2.11 a.m.: I wake, heart thwacking, as heat ﬂows up from my stomach, courses behind my face, and radiates out through the top of my head. I watch a lamp with a pink shade drift out of my neighbor’s window and hover over my darkened backyard.
An hour later I wake again, this time within the aura before the ﬂash. No matter my mood, each aura brings a surreal déjà vu feeling, the ‘thorn in the ﬂesh’ that Saint Paul talked about: everything is stilled, everything is wrong. It’s as if a shard of a different and darker reality has been thrust into my current one.
Auras are less universal than heat, though many in the diverse group of women I interviewed reported having them.
‘About a minute before the ﬂash comes I get the worst feeling,’ one woman told me. Another described the eerie quiet just before the feeling of thick unease: ‘I get very calm, then a sensation comes that scares the heck out of me.’ Another experiences a free fall: ‘I feel like I’m going down in an elevator, my stomach drops, ﬂash of nausea, a weird weak feeling, then the heat.’
I throw off my covers and feel, in the ﬁrst pocket of spooky quiet, that ﬂames are burning from my inner organs up into my muscles toward the skin. I’d run away, but how does one ﬂee one’s own body? Each hair is a thin electric coil heating up my head.
I know what’s going to happen and I know that it’s going to be bizarre. I leap up and go into the kitchen, run myself a glass of cold water, gulp it down. I jerk a bag of corn out of the freezer and press it against my chest and stare out the window. The leaves in the yard blow one way and then the other. I go back to bed, but the heat coming off my husband’s body is dangerous. I go into my daughter’s empty room and lie in her bed surrounded by posters for DIY bands and photos of her high school girlfriends. Her thick comforter triggers another ﬂash. First comes the stillness, the ‘sinister feeling’ one woman described. I feel outside continuous conventional reality, trapped inside the ﬂesh-and-blood corporeality of my body. Saint Paul, who may have had epilepsy, called his auras ‘an intimation of heaven’. Not the cliché ﬂuffy-cloud angelic sphere but a feeling of the next life in all its raw, brutal grandeur. I yank up the window. Heat sweeps through me like a tiny weather front. I know my parcel of the Earth is spinning closer to the sun and the air is heating up. Even a few degrees’ rise, when my windows are open, can trigger a ﬂash.
Much like my sense of smell was magniﬁed when I was pregnant, my body is now sensitive to the smallest calibrations of heat. When food is placed in front of me at a restaurant, most recently a plate of scrambled eggs, ﬁrst my belly and then my face burn. Entering a room, I won’t at ﬁrst know it’s sealed, but as I talk to a student in my office or teach in my classroom, the sense of entrapment grows. I’ll glance at the window, the door, panicking as one after another, body, room, building, is locked down tight. As the ﬁre bowls along my nerves, I long to escape my body, to shoot up through my own skin, the ceiling, and bust into the atmosphere itself.
When I wake next, there is smoky light at the window and the heat in my limbs is already subsiding. I shift. My husband asks what’s wrong. It’s happening again, I say, jolting up, running the tap in the kitchen, drinking down the cold water. I go back to the couch, and though the windows are open, they face a brick wall. I feel trapped in the narrow room, squeezed.
My Flash Count Diary, a mottled black-and-white composition book, lies on the coffee table. Nine ﬂashes today, not counting this current run. First, over coffee this morning, I felt my heart compress and then heat launch out horizontally into my arms and down into my hands. Later, while teaching, talking about how blankness as an interior state for a ﬁctional character has to be created, just like anger or desire, I felt a sudden pang of misery followed by a smoldering sensation in my back. After class, out for a drink with a friend, listening to her talk about her husband’s hallucinations, I felt heat radiate from my stomach up into my chest, neck, rolling up like steam behind my face. Once home, I ﬂashed while washing dishes and changing the kitty litter. And ﬁnally, just before bed, I had the sensation that my nightgown was afﬁxed to my body with hot glue.
Back in my bedroom, I am trying again to sleep. It’s almost daylight as I make a pallet out of blankets on the ﬂoor next to our bed. I want to be near my husband. I lie, one leg out of the blanket, calf pressed against the cold wood. I must always be a little cooler than is comfortable in order not to ﬂash.
