WHAT DOES MENOPAUSE MEAN TO YOU? AND HOW DO YOU MANAGE IT?
Menopause it’s a word that was never much heard as I was growing up. What about you, did you hear it mentioned often?
I would hear my elders, when the women would sit together discuss briefly that someone was “going through the change”. Usually giving acknowledgement to a woman’s recent uncharacteristic change in behaviour. As if it were some sort of thing to be endured! No support offered, no further conversation – just a label given, and the conversation would swiftly turn to something new.
Throughout history menopause was something to be feared – back in Ancient Egypt (1250 BC) there was reference to menopause being connected to witchcraft, which sounds a little crazy, however the most famous connection made between witchcraft and menopause came some time later, it was during the Salem witch trials. Whereby a group of young girls in their teenage years claimed to be possessed by the devil, blaming women in their menopausal years for being demons who had cast witchcraft into them. Over 200 people were accused of witchcraft. This created mass hysteria and of course the aforementioned, very famous Salem witch trials. It wasn’t just America where hysteria was created around a woman in her menopausal years. Not so long ago, as recently as the Victorian era in Britain, women would be incarcerated into mental asylums, with menopause being viewed as a mental illness. Women being labelled with such things as menopause induced hysteria. Women have had to endure such horrendous "treatments" as bloodletting, vaginal douches of morphine, lead or chloroform, purgatives, and enemas, and indeed worse, all for living to the age when their hormones go into decline!
Now, a very forward-thinking chap named Samuel Ashwell, (1798 – 1857) who was an English gynaecologist wrote a paper named “ Practical treatise on the diseases peculiar to women” and what he offered was really quite incredible, because he recommended: Reducing alcohol, Exercising and vegetarianism, which is pretty mind blowing, and well before its time! This is advice which still stands today.
He wrote “ It has become too general an opinion, that the decline of this function (menstruation) must be attended by illness, but this is surely an error. For there are healthy women who pass over this time without any inconvenience, and many whose indisposition is both transient and slight”
So, this very clever chap realised that, yes! There were women who struggled with this phase in their lives, but there were also women who didn’t, and that must be taken into consideration.
Things started to change for women around the time of Marie Stopes (1880 – 1958) she was seen as a bit of a champion for women, pursuing women’s rights. She firmly laid the blame for women fearing the menopause at the medical profession’s door. She stated they were "revolting, misleading and pedalling fear". Marie Stopes advice was to carry on as though nothing was happening , and not to worry as the menopause was nothing special.
In 1941 Premarin, the first synthetic oestrogen was patented and sold as a treatment for menopausal symptoms (Premarin was a conjugated oestrogen, isolated from the urine of pregnant mares …. Yes horses!)
It wasn’t until the swinging 60’s , around the time of the contraceptive pill, that there was some momentum, Robert Wilsons book “Feminine forever” caused a bit of a stir among women, he had written that “women on oestrogen therapy would be much more pleasant to live with and will not be dull and unattractive!” Surprisingly he sold 100,000 books in a matter of months, and women were now attending their GP asking for oestrogen supplementation. Sales of Premarin went through the roof.
Then along came another forward-thinking chap around 1969, Professor John Studd who set up (horror of horror!) the first menopause clinic in the UK. A service especially for women, with the aim of helping women understand and support their body through the changes experienced during this transient time in their lives. Unfortunately, this caused such an outcry from the medical profession, who protested bitterly, the clinic was closed for 3 months. However, by the 1990’s HRT had fallen out of favour due to the results of some studies citing its risks were greater than its benefits.
So what do we need to know?
The gap between menopause and life expectancy has widened. In the 1850’s life expectancy was 45 and the average age of menopause was 45. So many women didn’t actually reach their menopausal years.
Shoot forward to 2009, and the average life expectancy was 82 and the average age of menopause was 51. So, in this respect 30% of a woman’s life is in her post-menopausal years. Wouldn’t you agree that’s an excellent reason to understand our body, know what’s going on, and just what we can do to support ourselves as women?
