The Secret Knock
What your doctor isn't telling you about women's health—and why we're done staying quiet
I was walking my dog a week or so after my 911 call in April and ran into a neighbor outside. She wanted to check on me after seeing the emergency vehicles, and our conversation turned to women’s health in general. She mentioned that she’d been feeling tired and just “off” for a while, and her practitioner said it was “probably just because she’s a mom.”
I know. Sit with that for a moment.
Being a mother—or a woman in general—is reason enough to just feel like shit. At least according to many of our doctors. It’s postpartum, it’s midlife, it’s motherhood, it’s perimenopause—this is just what happens. Shrug and godspeed.
Reader, this makes me so angry. I wrote a post two years ago called The Suffering Club, partly about how we tolerate pain, health issues, emotional struggles (cough, crappy marriages), simply because, well, everyone else is suffering, and didn’t we know we would be low-key miserable when we: decided to have children / turned forty/ got married / and on and on. I spoke to a pelvic floor physical therapist about this once on my podcast—she said it was astonishing how many women tolerate peeing their pants when they jump or sneeze simply because they had a baby and everyone else is peeing their pants too, right? Wrong. There is help for this!!
And guess what? There is help for perimenopause, too. I of course immediately went right into my, “Soooo, how old are you? Listen, I’m not a doctor and I’m not saying you are definitely in perimenopause, but getting your hormones checked with a blood test isn’t really even that helpful, but it’s possible you’re having hormone fluctuations, and nobody is going to tell you about this, so I’m telling you, because our doctors aren’t bringing it up and apparently you need to know the secret knock…”
It’s fine, you guys, she didn’t run away. Heyyyy, me again! Your friendly neighborhood midlife women’s health advocate with a purse-full of estrogen patches for anyone whose are delayed again. True story, by the way: It’s like an underground estrogen network—so many of us get the pharmacy text: “Your prescription has been delayed…” and start crowdsourcing for patches.
I had half a mind to ask the pharmacist how the Viagra shortage was going. . . ohhhhh, wait. There has never been and will never be a shortage of ED meds. And I think we all know why.
I took a break from my column during a crazy busy season—I wrapped Listen to Your Mother Boulder on Mother’s Day weekend. It’s the busiest work time of the year for me, and I was also coming off the 911 call that spiraled into a pretty difficult month.
I had another, slightly less scary “episode” (just call me fucking Scarlett O’Hara) about ten days later, and felt “off” for a few weeks after that. I had one more just a few days ago—intense nausea, sweating, flushed skin, lightheadedness.
Here is the upshot: I have been weaning off an SSRI for the past year +, and I am one of the super sensitive people who needs a ridiculously slow med titration. The final level nearly did me in, and I am still holding steady on a tiny dose because I couldn’t risk feeling unstable during my show week. It may take me months of gradual titration on a liquid formula to finally get off the med.
Serotonin withdrawal is something we don’t hear about—while my provider told me that the final phase of titration could be the worst, and that stepping down slowly is important, I had never heard about SSRI discontinuation syndrome. If you have a good doctor or prescriber, they’ll tell you it’s not smart or safe to just stop certain meds, but nobody warns you that you could literally go into withdrawal when you move from 5 mg to 2.5 mg.
I understand that I am a “special” case, but since this happened, I have heard from multiple people: “Oh, that same thing happened to my sister / friend / neighbor.” You could argue that this particular situation has nothing to do with women’s health, and that’s partly true. But this is the layer that has caused me the most anger: I am weaning off this med because I don’t believe I need it anymore, because anxiety was never my primary issue. It was ADHD.
When I started taking ADHD medication, I noticed that many of the symptoms that had brought me to my SSRI were better managed by a stimulant. After adjusting meds for a year or so, we found a good combination/dose for me, and I was also feeling more emotionally stable after a terrible divorce. I wanted to reduce my Lexapro—I am not an anti-med person by any stretch (obviously), but I don’t really want to be on any more medication than needed.
Fast forward to withdrawal symptoms that wouldn’t have been attributed to the titration if I hadn’t spent hours researching and advocating for myself, and I was pissed:
Because if I had originally been diagnosed with ADHD, the true cause of my symptoms, I wouldn’t be in this mess. But we don’t diagnose girls and women with ADHD often enough, because after all this time, we still don’t know what we are looking for.
It’s getting better, you guys. It is. Mostly because women refuse to stop talking to each other about what we are experiencing. We puzzle the pieces together, share information (and estrogen), exchange information for that one really amazing psychologist who specializes in neurodivergent girls and women, and talk frequently and honestly about how we are feeling.
Gen X women are making real changes. I believe this, and I am proud of it. I mean, have you seen the story arc of Amanda Peet’s character in Your Friends and Neighbors? We are talking about perimenopause. Novelists (All Fours!) and screenwriters are writing about it and doctors are educating the masses on podcasts and Instagram, reaching people they could never have reached within the scope of their own practice. (Shout out to Mary Claire Haver’s The New Perimenopause + The New Menopause; also shout out to the “large print paperback” option.)
But sometimes I am still really fucking angry about how long it’s taken, and how hard it is to still be taken seriously, listened to, and properly treated. And it starts with one simple fact: We are not studying women’s bodies, health, and hormones adequately. Patriarchal structures and misogyny still infect the groundwater of our medical systems and nearly everything else. And until that changes, we need to be angry. And loud. And relentless.
XO
Steph
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There is an argument to be made that ssri decrease syndrome/seratonin syndrome is more of a female problem because the drug doses are tested on men and Drs often have to adjust (all) drug doses for women. But also because the drugs are tested on male mice and men, we don’t actually know how many women are “sensitive.” (Qualitatively, I know a lot of “sensitive” women.)
In a weird side effects no one talks abt genre, that points to the other reason this is more of a female problem: I was put on an snri (cymbalta) for post-exercise inflammation and pain. This drug is often prescribed for RA, an autoimmune disease that affects more women than men. It caused my blood oxygen saturation to drop into the 80s. (Above 90 is acceptable depending on your altitude.) Women’s under understood autoimmune issues and pains mean were often out on more brain drugs that may or may not be helping and rarely treat the cause, which means we also likely come off them more too.
I am with you! Angry that women's health issues have not been a priority, autoimmune diseases, endometriosis, fibroids...and no answers my whole life! It's one of the reasons I got so interested in Psychedelics, the anti-inflammatory effects and they are finally doing research on menopause! Hang in there on the weaning off Lexapro, that can be really difficult! Also...the 911 call?!?!