One night in November last year, my landlady, Debby, and I bumped into our neighbour Kate Muir – the women’s health and menopause expert. As we strolled home, Kate was saying that lots of women desperately try to get along without HRT when they could really improve their lives by giving it a go, and Debby asked a crucial question: “Might a blob of oestrogen help with Nina constantly peeing herself?” and Kate said, “Yes, it’s all part of it.”
I had arrived in London, aged 60, the previous March, after 20 years in Cornwall, to have a sabbatical – from life there (and my marriage) – in the house of the writer Deborah Moggach, who wanted a friendly lodger to share the odd Charlie Bigham pie and peas in front of Succession or Happy Valley. Though Debby was a positive role model for the newly single older woman (herself freshly out of a short marriage), I can’t deny I was all at sea. The soap I’d bought myself as a moving in gift smelled strongly of pork, and that upset me more than it should. The realisation that I looked silly in a trenchcoat was a blow, and chanting, “Oh God, oh God, oh God” under my breath the whole time didn’t seem like a good sign.
After I’d been a few days in my new home, my friend Stella rang with news that the nurse at her GP surgery had been unable to find and remove her intrauterine device, and told her it must have fallen out at some point. “I’d know if something fell out of my vagina,” Stella said, and I agreed. “Anyway,” she said, “how’s London?” I told her how earlier that morning my dog, Peggy, had picked up a chicken drumstick off the street and I’d had to fight her for it in front of a family on a bike ride, and slightly weed myself.
“You need to do pelvic floor exercises,” Stella said.
“I know.”
Soon I reacquainted myself with my old friend Misty (famous in our group for Freudian issues and inventing the bacon and egg salad). Misty was on a dating app for middle-aged culture vultures but couldn’t find a man whose footwear didn’t put her off. So far she’d had one who wore Crocs, one she dumped because he said Marilyn Monroe looked like Les Dennis and one who wore flip-flops year round. She was “out the other side” of menopause and confided that tofu gave her the horn. What about incontinence, I wondered. Yes, she’d had a few accidents, but fixed it via limited liquid intake and a no-caffeine rule. So I cut down, too, which seemed cruel because, honestly, tea was pretty much all I had.
Then I met up with a highly recommended friend of a friend. Rachel had recently left her husband of 30 years, listing his faults as “gloominess, speaking in burps, low-level hectoring, neuroticism about fridge temperature and constantly using the word vulva”. I was glad to note that Rachel was much worse than me, weeing herself-wise, so much so that she couldn’t bring herself to begin online dating and, out of courtesy to other passengers, sat on a carrier bag on the bus. One morning, over a Gail’s coffee and bun, I watched her filling out a “When might you wet yourself?” questionnaire:
In bed – no
In chair – no
Laughing – yes
Sneezing – yes
Walking – sometimes
Running – yes
Do you ever wet your socks? – no
She said her answers confirmed her as “borderline incontinent”. “Do you think it’s the menopause?” I asked. “No,” she said. And she wasn’t worried because her friend Lyn Flipper had just recommended a programme of extreme pelvic floor exercises – continuous pulsing every time she did anything: going through a doorway, watching a play or looking out of a window. I started to do the same whenever I remembered, including the evening in June that I accompanied my son Alfred to see the Red Hot Chili Peppers. I dutifully clenched all through the support act (A$AP Rocky), after which Alf looked concerned and asked was I finding it too loud. “No,” I said. “I love it – why do you ask?”
“It’s just that you keep wincing.”
* * *
In August, on the same day the former Soviet leader Mikhail Gorbachev died, my friend Fiona from Leicestershire could suddenly feel something bulging when she stood up or walked. My sister Vic, a former nurse, guessed it was a vaginal prolapse. Then, in early September, soon after a cloud formation resembling the queen appeared above Telford an hour after her death, I admitted to myself I was unsettled. Unable to enter a shop unless the door was already open, I found myself wandering about in a thin but long coat, buying expensive berries in paper cones, and one time a small tray of salad leaves that were still growing.