And what exactly is menopause? Menopause is defined as having had no period for 12 consecutive months. For some women this can really feel almost like a bereavement – that they have come to the end of their childbearing years, feeling a loss of womanhood and purpose, and in no way ready to accept the role of the “Crone”. Others ? well, they are beyond delighted, can’t wait to crack open the prosecco and embrace all the wisdom they have collected over the years, ready to support those other females in their close circle.
The stage that comes before menopause is known as perimenopause, and this is when all the fun and games begin, our hormones are completely out of whack, and we notice changes with our body, mind, and emotions.
Perimenopause is diagnosed in those over the age of 45 with symptoms and irregular periods. In those under 45 a blood test will be taken to diagnose an early menopause. Typically, it is progesterone that will start to decline first, this is the hormone that will trigger a lot of the psychological and emotional symptoms related to anxiety, mood swings low mood, loss of confidence, brain fog and loss of concentration etc. there are lots of women who go through these types of symptoms and don’t link it in any way to declining hormones and perimenopause. Often this may be because they are still having regular periods and see themselves as too young in their early 40’s to be in any way affected by perimenopause. Often feeling as if they are going mad, they may speak to their GP and subsequently be given anti-depressants. Anti-depressants tend not to work for declining hormones.
Along with progesterone, oestrogen also starts to decline rapidly. Follicle stimulating hormone (FSH) for egg growth, and Luteinising hormone (LH) for ovulation start to rise, attempting to compensate and kick the body into producing more oestrogen and progesterone again (but that doesn’t work) and egg release stops, the uterus no longer builds up or has the need to shed – resulting in no periods!
Oestrogen dominance is possibly the biggest contributor to a tricky menopause – and symptoms of oestrogen dominance could include :
FATIGUE, DEPRESSION, WEIGHT GAIN, FLUID RETENTION,BLOATING, HEADACHE, UNSTABLE BLOOD GLUCOSE LEVELS, LOW LIBIDO, MOOD SWINGS, IRRITIABILITY ENDOMETRIOSIS, LOW METABOLISM, CRAVING SWEET FOODS, CRAVING CARBS, SLOW SLUGGISH MORNINGS
Every woman is different and every woman’s journey with perimenopause and menopause will be personal to themselves. Can you remember the transition you had in your teens? When your hormones were flying loose, you started to grow breasts, widen at the hips, sprout hair and started menstruating, would fly of the handle if someone dared to look at you sideways, and be a teary emotional mess? Well, it’s a bit like that all over again. I bet your journey was different to your friends at the time.
As it goes approximately 20% of women will have every symptom going and have the worst experience ever, just having a really difficult time of it. Then around another 20% will fly through it, without batting a false eyelash, pelvic floor intact, wondering what all the fuss is about. Then there’s those of us who meander along somewhere between the two with varying symptoms, to different degrees of severity.
Symptoms can last between 4 and 10 years on average. It is so important that women are educated, encouraged, and empowered to self-manage where possible, and that they have access to professionals where required.
Menopause is not a period of illness; it’s a natural process which all women will go through. Its only in more recent times with celebrities such as Davina McCall, Gabby Logan and Louise Minchin flying the flag for menopausal women everywhere that conversations are now being had, and rightly so! Because if we don’t talk about it, how do we know how to deal with it? How do we know what to look out for?
The most common menopausal symptoms include:
HOT FLUSHES, NIGHT SWEATS, PALPITATIONS, CLAMMY SKIN, IRRITABILITY, MOOD SWINGS, INSOMMNIA, IRREGULAR PERIODS BLOATING, ALLERGIES, DRY VAGINA, FATIGUE, ANXIETY, DRIVING ANXIETY (yes its a thing!), DEPRESSION, POOR CONCENTRATION, POOR MEMORY, INCONTINENCE, ACHEY JOINTS, ACHEY MUSCLES, HEADACHE, MIGRAINE, WEIGHT GAIN, HAIR LOSS, FACIAL HAIR, WEAK NAILS, DIZZINES, GUM DISEASE, BAD BREATH, OSTEOPOROSIS, TINNITUS (this list unfortunately, is not exhaustive!)
