Nerlandes’ Story

Nerlandes Themistocle is a pharmacist and Pharmacy Manager at CVS Caremark, having worked in pharmaceuticals for over 25 years. She is a wife and a mother of two, currently residing in Rhode Island and finds joy with her family, listening to music, dancing, traveling, and exploring new foods. Nelandes Themistocle shares her truth about menopause, from what she experienced to what she wishes she knew about this important part of the reproductive health journey.

Can you tell us a little bit about your menopause experience?

I didn’t experience symptoms or body changes during the perimenopause stage as many others have. All of the symptoms started once my periods stopped very suddenly at the age of 50. What I’ve learned throughout this process and when talking with others is that not everyone experiences menopause in the same ways. Some may experience vaginal dryness, while others may feel more irritable or depressed. No experiences are one and the same.

What symptoms did you experience?

My symptoms were mainly hot flashes and night sweats, as well as trouble sleeping. The hot flashes, however, were pretty severe for me. I’d have to have fans on me at all times at work and when I go to bed.

Were there any other symptoms that caught you by surprise?

The symptom that really caught me by surprise was anxiety. I started to feel anxious about things I normally wouldn’t. For instance, I never felt or experienced anxiousness when it came to my work, especially because I have worked at the same place for years, however, one day I had such an overwhelming experience I had to call my husband. The palpitations were very intense, and this lasted for an entire week. I still feel anxiety from time to time, but I find ways to manage.

Did you feel prepared going into menopause?

Going into menopause is not something any woman can ever be fully prepared for. It took me an entire year to realize that I was going through the change . I definitely was not prepared. I did not have any idea what to expect or even how to identify if I was really experiencing it.

What do you wish more people knew about menopause?

Menopause is not as simple as people think. It is a very complex process that can be long and at times frustrating. The symptoms can last several years after your period stops and can be disruptive to your everyday life. Everyone experiences menopause differently, like I mentioned earlier, no experience is one and the same, so be patient with yourselves.

What do you think is the biggest misconception about menopause?

Menopause is still considered a very sensitive topic. I think that a lot of women struggle with this idea that once they go into menopause, their womanhood is stripped away. They may feel life is going to change forever, and people, including their spouses, will not look at them the same way. I felt that at one point, but my husband still treats me the same. Life may change in some ways, but the most important things don’t. People, not just women, need to be more educated about menopause to help with these feelings.

Is there any message you’d like to give to someone going through or preparing for menopause — maybe someone experiencing the same symptoms as you?

Menopause is not a medical condition but a natural process that will become a part of your life. Our bodies go through a lot of changes during this time, but there are so many ways to manage it. Don’t be afraid of talking about your symptoms; there is absolutely nothing to be ashamed of. Challenge yourself, change your lifestyle, exercise, keep yourself hydrated, lastly and most importantly, seek medical advice or talk to your provider. There are also so many drugs on the market that can help with the symptoms. I have learned to live with it and be happy.

Learn more about menopause

Menopause

Menopause 101

Menopause symptoms

Can you tell me a little bit about your menopause experience?

I started perimenopause about two years ago with minimal symptoms. Currently I am experiencing all the symptoms: hot flashes, bloating, weight gain, headaches, changes in my cycle. I feel aches and pains in my joints, tiredness, mood swings, anxiety, and generally just feel crappy on some days.

You don’t get prepared for menopause and we just dont talk enough about this stage of life. It’s an emotional time because you’re getting older and you have all these things happening to your body. 

I was fully expecting the hot flashes and cycle changes, but the overall feeling that I have on a daily basis, I did not expect. It’s hard to describe, because you know that you are not sick, but you feel very off. It’s like having extreme PMS all the time.

I am also a single mom of a 16 year old daughter and I do strongly feel that my symptoms affect the way I parent. She is at the beginning end of all this — she got her cycle a few years ago —  and is adjusting to hormones, driving, and teenage stress. So we’re both having mood swings for different reasons, which can be a challenge. 

So in a way you’re seeing the mirror image of yourself in your daughter’s experience.  

Yes. Teenagers can be emotional and I sometimes feel like I’m very reactive. If I wasn’t going through menopause I feel like I would be more laid back. Parenting a teenager makes you feel more alone and I’m also preparing myself for her to leave home. I’m going to have that empty nest and start another chapter. 

People told me when I got divorced that I really needed to really think about myself. But I made my daughter my main focus my entire life. I built everything around her and I feel like I missed nothing. If I had to do it all again I would do it all the same, but now I’m at the point where I know I need to invest in myself. 

How’re you investing in yourself now in ways you maybe didn’t before?

I joined a gym four months ago and I go every day after work. It’s another whole community! I was so nervous to go and about whether I’d be doing the exercises wrong, but it’s just been the best thing I could have done for myself. I feel so much better. My symptoms have really improved.  

