Throughout this series on women’s reproductive care, we often identify women as people with biologically-female anatomy, such as a uterus, a vagina, and ovaries. However, we acknowledge that people with this anatomy identify as other genders, that having this anatomy does not necessarily mean a person is a woman, nor is it a prerequisite for being a woman.
As I began my conversation with Barbara Presnell, I immediately noticed her great ability to reflect. Even over Zoom, her careful yet certain speech appears second nature to her. You can see her thinking with her eyes – they travel as she gathers her thoughts or pauses for the perfect word. Occasionally, her face sparks with remembrance as she recalls a ridiculous story or laughs at a funny memory. Although her sentiments are packed with information like those of a scholar, they impact with the subtlety of poetry, rather than the pedagogy of analysis.
Like every woman, Barbara is the expert on her own story. Fortunately, Barbara is willing to share that story– her journey through menopause – with us now.
Barbara started to notice changes in her body during her mid-40s, and she quickly assumed that she was beginning perimenopause. As someone who has always looked out for her health, Barbara sought out information on what to expect during this transition. Through her own reading and conversations with other women, Barbara began to create a picture of what menopause might look like for her.
She recalls, “most of the things I learned from reading materials were medical in nature, and most of what I learned from women dealt with what to expect and what’s actually going to happen to your body.”
Armed with information, Barbara braced herself for an onslaught of terrible symptoms – hot flashes, emotional outbursts, piercing headaches – fueled by the “horror stories” she had heard about menopause earlier in her life.
Expecting the worst, Barbara was surprised to find that menopause was not that difficult for her. In fact, it was easy. She says, “I had night sweats and headaches – and that was kind of it. My periods were gone, and life was good. I was free.”
Barbara may have ventured through menopause unscathed, but she is no stranger to hardship in her reproductive health and life. Although Barbara was able to conceive and carry a healthy son, she and her husband spent years trying to have more children, with no success.
She recounts these years of trying, waiting, and hoping: “I have one child, but I miscarried a lot. I went into a period of infertility, and I was thinking that maybe after all this trying another pregnancy would come along.”
Eventually, menopause signified “the end of that dream” – the dream of becoming a mother to another child.
Along with menopause came a period of simultaneous liberation and loss. Liberation because the days of bleeding, cramps, pain, and period planning were over, but also loss because menopause marked the definitive end of child-bearing.
“The freedom was not having to worry about those monthly periods, which were so important, so vital, but often so annoying.”
Complicating this happy liberation from fertility’s signs and symptoms (menstruation) was the saddening certainty of the end of fertility itself.
“I guess the dream [to have a child] was still there, even though it was years over. There was some sadness, but also the reality that I was too old to have another child anyways.”
Along with the emotions brought on by the end of her personal fertility, Barbara faced questions about her newfound place in society as a menopausal woman – a role that society has consistently disregarded as irrelevant and undesirable.
She says, “maybe it’s society or maybe it’s society ingrained in us, but there’s a view of women as child bearers, and once we’re not, what good are we?”
Unfortunately for Barbara, her early experiences with perimenopausal medical care reflected the harmful idea that menopause marks the end of a woman’s significance. In other words, in order to remain valuable as a woman, a woman needs to maintain reproductive viability and physical youthfulness.
She recalls an encounter where, while sitting in a cold examination room in a paper gown on a paper-covered table, her gynecologist pulls out a paper with a list of perimenopausal symptoms. With the attitude of a parent informing their preteen children about puberty, he points to the paper and says: “you’re going to be experiencing some changes…”
“Duh!” she thought.
Her doctor proceeded to rattle off symptoms – depression, headaches, fatigue – so many of the impersonal, nebulous challenges of everyday life and hardly a comprehensive picture of what menopause would feel like. Looking for more personal care, Barbara searched for a better-suited gynecologist.
Barbara also recalls a conversation during her perimenopausal years where a persistent gynecologist kept pushing hormone-replacement therapy as a “medication” for perimenopause.
“I don’t need to be on hormones,” she says, “I’m not having any problems.”
However, the doctor continued to insist on hormone therapy, saying: “if you were my wife, you’d be taking them.”