Post-menopausal women are at risk of several long-term conditions such as osteoporosis and heart disease. Long term issues can occur and worsen post menopause due to the continuing decline of oestrogen. The most common symptoms post menopause include:
VASOMOTOR SYMPTOMS such as NIGHT SWEATS and HOT FLUSHES, UROGENITAL ATROPHY, OSTEOPOROSIS, CARDIOVASCULAR DISEASE, CANCER, DEPRESSION , ANXIETY, MENTAL CONFUSION, POOR CONCENTRATION, VAGINAL DRYNESS, IRRITABILITY, INSOMNIA, HEADACHES.
Lower genital atrophy can cause urinary urgency, incontinence and repeated urinary tract infections, painful sexual intimacy – this is common in more than 60% of women by the age of 75, but is under reported, as many women see it as having to be accepted and are too embarrassed to discuss it, many thinking they are alone in their suffering. Which is not the case, its just NOT being spoken about!
Musculoskeletal changes, loss of muscle mass and strength, bone density, inflammation cardiovascular disease, collagenous problems with skin, mucous membranes, and blood vessels. Dementia and cognitive decline – sound’s bloody horrendous! , doesn’t it? and no one talked about it until very recently.
Menopause can affect men and partners too; relationships have failed and do fail due to the stress from menopause.
With most women working, perimenopause and menopause can really impact on our job. Workplaces should now be providing adequate support so that. Women feel safe and supported during this time. The equality act 2010 mentions menopause, and that all workplaces should now have a menopause policy. GP’s also now have access to guidelines on how to manage menopause from the National Institute of Clinical Excellence (NICE).
It really is up to you as a woman and an individual whether you want to see menopause as a curse, or an opportunity as a healthy ageing journey. The more we discuss menopause the more educated on the subject we become, and the more we can help each other as women, get ready for this next stage in our lives. As women we need to start looking at menopause as a positive stage, a stage where we can take stock of our lives and make changes to move into “healthy ageing”. As I said earlier if we live into our 80’s or 90’s, then that’s a third of our life in post-menopausal years …. So, let’s get ready for it!
Let’s not be like our elders who didn’t discuss these things, let’s make sure we support younger females to know menopause doesn’t need to be a nightmare. Perhaps healthy menopause should be included in the school curriculum for girls, as part of health and lifestyle education. Teaching girls how to support their hormones as part of their self-care. Remember that clever chap? Samuel Ashwell, the gynaecologist from the 1800’s who was very much before his time. Perhaps if he had been listened to and his work acknowledged at the time, with further research done in this area, we would have been far more aware of how our body works and just what we could do to support it as individuals long before now.
A healthier lifestyle approaching menopause means an easier menopause. We have access to so much information now, with books, magazines, podcasts, research articles etc, it really isn’t difficult to find the information we require.
The most important thing to recognise here as a woman is – We have a choice! For some the natural approach is their choice and for others its HRT, because no matter what they do, they just need a little extra help.
The new body identical HRT involves the use of hormones that are chemically identical to those produced in the human body, they are often better tolerated than the older forms of HRT and may carry fewer side effects.These are the more commonly used by GP's and can be effective in managing menopausal symptoms, protecting bone health and cardiovascular health.
