shot,” I told Rob. “It’s like they have no covering. I’m completely raw and exposed.” I was a raging, weepy estrogen addict in need of a fix.

At that point, we weren’t having much sex. It was the last thing I felt like doing, and Rob was afraid to come near me and set me off. We were lucky if we were on the once-a-month plan. “Clearly, you’re not getting what you need,” he said. “Can’t we go back to the one with sex every day?”

After a few excruciating months, I found myself back in a doctor’s office, where a new female practitioner put me back on the bioidentical creams. Her approach was to use integrative medicine to address all forms of hormone health. She was a firm believer in bioidentical creams and had been treating women with them for decades. She also gave me DHEA, thyroid and adrenal supplements, plus a sleep formula. I was like a junkie who’d just found a fantastic new dealer. I felt better in my body, and it resuscitated my sex life.

It worked until, as I turned 50, I began to feel flat again. I started an anti-depressant.

Months went by, and I was dragging. I once again had little enthusiasm for anything, especially sex. This did not go unnoticed. Rob and I fought about it. Sure, I could give in just to avoid a fight. It’d happened before. Sex was a mood regulator; I knew his rhythms and how many days we could go without sex before he would get edgy. But now that felt too much like work. Why did his needs always have to come before mine?

This wasn’t a question I’d ever before asked myself. Despite having had plenty of sex, I didn’t even have an orgasm until my mid-20s. When I was younger, I’d spent years more concerned with my partner’s experience of sex than my own. I wasn’t intimate with my body, and there was often an element of performance to it, as if my body were a vehicle for the pleasure of others. Finally, in midlife, my body belonged solely to me, for better or worse. I was fighting to understand all the changes happening, and sometimes that meant I had room to worry about my own feelings only. It was liberating, even if exhausting.

But although I was alone in my body, I was not alone in my marriage.

As marriages frayed all around us — a number of couples we knew were getting divorced or were openly struggling — I wondered if Rob and I were going to make it. That strong biological urge to mate had subsided, and a feeling of expansiveness had taken its place. Midlife can be a scary time in a union. One half of a couple that got divorced during COVID told me, “Man, she really went crazy with the hormones,” as if that absolved him of any responsibility.

I wanted to avoid that fate; I loved Rob and felt we could work through our issues. I started reading about testosterone therapy to ramp up libido, so I signed up for that, too. I had two girlfriends who were seeing a doctor in Santa Monica for hormone pellets, so I took them up on their referral. He looked at my blood tests and said that my testosterone levels were “almost non-existent.” The doctor joked that he didn’t know how I’d been getting out of bed. He made an incision and injected dissolvable testosterone and estrogen pellets into my butt cheek. It hurt so badly I could barely lay still on the table. It felt like the anesthetic hadn’t worked at all. For the next few days, whenever I went to sit down I had to ease myself gently into the chair. At home afterwards I did more research and found that they were highly controversial within the medical community and not FDA-approved. If the testosterone dose is much higher than a physiological level, it can lead to a lot of problems. And if there’s a complication, you have to wait it out until they dissolve in three to five months. But I was desperate.

The testosterone, it turned out, was a game-changer. After about a week, I had renewed energy and purpose. I was working out, and simple things like going to the market stopped being overwhelming. And I wanted sex again. But it was different this time: It was less about him. He was used to leading, but now I wanted to be in control. It needed to be on my schedule, my rhythms, my favorite positions — and then when it was over I bounced up and got on with the rest of my day.

“You don’t even want to cuddle after sex anymore,” Rob told me once as I leaped out of bed and dressed to go on my walk. “You’re just up and out of here. It’s kind of insulting.”

He was right, but I was not in the mood to listen to him talk about his feelings.

The testosterone had apparently made me more blunt, less emotional, and less of a caretaker. When he expressed concerns over this “new me,” that I wasn’t making time for him or considering his needs, I snapped at him: “You’re getting all the sex you could possibly want. What’s the problem?” I was pissed and felt like I couldn’t make him happy.

“We’re not connected. You don’t want to plan trips with me. It feels like you don’t care anymore,” he said. “I’m way down on your list of priorities. Behind the dogs.”

I had to acknowledge how he felt. After 16 years, I was turning into a different person and chafing at the constraints of our old contract. We were experiencing some growing pains. A therapist told us that Rob “needed to grieve” over the fact that my body was aging. I understood that because I had been grieving throughout this process, too.

I agreed to throttle back on the testosterone because the dose was way too high, though I refused to give it up completely. It was a hormone I had never really paid much attention to before, but it’s been vital for my energy and my sexuality.

I’m 54 now and hopefully over the worst of it. I’d like to feel as good as I can, for as long as I can, and I am still figuring out which delivery system is best to achieve that. I have a new gynecologist now (again), a menopause expert, and she wants me to try a patch or gel, something that is FDA approved.

At least I’ve finally figured out the map to my body, as far as intimacy is concerned anyway, and I have more sexual capital than ever before. Now I have the agency to know what to do with it. After having been through so much together, Rob and I have realized that our connection and sex life is something that is fluid — our aging bodies insist on their own say in it.

We’re planning getaways together again. For a recent anniversary, trip we went to Japan and found that we made the most of our debilitating jet lag with 4 a.m. sex in Tokyo. Huddled together under the covers, with Rob fumbling around for lube in the dark, we couldn’t stop laughing as we tried to guess what time it was for us. I figure if we’re still laughing through all of it, we’re doing okay.

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Love and Marriage and Menopause