Ruby Irons

It started with what I’m sure seemed like an unhinged message to my nurse practitioner. You know the kind – the ones we write in moments of desperation, when we can no longer pretend that everything is okay. Here’s what that raw, unfiltered moment of frustration looked like:

“Happy Monday Christine! Since we experimented with me coming off of the birth control pill for a few months, I’ve had a few periods with lots of bleeding. I realize this is not your fault, obviously, so I’m not directing my frustration at you. But I’m so tired of this. I’m feeling like I’m beat down. I don’t want to bleed. And I reeeeeally don’t want to bleed this heavily. Soaking pads, messing up underwear & sheets. Barely making the drive to work without leaking. I’m so over it!

It’s very frustrating to still be dealing w/this at my age. No woman should have to plan her day around when she needs to stay by a restroom. Oh, sorry, I can’t go hiking (or anything) I have to stay close enough to a bathroom, in case. So frustrating, it brings me to tears.

Another thing that frustrates me (and my loving hubs) is my loss of libido. Why aren’t there remedies for us women? I need to want to have sex with my husband! And is there anything out there that can help women with libido?!? I’m desperate! I’m too old for the BS.

 I haven’t even mentioned the horrible night sweats! Again, I’m not aiming this at you. Just frustrated that the US seems to be so far behind the times when it comes to women’s health and helping us live a life we deserve without all the stupid suffering.

Thank you so much for your help! Ruby

ps: I realize how nutsy I sound. I am aware. I don’t want you to think I’m jumping off the deep end. :)”

That message, born from a cloud of severe disappointment in my current treatment results, became the gateway to what I can only describe as a dizzying rabbit hole of medical research. And you know what? That raw, emotional outburst – complete with its apologetic postscript about sounding “nutsy” – was exactly what needed to be said. Sometimes self-advocacy starts with simply admitting that things aren’t okay anymore. Sometimes that’s exactly what self-advocacy looks like – diving headfirst into the maze of medical literature, comparison charts, and treatment options, armed with nothing but determination and a good internet connection.

The Research Spiral…

Here’s what I’ve learned: everything is connected, and nothing is simple. I’ve found myself navigating the intricate web of SSRIs, comparing Sertraline (better for anxiety) with Bupropion (more effective for depressive disorders like PMDD). I’ve delved into the hormone profiles of birth control pills versus IUDs, trying to understand how each might interact with these medications. And just when I thought I had a handle on things, there’s suddenly talk of vaginal estrogen – with some sources singing its praises for PMDD management while others offer a more skeptical “hmm, not so much.”

The Overwhelming Reality of Self-Advocacy

The truth about self-advocacy that nobody tells you? It’s exhausting! It’s spending hours cross-referencing medical journals and treatment options. It’s maintaining spreadsheets of side effects and success rates. It’s walking into your healthcare provider’s office with a folder full of research and trying not to feel like you’re overstepping.
 
But here’s the other truth: it’s necessary! In a healthcare system that often moves too quickly to catch the nuances of our individual experiences, being our own advocate isn’t just helpful – it’s essential. Even when it means scheduling an IUD placement in my mid-50’s (yes, really!) while simultaneously juggling clinical referrals for myriad other treatments.

The Simple Truth in Complex Solutions

At its core, what we want is beautifully simple: to feel good. To remember what “normal” feels like. To not accept midlife miserableness as our new default setting. But the path to that simple desire often requires navigating complex medical decisions and treatment combinations.

This isn’t about distrusting healthcare providers – it’s about partnering with them more effectively. It’s about walking into appointments with informed questions and clearer pictures of what we’re experiencing and what options might help. I like and trust my healthcare provider. She responds to me. However, many, many more women are dismissed and gaslighted by their providers. Ladies! You Are Not Crazy! You can find a provider – even online – that will listen, that will work with you, and not just dismiss your symptoms and frustration with them as a normal part of life. It may be normal, but we certainly do not need to be perpetually miserable going through this. Not with all the advancements of science and medicine. Remember, it’s 2025!

