Read an Excerpt

Chapter 1

Change, Change, Change—a Basic Look at Our Bodies and Their Transitions

Laugh and the world laughs with you. Cry and you cry with your girlfriends.

—Laurie Kuslansky

Today, looking at my granddaughters as they enter puberty I understand from my own life experience that they can't know that the ease of their little girl lives is now going to start becoming complicated. Chemical changes and life itself become very difficult to understand. This is the life cycle. As we enter womanhood we grow breasts, our moods change, our bodies change, the known is now unknown, uncharted new territory.

Becoming a woman, especially before you are a woman, is a difficult passage at best. There is so much pressure. You may be the first one in your class to get your period, or the last one; both scenarios feel awful. You may be the one with the huge boobs, or the one whose breasts have not grown at all and the boys notice. Again, either way, other kids make fun of you, and you feel mortified.

I was the last in my class to grow breasts and the last to get my period. I was so embarrassed by this that I pretended I had my period when I really didn't just so I wasn't the one who was "out of the group." I made up stories about my "cramps" like the other girls. There was always some girl in the class who had cramps so bad, real or imagined, that she had to be sent home. I wished so much then that it could be me. (Imagine.)

One day, the other girls found out I was lying when my mother, who did not know how to tell a lie or be dishonest, told the mother of the most popular girl in the class that she didn't know why I was such a late bloomer.

The word was out and they all made fun of me. "How could you?" I wailed to my perplexed mother.

The year before this, the Catholic school I attended started running those scratchy black-and-white films showing sterile pictures of fallopian tubes and talking about "bleeding." Eeewww! I didn't want to know anything about it, at the time, which is pretty funny considering my work now. But I digress. So there I was, the only one in my class without her period and wishing/praying for it!

It all seems silly now, but so overwhelming when you are a fifteen-year-old.

Why did I even want the process to begin? I had the freedom of living without hormonal cycles, and the relatively steady physical and emotional balance of that freedom. Yet I did not know to appreciate it. No one told me about the long, drawn-out process I was about to enter; I did not know of the cycles of woman.

Then it finally came . . . a spot of blood. I was thrilled! "Guess what?" I blurted out to my mother. "I'm bleeding!" She seemed embarrassed, but later that evening without a mention she put a box of Kotex (trade name for humongous sanitary pads) in my room along with this awful-looking strap-thing-y to hold it on to my skinny little body. It felt like I was riding a horse, but I wore it proudly and complained about the discomfort to my girlfriends (for attention) while I prayed for cramps.

My mother was very Victorian, modest and shy, so she never really talked to me about it. In fact, the entire "sex talk" we had happened one day when I was standing on the kitchen stool putting away some dishes for her on a high shelf. She remarked that I had some hair under my arms (about four strands), and then she whispered, "Oh, do you have it down there also?"

Down there. That was it; the closest we ever got to talking about my changing body, my transition, my new life. A product of her time, my mother's shame of her own body became my shame, so I kept all things girly and personal to myself.

I entered womanhood having no idea of what it meant.

A Peek Under the Hood

The female body is miraculous and complex, capable of bringing new life into the world by way of our reproductive organs. But what exactly goes on "down there" and in there? It's important to understand how our bodies work: our exquisite female reproductive system consists of internal and external parts.

The external parts include the labia majora and the labia minora, also called lips, that surround the vagina and urethra and protect the internal organs from infectious organisms. The internal parts include the vagina, which claims both the functions of enabling sperm to enter the woman's body and being a birth canal. The uterus is the organ that carries a growing fetus, and the cervix is the lower part of the uterus that joins the uterus and the vagina. The ovaries, which rest to either side, produce eggs, and the fallopian tubes allow eggs to travel into the uterus.

Our bodies are magnificent. Each month we experience apoptosis, a fancy name for the necessary death of cells. We can understand this better by an explanation of our monthly period and what happens in the uterus. Each month we shed the lining of the endometrium (cell death) and it is cleared from our bodies through the process called menstruation. This monthly bleed is a necessary form of cell death to make way for new cells and to remove cells whose DNA has been damaged to the point at which cancerous change is liable to occur. It's a brilliant process, always clearing our bodies monthly to keep us healthy; it is only interrupted if we become pregnant, and in that case the endometrium lining holds the nourishment for the developing fetus.

If an egg released from the ovaries is fertilized by sperm, and pregnancy occurs, it will travel through the fallopian tube and implant itself in the uterus. During pregnancy, the egg, or embryo, grows into a fetus inside the uterus, which expands in size to accommodate the developing baby. A woman carries the baby in her uterus, or womb, until the baby is ready to be born.

When a woman's body expels all the eggs produced by the ovaries during the course of her lifetime, menopause begins and the ability to reproduce ends. Menopause should really be called "egglessness." It's a friendlier term. Before we get to eggless, however, our hormones begin to decline subtly, in what we call perimenopause. Meaning you can still reproduce but it will become more difficult to conceive, difficult to carry to full term, and the eggs left are often not as strong and healthy. Sometimes, but not always, this leaves babies born to moms at risk for birth defects and health conditions.

As fully reproductive women we make enough estrogen each month so that it reaches its peak on the twelfth day, stops the growth of cells, and makes progesterone receptors. Without an estrogen peak, your brain can't send the signal to release any of the eggs you have left. With no estrogen peak there's no feedback information to shut off follicle-stimulating hormone, so FSH pours constantly, overstimulating your ovaries and ripening all at once most of the eggs you have left. The loss of this rhythm in perimenopause actually triggers the destruction of the rest of your eggs through the action of excessive FSH, using up the remainder of your eggs. At about this time, you begin to feel the heat of hot flashes. That's how the system effectively shuts itself down for good. This process can take a decade—a long uncomfortable decade!

