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“The menopause arrives, seeking out our vulnerabilities like a guided missile, just as we need all our strength to cope with daily life.” Susie Orbach
It is estimated that there are circa 13 million women (33% of the UK female population) who are currently experiencing one of the stages of the menopause. Whilst the menopause is not an illness or a disability; for many women, its effects can be significant.
Just imagine a scenario where one third of the male population experienced a debilitating condition that made their lives difficult at the pinnacle of their working lives – would we stigmatise it, treat it with derision and hostility, use it as an excuse for discrimination and prejudice, or would we have found ways of mitigating the impact, aeons ago?
Women of a certain age
For millennia, women have been defined, constrained, penalised and occasionally celebrated for their role in procreation and the continuation of our species. Once women became post-menopausal, they have been given countless labels that included sexless, shrews, whores, dangerous, hysterical and pointless. In our apparently modern world, it often feels like little has changed.
Whilst not all women will choose to or be able to have children, for all women the menopause is inevitable. Generally this change (or the change as it is euphemistically called) occurs between the ages of 45 to 55; however, for about 1% of the female population, premature menopause can, for a variety of reasons, happen before 40.
Why the fuss, it’s only natural after all
For those who haven’t yet experienced the menopause, or for that 50% of the population who never will, you might wonder what all the fuss is about. Your periods cease and there you go – the natural end to a reproductive life. Oh if only that were true! A few women sail through the menopause; however, research indicates that 80% of women will experience a variety of debilitating symptoms, with 25% experiencing severe symptoms, to the detriment of their lives, their families and their work.
We might think that in the natural world the menopause is a common occurrence and wonder why human females seem to have such difficulty. The truth is that menopause is only experienced by two other species, both whales and both long lived, both of whom are likely to have developed this long before humans existed. There are all sorts of hypotheses as to why so few species experience the menopause, but as yet, no definitive conclusions.
A three stage progression
We use the expression menopause generically to cover a three stage progression that women experience as part of their natural ageing process. The word menopause means to cease menstruation (monthly periods) and from a clinical perspective is defined as a date 12 months after the last menstrual bleed. There is however a transition stage the perimenopause, when hormonal changes start to occur and then post menopause after menstruation finally ceases.
The duration of these three stages can vary from woman to woman but can in some cases take up to 15 years! The average age in the UK for onset of the perimenopause is 47.5 years and the symptoms experienced generally last for between two and 10 years.
From the frying pan into the fire
From puberty, I experienced what was called premenstrual tension (PMT), which then became a less judgemental premenstrual syndrome (PMS). The premenstrual stage of unpredictable mood swings, irritability, exhaustion, migraines and so on, was then predictably followed by extremely heavy and painful periods. This monthly, highly debilitating experience was a blight that made me often say ‘roll on the menopause’, in the mistaken belief that my monthly woes would finally come to an end. How wrong could I be, in a cruel irony, many of the symptoms experienced monthly became an even more permanent part of my life for nearly 10 years. I calculated that during my 38 years of possible reproduction I had spent about 13 in the PMS/ menstrual cycle, 10 of those years would have been in significant physical and/ or emotional discomfort. What I can now say is that at least those symptoms were time predictable and dispersed within periods of respite; not so for the menopause.
No one talked about the menopause, it was then and still is now thought of as a life episode that is best forgotten or its existence ignored. It is a time when a woman knows she is approaching old age. Our sexist and ageist society is not kind to women and it is particularly unkind to older women. Because of this, like many women the perimenopause crept up on me (surely I can’t be that old!) and I was confused as to why the symptoms I was used to experiencing were no longer cyclical (every 28 days).
The first indication that my body was changing was that my normally predictable periods were becoming erratic and varied in their flow. Unlike some women who can experience menstrual flooding for the first time, it was the one thing that didn’t get worse for me during the menopause. What was problematic were the hot flushes (up to 20 a day), the night sweats, heart palpitations, severe mood swings, extreme tiredness, difficulty concentrating and as someone who had worked hard to successfully control a body that was prone to weight gain, I seriously lost the plot and put on significant pounds with no change in diet or physical routine.
The workplace doesn’t or won’t understand
I was running a business and it felt at times like even the most routine tasks had suddenly become challenging. At least I was my own boss – and she understood what I was going through – not so for women who are conventionally employed and have to deal with companies and superiors who can’t or won’t understand. At least I wasn’t unfairly penalised, like many menopausal women by common workplace policies around sickness absence or performance management, because of memory loss or a lack of concentration.
Our workforce is ageing and a significant proportion of that ageing workforce is women, many of who will be going through or about to go through the menopause. Strategies such as flexible working, sick leave or even a private room that can be used as a retreat when symptoms get too difficult might sound like common sense, but common sense has never prevailed where women and the workplace is concerned.
The average age of Chief Executive Officers (CEOs) in the UK is 53. At the age a career reaches its pinnacle, many women are having their working lives hijacked not primarily because of their menopausal symptoms but by the lack of acceptance, understanding and support in the workplace. A TUC survey of 4,000 women revealed that 85% said the menopause impacted their working life. This has resulted in an estimated 900,000 giving up work; often as a result of prejudice, discrimination and ridicule – it’s a national disgrace that this is happening to gifted, highly competent women in the 21st century.
Breaking the stigma through education
We need to break the stigma associated with the menopause and a start would be to understand why these extreme symptoms occur. Many women are too ashamed or embarrassed to talk about the menopause and the symptoms they are experiencing. This cannot be a surprise given that menopausal women have been the butt of jokes for far too long. Menopausal symptoms are not imagined nor invented, they are not hilarious, they are serious and life changing; even to the extent that it is well researched that women with the highest suicide rate in the UK are those between 45 and 54 – a coincidence, I think not!