I have found ﬂashes to be desperate, uncomfortable, sometimes even sublime, but never funny. On TV and in ﬁlm, if they are shown at all, hot ﬂashes are comedic bits akin to a man slipping on a banana peel. As a child, I remember watching Edith Bunker on All in the Family redden, fan herself, get discombobulated, and dash into the kitchen as the laugh track roared. Menopause is often ﬁltered through male bafflement and repugnance. In Mrs Doubtﬁre, Robin Williams catches his fake breasts on ﬁre and, using two pan lids, eventually puts out the ﬂames. He stands disheveled, his chest smoking. ‘My ﬁrst day as a woman,’ he says, ‘and I am already having hot ﬂashes.’
Kitty Forman on That ’70s Show is menopausal, complaining about the heat and snapping at her family. Her husband, Red, refers to ‘the horrible thing that has taken over your mother.’ When Red looks up menopause in the encyclopedia, he is repelled. ‘Good god, I didn’t think they’d have pictures.’
Jokes about menopause abound.
Q: What is scarier? A puppy or a rational woman in menopause?
A: A puppy, because a rational woman in menopause does not exist.
Q: What is ten times worse than a woman in menopause?
A: Two women in menopause.
Q: Why do women stop bleeding in menopause?
A: They need the blood for their varicose veins.
Women, too, make fun of ﬂashes. On Etsy you can buy buttons that read beware of temperature tantrums and out of estrogen: approach at your own risk.
Humor can be a way out. A means to exalt and redeem what might otherwise be unbearable. I get that. Humor, as in the work of Samuel Beckett, can show the absurdity of life, of living in a body. ‘Nothing is funnier than unhappiness,’ Beckett once said. ‘It’s the most comical thing in the world.’
The laughter around hot flashes, though, is not life-affirming. It’s thin, strained and often mean-spirited. Some men are bewildered by the changes in their partners’ bodies. They suffer a parallel loss, but their honest grief is too often channeled into misogyny. Many women are fearful that the loss of fertility will take away their femininity. This unexamined shame rushes headlong into self-abasement and produces a brittle humor that is more a symptom of humiliation than actual catharsis.
None of the women I spoke to thought flashes were funny, but all were surprised, as I was, at the severity and isolation of the flash.
— At 3.00 p.m. it hits you like a ton of hot charcoal.
— Hot flashes for me are so severe that I fear I will have a heart attack and die.
— Mine start with . . . fear. It’s a quick burst of heat and nerve endings igniting in fear.
— They are like four-minute surprise anxiety attacks. I want to grab at my clothing, find a fan, open the fridge, whatever I can do.
Heat and panic drive many women out of doors for relief. One told me she often finds herself standing in the yard, flapping her pajamas in the middle of the night. Another puts on a sundress and stands barefoot in her freezing garage, surrounded by the tools on her husband’s workbench.
I often grab stuff out of my freezer – peas, pita bread, strawberries – and plunk them on my forehead, chest and stomach. I’ll admit that the manic way I run to the fridge, pull out items, throw myself onto the couch, and lie with a slab of frozen ham balanced on my forehead might appear funny. But my flash is much more than a comedic skit. Though no one wants to say it out loud, menopause is about loss; it’s about departure – each flash reminds me of my corporeality, my mortality. With every flash, my psyche is pushed to grasp what it does not want to let itself know: that it is not immortal. This is terrifying. It’s also a rare opportunity, if faced directly, to come to terms with the limitations of the self.
Looking beyond boilerplate misogyny, I’d argue that the flash has been debased because it’s a sort of conduit, a profound crossing to the older stage of life. The sensation I have in the aura before the flash is elevated, possibly even hallucinatory, though that does not diminish its power: I feel I will soon find out knowledge no one else possesses, something to do with the boundary between life and death.
Of the spiritual dimensions of the flash, I find little to nothing in the scientific and self-help literature of menopause. Most of the writing deals with how to get rid of hot flashes, not how to understand them. Premarin, a hormone replacement made out of the urine of pregnant horses, is the most common suggestion. Natural remedies are more humane but vary in effect. Herbalists recommend black cohosh, nettle, soy, rose hip, creams made from wild yam, vitamin E and vitamin B. One website suggests taking a tablespoon of apple cider vinegar twice a day and another drinking 10 percent of your body weight in water. Belinda Carlisle, the singer from the Go-Go’s, recommends putting a magnet in your underpants.
Many online essays urge me to laugh at myself more and complain less. Nobody wants to hear about menopause, even menopausal women themselves. Other female milestones are of more general interest. There is a whole literary genre, the coming-of-age novel, that addresses the move from girlhood to womanhood, and both men and women write about birth as a liminal event. Outside sex, men are never keen on hearing how our bodies feel, but both the onset of fertility/sexuality and birth are of interest to them in a way that menopause is not.
