Why does the menopause remain such a taboo subject?

Why don’t we talk openly about menopause? Is it taboo? Or mere embarrassment? Áilín Quinlan investigates.
Why does the menopause remain such a taboo subject?

The list of menopausal symptoms is not only long and hair-raising, the misery can last for years.

From night sweats to hot flushes, from anxiety, weepiness and onsets of rage or irritability to insomnia-induced exhaustion, forgetfulness and reduced concentration, menopause is often deeply disturbing.

And let’s not forget the aching joints, sore breasts, weight gain, or the reduced sex drive, a potentially significant stressor for relationships.

This is only a sample of the challenges in store for many women from their mid-40s or in some cases, even earlier.

Symptoms can range from mild to severe — and as British-based Dr Marion Gluck, a long-time expert on the miseries of menopause explains.

“In some cases, it can be dramatic, either emotional or physical — women can put on weight, or be unable to lose it, they can experience joint pain and melancholia, insomnia.”

In many cases the symptoms can become so overwhelming, she says, that doctors will assume a woman is depressed.

“Many women have been falsely diagnosed as depressed,” says Dr Gluck.

Yet, strangely, given the massive physical and emotional turbulence which so often accompanies it, menopause tends not to be openly discussed.

As Dr Julia Prague, endocrinologist and clinical research fellow at Imperial College London observes: “Menopause is under-represented in terms of what people discuss. Sometimes women feel that because no one is talking about it, they’re the only ones experiencing these symptoms.”

Alas, when women do get up the courage to broach the issue, she says, people can be dismissive.

“As a result, it is an issue that is not really out there.”

BBC news presenter, Kirsty Wark (below), who entered menopause at the age of 47 following a hysterectomy, believes women are still “shockingly ill-informed” about what it actually is and how to deal with it.

“Every woman goes through the menopause but there is something about the word itself which has these negative connotations of ageing and atrophy,” 62-year-old Wark observes in The Insiders’ Guide to the Menopause, a recent BBC Scotland documentary.

“In our youth-obsessed culture that is debilitating for women, even embarrassing. We are all living longer and the menopause is a feature of mid-life. It’s the start of a new chapter, so why the persistent taboo?”

Lack of knowledge about menopause is a problem, according to Aisling Grimley, founder of the popular Irish menopause website My Second Spring.

The website gets more than 2,000 page views a day from all over the globe and, says Grimley, the menopause and its link with hormone disruption in the body is not generally understood.

On top of that, she adds, every woman’s experience of menopause tends to be different — something which contributes to the lack of clarity about the condition.

Grimley, also warns that supports for women experiencing menopausal symptoms “are very thin on the ground.”

Even GPs, she says, are not always well-informed about menopause which is also often associated with a drop in libido, a result of changing levels of sex hormones. This, in turn, can cause relationship problems and reduced confidence and self-esteem.

However, observes Grimley, whose website contains advice and tips on how to enjoy sex at menopause, many post-menopausal women find they enjoy the best sex of their lives as they are free from the worry of pregnancy as well as the bother of monthly periods and the emotional roller-coaster which is so often associated with the monthly hormone cycles.

In the meantime, a new form of help is on the way.

Dr Prague reveals that research has shown that, of the avalanche of symptoms which accompany the onset of peri-menopause and menopause, it’s the hot flushes, the night sweats and the lack of sleep that appear to affect women most.

Studies also show that on average, night sweats and hot flushes remain for 7.4 years.

“It does go on longer than people actually appreciate,” she says, pointing out that if you’re waking up repeatedly at night as a result of night sweats, it’s not surprising that your memory and concentration are affected, or that you’re irritable.

A new medication is in the pipeline which, it seems, can reduce the frequency of hot flushes, as well as their severity and impact on a woman’s life, by nearly 75%.

In April it emerged that successful early-stage research carried out at Imperial College London had established that the drug, which works by targeting receptors in the brain, can help women affected by flushes and night sweats.

These are women for whom traditional Hormone Replacement Therapy was either unsuitable or unwanted, due to safety concerns.

The research carried out by Professor Waljit Dhillo and Dr Prague, both of Imperial College, showed that a twice-a-day oral tablet — which, unlike HRT, does not increase oestrogen levels — had benefits for study participants because it blocks a chemical in the brain called neurokinin B (NKB) which, studies show, appears to be linked to hot flushes - researchers have found that the new medication is safe and effective.

However, warns Dr Prague, it could be up to five years before the pill comes on the market.

When it does arrive, it will offer women an alternative to Hormone Replacement Therapy which experienced a drop in popularity some years ago following the publication of findings from the Million Women Study.

This study confirmed findings that women currently using HRT were more likely to develop breast cancer than those who are not using the therapy.