This doctor’s continual assertion of hormone-replacement therapy in the absence of Barbara’s personal desire or medical need reflects a misogynistic idea that all women want to remain as they are pre-menopause; in essence, that women want to resist aging.
Luckily, Barbara knew that there had to be better care out there, and she kept searching for an understanding, trustworthy gynecologist.
“It’s such an intimate experience,” she says, “you can’t get more personal than that. And if you’re feeling uneasy, then you have to get out of there, because there’s definitely better.”
Luckily, Barbara has found excellent reproductive care with her current gynecologist, a woman who consistently listens to Barbara’s concerns and respects her boundaries. However, the lessons in self-advocacy which Barbara learned from her previous, horrible experiences continue to inform her attitude as a patient.
She says, “the most important thing is that we first take care of ourselves and respect our own bodies, to the point that we will know when someone is out there to help us or to hurt us. Doctors are there to help us take care of our bodies – that’s the whole business! It’s us taking care of ourselves, with the help of someone with expertise. If someone’s telling you what to do and it doesn’t seem right, or it doesn’t seem true, then you have to move on.”
Throughout perimenopause and into post-menopause, Barbara has resisted the idea that her worth is inked to her reproductive capacity. Instead, she has conceptualized menopause as “a very natural part of [life’s] process. It’s a stage, a new stage. It’s not a loss, it’s just change.” She reflects, “I equate menopause with aging, which I see as a positive, not a negative. I think to see menopause as a loss is sad. As I am coming to understand, it’s not a loss; it’s just a process.”
Barbara’s positive and accepting view of menopause extended to her daily experience of hormone-driven symptoms, even those restless nights where she woke up “drenched” in sweat.
She recounts, “night sweats would wake me up. But I found the night sweats to be comforting, and for a really weird reason – my mother had lung disease, and years before, I had an abscess in my lungs. And my mother always told me that night sweats were the lungs ‘cleansing themselves.’ So, I always felt like when I was having the nights sweats that I was cleansing myself of toxins, and that was refreshing.”
Barbara’s story brings to mind the industries which have evolved out of the belief that sweating is cleansing. You can pay to sit in saunas or steam rooms, or take a hot yoga class, with the aim to end up soaking in sweat. Could we view night sweats, then, as a positive? Could we dare to apply this mentality to other perimenopausal symptoms, or menopause itself?
In addition, Barbara was interested to find that the end of her monthly bleeds did not mean the end of predictable, monthly cycles that so strongly characterize women’s health.
“I think because of our [menstrual] cycles, women are so much more attuned to our bodies and their ups and downs, and I think that continues after menopause. What I’ve personally experienced, and I have talked with other women who have experienced the same thing, is that we predictably have similar monthly highs and lows. For a long time post-menopause, I could feel my cycle even though I had no blood. Even still, I honestly feel like my body is going through a cycle. It may be all psychological, but I can still feel those changes.”
As she has been all her life, Barbara continues to be an advocate for women’s and children’s issues of all kinds, as well as a prolific essayist and poet. She is now a grandmother and is “learning how to be nurturing to a child again.” She cherishes her relationships with her husband, son, grandson, and friends.
In her words: “I’m still trying to contribute to the world and maybe make it a little bit better.”
Although Barbara has certainly experienced her share of reproductive hardship, she describes her own menopausal journey as relatively easy. However, menopause is not easy for every woman – and how could it be? A total and drastic way in how a body uses hormones is bound to be uncomfortable and challenging for some. For many women, treatments like hormone-replacement therapy, which Barbara chose to forego, are necessary and helpful.
What stood out to me, however, was how Barbara’s conceptualization of the process served her so well throughout perimenopause, menopause, and continues to serve her as a woman in mid-life. Her sentiments suggest years of carefully cultivated self-acceptance and reflection – that’s hard work. We could all do better to take a page out of Barbara’s relaxed, change-positive view of menopause, and perhaps more importantly, aging as a whole. Women deserve to see menopause as one step in the progression of womanhood and as a human being, if not yet in the society’s eyes then in their own.