Menstruation has long been stigmatized, surrounded by malignment, misinformation, and misogyny. My own personal journey unfolds across three distinct phases of “menstrual awareness”: the rude shock of my first period, two “pause-button” surprise pregnancies, and now, the ultimate boss level of womanhood: the dreaded menopause.
Buckle up, because this phase isn’t whispered about at sleepovers or shared over brunch. Unlike the first two stages, which came with ample education and conversation, menopause has been a very different experience. In my youth, I had sex-ed classes, hushed yet excited discussions among my preteen friends, and classic books like Judy Blume’s Are You There God? It’s Me, Margaret to demystify menstruation. Pregnancy, too, was met with a wealth of information, thanks to authors like Heidi Murkoff and her What to Expect When You’re Expecting, alongside a flood of advice, both solicited and unsolicited, from friends and strangers alike.
Well-known internet meme from 2013 depicting the aging process of Asian women. Artist unknown.
Yet, as I entered menopause, I was surprised by the collective silence around it. Most of my friends sidestepped the topic, and those who had experienced it seemed to know surprisingly little. The absence of well-known, comprehensive resources mirrored this void. This silence is somewhat understandable, given that menopause remains inadequately addressed, even in many medical schools today. Many physicians, particularly those trained in the early 2000s, still rely on outdated information influenced by flawed research from that era.
Perhaps as the universe’s way for balancing out my first 50 years, marked by short, predictable cycles and pregnancies with no fertility issues, menopause arrived for me with a vengeance: hot flashes, exhaustion, and relentless insomnia. When I consulted my primary care physician, her response was essentially: “Try meditation and cut back on coffee.” So my official medical directive was essentially: “Breathe deeply and sip herbal tea.”
When I inquired about hormone therapy (HT/HRT), she recommended a “natural” approach, pointing out my grandmother’s 102-year lifespan and my 81-year-old mother’s enviable golf schedule. Her stance was clear: age naturally and holistically.
Cue my incredulous cousin in Korea, who was appalled at my doctor’s zen-and-tonic advice. She recommended I head to Seoul, where specialized menopause clinics are as common as coffee shops and hormone therapy isn’t just a consideration, it’s a lifestyle. I knew that anti-aging was serious business in Korea so I was intrigued, and truth be told, I was not quite ready to embrace my impending ajumma status.
I dug into research and discovered that hormone therapy is most beneficial during a short window just before (perimenopause) and just after menopause. Although my grandmother – who never drank, smoked or overindulged – lived quite a long life, she spent her last two decades bedridden, a fate I hoped to avoid and motivation for me to keep exploring further.
The author with her grandmother, who lived to the age of 102. Photos taken 30 years apart.
On my next trip to Seoul, I scheduled an appointment at a women’s clinic and was asked to bring a DEXA scan, an easy and affordable task in Korea for about $35 at a local health clinic. Navigating the medical forms and consultations with my “functional-but-not-fluent” language skills added a bit of spice to the experience. The menopause appointment included a thorough blood panel, hormone testing, and a hysteroscopy. If you’re unfamiliar with that last one, picture a telescope giving a guided tour of your uterus on a big screen. At 52, seeing my internal anatomy for the first time projected like an IMAX film was oddly fascinating.
The doctor, noticing my wonder, pointed out some cervical wall thinning, which helped to explain my frequent bathroom trips. She even compared my pics to images of younger cervixes, leaving me equal parts amazed and slightly mortified (though my two children with well-endowed craniums deserve some of the credit here).
My DEXA scan revealed borderline osteopenia in one hip, and my cholesterol reading showed that I had suddenly been enrolled in the “high” club (>200 mg/dL), despite having spent most of my adulthood being an overachiever in the ‘low’ category. Easy come easy go, it seemed. At the conclusion of my visit and analyzing my family medical history, my Korean doctor recommended a hormone therapy called Tibolone, known globally but not approved by the FDA.
It came at a wallet-friendly $45 for a three-month supply, so I picked some up with the intent to research further back in the States. The entire appointment was $240. (By the way, there’s a bigger overstory about Korea’s healthcare system, which focuses on prevention rather than the U.S. model which emphasizes treatment after issues arise. While the U.S. excels for serious or rare medical conditions, Korea’s system really stands out for its thoroughness and affordability with routine annual exams.)
My HRT of choice: Tibolone, a drug unavailable in the US, but widely used in Canada, Europe and Asia.
