Gen X women are going through it

At the end of last year, I started to see a cognitive behavioral therapist. My executive function, the set of mental processes that help order the day-to-day — like organization, working memory, time management and focus — was in shambles. In my intake interview, the therapist asked when I noticed that my focus had gotten worse, and I said that I’d been diagnosed with ADD when I was in my mid-40s, but added that I was also possibly in menopause. My ex-husband and co-parent had recently died, and I was now the single mother of a grieving teen. Add in encroaching fascism, and it just felt like too much.

In the next three sessions, we talked about patterns of behavior, family and workplace dynamics and coping mechanisms. I took pages of notes. I didn’t expect to see results right away, but having a different perspective and a set of new tools for managing my internal chaos made me feel hopeful. And then I missed a session and was too embarrassed to schedule another one. The irony was overwhelming. I’ll get back to it, I thought, just not right now. When I shared this story with a friend, she gave a small, sympathetic hoot and said, “Do you want to hear how many times I’ve misplaced my phone this week?”

Did I ever.

Over the next several months, I heard anecdotes like those all the time, from most of the women I knew and quite a few I didn’t. At a party, a friend of a friend of an acquaintance admitted that she almost didn’t come: Right before she left her house, she had a hot flash and sweated through her T-shirt and then realized there was a load of moldering laundry in the washing machine that she had forgotten about. (“For at least two days,” she said, in a mournful voice that made me think it was probably more like four — not that I was judging.) A woman who knows that I write about women and popular culture told me about this amazing Norwegian series on Netflix that she couldn’t remember the name of. (It’s “Pernille,” FYI.) At a communal coffee-shop table, a stalk of a woman with a mane of gorgeous gray curls sat down, complimented my glasses, and within minutes was telling me the horror story of going through menopause twice as I drank my coffee in gobsmacked silence. This could happen twice?

As the last generation to come of age at a time when both neurodivergence and menopause were considered shameful secrets, Gen X includes a lot of women who arrive at middle age feeling like their brains are broken and not knowing why. It turns out that perimenopause — the symptomatic runup to menopause that can last anywhere from four years to a decade — starts a lot earlier than we were led to believe, meaning you might mistake its symptoms for something else, or brush them off entirely.  It also turns out that Attention Deficit Disorder is not just for boys, as conventional wisdom had always suggested; but because it presents very differently and often much later in life, women diagnosed in adulthood have in many cases internalized decades of symptoms as individual failings.

Trying to discern what’s perimenopause and what’s ADD is tricky because the same hormones are involved. “They really haven’t found a direct correlation” between the two, says Dr. Mache Seibel, physician, menopause coach and author of “The Estrogen Window.” “But estrogen is really important to maintaining certain neuropeptides, like dopamine and serotonin. ADHD is associated with lower dopamine levels, so when those levels start dropping [in perimenopause and menopause], ADHD behavior might increase,” he says. “And then you have serotonin, whose levels impact mood and things like depression and anxiety. Combine that and you have a set of conditions that mimic what goes on in people who have ADD. You don’t know if it’s the chicken or the egg.”

“A lot of people notice cognitive changes in menopause, that they feel foggier and can’t multitask as well,” says Dr. Julie Holland, author of the books “Moody Bitches: The Truth About the Drugs You’re Taking, the Sleep You’re Missing, the Sex You’re Not Having, and What’s Really Making You Crazy” and “Good Chemistry: The Science of Connection from Soul to Psychedelics.” “Some women who go on HRT feel like “a veil was lifted” — I hate that phrase, but it’s true. They feel crisper, more focused and less murky. I talk to a lot of women about what to try first: It’s a bad experiment if you have two variables, so you really want to just try one thing at a time.” Seibel likens the before and after of HRT to driving through a tunnel and losing reception. “And then you come out the other side and hey, you have reception. It’s the same with your brain,” he says. “In 90, 95% of women, it’s going to be fine.”