But what of my feelings – embodied for the first time in a flash – that I am divided, split into soul and body, that there is a me, lonely and frantic, who wants out of my corporeal form?
Charles Finney, leader of the First Great Awakening, detailed his religious conversion in language similar to how I and other women describe a flash. In his memoir, he says that his heart seemed to be liquid fire: ‘My feelings seemed to rise and flow out . . . like a wave of electricity.’ Another convert reported that she felt a presence traveling over her: ‘Suddenly there seemed to be something sweeping into me and inflating my entire being.’
Some describe conversion as pleasurable, but for most it’s eerie, even frightening. In The Varieties of Religious Experience, William James collected conversion testimonials: ‘Suddenly without a moment’s warning my whole being seemed roused to the highest state of tension or aliveness, and I was aware, with an intention not easily imagined by those who had never experienced it, that another being or presence was not only in the room, but quite close to me.’
In an earlier era, I might have felt the flash as wicked as easily as divine: a witch’s spell that sends waves of heat into my body, makes my tongue blaze, gives me the feeling, just under my right elbow, of a strong electrical shock. James, being a psychologist, believed religious conversions were caused by ‘an underground life’, which led a ‘parasitic existence, buried outside of the primary field of consciousness.’ During a flash I reside in the liminal; I feel that the membrane between me and another world is worn thin. James felt his scientific explanation of conversion was also compatible with the idea of a higher power: ‘The notion of a subconscious self certainly ought not at this point in our inquiry be held to exclude all notions of a higher penetration.’
Religious conversion, if we believe in it, is an experience of divinity unmediated by doctrine, hymns, or prayers. Those conduits that the transcendentalists thought blocked our relationship with divinity also serve to protect individuals from the full scourging force of the godhead. In conversion that safety filter is blown off its hinges, and believers feel unnerved, nauseated, filled with lava-like heat.
I’ve been having flashes now for nearly two years. Their onslaught has wiped out the composure and integrity of my old self. ‘Everyone wants to be the person she was before,’ Gail Sheehy writes in her book about menopause, The Silent Passage. But I am no longer my old self, and I can’t go backward. Why would I want to take hormone supplements, as Sheehy both advocates doing and did herself to start menstruating again, to dupe my body back into thinking it can still make babies? The feminist Germaine Greer has said that during her brief period on hormones, she didn’t like the feeling of going back into the cycle. She felt she had spied another region, one beyond sexual desire and hormonal docility, and wanted to get back there.
There are things I miss about my old self: the ferocity of physical desire, the sense of well-being (aside from the days before my period) that appears to have been in part hormonal, and the fantasy, no matter how ephemeral, that I might have another child. Now I am dinged up, less ‘moist’, as Sheehy so annoyingly points out. But the brokenness that the hot flashes and sleeplessness have wrought feels real – a real-ness that encompasses a wider emotional sweep, a larger sense of the world, and a keener awareness of my own self. Dr Pauline Maki, of the Center for Research on Women and Gender at the University of Minnesota, told me that one unexpected side effect of hot flashes is greater empathy: ‘The hot flash comes unbidden. You can’t control your body, and this makes women more empathetic to others who are suffering.’
The suffragette Elizabeth Cady Stanton, a mother of seven, writes in her memoir that the best part of a woman’s life is the back side of fifty, when her energies are not scattered in house work, ‘when philanthropy takes the place of family selfishness, and when from the depths of poverty and suffering the wail of humanity grows as pathetic to her ears as once was the cry of her own children.’
Many women feel during menopause that an old self is dying and, as one woman, an actress and a health coach, told me, ‘a new creature is trying to get out.’ Another woman, a young- adult novelist, told me that her flashes begin with her heart hammering so hard and fast that it feels like it’s trying to batter its way out of her chest: ‘I feel like I’m going to burst out of my skin and roar like the Incredible Hulk.’
During a recent sleepless night as a flash came on, I got so frustrated that I kicked the stack of books by my bed and squeezed my fists together; then out of my mouth came a deep and guttural roar. ‘Don’t make me angry,’ Bruce Banner, a.k.a. the Hulk, often warns those around him, knowing that high emotion will raise his pulse and bring on his transformation. Ang Lee’s film Hulk opens with Banner trying to cure his condition (Banner was blasted with radioactive gamma rays while testing a bomb for the military) with two natural remedies often suggested to menopausal women: herbs and meditation. Later in the film, when his girlfriend asks him what his metamorphosis feels like, he replies, ‘It’s like someone has poured a liter of acid into my brain.’