Back home, my U.S. gynecologist surprisingly endorsed the Tibolone prescription, noting that while it was unfortunate this drug was not available in the U.S., millions of women across Canada, Europe, Australia and Asia have benefited from it for over two decades. He appreciated its osteoporosis support and its lower hormone dosage compared to similar options in the U.S. Trusting him after nearly 20 years as his patient, I decided to move forward.
Knowing that the Korean Ministry of Food and Drug Safety (MFDS or 식품의약품안전처) is equally, if not more, rigorous than the FDA also gave me confidence. Tibolone is taken orally as a small daily pill, much like birth control, ideally at the same time each day. It is classified as a conventional HRT and is a synthetic hormone, as opposed to a “bioidentical” hormone. While some researchers argue that bioidentical hormones may be superior, there is no conclusive evidence to support this claim. The term “synthetic” often carries an unfairly negative connotation, despite the fact that many widely used medications, such as birth control pills, Tylenol, and Advil, are synthetic.
Hormone therapy also comes in various forms – patches, creams, and intrauterine devices – allowing for tailored approaches. Consulting with your physician is essential to determine the best type of therapy and mix of hormones (both estrogen and progesterone) to suit your unique health needs, genetic history and lifestyle.
Three Months Later: My Results
The changes were notable. Without major lifestyle alterations, my total cholesterol dropped by 50 points, returning back to the normal range. The only adjustment I made was cutting out alcohol, a minor habit of two to three drinks per week. Sleep improved; my Garmin watch reported higher sleep scores with more time in the deep and REM sleep stages. Energy levels surged, and I lost about five pounds, likely due to more energy and better sleep due to no alcohol and the disappearance of my hot flashes. The hot flashes however reappeared quickly when I ran out of my three month supply of medication.
Charts showing various ways that my body responded to hormone replacement therapy.
Pleased with the results, I had a follow-up visit with the womens’ clinic as I had other reasons to be in Seoul. Since I had recent lipid panel results from back home, I did not have to do any further testing in Korea so I was not charged for my clinical visit, except for a $20 charge for my prescription refill, a common practice in Korea.
Considering Hormone Therapy?
I’m realistic about hormone therapy. It’s not a cure-all, and research suggests certain elevated health risks. Women with a history of cancer, strokes, diabetes, or blood clots may need to avoid it, and it’s generally not recommended for women who are more than 10 years post-menopause or for those over 60. That said, HT/HRT can be especially beneficial for women who reach menopause early (between 40-45), as there’s clear evidence in lowering cardiovascular risk for this group. Though the reasons are not known, Korean women have double the rate of early menopause versus American women.
The “timing hypothesis” which suggests starting HT/HRT during perimenopause or soon after menopause may provide the most benefit in certain areas such as cognitive function, particularly in APOE ε4 carriers with Alzheimer’s risk.
Ultimately personal research is essential, as every woman’s medical history and risk tolerance varies. And for those for whom HT/HRT isn’t suitable, rest assured that there are alternative medical approaches available. To anyone navigating menopause: get informed, ask questions, and don’t settle for vague suggestions like “just relax.” Whether your path includes hormone therapy, lifestyle adjustments, or more yoga (yes, one menopause book listed yoga as a menopause solution), embrace “The Change” on your terms.
As for me, I plan to stay on Tibolone as long as it’s working for me, and reevaluate its benefits year by year. I’ll be consulting my progress with both my American and now Korean medical teams, so perhaps this third and final phase of my menstruation odyssey won’t feel so doom and gloom after all.
I’m sharing my journey through the misty maze of menopausal mysteries with both my Korean and non-Korean sisters, hoping to cut through some of the fear, confusion, and wildly contradictory advice which so often clouds this natural stage of female biology. If my story brings a few insights and some more peace of mind, that’s a win. Just remember, this is my own personal path and definitely not a prescription, so consult with your physician before booking that flight over to Korea!
Suggested Readings from the author:
- The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts by Dr. Mary Claire Haver. This book offers evidence-based guidance for women navigating menopause, empowering them to advocate for their health.
- The Menopause Manifesto by Dr. Jen Gunter. This book provides a no-nonsense, science-backed approach to understanding menopause, challenging common myths and encouraging women to take control of their health journey.
- Estrogen Matters by Dr. Avrum Bluming and Carol Tavris. This book directly challenges myths about hormone therapy and breast cancer risk, advocating for the benefits of estrogen for both symptom relief and long-term health.
- Unlock Your Menopause Type by Dr. Heather Hirsch. The book aims to empower readers by helping them understand their individual menopause types and the corresponding strategies for managing symptoms effectively.
- The Menopause Brain by Dr. Lisa Mosconi. This book explores the effects of menopause on brain health and offers strategies to support cognitive wellness during and after this life stage.