HRT, however, isn’t a magic button! The body still needs to be a receptive environment for the HRT to work properly, so things like diet, lifestyle, stress management, exercise and sleep are still crucial parts of the bigger picture. Many women refuse HRT because of the headlines in the press. What we need to remember is all medication has side effects, it’s a case of weighing up the benefit against risk for the individual. The pros and cons must be discussed with your GP and allow it 3 to 4 months to “bed in”. If you choose to start HRT it should ideally be reviewed at 3 and 6 months, to ensure it is effective and address any difficulties. Remember the risk will return to baseline on stopping the HRT. If its not working for you go back to your GP to discuss what next. If you have had a hysterectomy, you will not require progesterone, this is only required to protect the lining of the uterus.
HRT does not “delay” the menopause, it overrides natural hormones, and symptoms. When stopping, the hormones have free reign again and can often become a bit wild for a time, with symptoms returning, and taking a wee while to settle back down.
A study carried out by the British menopause Society found 95% of women would try holistic therapies before HRT, as they felt it was more in keeping with their body, its natural cycle, and because of the worry around health risks and HRT.
So, I hear you scream – “what can we do to help ourselves as much as possible?”
Well, we can learn which body systems to optimize to aim for a healthy menopause. We can take our power back as women and take control of our hormones, our body, and our autumnal years. It is in our hands!!!
We want to ensure we are encouraging optimal digestion, and absorption from our gut, to ensure our body is getting everything it needs at this crucial time, and that if we are taking any supplements or medication, it is being absorbed. We want to be aware of our blood sugar regulation, ensuring our blood sugar is balanced through a supportive diet. Building our immune system and reducing inflammation, ensuring optimal thyroid function, increasing antioxidant status, improving structure and strength – through exercise, and of course sex hormone balance, ultimately, we would also want to reduce stress from all areas of our life, mother nature is wonderful and didn’t just abandon us completely, like all good women, she had a back-up plan. The plan was the adrenal glands (two little glands sitting just at the apex of your kidney’s) would start to produce a weaker form of oestrogen post menopause to help us remain fit and healthy. However, its worth remembering the adrenal gland produces stress hormones first and foremost and will put those stress response hormones above all else. If we are over stressed with work, family, juggling far too many balls with no time for ourselves then the adrenals won’t be putting your oestrogen first, they are too tied up with the stress response, releasing cortisol and adrenalin, which – yep! You guessed it has a direct hit on our hormones causing further imbalance, and a lot of us women know nothing about any of this, and put ourselves under so much pressure to "do it all".
Stress is a major factor for your hormone health, not just stress from doing too much, worrying too much, our bodies become stressed from poor lifestyle choices – things like too little sleep, too much and too little exercise, alcohol and other toxins from our diet and our environment – these things all cause stress to the body and disrupt the body’s own natural equilibrium by disrupting our hormones.
We need to realise that what we put into and onto our body will have an impact on our hormones, and by sticking to supportive foods, reducing toxins, and getting our metabolism going, we really can help our body as much as possible, hopefully having a reduction in symptoms and less of a requirement for exogenous hormones. However, for some women, exogenous hormones are required, because they are just having the most horrendous time of it, or they just don’t have the time or inclination to set about sorting out their diet and lifestyle, and that’s OK! Because we are all unique, we all have “life” going on, and what may work for one woman, may be the idea of another woman’s hell!!
It really is all a bit of a minefield, isn’t it? The multi million dollar question you need to ask yourself is
“ who do you want to be for the next stage of your life?” Is it time for you to start planning and initiating change?
If you think you may need some help managing your menopause please sign up to my newsletter, via the pop up on the first page of my website. Check out the reflexology in menopause programme "Mastering Menopause" This programme will provide you with 6 weeks of reflexology targeted to your specific needs, we will assess your lifestyle together, by looking at the 5 pillars of menopause health. looking at what areas you feel you need to tackle first from these 5 pillars. Focusing on what is most important to you as an individual. It will provide you with information on diet and lifestyle, empowering you to go forward with confidence. At the end of the 6 weeks, you can choose whether you wish to continue attending for reflexology which will continue to support you through peri-menopause and menopause, while you continue to put into practice the dietary and lifestyle changes you have made.