This is all background to explain why the healthiest woman is a reproductive woman, and once hormones begin to decline, new science has proved that replacing the missing hormones restores a woman to her healthiest prime even though she is no longer capable of making a baby.

What I did know was that now I felt different. I was getting used to the ups and downs of the surges of sex hormones and menstrual cycles, as well as the (very welcome) growth of pubic hair, breasts, and sex feelings. Now I felt that I was like all the other girls.

But then my breasts kept growing. (Wow, be careful what you wish for!) I started out at fifteen wearing a scant 32A cup (padded), hardly filling it, and by the summer of my sixteenth year I was an overflowing 34C that could hardly be contained. My breasts grew so big and so fast on my skinny little body that they were a little embarrassing, but I liked the attention I was getting from having them, including attention from my lecherous drama teacher who would say highly inappropriate things to me when no one was around. I got the part of Adelaide in Guys and Dolls partly due to my talent, partly due to my shapely, curvy body, and partly because that lecherous one wanted me around. My father didn't like the new me at all. My body seemed to make him angry, and he would say things like, "For chrissakes, put some clothes on."

BYE-BYE PUBERTY

Transitioning into womanhood, like all transitions, is an agitating and confusing experience. It's a long, bumpy, uncomfortable road; but then you adjust to the excitement, privileges, and challenges of being an adult. This is also a time when your hormones reach their maximum. By the time you are in your twenties and thirties, you enter a period of remarkable high energy, clear thinking, and all the drama of being an adult and building your adult life. You don't quite know who you are yet in most cases, but you sure are having fun. Your body is the best looking it will ever be; your breasts are high and perky, and your sex drive is off the charts. You are oozing estrogen. For most people this is a time of perfect hormonal balance. Diet affects your hormones at this time like any time, but your youth withstands the assault of binge drinking, hangovers, fast food, quarts of ice cream, and sugary desserts. Somehow you sleep it off, bang down giant cups of coffee, and sail through work until the end of the next week, when you do it to yourself all over again.

HELLO, MIDLIFE . . .

Sometime between your midthirties and midforties another series of physical changes begins to takes place. Transitions! In general, this is a time of strength and vibrancy, but now you are more affected by outside factors and lifestyle choices. And as I just said, things are shifting again. Your periods may become a little erratic, your breasts may get painfully lumpy, and sometimes your periods get lighter or heavier than usual, or you are bleeding between them. You or your friends may be struggling with: infertility, difficulty conceiving or carrying a pregnancy to term, endometriosis, uterine fibroids, sudden weight gain, foggy thinking, memory loss, migraine headaches, cold hands and/or feet, and premenstrual syndrome, even when you've never had it before.

You are a little moodier than you used to be and you tire more easily. The kids can get on your nerves in ways they never had before. By the end of the day you can't wait for that 5:00 cocktail to cool out and relax. You don't recover from a long trip or a night out as easily, either, and staying home becomes more alluring than constantly running to the next event. You need more sleep, but the sleep you are getting isn't as sound as it once was. Your muscles strain more easily when you are working out, and when you get out of bed in the morning, you might grunt a little from the stiffness. The fast food you enjoyed in your twenties now gives you heartburn, and drink one too many glasses of wine and you will have a whopper of a headache.

But the big one . . . you don't feel like having sex the way you used to. Is it you? Is it him? You don't know, but it's depressing and it takes its toll around the house.

Your husband is working as hard as he can to give you the lifestyle you both want. You likely are working two jobs: in your career and at home. You feel "put upon" because he is always gone and you have to do everything. He doesn't seem to realize all you do and that you are working from morning till late at night being the perfect mom, wife, housekeeper, career woman, and preparing for everyone for the next day while he's already asleep under the covers with the TV blaring. You can't help it when you get annoyed that he didn't stay up for you, even though he has an early morning appointment. Could this be PMS? No, you say to yourself. This is real. It's him. You start to have dark thoughts about breaking out, getting away. But these are just fantasies . . . aren't they? Your PMS used to be mild, but now it can carry with it a surge of fury. Plus, you've gained a little weight and you can't seem to exercise enough to get it off. That too is annoying. You ask him if what you're wearing makes you look fat, and if he says yes, it's an evening wrecker.

What is happening? You are now at midtransition. Fun, huh?

HORMONE HELL

Just like with puberty, now your hormones seem to be all over the place again. Just when you had gotten used to feeling great all the time, it's like something has stripped it away. Your hormones are fluctuating up and down, like they have a mind of their own, but the overall direction of them is down, just as your reproductive years are winding down.

In puberty your hormones fluctuate, which is why you cry, yell at your mother, get depressed and feel suicidal if your boyfriend breaks up with you. Plus you hate your body and you feel fat, and your parents are mean and no one understands you.

Then you transition through that passage into your reproductive years and suddenly your cycles are regular. You feel happy and serene, and proud of your abilities to reproduce. And aren't you something that you have given birth to these incredible children? They are perfect and so is your life. Your husband brings you flowers, and you have great standing-up sex in the shower with the door locked, while the kids are still safely sleeping in their rooms. Life is good. Life is smooth sailing and delicious.

Then along comes perimenopause and the fluctuations start again, almost like you are back in puberty. You cry for no reason, no one understands you, you are overworked and underappreciated, your body is betraying you, and did I mention, no one in the house understands you?