Before we look at how Menopause affects our relationships, we need to know more about what it involves. While I am not medically trained, this information is readily available in the public domain. If, at this stage, like many women you know little about Menopause, this will be a useful grounding to take through the rest of this book. It will also help you gain some perspective when preparing yourself for discussions with those you interact with.
CHAPTER 1
MENOPAUSE FACTS AND FIGURES
As a society, we tend to view Menopause in its generality. We see it as an older woman’s condition, a bit sweaty, a bit overweight but something not too bad, more of an inconvenience that women can manage on their own in the shadows. After all, isn’t that what cardigans are for? For older women who need to take them off discreetly when they get hot? I can see why we think that. After all, those have been the only images we have seen in the media until now, but Menopause is so much more complex than that. It doesn’t fit a social stereotype; it doesn’t conform to specified limits or rules.
Your Menopause is as unique as your fingerprint.
Medically, Menopause can only be identified in retrospect. It is when you have not had a period for 12 months, effectively 12 months and one day. If you are one day short, sorry, but you start the countdown again from the beginning. It heralds the end of your reproductive years, signalling the end of your egg reserves. For some this will be a relief, while for others it will cause deep sadness and grief. It is important to note that should you have a bleed once you become post-Menopausal, you should seek medical advice
The average age of Menopause in the UK and the US is 51,1 with the core period to experience symptoms being 45 to 55. However, one in every 100 women2 in the UK experience Menopause before the age of 40. As a society, we assume that Menopause is an older woman’s issue, but this is not the case. While rare, young women in their teens, 20s and 30s can have what is medically known as Premature Ovarian Insufficiency (POI). Experiencing Menopause at this young age is extremely difficult for a multitude of reasons, including society’s visual and narrative presuppositions regarding age.
For those women who have a medically induced Menopause, which can be through cancer treatment or the removal of their ovaries (oophorectomy), this can of course occur at any age and is especially severe, as there is no gentle preamble. Psychologically in these instances, women need to deal with the medical condition that brought them to this point, plus an instant and extreme Menopause.
No woman lives in isolation; therefore, those around her will no doubt be exposed to her Menopausal symptoms as well. This is by no means a criticism; it is a recognition of the far-reaching impact of symptoms on all aspects of women’s lives and the lives of those within their social networks.
There are many things about Menopause that make it a tricky subject to discuss openly, for women and those they interact with. It is still a social taboo, partly due to its wide-ranging impact on women’s physical and emotional states. Another is the lack of objective and defined uniformity experienced from one woman to the next. In this respect, there are three key areas of variance.
CHAPTER 2
DURATION
What we commonly call Menopause is often the period during which we experience symptoms. On average, this can last for four to eight years,3 but it’s not uncommon for women to experience symptoms for longer. Menopause has three recognized phases:
1.Peri-Menopause – the time leading up to Menopause, when your hormone levels start to fall
2.Menopause – 12 months since your last period
3.Post-Menopause – your life after Menopause
A very small percentage of women continue to experience some symptoms for the remainder of their lives. While this is rare, it is no consolation if you are suffering from hot flushes, night sweats or vaginal atrophy decades after becoming post-Menopausal.
CHAPTER 3
SYMPTOMS (PART ONE)
There are a wide range of symptoms, which can affect women psychologically, physically and emotionally. You may experience many or none. If you do experience symptoms, they can change as you move through your Menopause. Equally, you may sail through peri-Menopause without a single symptom other than unpredictable periods and find that your early post-Menopausal years cause you the most problems, or vice versa. Of course, your symptoms could continue throughout.
So, who gets symptoms and who doesn’t?
On average, 75%4 of women experience symptoms, 50% of which find that those symptoms can at times be detrimental to their wellbeing; 25% of women have severe symptoms that are extremely detrimental to their wellbeing, affecting their ability to function as they used to on a day-to-day basis. The lucky remaining 25% have no symptoms at all. We would all like to be in the last tranche, but sadly, it’s a lottery. If you and three girlfriends sat around a table chatting and drinking tea, one of you would be wondering what the fuss was about, two of you would be finding your symptoms troublesome and one of you would be having a very hard time indeed. Lastly, the three of you experiencing symptoms could all be suffering from completely different things.
There are many symptoms of Menopause, and some are more well known than others. Hot flushes, while common – currently estimated at 79%5 – are not ubiquitous. They are often used as the yardstick for diagnosis or dismissal, which is unhelpful and isolates many women further. Conversely, depression and anxiety, while extremely common, are often wrongly considered as unrelated to Menopause and, therefore, not treated in the right context.
The table below is a list of Menopausal symptoms, some of which you will already know and others you may not have associated with it. I have split them into three sections in descending order of occurrence, i.e. the superstar symptoms we all know about and hear of in the press, followed by those that we are starting to hear more about. Lastly, I have included those symptoms we rarely hear about. In most instances, this is because we feel buttock-clenching embarrassment discussing them in public, while for others it’s simply that we never thought they were Menopausal symptoms before now. Gladly, through awareness this discomfort is slowly diminishing.
Take a minute to read over the list and tick the ones you think or know you are experiencing. This is important, because you will come back to this in the next chapter when we will look at their severity and impact.
Now that you have read and ticked your symptoms off the list, I am sure that some of you are horrified by some of the symptoms, hoping that you don’t encounter them. I can’t promise you won’t, because your symptoms are likely to change and undulate in severity before you get to your final post-Menopausal state.