That’s amazing to hear. Many of us struggle to start an exercise or movement routine even if we believe it will make us feel better. Do you have any advice for someone struggling to get started?

It started for me because I was starting to have pain — my body was just feeling different and I knew it was time to make a change. 

But I was so nervous to go. On the first day I went, I obsessed about what I should wear. I bought new sneakers. I sat in the parking lot outside the gym for a long time. When I finally went in, I just did the exercises I was comfortable with (the treadmill or the bike). And then looking around I started to notice that there were so many people much older than me there. I was inspired by them! They were in such great shape, slowly walking on the treadmill or chatting with friends, and I thought if they can do it I can. I track my exercise too which helps me feel really motivated. 

I go after work to de-stress and find some release. I feel great when I come home and I sleep so much better. Once you start to feel better and see all those positives, that’s what keeps you doing it. 

If I wasn’t going through this or feeling these symptoms, I probably wouldn’t have joined a gym or realized how much I loved exercise. If you told me a year ago that I’d be going to the gym almost every day I would have told them you’re crazy. 

For someone who’s invested so much in your daughter, it must feel really good to finally be prioritizing yourself

I tell my daughter now that it’s time for me to do something for myself and going through menopause was the kick in the butt that I needed to do something for myself. Now it’s time for me. 

What do you think is the biggest misconception about menopause?

That it’s just hot flashes and cycle change and also that it’s just part of life. I have learned that there are things that you can do to help ease many of the symptoms. Small changes like adding exercise into your daily routine and changing your diet. These changes have dramatically impacted how I feel on most days. 

I wish more people understood exactly how you feel as you are going through this. In addition to getting older (which few of us like), your entire body and emotions are changing. There is a misconception that menopause is just when your period stops, but it’s so much more than that. Some days, the symptoms can be extreme and make it hard to do your daily routines. 

In addition to adding exercise to your daily routine, what else has helped? 

It’s so important to talk to others about how you are feeling. Millions of women go through this and we shouldn’t keep it quiet or just accept that it’s just part of life. Talk to friends, your healthcare provider, support groups. It helps to talk with others who know exactly how you are feeling. I even joined a FB group called Midlife Crisis and it makes me laugh at all the things that we are going through and never imagined we would.

How has this stage impacted your work life?

Working from home has been a life changer for me and I’m extremely grateful to have a job that allows me to. There are days that I would not want to go into an office and I’m thankful that the company that I work for really cares about this part of a woman’s life. Menopause impacts so many working parents. In my case, I’m the only source of income for our home — it’s so feeling supported and empowered is really important.  

Read more from this series:

• An interview with Dr. Leslie Saltzman
• An interview with Brooke Sumner

Can you tell me a little bit about how menopause has been for you — how are you feeling right now? What’s come up for you during this process?

It’s been frustrating. I would say the weight gain has been the most frustrating part. It changes my day-to-day life — from what I wear, to how I feel in my body, to how I navigate life. Sometimes I notice it in the little moments, like scooting between a chair and the wall and realizing that my body has changed. 

I saw an endocrinologist for a bit and she had me try a number of things to help me feel better in my body, but they were either temporary or ineffective. Her answer was usually just, “You’re just at that stage of life.” It’s really frustrating and unmotivating. 

Were there any other symptoms that caught you by surprise?

Yes, I’ve had joint pain for the last couple of years. My primary care provider didn’t think it was arthritis but didn’t really know what to call it. The more I read and learned about menopause, the clearer it became that this joint pain is likely a menopause symptom. It’s disappointing that my provider never brought it up!

That’s very disappointing. 

But the thing is, even knowing that something could be a menopause symptom is just the beginning. It’s in my personality to want to fix something when it’s not working, but with menopause you can’t usually just fix your symptoms. 

And even beyond the physical and mental symptoms, it can be a signal of a new time in your life. 

Right. I’ve known for a while that I couldn’t have more kids because I had to have a hysterectomy. But still, it’s an emotional step in a woman’s life. It’s emotional to realize this is a chapter in my life that’s happening. I wasn’t quite ready for it. Menopause happens at a time when many of us are going through other emotional personal experiences and that emotional piece can exacerbate the physical pain and discomfort. 

Plus, the people around you don’t always get what you’re going through. It would also help me to be able to give my husband information about how menopause impacts my health, beyond my personal experience. He still remembers when his mom went through it, but there are so many misconceptions.

That’s such a great point. Friends and family helping to destigmatize menopause is huge. What did you expect from menopause?

I expected hot flashes. Period. That was all that I expected. And I have a master’s degree in health education! I did not expect the moodiness, internal thermostat that is always set to 100 degrees, inability to lose weight, and the constant crying. Also I don’t know if you can really call it a “hot flash.” I get hot, but it doesn’t come and go – it stays around. It feels like you’re hot from the inside out and it’s miserable.