The Hulk was created for Marvel comics by Stan Lee and Jack Kirby in the early sixties, but it’s Bill Bixby’s and Lou Ferrigno’s portrayals of Dr Banner and the Hulk, respectively, in the seventies television show that most relate to my experience of the change. The show, with its barren desert landscapes and makeshift sets, is permeated with alienation and sadness. Banner’s melancholy suggests to me that while the Hulk is make-believe, his burden is real. He struggles to control his out-of-whack body chemistry and also ‘the raging spirit that dwells within him.’
YouTube has hundreds of ‘Hulk Outs’, short clips from the TV show in which Banner changes into the Hulk. Banner is in a variety of situations: held against his will in a small-town jail, chasing pickpockets, trapped in a car in a demolition derby, tied up in a wax museum. The situations are different but the steps in his mutation are always the same: his face flushes, his forehead gleams with sweat, and there is an expression of panic, of his not wanting this to happen. Before he turns green, his face is open, tentative – an expression similar to my own when I watched myself flash in the bathroom mirror, troubled features flooded with animal longing.
The Hulk, monsterly kin to both Frankenstein’s creation and Mr Hyde, differs from other superheroes. He goes after bad guys and saves damsels in distress, but his violence is also chaotic. He’ll bust up any room, even his own bedroom. His rage is inchoate, what with his dead mother, his messed-up childhood, his chemical imbalance, and his inability to control his own body. The flash is chemical and emotional, encompassing past and current frustrations. It is also a means of self-expression. After years of docility, Banner can reveal his rage. Greer writes in her book The Change that some of our negative feelings about menopause are ‘the result of our intolerance for the expression of female anger.’ In menopause women come up, as never before, against their own mentality.
The change for decades has been a euphemism for menopause, whispered behind the backs of aging women: She’s going through the change. It sounds sinister and surreal but is actually accurate. Like the Hulk, I don’t have symptoms or a condition; I am in the midst of a rupture, a metamorphosis, an all-encompassing and violent change.
I watch Bixby’s chest bloat, the buttons fly off his plaid shirt, his green skin expand like the stem of a gigantic plant. Seams split, his belt pops, even the leather of his boots explodes. He is out of control but also free. And while he may break down a few doors, he also acts with an inner integrity. ‘The woman who lashes out at menopause,’ Greer writes, ‘has found the breach in her self-discipline through which she may be able, finally, to escape to liberty.’
Freedom is on the horizon – freedom from child care and domestic duties, from trying to be beautiful, from the leering male gaze, from derailing sexual desires. First, however, my body must evolve. As a woman, I should be used to the seismic changes of flesh and blood. During puberty my skin got greasy, my breasts popped out, and I started, to my astonishment, growing black hairs under my arms and between my legs. During the last month of my pregnancy, the creature inside me often jammed a toe into my stomach and dragged that toe across the curved plane of my protruding belly. In both puberty and pregnancy, I was often mystified, but there were also solid gains to look forward to – a grown-up female body, sex, a baby.
The bodily changes the flash forewarns – vaginal entropy, wrinkles, bones crumbling with osteoporosis – are less hopeful, even grim. ‘So we die before our own eyes,’ Sarah Orne Jewett wrote in 1898. ‘We see some chapters of our lives come to their natural end.’ The Bulgarian-French philosopher Julia Kristeva locates horror, which she calls the abject, in the moment we are reminded we are living in a body. ‘Abjection is above all ambiguity. Because, while releasing a hold, it does not actually cut off the subject from what threatens it – on the contrary, abjection acknowledges it to be a perpetual danger.’ What frightens me most – decay, death – is me.
It would be hard to find a structure more abject than the Port Authority Bus Terminal in New York City. It reminds me of what purgatory might look like: smeared glass, grubby tile, exhausted souls slumped on plastic chairs and waiting on line. I’ve just taught my class at Columbia, and I’m going back up to our little cottage in Sullivan County to help my husband close down the place for the winter. The bus is full of slack-faced men in ill-fitting suits and women in polyester floral dresses. Walking down the bus’s center aisle, I pass a large lady in a pink tracksuit and a bald man wearing Elvis sunglasses. I find a window seat near the back. The elderly man beside me is talking on his cell phone about his appointment in the city. He got mixed signals from his doctor about whether he is going to live or die.