But because perimenopause and menopause have never been prioritized as a subject of medical education or training, figuring out what to try first and how can be a challenge. A 2019 report from the Mayo Clinic revealed that for 58% of medical residents, training in menopause amounted to a single lecture, while 20% had none at all. “Until internists and family medicine doctors see menopause as a threat to health in general, they’re not going to take it seriously,” Dr. Stephanie S. Faubion, Director of the Mayo Clinic’s Center for Women’s Health, told the New York Times in 2021. “They’re going to say, ‘This is one of those female things that will go away.’” No one’s likely to say straight out that women past reproductive age aren’t worth studying or listening to, but that’s definitely the message that women over 50 — who comprise more than a quarter of the world’s population and have a longer average life expectancy than men — have gotten for decades.

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Donna (not her real name), who is 47, told me that when she talked with her primary-care physician last year about what felt like constant brain fog and frequent heart palpitations, the doctor told her it was probably anxiety and prescribed Ativan. “She asked me maybe two things about my symptoms, and didn’t mention perimenopause at all,” Donna recalled, still palpably frustrated. “I wanted to say, ‘You’re a woman! Maybe you should care a little more?’” But while there’s plenty of R&D funds for a constant influx of cosmetic products and procedures meant to keep women looking younger for longer, there’s very little put toward studying the shifts in brain function that, for many women, can feel like an identity crisis. At least until recently. Menopause is “a f**king goldmine,” says Heather Corinna, a sexual-health activist and author of the 2021 book “What Fresh Hell Is This? Perimenopause, Menopause, Other Indignities, and You.” Menopause start-ups, boutique healthcare, celebrity-owned product lines and more, Corinna points out, are stepping into the breach where a much larger body of research should be.

Meanwhile, “the running gag of ‘Is it menopause or is it fascism?’—that’s real,” says Corinna. “It’s both. It’s everything.” Holland echoes this: “There’s fear about what’s happening in the government, but there’s also sadness and sorrow about what’s happening to the planet. And this population of women is raising kids, caring for parents and stretched really thin. We’re multitasking, we’re distracted all the time, we’re scrolling our phones looking at things that make us sad and enrage us,” she says. “The algorithm is not designed to make you feel good or happy, but to feel like, if I don’t read all of this, I’ll be in danger. The things with the most virality are the things that make you angriest.”

And though it’s much easier now to find books and other media taking a range of perspectives on menopause, it’s also easy to be waylaid by influencers, charlatans and factionalism. “There are books by celebrities where they’re like, “There’s a thing that will make you feel so much better, and I just happen to sell it,” says Corinna. “You’ve got the dichotomy of things considered good because they’re natural, like wild yam — there is so much wild yam — and things seen as bad because they’re pharmaceutical. And actual information is lost in this din of marketers on one side screaming ONLY NATURAL THINGS and pharmaceutical companies on the other side screaming with their zillions of dollars and advertising. It’s almost impossible for the consumer to have a good sense of what’s legit and what’s not.”

No surprise, then, that the menopause influencer with the widest appeal seems to be the one telling us what we don’t have to do or wear or buy and not what we should: Melani Sanders, the content creator who launched the We Do Not Care Club to “[put] the world on notice that we simply do not care anymore.” Sanders has 1.8 million followers on Instagram who sit up straight when she runs down daily lists of “things we no longer care about” — everything from unpainted toenails to cleaning the baseboards to looking like Adam Sandler and/or Wesley Snipes (“If that’s how I look, that’s how I look”).

The thing about estrogen, Holland points out, is that it’s an accommodating hormone, and when women stop producing it naturally, many of them also stop trying to do things that seemed important in their estrogen-loaded 20s and 30s — picking up other people’s slack, biting their tongues at work or with family, making sure everyone has everything they need and caring about other people’s opinions. “Perimenopause is more like PMS, where you say ‘I don’t have the bandwidth’ or ‘you need to do this yourself.’” It’s a good time for self-protection, Dr. Seibel suggests: “One woman told me, ‘Of all the things I’ve lost, I miss my mind the most.’”