How to have a happy menopause
THIS ARTICLE BY LOLA BORG FIRST APPEARED IN STELLA MAGAZINE 20th OCTOBER 2018
It’s official: the menopause is being rebranded. New research reveals that women at this stage are feeling more fired-up and ambitious than ever – and what’s more, symptoms, from hot flushes to anxiety, can be fixed.
Menopause has traditionally had a bad rap. A perfectly natural life transition, it’s either glossed over or the butt of bad jokes such as Joan Rivers’ one about the menopausal friend who came to lunch and ended up steam-cleaning the carpet. No wonder women often choose to ignore it – until they are confronted by shouty symptoms that demand attention. But more and more women are now looking at ‘the change’ differently.
Rather than burying their heads in the sand, they’re choosing to approach the menopause actively and openly – not just striving to break the stigma, but also to tackle the symptoms. Because the same women who are having night sweats are hot in other ways, too. With children growing up and gaining independence, women in this life stage have more time and headspace than they’ve had in years: they’re setting up their own businesses, running countries or corporations, or simply restarting their lives.
Two thirds of menopausal women feel that they’re in the prime of their lives, with nearly 70 per cent considering themselves more ambitious than a decade previously – according to new research by female-run marketing agency SuperHuman, exclusively revealed to Stella.
They found that the wider perception of the menopause totally contradicts how menopausal women see themselves–no wonder that 81 per cent feel they’re misrepresented in society. ‘We really believe the menopause needs a rebrand,’ says SuperHuman co-founder Rebecca Rhodes. ‘It’s bang out of date. Its cultural, medical and societal portrayal is out of touch with how women live their lives today.
We initially did this research because our agency helps brands engage with women. And this is a hugely important universal life stage that has been totally ignored and isn’t ever featured in marketing campaigns in the way others are.’ Emma Edwards, 51, a comedy writer and performer, is another woman trying to drag the menopause into the spotlight. She decided to take action after witnessing her friend and writing partner, Abigail Dooley, go through it a couple of years head of her, and is herself now in the middle of what’s known as the perimenopause (the hormonal Himalayas that lead up periods actually stopping).
Comedian Emma Edwards, who is touring a two-woman show about the menopause
She knew the menopause was the horizon but initially, like many women, failed to join the dots. For her, symptoms have included ‘sponge brain’, migraines, memory lapses (‘I couldn’t member my child’s name’), brittle nails, strange rashes and disturbed sleep.
Then there was what she describes as occasional fury. ‘You know when you have PMT and you get irritable? This wasn’t that. I was furious and found myself walking by the beach shouting at the sea,’ she says described my symptoms to Abigail “Oh yes, it’s definitely the menopause." Emma researched what she could alleviate symptoms (see box overleaf) she and Abigail channelled their experiences into a two-woman show, Enter the Dragons. Performed by the pair at Edinburgh and soon to go on tour, it busts the myth around this stage of life. ‘I started writing the show because I got to 49, I really wasn't OK with it, and it was a way of exploring that,’ Emma explains.
So what can be done about the plethora of symptoms? Quite a lot, actually. And it starts with learning what’s going on in your body. SuperHuman’s research found around two thirds of women have no idea how to manage the symptoms. Some 69 per cent of women suffer in silence, and 71 per cent don’t feel comfortable talking about it.
Pretty scary. So here’s the science bit: at actual menopause the ovaries stop functioning, producing no oestrogen, progesterone or testosterone, and it is no longer possible to become pregnant naturally. This is preceded in most (although not all) women by the perimenopause, starting at any age from around 45, but on average in the late 40s. This can be a time of roller-coaster hormonal fluctuation – the ovaries’ last hurrah as it were – typified by menopausal symptoms such as night sweats. Many women find this stage harder than the menopause itself, which often is considered to be one year after periods stop, or when the ovaries more or less cease all hormone production.
Hormone replacement therapy (HRT) was the go-to treatment to alleviate menopausal symptoms until around 2002, when studies–now largely considered to have flawed conclusions – linked it to an increased incidence of breast cancer, heart disease, stroke and blood clots. But more recent thinking suggests HRT is beneficial.
‘NICE guidelines now state that it’s safe to give women HRT if they need it,’ says Dr Jan Toledano of the women-run London Hormone Clinic. ‘It’s important to stress that women do not need to suffer – they can get HRT if they want to.’ HRT, she explains, works by topping up the hormone that is not being made – she compares this to treating diabetes with insulin. Blood tests are sometimes prescribed by GPs, and it is crucial to get the diagnosis right in order to prescribe the correct HRT. However, the symptoms alone can often be enough to make a diagnosis.
Many women prefer BHRT (using body or bioidentical hormones, derived from more natural sources such as plants; seelondonhormoneclinic.com for more information), often paying for private treatment, although some bioidentical hormones are now available on the NHS. "For example, all the oestrogens you get are body-identical now, which didn’t use to be the case," says Dr Toledano.
