This Is What No One Tells Women About What Happens To Your Body In Your 40s

The symptoms were subtle at first: insomnia, a racing heart, a lost word, sometimes a wrong word. But within months there was no denying it. Soon enough there were panic attacks, sobbing fits and that verboten emotion of middle-aged women ― rage. Just after my 40th birthday, I bled for 10 days straight.

Trying to make sense of these changes, I kept coming back to a childhood memory. Sitting on the orange shag carpet in my Midwood, Brooklyn, living room, at the age of 8, my family was gathered around our color television watching an episode of “All in the Family.” Archie Bunker was yelling at his wife, Edith, to hurry up and go through her “change.” My parents chuckled knowingly as I tried to keep up with the plotline. That was the totality of my education on menopause. But Edith looked to be in her 50s and, as far as I could tell, I still had a whole decade before I needed to “change.”

I dialed my OB-GYN, gearing up to explain this anomaly, to convince her that I was a freak of nature. But the nurse cut me off, introducing a new word to my lexicon: perimenopause.

That was the moment I learned that before menopause, there is a completely separate, though somehow related hell called perimenopause. According to the nurse, this marked the beginning of a gradual decline in estrogen in my body ― and, “by the way,” she added, “it can last for years.” She said that last bit like she was indoctrinating me into a special invitation-only club. I half expected to get an ID card.

But I could read between the lines, and what she was really saying was, This is when both your body and your mind begin to betray you. I called up my girlfriends to discuss and, in doing so, became the bearer of bad news.

“Did you know about this?” I demanded, wondering if everyone else had been in on this secret. I was met with silence. We had all been duped. No one had told us.

When I was pregnant, other women bombarded me with advice, perhaps because that was supposed to be a “joyous” time and people wanted to share in it, but this was different. This was the darker side of womanhood.

I started researching phrases like “sex in your 40s,” “pissed at my family all the time,” and “left boob pain; am I dying?” When that didn’t garner satisfactory answers, I began making regular appointments with a naturopathic doctor, studying the benefits of essential oils, throwing back vitamins and herbs like an addict, and becoming obsessed with “female” tea ― hibiscus, primrose, milk thistle, anything reminiscent of a beautiful blossoming flower.

Fast-forward five years, at the age of 44, with my son in his tweens, both of us now full-tilt with yoyo-ing hormonal surges, and my husband deep into his own midlife crisis, contemplating giving up his power equipment business and moving us to Central America. I began locking my bedroom door, an apparently seismic shift that offended the rest of the family, but in doing so, I created a small space for myself to think and breathe and read for a few precious hours each evening and further adjust to the increasing changes in my body: the longing for complete silence, the new sensitivity to smell, coping with what felt like sensory overload.

And then, just as I began embracing that long-craved autonomy, a hitch.

With my first missed period, I denied the possibility, but by the time the estimated date of the second one came and went, I had begun cupping my breasts in the shower to see if they were sore and feeling my belly for the telltale firmness. And afterward, I’d catch my naked profile in the mirror looking for visible differences in my body. Was I glowing? I definitely wasn’t glowing.

Google was no help. As if God, the universe or some other holy power were in on the conspiracy to drive all middle-aged women mad, it turns out the symptoms of pregnancy are almost identical to the symptoms of perimenopause: weight gain, breast tenderness, spotting. I had them all.

My husband was painting the deck when I approached him with the news early one morning. I had waited weeks but my anxiety, always stalking beneath the surface, was now becoming an unmanageable beast. “I might be pregnant,” I blurted out. His brush paused mid-stroke. I could see his unspoken thoughts floating like specks of pollen through the warm spring air.

“Well, we’ll figure it out,” he said, before dipping his brush again.

My first pregnancy had put me in bed for five months, with the label “high risk” slapped on my tender uterus. Aside from the life-threatening complications for me and my baby, I had suffered from both prenatal and postpartum depression that lasted years. Now faced with the prospect of having an offensively termed “geriatric pregnancy” at the age of 45, the odds were stacked against me. Not to mention the logistics. Where would we even put a baby?