It’s not as if I hadn’t heard about the menopause. My Cornish friend Cathy Rentzenbrink had been boring me rigid on cliff walks for years, endlessly banging on about fluctuating confidence and joint pain, and with the medical fact that anxiety increases as oestrogen declines, etc. Ditto Vic, who had gone on HRT to combat feelings of bleakness and hot flushes so severe she thought she’d expire. It was just that, for some reason, I preferred Rachel’s menopause denial. Rachel, who shaved her whole face every other day with a Bic (since her grandson drew her with an iPhone and a beard) and insisted her clearly menopausal symptoms – insomnia, new body odour (sugar puffs), twitchy eye, itchy skin, sensitivity to cooked onions – were all down to age.
Finally, using the most discreet Tena Lady pads available (Tena Silhouette Noir), Rachel was confident enough to start online dating, although her first date brought a small foam ball to the pub and habitually bounced it when she was talking. Her second, an Uber driver who pretended to be a lawyer, at least listened to her side of the conversation. Her third spoke mostly in James Joyce quotes and took her to Dublin for Bloomsday. It took a lot of pads, but still. Inspired, I bought my first-ever pack of Tena Lady (two-drop Discreet Ultra, the thinnest liner they do) from Boots, and as I made my transaction at the self-checkout, Alf took a photograph and posted it to his close friends list on Instagram.
In early October I had a Norfolk minibreak with my parents. It was my stepfather’s first time away with an indwelling catheter. He remained dry as a bone, while my mother and I both had a few accidents. Added to which my mother experienced stabbing pains up her vagina, and when I got my phone out to make a note she said, “Please don’t put my vagina in your book.”
I told her at least three women I knew had “atrophied vagina”. One said, “It just shut up shop.” Another blamed her husband’s recent erectile dysfunction because before that, he just “shoved it in once a fortnight and that kept it open for business”. The third, aged seventysomething, fixed hers with some oestrogen.
Halloween turned me gloomy. Life was bad enough without crime scene tape everywhere. Old grievances came to the surface. I felt furious with Ian McEwan for inventing long-married, middle-aged characters who have sexual intercourse every morning, from behind, and then tea in bed together before starting their day. Where was the vaginal dryness or body odour anxiety? I wasn’t alone. Rachel was annoyed that Kate Bush was back in the news, harking back to that awful, long outro on Wuthering Heights. Stella banned me from speaking to Uber drivers unless it was about the specific journey, and raked up the time our taxi driver masturbated to Like a Virgin on the way to a Greek airport. Even kind-hearted Misty had curmudgeonly moments, turning against still-life painters such as Giorgio Morandi for no reason, and was almost barred from her local Co-op for calling the produce “a pile of toxic garbage”.
Later that month, my friend Fiona (with the bulging vagina) went to see a menopause specialist, was diagnosed with significant prolapse (bladder and bowel) and told there was a two- to three-year waiting time for corrective surgery. And my mother’s intermittent stabbing pain got worse in the cold weather. Vic wondered if plastic transvaginal mesh might have been used for the surgical repair she had in 1990 when we all clubbed together for a two-position recliner and I upset her by reading Adrienne Rich poems out loud.
Back in Cornwall for a family Christmas, I caught up with old friends, cooked nice food, played games, watched telly and weed on the sofa.
* * *
On Boxing Day we set off for a walk. It rained so hard on Perranporth cliffs it was like being pelted with tiny cold stones. The sea below was dark grey with frothy breakers; we struggled along with our hoods up. Then the sky changed, it stopped raining, the sun came out and the scene transformed as if by some divine power. Skylarks began fluttering above the ploughed fields. All wonderful except I was in a two-drop pad on what was clearly a three-drop walk.
My friend Wendy came round for coffee and asked if the small pile of cushions in the corner were new. They weren’t – they were waiting to be laundered, and I remembered for the hundredth time what Kate Muir said about oestrogen and resolved to make an appointment to see someone in the new year.
One morning in mid-January I got the train to Leicester for my appointment with Aly Dilks – menopause and HRT specialist. In preparation I filled out the Greene Climacteric questionnaire, which measures menopause symptoms. Scored 17 out of a possible 59. Vic accused me of “playing everything down” because I’d given myself 2 out of 10 for loss of confidence and she said, in her opinion, I was easily an 8.