The symptoms and their causes
Why do we experience the menopause? The truth is that we don’t know. We now believe we are one of only three species that experiences it. We know that the other two species have been around for much longer than we have, in the case of Killer Whales (Orca) around 11 million years; whereas Homo Sapiens has only walked the earth for approximately 300,000, although our origins go back six million years. We don’t know if Killer Whales experience debilitating menopausal symptoms, however, in 11 million years maybe their physiology has developed ways of dealing with it better than ours has.
Image Source: https://promensil.co.uk/34-symptoms-of-menopause/
Menopausal symptoms are a result of the change in the balance of the body’s sex hormones, in particular when our ovaries reduce the production of oestrogen and stop releasing that monthly egg into the uterus. Sometimes the menopause can be premature (before 40) and can be caused by several things such as total hysterectomies (removal of ovaries as well as the uterus), chemotherapy, radiotherapy and certain conditions such as Addison’s disease, chromosome disorders like Downs syndrome and autoimmune conditions like rheumatoid arthritis. Sometimes early menopause runs in families.
So much about the menopause is unknown. We now know that oestrogen is more influential and more extensive in the human body than was previously thought. It is a gonadal steroid produced by the ovaries; a sex hormone essential to reproduction. However, recent research has identified that there are oestrogen receptors all over our body. It is in our brain in the amygdala, the hippocampus and the hypothalamus and influences serotonin, dopamine, glutamate and noradrenaline. We also know it is associated with cognitive function and if it is reduced, it can impair verbal agility, memory and clarity of thought. Scientists have also learned that oestrogen is also manufactured in the adrenal glands, breasts, adipose tissue and brain. Given this, and oestrogen’s volatile and diminished production during the menopause, maybe it’s not difficult to understand why women suffer so many debilitating symptoms. What is astounding is why there is so much that is still unknown!
Just learn to live with it!
When I went through the menopausal stages, I thought about using Hormone Replacement Therapy (HRT) to reduce some of the more incapacitating symptoms. Unfortunately this was in 2002 when the now infamous Women’s Health Initiative (WHI) study was released. It purported to be a study of more than 16,000 menopausal women and the conclusion was that breast cancer rates rose significantly in HRT users. As a result of the damage wreaked by shocking headlines, millions of women either stopped using, or decided not to start using HRT and just felt they had to learn to live with it – me amongst them.
Years later the study was discredited after it was revealed that at an average age of 63, women on the study were post-menopausal, many were smokers and that most were overweight. All key factors in increasing breast cancer rates. However, the damage was done, the WHI legacy means that even today, women are reticent about using HRT.
A plethora of confusion
What to believe and what not to believe. The advice is confusing for both women and health care providers. The Cancer Research UK website will tell you that ‘the evidence that HRT can cause some types of cancer (breast, womb and ovarian) is strong.’ However the British Menopause Society information (aimed at healthcare professionals) tells you the risk of breast cancer is small or for ovarian cancer, not high in statistical terms. Is it any wonder that there are so many anecdotes about the varied support women get from their GPs and other medical professionals – not least because the menopause is not mandatory as part of medical training? In a recent study of universities, 41% of the 32 medical schools that responded did not have a mandatory menopause education programme. This means that all their students leave university with no education in the menopause. It therefore, cannot be surprising, that women get conflicting treatment, no treatment or in too many cases treatment that is unforgivable – like those women who are told to ‘pull themselves together’ or ‘not to be such a hypochondriac.’
So where do I get help?
The NHS information about the menopause is a good place to start and their advice is, if you have menopausal symptoms to go and see your GP. However, given much of what we read, it is possible that you might not get the response, support or treatment you require.
The best thing for any woman is to do your research; look at the evidence so that you can feel confident in engaging with a healthcare professional on an equal footing. If you get fobbed off, go to another professional. Getting the right information is the key and the following organisations can help:
Menopause Matters founded by Dr Heather Currie MBE Gynaecologist and Associate Medical Director, Dumfries and Galloway Royal Infirmary. This award winning, independent website provides up-to-date, accurate information about the menopause, menopausal symptoms and treatment options.
The Menopause Charity an organisation founded by Dr Louise Newson to improve women’s and healthcare professionals’ understanding of the menopause.
Menopause Support is a not for profit community interest company and the home of the national #MakeMenopauseMatter campaign, both founded by Diane Danzebrink.The organisation provides access to factual, evidence based, non biased information, education, advice and emotional support during the menopause and beyond.
Hippocrates, the founder of modern medicine, who died 2,500 years ago, believed that women were controlled by their wombs. Whilst we no longer accept this as truth, medicine has and still is failing women. Women are not just men with boobs and tubes, our physiology is different, our immune system is different and our life experiences are different. Given that male subconscious (and often conscious) bias has dominated medicine and medical research for so long, maybe this is not surprising. However, it needs to change if 50% of the world’s population is to be treated with knowledge, understanding, respect and most importantly, with success.
Less than 150 years ago, more than 2,000 years after the death of Hippocrates, with mental illness widely attributed to ‘womb trouble’, the Victorian surgeon Lawson Tait thought that the solution to the menopause was to ‘lock women up’.
Hopefully no healthcare professional would consider expressing such an opinion now, however, we need to make sure that things change exponentially in the 21st Century so that we, our daughters, granddaughters and great granddaughters get the treatment we deserve.