Two days later, when I can no longer delay the inevitable ― the blood pressure medication I am on too detrimental to a fetus for me to continue without speaking to my doctor ― I sit on the bathroom floor early in the morning, squinting at the directions on a pregnancy test while the rest of the house lies in quiet slumber. My hands tremble as I peel off the wrapper. I brace myself and wait the three required minutes.

As the clock ticks, I question whether I could muster even the smallest desire to care for a newborn. I have middle-of-the-night hot flashes where I blindly stomp around my bedroom ripping off clothes and cursing the air conditioner because subarctic is not a temperature setting. The very thought of being prematurely awoken from hard-won sleep gives me palpitations. I’m on not one but two medications that say something along the lines of, if you’re even thinking about getting pregnant, don’t be in the same room as these pills.

Friends and I began whispering about our “changes” at book club meetings and writing groups and those all too rare “moms’ nights out,” and soon I found that this is a dirty secret we keep, walking through life, all of us pretending to hold it together, while inside we are unrecognizable to our own selves.

With it out in the open, my girlfriends had been speaking more freely, lauding Botox, fillers, vibrators and therapy as ways to empower ourselves and confront these years. I am in no way prepared to cast off this tribe of unabashedly honest women to form new relationships with young, lithe mothers who have an endless supply of their own collagen.

Four bars on the stick appear. The results are in.

Not Pregnant.

I wipe away my tears, wishing someone would have mentioned I’d spend much of my midlife on the bathroom floor, crying ― I would have opted for nicer tiles.

I sit there for a few moments and then crawl over to the garbage pail, burying the test, but the heaviness in my heart surprises me. I could wake up my husband, but he could never understand what it means to be on the cusp of 45 taking a pregnancy test. He could never intrinsically comprehend the implications of what it would mean to be pregnant at this age, and alternately, how devastating it is to know that I will likely never be pregnant again. That chance for the elusive second child I had never been sure I wanted vanishes into the bottom of a wastepaper basket buried beneath snotty, tear-stained tissues. Before the complications of my first pregnancy, I had planned on so many children.

I dig the test out of the trash can and hold it to my heart as if it is an actual embryo, thinking about how I, like so many other women in their 40s, am in between ― taking care of both kids and parents ― the sandwich generation. But who is taking care of us while we navigate this new territory? Who is telling us that it is perfectly normal to drive halfway to work before realizing that we forgot to pop in our contacts? Who is consoling us as we sit in our cars at the school pickup line crying to songs like “Shut Up and Dance with Me” because we haven’t really danced in years? Who peels us off the bathroom floor when we are frightened?

I grab hold of the tub, noting that it could use a good scrubbing, and pull myself up. Walking to the mirror, I take stock of my body, my rounded belly, my sun-weathered décolletage, the triceps that are not as firm as they used to be. I have changed so much. I have stopped caring what anyone else thinks, have started claiming my time, growing my tribe, and trying so hard to hold onto the shits I have because I have so few left to give. I am more beautiful and confident than I have ever been in my life, while simultaneously becoming invisible to much of the world.

Perimenopause is like preparing to graduate college. There are so many choices to make, so many options, only now I don’t have the cushion of youth to bounce back from my mistakes.

I hear a soccer ball being thwacked against a wall. Casting my thoughts aside, I throw the test in the pail once again and tie up the bag so my tween doesn’t accidentally discover it. And then I open the medicine cabinet and take out a vial of lavender scented oil. I dab dots on pressure points; I’m told it will keep me calm.

Aileen Weintraub has written for the Washington Post, Glamour, HuffPost, NBC, and AARP, among others. Her book "Knocked Down: A High-Risk Memoir" is a laugh-out-loud story about marriage, motherhood, and the risks we take. Find her on Twitter @aileenweintraub or drop her a note on her website. 

This article originally appeared on HuffPost in March 2019 and was updated in December 2021.