Deborah is a New York Times bestselling author of seven books, including Ladyparts & Shutterbabe, and she was a writer on the Golden Globe- and Emmy-nominated Emily in Paris.
Deborah shares her story through menopause, and her own sexual awakening.
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Several years ago, I was hired to write advertising copy for a vaginal estrogen ring. I was 49 years old and in either full-on perimenopause or menopause, but did I know this? No, I did not. No doctor had ever told me what was happening to my body, or warned me of the symptoms, or prescribed any of the drugs I might need to alleviate them. Moreover, I’d had a hysterectomy three years prior, and though I’d kept my ovaries, in the absence of a uterus, I had no way of knowing if they were still working.
Vaginal estrogen?, I wondered, what’s that? I did some googling. And found myself even more confused than before. Did estrogen increase one’s risk of breast cancer or not? I’d been diagnosed with DCIS, stage 0 breast cancer, several years prior, so the answer to this question mattered to me. Where were the studies? Why couldn’t I find any? And what was the difference between vaginal estrogen and…I didn’t even know what to call it, “the other estrogens”? I’m a science writer for The Atlantic, and even I, with my journalist’s eye, could not figure out any of this.
At the time, I was a single mother of three, recently separated after a two decade marriage. I was also—thanks to that holy trinity, Tinder, Bumble, and Hinge—out there dating again, but I’d started noticing a disturbing trend. Though my body should have been thrilled with this midlife re-blossoming of my sex life, my vagina could not get with the program. Instead of a rain forest, it was more like, well, not exactly the Sahara, but let’s just say it felt like having sex on the beach: something that seems like a good idea in theory until you actually try it and realize it’s scratchy, abrasive, and inhospitable to guests.
I sat down and wrote my ad copy, basing it on my own experience.
It began thus:
“Oh, the irony of menopause! Just when you have time to really explore your mature, adventurous, sensual self…your vagina goes on strike.”
If this sounds familiar to you, it should—not only if you’re in perimenopause or menopause and dealing with your own striking vagina but also if you’ve watched the first season of Emily in Paris. I was a writer on that show, having lived in Paris in my 20s and having worked, later on, in PR. So I simply borrowed that line from my vaginal estrogen ring assignment and gave it to Emily.
Not that I had any idea that I, myself, was in menopause when I wrote those lines, either the first time or the second! Which in retrospect is crazy. How could I not have known this fundamental thing about my own body when I was fully aware of having gone through puberty because doctors and teachers had told me I would? Also, I think it’s important to note that I put that line about the vagina going on strike in Emily’s mouth for one reason and one reason only: to play it for laughs.
Of course, a vagina going on strike is anything but funny. In fact, it can be downright dangerous.
To wit: in my search for a post-marital partner, I did, well, let’s call it a lot of field work. And each time I played a new field, I came down with a new UTI. My primary care provider, like most PCPs trained in modern medicine, prescribed a prophylactic antibiotic that I was supposed to take immediately following each assignation. Never mind that taking frequent antibiotics has been shown to increase breast cancer risk. Never mind that people like me without a uterus have a greater risk of breast cancer if we don’t take systemic estrogen. Never mind that an estimated 13,000 American women die every year from the sepsis that results from untreated UTIs. Never mind that antibiotics do not treat the underlying causes of UTIs, which are thinning vulvar and vaginal tissue and injury to the urethra during less-than-fully-lubricated sex.No one told me about any of this!
No one told me about the importance of taking estrogen, vaginal or systemic.
In fact, it took a young urologist reaching out to me over Twitter, after reading one of my science stories in The Atlantic, to open my eyes to the necessity of estrogen, both systemic and vaginal. That’s when I started following and befriending that urologist’s friend, Dr. Ashley Winter, whom I found incredibly amusing—a joy, really!—and whom I’ve asked to answer a few questions on the following page.
Suffice it to say, ever since I’ve been on both systemic and vaginal estrogen, both my life and my health have greatly improved. I no longer get recurring UTIs. Sex with my partner is both joyful and well lubricated. My mind feels sharper, my word recall issues have faded, I have more energy, and I almost never feel depressed or hopeless. Even my bones have stopped turning to chalk: in fact, the osteoporosis seems to be reversing.
What I do feel these days, on a daily basis, is elated. Hopeful. Aroused and sexy. “My vagina feels 22 again!” I told the new gynecologist who prescribed my vaginal estrogen: a doctor I’d sought because she is an expert in menopause, and there are so few. “I feel like…myself again.”
“Yes,” she said, that’s the whole point. And that’s what all those outlandish and false news reports tying estrogen therapy to breast cancer took from me and from all her middle-aged patients: our best selves.
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