But mostly, I wish I understood the emotional toll that it can take. This is especially true when you don’t know where you’re at in the process. You don’t know exactly when it started, and you don’t know when it will end. 

Is there any message you’d like to give to someone going through or preparing for menopause — maybe someone experiencing the same symptoms as you?

Find a good provider who listens to you and is a menopause specialist. There are ways to combat the symptoms, but the first step is to have an excellent provider as your partner.

Read more

• An interview with Dr. Leslie Saltzman
• An interview with Emma Doyle

Can you tell me a little bit about your menopause experience?

I experienced menopause as a result of a hysterectomy BSO, or having my uterus, tubes and ovaries removed. I was only 36 years old when I had the surgery. 

Going through menopause so early was really hard for me to deal with. In a way, I had to mourn the fact that my life didn’t turn out the way that I thought it would. There was a part of me that wanted to have more children, and I was really sad about that chapter of my life coming to an end. I felt that my decision about whether or not I would have more children was made for me. 

I also think I had internalized some of the messages that post-menopausal women have less value in our society. I was worried that I’d suddenly feel much older and that I wouldn’t be the same. I was also breastfeeding at the time and was concerned it might impact my milk supply.

Now looking back I feel very comfortable with my decision, but it’s important to acknowledge that there can be a real profound feeling of loss associated with menopause. 

Did you feel like going through menopause at an earlier age than most people do impacted the conversations you were able to have with your community?

Most definitely. It made me so much more comfortable talking about menopause and the experience of loss that we all have throughout our lives in different ways. 

Can you tell me a bit about the symptoms you experienced? Did you feel prepared going into menopause? 

Because I’m a doctor I knew a lot about menopause — particularly the symptoms and the treatments — and still I didn’t feel prepared. The hot flashes were really intense. Even in the winter, if just the smallest sliver of sun shone on my arm, I would break out into a hot flash. Or if I drank a hot beverage or had soup. I couldn’t eat anything that was hot. I couldn’t tolerate it. 

My resting heart rate was higher and that was terrible. It made me feel very anxious and jumpy  all the time. I remember telling my doctor this and being dismissed because my vital signs were in the normal range.

I had vaginal symptoms, and while I expected the vaginal dryness, I also noticed that my labia were thinner. When the tissues of the labia don’t feel as cushioned and comfortable, sex becomes uncomfortable (HRT helped with this).

I asked my doctor about hormone replacement and breastfeeding and no one had answers. They had never talked about this with their patients and they didn’t know. It was discouraging. 

Let’s talk about HRT – how did you weigh the pros and cons?

First, not everyone can go on HRT. It depends on your personal health and risk factors. It’s also different if you don’t have a uterus (like me) because we don’t need to take progesterone, so I just use an estrogen patch. Those with uteruses will need to take progesterone too. 

I was also under 45, and for this age range we know that estrogen helps to maintain bone density, protect against early progression of cardiovascular disease and dementia, and minimize symptoms.

I wonder if going through this process and doing HRT made you feel more connected to  your body and its signs and symptoms? 

Yes, one of the benefits of getting older is that you understand more about your body when it comes to noticing symptoms, sexual satisfaction, etc, but I also just love not having a menstrual period. I really don’t miss that. And for me, it’s a relief to not have to worry about getting unintentionally pregnant. There is liberation in that knowledge.

What do you wish more people knew about menopause?

I wish people understood how the symptoms can be so full body and I hope that people feel comfortable asking for treatment. 

But also, so much of what we internalize makes us think that really bad things are going to happen during menopause or somehow overnight everything is going to change. And that’s not necessarily true. I’ve been in the best shape I’ve ever been in my life — I’m running at the fastest that I’ve ever run in my mid forties!

As a doctor, what do you think is the biggest misconception about menopause?

A lot of people are still uncomfortable with hormone replacement treatment as a result of the WHI study and the warnings that were applied to HRT. It’s really important to look at more recent studies.

Anything else you’d like to share?

This impacts 50% of the population. We need to talk about menopause to normalize this part of life, starting early. 

I think about my daughter’s school — they approached puberty in a very inclusive way. All students received information about menstruation, not just the students who were going to be menstruating. And when she got her first menstrual period, my daughter felt totally comfortable sending her father to the pharmacy to buy sanitary products. This is so different from when I was her age. It gives me hope that people can become more comfortable talking about menopause transition and menopause and thinking about how we educate people to get rid of the shame and stigma.

We don’t have a class for middle aged people to understand what their peers are going through and maybe that’s what we need. We need to teach everyone about what menopause means, what it looks like, how it effects our community. It’s a community health issue. 

Read more from this series

• An interview with Brooke Sumner
• An interview with Emma Doyle