For now the bus door is open, but once it closes I’ll be sealed in, and though I have on three removable layers, not counting my sports bra, I know I am bound to flash.
I knew so much more going into both menstruation and pregnancy than I did going into menopause. Part of this is because secrecy, shame and fear still stigmatize the change. But the other part is that so little is known for certain about menopause and the science of hot flashes. Because there are few good animal models – the only creatures that go through menopause are human women, female killer whales, narwhals and short-finned pilot and beluga whales – most of what we know about how the body works in menopause is speculation. Studies have found that flashes are associated with decreased levels of hormones and that these decreases confuse the vasomotor system.
The vasomotor system includes the brain’s brain, the hypothalamus, as well as the stomach, the central nervous system, internal organs, the spinal cord and skin. Cilia and fibers in all these systems send information to the hypothalamus about our body temperature. Think of the hypothalamus as the main control center of the New York City subway system and of the outer vasomotor system as the various stations and miles of track. Hormones make this system run smoothly. During our reproductive years, our brains grow addicted to synchronized changes in hormone levels or, to use the subway analogy, there are established frequencies of communication and well-worked-out rules of travel. In menopause, hormone levels become unpredictable, and the messages that once moved smoothly from the outer-borough vasomotor systems into the control-center hypothalamus become chaotic and imprecise.
Lessening estrogen sets the stage for hot flashes. It may also make the skin more sensitive to calibrations of heat, but estrogen is not the only trigger. Studies have found little variation between estrogen levels in women who do and do not flash. Dr Naomi Rance, a professor of neurology at the University of Arizona, studied cells in the hypothalamus. She found that kisspeptin, neurokinin B, and dynorphin (KNDy) neurons were twice the size in menopausal women as they were in premenopausal ones. ‘They were large and over-excited,’ she told me. Using animal models, Dr Rance found that these discharging neurons may be what brings on a flash. As heat is off-loaded, the heart rate increases, by seven to fifteen more beats per minute. Vasodilation permits warm blood to circulate quickly into the arms, thighs and calves. One study showed that the first part of the outer body to heat up was the fingertips.
A flash is both something going wrong and something going right. Hot flashes may ward off hardening of the arteries and plaque buildup associated with heart disease. And as the brain struggles to find equilibrium, it also grows more flexible. With each flash, the brain adjusts to a wider range of hormonal messages. Dr Maki told me that recent studies have also shown that while it’s trying to reset, the brain learns to make its own estrogen. Could the post- reproductive flexible brain be, in part, responsible for the resilience, wisdom, and peace I see in the older women I admire? ‘We don’t know for sure,’ Maki said, ‘but it’s definitely possible.’
My bus moves, buoyant as a boat, past the Jersey strip malls, the neon liquor-store signs, the traffic-worn trees, 7-Elevens, Outback Steakhouses. A red lantern floats out of a Chinese restaurant’s front window and hovers in the air over the wet street. Rain hits the big window and falls in blue streaks down the glass. We climb up into the mountains. Pass Bear Mountain. On Route 17, the lights get farther apart until it’s just mottled darkness, the rain-smeared window, and the old man snoring gently beside me.
From my bag I pull out my Flash Count Diary. Eight flashes today so far. On the subway going under the East River the heat came on so fast I pulled off my coat and sweater and sat in my undershirt. I flashed while eating a Greek salad at a diner and while perusing a book on killer whales at Book Culture. I flashed at the Citibank where I got cash and in line at the coffee shop. The worst flash occurred while I was teaching. I felt the dart of panic as my face started to bake, and heat escaped through the top of my head. I kept talking, pretending nothing was wrong. When I shifted back in my chair, I saw the two dark wet spots on the table where my arms had been.
Near Monticello, in the foothills of the Catskills, the bus pulls off the highway and I see, through the rain, a gas station, blunt under the fluorescent light. A pale blonde woman pumps gas into her Jeep; a man inside gestures angrily at the cashier. The old man beside me wakes, pulls out his cell phone, punches in a number, and starts to talk. He’s not sure. Is he going to die? The doctor was so vague. The old man is facing death. I am at the meridian, life’s disconcerting center. Unease flows into my brain. I feel the first torrid prick and my heart thumps. I panic, desperate to break free of both my body and the reality of my own mortality. I pull off my sweater and press the inside of my wrist up against the bus window. The cool glass against my skin helps a little as I’m overtaken again by the ascending heat.
Photograph © Cristopher Smith