Aly introduced herself and explained how my appointment would work. I don’t know how it happened, or why, but I was suddenly crying, and without pausing Aly pulled a tissue from a box and handed it to me. “I don’t know why I’m crying,” I said. “People always do,” Aly said. “Why?” I asked. “I think it’s because someone’s listening,” she said.
I was prescribed daily topical oestrogen gel (made from yams, not horse urine) and a progesterone tablet to be taken orally.
Back in London, the next day, I was on the phone with Rentzenbrink when I saw Tariq Ali driving a Fiat Panda Eleganza indicating to turn left into a cul-de-sac near Kentish Town swimming pool, waiting calmly while a delivery driver made a tricky U-turn. Rentzenbrink (herself now taking testosterone) said, “If men feel like this all the time, we should congratulate them – it’s a wonder they don’t go round just punching everyone.”
I started my HRT medication a couple of days later and, as if by magic, that night I had a romantic dream in which I held hands erotically with the mayor of Greater Manchester in front of some other people but we didn’t care. A big change from my usual dreams (calling a person by the wrong name, devastating garden neglect, wandering about in an empty hotel). By the third or fourth day I was feeling quite nauseous and hoped it was because I’d been eating a lot of cheese but emailed Aly for advice. She replied that side-effects are common and usually soon resolve, and I could try inserting the capsule into my vagina at night instead of swallowing it.
When Rentzenbrink came to stay a couple of days later, I was feeling demoralised by the side-effects and said some negative things about HRT such as, “It’s just not worth it” and, “It’s not for me.” Rentzenbrink told me to be patient and give it a chance, and reminded me that without her little patches, she might have stabbed her husband with one of the knives off their magnetic knife holder. And, sure enough, the nausea had gone by the time I next saw her and we had coffee with Rachel. I raised the subject of HRT. “Yeah, save your breath, I’m on it,” she said and proudly displayed a patch on her arm. Later, privately, Rentzenbrink wondered if she might also be taking testosterone, to explain her surge in aggression, for example discussing the spectacle of Tiger Woods handing a tampon to another golfer during his comeback round. Rachel had called him a “childish, misogynist little cunt” and said she wishes he’d handed her the tampon because she’d have rammed it up one of his nostrils.
In February a national shortage of tomatoes was in the news, also shortages of my progesterone. Added to which some newspapers were bemoaning the fact that 4,000 women were taking testosterone on the NHS as part of their HRT, for libido issues. They didn’t compare this with the three million men a year who are on Viagra for the same thing. What would happen if there were a nationwide shortage of Viagra, we wondered. Misty thought half the women in the country would put up a cry of joy at not having to be penetrated by a pharmaceutically enhanced erection. Debby said it wouldn’t be allowed (the shortage), Stella wasn’t interested and Rachel said something so dark and worrying, I can’t record it here.
Seeing the GP for a repeat prescription, she warned me pharmacies were struggling to stock HRT medication. Boots in Truro had just one pack of the oestrogen and one of progesterone, which I took. While the pharmacy assistant scrolled the manufacturer database for information on when new stock might be available, her colleague whispered to her, “It’s pancake day.”
“For real?” said the assistant, concerned.
“Yeah,” said the colleague, “it’s either today or tomorrow, I know that.”
“Shit,” said the assistant, “I need the ingredients. What are the ingredients?” Then, glancing up at me, said, “Yeah, so the manufacturer is out of stock. No clue when we’ll have it again.”
In early March, in Suffolk for a book festival, I had a spaghetti dinner with the writer India Knight and her agent, Georgia Garrett. I spoke at great length about HRT, etc. They seemed very interested, especially about how it has helped combat my stress incontinence, and then India’s terrier puppy, Lupin, got up after weeing on the cushion next to me. And for the first time in a year I was able to say in all honesty, “That wasn’t me.”
By mid-March I was noticing improvements through my entire body and mind; I was no longer chanting, “Oh God, oh God, oh God” under my breath the whole time. I was delighted that Ian McEwan’s latest was his best for a long time (my words), and started to call out, “Thank you, driver” on alighting from a bus.
Back in Cornwall later that month, on a cliff walk with Peggy, Rentzenbrink asked for an update.
“All good,” I said. “I don’t wet myself any more.”
“Not at all?”
“Only when I laugh.”
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