So far, so logical. But every woman’s experience of the menopause differs – not just medically but emotionally and culturally. Much has been made of studies that show Japanese women suffer fewer symptoms and, indeed, don’t even have a word for hot flush. On the other hand, in the UK the highest rate of suicide for women is among those aged 50-54, with the number slightly creeping up this year.
Ten per cent of women experience depression during menopause. There is, says Toledano, still fear and shame about this life stage. Among women I spoke to, a common theme emerged: most wished they had been better informed so they were not hijacked by pesky perimenopausal symptoms. ‘I still have up to 10 hot flushes a day,’ says Helen Brewer, 56, who runs her own company. ‘I haven’t worn a polo-neck jumper in six years. Who knows what’s going on? Not me.’
Many women expressed how truly frightening it is to be held hostage by mood swings, off-the-scale PMT and depression. There was a common feeling of ‘not being myself’. Pretty much all of them seemed unsure when their menopause or perimenopause started, when it might stop and which precise stage they were at.
Symptoms had often been mistaken for other medical conditions. One nurse assumed her anxiety was a cardiac arrest (which sparked a sitcom-style sequence of events). Anxiety and depression are a common feature but untangling these can be tricky, as the late 40s and early 50 is often a time when ‘stuff happens’: children become independent or moody, so there are possibly two sets of rogue hormones at work; parents are needy; there are separations, divorces, work changes, bereavements. Getting the hormones right, says Dr Toledano, can help women cope with what life throws at them. So how does it feel to have a faulty internal thermostat?
Katie Phillips, 44, a transformational life coach and founder of School of Self Love, was taken aback by sudden adult acne, ‘crazy periods’ and inexplicable depression. When female friends suggested she might be perimenopausal, she says, ‘I hadn’t even ever heard of it. Then I felt worse. I thought, “Oh my God, I’m going to lose my sex drive and everything is going to dry up” Until I realised… hang on, I’m a life coach. If I believe this is going to be horrible, it will be horrible’.
Katie did see her GP for a blood test, but only after she had educated herself y making a series of video interviews with experts on the menopause, which she posted on YouTube so that they might benefit others. What helped her, she says, exercise (walking, yoga), supplements, meditations – but above all a change of mindset to approach the menopause positively, which made her feel she was in charge of her own body.
It is clear there is no average transit through perimenopause and menopause, and no standard treatment. If only. But, HRT to one side, commonly it is diet and exercise that women use to steer them through. Some swear by herbal remedies, some by upping their supply of natural phytoestrogens (such as soy), and most by taking care of themselves in a way they hadn’t, especially through the child-rearing years.
‘Every time I got a symptom I worked really hard to resolve it. I’d think, “How can I make this better for me?”’ says Emma’s comedy writing partner Abigail, 55. ‘Some things have worked, such as herbal remedies for night sweats. Some symptoms I had to sit out.’ For Emma, the trick is yoga three or four times weekly, an improved diet, far less alcohol and a weekend retreat, Menoheaven, which she went on as research for the show. ‘It really helped me to think about menopausal symptoms not as your body going “wrong” but doing what it is supposed to do,’ she says. ‘As soon as I decided to make it a positive experience, that was the game changer.’ Bring on that rebrand.
What you can do about it
Be informed
Read as much as you can, and talk to other women as well as experts. Research shows women are happiest talking to other women (many areas have local groups or ‘menopause cafés’. Women’s Health Concern(WHC) has free, no-nonsense fact sheets.
Get advice
See your GP or a specialist clinic to talk over symptoms and treatments. HRT can be prescribed on the NHS, as can some bioidentical hormones. HRT appears to be the most effective treatment for symptoms such as vaginal dryness and reduced sex drive.
Nutrition and exercise
This is 50 per cent of what a woman can do to help herself, says Dr Jan Toledano of the London Hormone clinic. Nutrition often needs to change around the time of menopause because the body manages blood-sugar levels less efficiently, so carbohydrates are not metabolised as well. Eating fewer high carbohydrate foods can help (for guidelines look at dietdoctor.com, she suggests). A Mediterranean-style diet – rich in protein and useful fats such as olive oil – can be beneficial too, as can exercise. ‘But it has to be proper exercise,’ says Dr Toledano, ‘and not just walking to the station.’ Anecdotally, yoga and Pilates both appear to be effective.
Find alternative treatments
In trials, herbal remedies such as black cohosh (for hot flushes) and St John’s wort (hot flushes and night sweats) have been proven to alleviate symptoms, but they can interact with other medications so ask your GP before taking them. CBT (cognitive behavioural therapy; WHC has a downloadable guide), available on the NHS, is an evidence-based method for dealing with anxiety, stress and low mood, and can give practical strategies for dealing with hot flushes and night sweats too.
Know it doesn't last
The perimenopause is the space between a normal menstrual cycle and the point when periods stop. ‘In other words,’ says Dr Toledano, ‘it will pass.’
Enter the Dragons is on tour from 2 November. Visit The School of Love website for details of ‘My Menopause – The Interview Series’ and the women’s retreat ‘Rise’ – there is a £250 discount for those who quote ‘Stella’ upon application. Menoheaven can be found at florencehouse.co.uk