SEVERITY
This leads us to the severity with which you experience symptoms. For some, and sadly I was one of them, Menopause can take you to a very dark place. For others, the symptoms are simply annoying. This can and does change as the hormone production from your ovaries (oestrogen and progesterone) ebbs and flows before finally giving up and leaving you with your new status quo.
I have been asked many times to describe what Menopause feels like for the unlucky 25%, often by those who will never experience it and those who are yet to. The best I have come up with to date is that it can be like having the worst flu, with a massive hangover, little sleep and intense morning-after anxiety, where you either burst into tears or struggle to contain pure vitriolic anger at anyone who even looks at you, all day, every day, for years. It can be a downward spiral which is hard to escape from. This sounds extreme and somewhat dramatic but, for some of us, that is how it is. It’s not surprising that the Samaritans in the UK report that the highest rate of suicide among women was in the 50-to-54 age group in 20176 and the 45-to-49 age group in 2018.7
I would like to reassure you, though, that this – as with the other two variances (duration and symptoms) – is very much at the far end of a sliding scale. Every experience is valid and deserves empathy and support, not judgment.
CHAPTER 5
VARIATION, VARIATION, VARIATION
Each woman’s Menopause is unique to them – one woman cannot be judged by another’s experience. There is no standard solution nor a support package that can be appropriately applied.
The degree of variance, plus the nature of the actual outward and inward symptoms themselves, is one of the reasons that culturally many have been reluctant to openly discuss Menopause in work or social environments, causing it to be swept under the carpet as though it were in some way distasteful. This is, of course, a ‘Catch 22’.8 Women don’t speak up because people find it an uncomfortable subject and find it easier to dismiss it than confront it. Unlike menstruation, which happens every month or pregnancy, which lasts nine months (if full term), Menopause has little uniformity and lasts for years. Yet, all of us have either known or interacted with a woman who was going through it, even before we ourselves started to be aware of our own Menopause. There is little else in life that has such a wide-ranging impact on all areas of life which, until recently, seemed to happen in secret.
We, as a society, have failed to communicate a simple message to women, advising what Menopause is, how it might impact us and the steps we could take, without swinging from the dismissal of ‘typical mad woman’ to horror stories of ‘it’s the end of the world and should be avoided at all costs’. We arrive at this phase of our lives uninformed and without the support structures needed. The lack of narrative and information that neither downplays nor scares us means that we have little in the way of commonly known signposts or conversation starters that we could call on at this time. If we had these, it would enable us to ask for help and support, with no stigma, shame or embarrassment from those we interact with, whether it be our colleagues or those we love.
It is entirely possible that we will spend a quarter of our career managing our Menopause, and a third of our life as a post-Menopausal woman. When you put it into perspective, it is no wonder that this generation of educated, informed and successful women want to bring this life event out of the shadows. In short, we are no longer prepared to take off our cardigans quietly and whisper in the shadows.
HORMONE REPLACEMENT THERAPY (HRT)
Before I begin, I need to state I am not a doctor and I cannot advise you whether to take HRT; therefore, my comments are simply my opinion. Some general observations are possible without medical training.
You will only be considering taking HRT if you are having a hard time with your symptoms, have a medically induced Menopause, have POI or, like me, have the early signs of osteoporosis (as well as a hard time). At this point you will need to consult your GP (General Practitioner) or a Menopause specialist9 to discuss your options and the risks. If your GP doesn’t feel comfortable prescribing HRT for whatever reasons, in the UK you can ask to be referred to one of the excellent NHS Menopause clinics or, alternatively, you could opt for a private clinic. If you are doing the latter, please ensure that they are a registered specialist recognized by a national body.
Opinions of HRT are divided into two camps. On one side there are those who say that it should be avoided at all costs due to the associated risks. On the other, they say that it is an essential part of women’s health and that the benefits far outweigh the risks.
During my entire Menopause experience, at different times I have sat in both camps.
Few treatments for any condition are free of risks or side effects. HRT is a choice that every woman needs to make for herself. We should be provided with up-to-date information on risks and benefits to enable a balanced choice to be made. As with many treatments, the potential risks need to be weighed against the positive impact on the quality of life it will bring. HRT can be life-changing for many. The choice to take it should be commended, not belittled.
CHAPTER 6
SUMMARY
W H A T W E L E A R N E D
Your Menopause is as unique as your fingerprint. Every woman will experience their Menopause differently. In fact, one in four of us will experience no symptoms at all. For those of us who do, there is a long list of possible symptoms.
We may experience one or many, the degree of severity may be annoying or utterly debilitating, and we may experience them from anywhere between four to eight years – or perhaps even over a decade. This level of variance is what makes each woman’s Menopause unique.
W H A T W E D I D
You looked at the list of symptoms and identified those which you are currently experiencing or have experienced. Some may have come as a surprise, and with others you may have crossed your fingers, legs and everything else in the hope that they would never be part of your life.
We recognized that symptoms may come and go throughout Menopause due to our ever-declining hormone levels.
H O W T H I S H E L P S
Knowing that much of what we experience at this time of life is due to our declining hormones and not something more serious, such as a debilitating or life-threatening disease, means that we can take action and gain control for ourselves. The fear associated with not knowing robs us of control.
Knowing that you are on a journey enables you to prime yourself for the changes ahead.