It started with sex. Searing, agonizing sex—just like the very first time I tried it. But now I was 40, and unlike when I was 20, there was no reason to be optimistic that the pain detonating across my pelvis would eventually go away.

I tried shifting my hips, curling onto my side, holding my breath, but each time I had sex, the throbbing pain roared. At first I was convinced it was a cyst—a ball of cells so large that nothing, barring a tampon, could enter. I had gone through five rounds of IVF to have my daughter, so it didn’t seem far-fetched to concoct a theory that the injected hormones had transformed into a pulsating polyp blocking my cervix. (Though highly unlikely, it was possible.) But an excruciating 15-minute vaginal ultrasound turned up nothing.

With no apparent physical problem, I was told that I probably had vaginismus, a painful contraction of the muscles around the vagina that can make sex hell. According to the Cleveland Clinic, it’s considered a primarily psychological condition, the pain arising from, “fear of sex, anxiety, past sexual abuse or trauma, and negative emotions towards sex.” Treatment often involves therapy—but I was already in therapy and had been for years. Cracking open memories and dissecting grief in a psychotherapist’s office was something I grew up with. I was flummoxed. Had I been so deep in the emotional weeds that I had unintentionally sidelined a trauma that was now wreaking havoc on my sex life? I couldn’t shake the feeling that the diagnosis was a cursory reading of my pain—yet another dismissal of women’s symptoms by the medical system.

And then came the sweat.

One night I awoke to a mosaic of perspiration covering my eyes, upper lip, and chest. It became my new nocturnal norm. Shirts turned sloppy wet. Waves of searing heat radiated from my core. Pajamas were ruined. The night sweats were only made worse by my almost-two-year-old deciding to transition from her bed into ours and lovingly wrapping her arms around my torso, head, or whatever she could cling to throughout the night. I felt like a human hot-water bottle.

Finally, with a thud, my period stopped. One month turned into two, turned into eight, and I had to face facts: This looked a lot like menopause.

By this time I was only 41—a full decade younger than the average age of women in menopause. The idea that I might be entering early menopause—or even the stage before it, perimenopause—had not even been a footnote in any of the conversations I’d had with doctors up until this point. I felt stumped by my body as it convulsed with changes I thought were meant for women much older than me. Women like my mom and my grandma. Those were the women who went through menopause—not new moms like me.

I made an appointment with an endocrinologist, who asked me a battery of questions and then took several vials of blood. A week later he called and confirmed: I was in perimenopause. My ovaries were slowing down their production of estrogen until I’d never have a period again.

I thought I had years of my youth left to contemplate what this experience might mean, but my rapidly waning fertility, and even the loss of the predictable monthly routine of menstruating, forced me to face the notion that I was transitioning into the second half of my life. I felt relieved to finally have a diagnosis, but there was also a surprising feeling of shame that I had somehow hadn’t managed to hold on to those precious nubile years quite as long as most women.

Unlike most of my menopausal relatives who didn’t start dealing with this until their 50s, I was advised to take hormones—namely estrogen and progesterone, in the form of patches, pills, and vaginal inserts—to confront my prematurely aging body. “If you go into menopause earlier than 51, the priority in terms of medical issues we worry about is your bones,” says Taraneh Shirazian, M.D., a board-certified ob-gyn and founder of Mommy Matters. “That is because between 40 and 51, you have that many years left ahead where the bones won’t get as much estrogen.”

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