Recently, I watched an episode of Inside Out London which included an item about menopause. It showed a group of women talking about their varied experiences of menopause and how they tried to seek help from their GPs. One woman asked 19 times for a referral to an NHS specialist menopause clinic, whilst another woman was told by her GP that menopause was normal so she should “suck it up”. I found this extremely alarming. Why are menopausal women not listened to? Why is it that, just because menopause is part of a natural process for women, it should simply be ignored and endured? The answer is, of course, is that it shouldn’t be side-lined. If anything, it is precisely because menopause is natural that greater knowledge and understanding of it is needed.
What exactly is menopause? Menopause is when a woman stops having periods which is caused by a change in the balance of her hormones, particularly with levels of oestrogen. This usually occurs between the ages of 45 and 55, but it can happen earlier. Women who have surgery for instance, such as a hysterectomy (removal of the uterus), can go straight into menopause. Sometimes a woman’s ovaries might naturally stop producing oestrogen, resulting in early menopause. At other times, there is no clear cause for premature menopause. The first sign of menopause is irregularity in a woman’s periods in terms of heaviness and frequency, just like when you’re a teenager when your periods are first starting.
What are the symptoms of menopause? Symptoms commonly include: hot flushes; night sweats; insomnia / difficulty sleeping; reduced sex drive (libido); problems with memory and concentration; vaginal dryness and pain, itching or discomfort during sex; thinning of hair and increased hair loss; headaches; mood changes, anxiety and depression; palpitations; joint stiffness, aches and pains; reduced muscle mass, and recurrent urinary tract infections. An increased risk of osteoporosis can also develop. Symptoms can begin months or even years before a woman’s periods actually stop and last around four to five years after your last period. Sometimes they can last for longer, up to ten years or they may never cease completely.
As you can see, there is a huge variety in symptoms and their duration that women can experience. Some women experience hot flushes and depression whilst others have no flushes but suffer from insomnia. Some women might present no symptoms whatsoever. Every woman’s experience of menopause is different and unique, and that is what makes it so difficult to relieve – I say relieve instead of “treatment” because menopause is not an illness or disease that can be cured. Rather, it is a natural response to your body’s hormone changes, just like puberty in your teens.
Just as the symptoms are varied, so too are the options available to relieve them. Hormone Replacement Therapy (HRT) replaces the lost oestrogen and is the main medication used to relieve menopausal symptoms. Other sources for relief include maintaining a healthy weight and balanced diet, regular exercise, taking vitamin supplements and antidepressants. There are also natural herbal medicines that can help relieve symptoms, such as soya, sage, red clover and black cohosh. It is certainly not the case of ‘one size fits all’; what works for one woman doesn’t necessarily work for another. And of course, the problem with all medication is that it has side effects. HRT increases your risk of breast cancer and stroke whilst taking it, even if you only take it for the recommended five years. Family history of breast cancer and stroke can also increase your risk. In a BBC program, The Truth About The Menopause, a group of ten women shared their experiences of the menopause. All ten took HRT to relieve the symptoms and all ten later developed breast cancer. Now, this isn’t an article against (or for) HRT or any other sources for relief. But it just shows the kind of difficult choice menopausal women have to make.
Having seen first-hand what menopausal symptoms have been like for members of my family, I can comprehend that difficult choice. I understand what a hot flush feels like as I get them during my period. But this only lasts for a few days once a month. It is wearying to imagine having them on and off, all the time, day and night. Women have to make a decision based on what they value more: risk or quality of life. Naturally, if you’re feeling extremely depressed and even suicidal (as can happen), then you might be more willing to prioritise your quality of life by taking HRT and accepting its health risks. But if you’re symptoms are less severe, consisting of hot flushes and night sweats for example, you might be more tolerant towards them, deciding that the health risks attached to HRT are not worth taking.
Seeking advice from your GP about how to relieve symptoms doesn’t make things any easier. GPs’ knowledge of menopause and how to cope with it can be very limited – they are, after all, GPs, not specialists in menopause. Some women can be thrown into menopause and have no idea what is happening to them, what to expect or what to do about it. That kind of experience can be frightening and incredibly isolating, especially if you don’t feel like you can talk to anyone about it or that no one understands you. This is why greater knowledge and understanding of menopause is needed.
Specialist menopausal clinics would be ideal for helping these women. They would provide a space in which women could freely discuss their experiences in a safe and comfortable environment. Such a clinic would also help to eliminate the stigma and embarrassment of talking about menopause. It could provide a community amongst women where shared experiences could lead to shared methods of relief. The provision of this kind of clinic is naturally dependent on the NHS budget (which is another issue altogether). What exacerbates the lack of understanding is having others make jibing comments about the menopause. For example, in May last year, Ben Broadbent, deputy governor of the Bank of England, used the word “menopausal” to describe the economy. Not only was this comment sexist, but it also implied that the economy was past its best and unproductive. As if menopausal women didn’t feel bad enough, remarks such as these leave them feeling a lack of self-worth and angry. I doubt very much that a woman would have made such an observation, and I cannot help but feel that such a remark would not have been made in the first place if more was known about menopause.
It may be some years away for us university women yet, but menopause is something that will happen to all of us one day. It is such a life-changing process that I think it is important to learn about it and talk about it, even at our age. It’s also important for men to learn about it too so they can be in a better position to understand, support and help their female partners when they hit menopause. If the stigma surrounding mental health can be broken, there is no reason why the same can’t be done for menopause. The more we as a society talk about it, the more prepared we can feel for it and greater understanding and sympathy can be felt for those who experience it.