The Trans-Atlantic Divide in Women’s Healthcare

My own journey of discovery began years ago with a PMDD diagnosis that led me to stumble upon a term I’d never heard before: “Perimenopause.” The fact that I first learned about this significant life phase through European sources speaks volumes about the information gap in US healthcare. While browsing through the modern, frank discussions in “Menopause Matters” magazine (a European publication), I found myself wondering why these conversations weren’t happening here at home.

In countries like the UK, Netherlands, and Sweden, menopause isn’t just treated as a medical condition – it’s approached as a significant life transition deserving of comprehensive care and attention. Their healthcare systems often provide specialized menopause clinics, and their medical education includes extensive training in managing menopausal symptoms. Meanwhile, in the US, many of us find ourselves piecing together information from various sources, often feeling like we’re navigating this journey alone.

The contrast is particularly stark when it comes to hormone therapy. European healthcare providers typically take a more nuanced, individualized approach to hormone replacement therapy (HRT), while many US practitioners remain hesitant due to outdated interpretations of the Women’s Health Initiative study. This leaves American women often struggling to access treatments that their European counterparts consider standard care.

Perhaps one of the most striking differences is how European workplaces approach menopause. I was amazed to discover workplace training programs that educate managers about supporting employees through menopause – something that seems almost revolutionary from a US perspective. This matters more than many realize: women aged 35-60 make up approximately 20% of the US workforce, representing millions of professionals potentially dealing with perimenopausal and menopausal symptoms.

The Workplace Impact: A Hidden Economic Crisis

Consider this: while we’ve made strides in accommodating many health-related needs in the workplace, women experiencing severe menopause symptoms often suffer in silence, afraid to speak up or ask for simple accommodations that could help them continue performing at their best. The Europeans have recognized this challenge and are actively addressing it – not just as a health issue, but as a crucial economic and business imperative. When will US businesses wake up to the fact that supporting women through this transition isn’t just the right thing to do – it’s a smart business decision?

The irony is painful: just as women reach their professional prime – armed with hard-won wisdom, refined leadership skills, and deep industry knowledge – many find themselves forced to choose between their health and their careers. This isn’t just about individual women stepping back; it’s about organizations hemorrhaging talent at the executive and senior management levels, where female representation is already concerningly low. This isn’t just a personal health issue; it’s a significant workforce retention challenge that businesses cannot afford to ignore.

When experienced women leave the workforce due to a company’s lack of education and support for menopausal symptoms, businesses face staggering hidden costs. Consider the expense of replacing a senior-level employee: recruitment costs, training time, lost institutional knowledge, and decreased team productivity during the transition. Conservative estimates put the cost of replacing a mid to senior-level employee at 1.5 to 2 times their annual salary – and that’s just the quantifiable part. 
 
What’s harder to measure, but perhaps even more valuable, is the loss of decades of accumulated expertise, mentor relationships, and leadership capabilities. These women often serve as role models and guides for younger employees, creating a ripple effect when they depart. Their exodus can disrupt succession planning, weaken team dynamics, and even impact company culture.

Moving Forward: Bridging the Gap Through Self-Advocacy

Self-advocacy isn’t just about speaking up – it’s about doing the legwork to know what we’re speaking up about. It’s about understanding that sometimes the best path forward requires us to become temporary experts in our own medical mysteries. And increasingly, it means being aware of global advances in women’s healthcare, even when they haven’t yet become standard practice in our own backyard.
 
So here I am, armed with research about SSRIs, hormone treatments, and weight management options, preparing to make decisions that could significantly impact my quality of life (for the better). No longer apologizing for “sounding nutsy” when expressing legitimate concerns about my health and quality of life. Is it overwhelming? Absolutely. Is it worth it? Also absolutely!
 
Because at the end of this rabbit hole of research and self-advocacy, there’s hope. Hope that understanding our options better will lead to better outcomes. Hope that by doing this legwork, we’re moving closer to that simple goal: feeling good again.
 
And maybe, just maybe, by sharing these experiences, we can make the path a little clearer for someone else who finds themselves at the beginning of their own self-advocacy journey.
 
*This post is a reminder that you’re not alone in this maze of medical research and self-advocacy. Sometimes the most important step is simply deciding that you deserve better – and then doing the work to figure out what “better” might look like. *