But several years later, the National Institute of Clinical Excellence (NICE) a body that recommends prescribing and treatment in Britain, stated that a review of the research showed that for women around menopausal age, oestrogen-only HRT caused little or no change in their risk of breast cancer.

And while HRT which contains both oestrogen and progesterone may increase breast cancer risk, it found, the effects were minimal.

However, says Dr Prague, there is still evidence of an increased risk of breast cancer, cardiovascular disease, stroke and blood clots after five years on HRT.

“If you have had breast cancer or have it, or have a history of blood clots, the medical advice is not to take HRT. That is where our medication will hopefully help.

“Lots of women avoid HRT because they are worried about breast cancer, so our treatment will help anyone who does not want to or who cannot take HRT.”

Herbs offer significant relief to many women, says Galway-based medical herbalist, GP, author and founder of www.healthandherbs.ie Dr Dílis Clare.

Dr Clare, who has worked in the area of herbal medicine for some 20 years, describes menopause as a “process,” and not an “event” - but she reassures, the symptoms are temporary:

“Once the hormones settle into their new balance, it’s like being in a steady state and on an even keel for the rest of your life,” she explains.

“Menopause is a transition from the state of reproductive expectancy to independent physiology, and the process is a lot of work for the body,” she says, adding that in her experience patients have found significant benefits from herbal remedies.

“Dandelion root is good for helping hormone elimination through the bile, Ladies Mantle tones the pelvic organs, Dong Quai or Angelic Sinessis is very important for energy balance, and also balances the female hormones — these are herbs I have found to be most effective,” she says.

Dr Clare uses these herbs and others in the preparation of tinctures for her clinic Health and Herbs in Galway.

Dr Marion Gluck, who has worked in the area of bio-identical hormone therapy for more than 20 years, says her patients find the treatment very successful.

At her clinics in London and Italy — she’s in the throes of setting up a clinic in Malta, and is also planning to set up another in Dublin over the next six months — she sees patients from Ireland, Britain, Europe, the Middle East, India and Africa.

“The hormones are identical to the woman’s own hormones and therefore they are a perfect fit,” she explains.

Once a hormonal imbalance is diagnosed, a personalised treatment plan of bio-identical hormones is specially formulated for the patient - the medication is usually prescribed as a lozenge or cream, tailored to the patient’s requirements.

Because every woman’s endocrine system is different, she explains, every woman needs an individualised treatment tailored to her specific requirements.

“With bioidentical hormones this can be provided, as opposed to HRT, which is a kind of one-size-fits-all-or-many form of treatment. With bioidentical hormones you can give the person a prescription which is tailor-made,” she says.

“A majority of women want to stay on the therapy indefinitely because their quality of life improves significantly.”

Dr Gluck’s personalised treatment comes at a cost — on top of the initial consultation fee of £260 (€310), the tests cost about £1,000 (€1,184), and, after that, the prescription is about £50 (€60) a month.

While menopause is a natural process, it can last for years and is potentially a hugely disruptive and difficult experience.

And, while women may have some control over how they manage their symptoms at home, it can be more difficult in an inflexible workplace where there may be rigid rules on opening windows or taking toilet breaks.

Raised body heat, for example, can make uniforms and workplaces uncomfortable.

Kathryn Colas, a British-based company director says menopause is “the last workplace taboo”.

Looking to normalise the menopause, she believes that senior female managers have a pivotal role to play in putting training and policies in place to help mature female employees through ‘The Change’.

Such policies and training may still be well down the road. However, one thing is clear — we really do need to start a public conversation about this hugely disruptive phase in women’s lives.

Pause for thought

Educate yourself about peri-menopause and menopause so that you make informed decisions. Start reading about menopause from your early 40s advises Aisling Grimley.

Help break down the taboo about menopause — talk about it openly with your friends and acquaintances, discuss how difficult it can be, and how you make it better, advises Dr Julia Prague.

Consider HRT — chat to your GP about it, says Dr Prague

Investigate the benefits of cognitive behavioural therapy, suggests Dr Prague — research has shown that it can help

Take 30 minutes of exercise every day — walking is fine.

Eat lots of vegetables, oily fish and drink lemon water daily — it’s great for flushing out your digestive system and cleansing the liver, says Grimley.

The second big chapter

Former investment banker Catherine O’Keeffe, 46, is acutely aware of the impact of menopause — she’s currently writing an e-book on menopausal anxiety for the My Second Spring website on menopause.

Catherine O’Keeffe says exercise, healthy eating and self-care are key to managing the transition. Picture: Dave Meehan
Catherine O’Keeffe says exercise, healthy eating and self-care are key to managing the transition. Picture: Dave Meehan

Currently the Rathfarnham, Dublin stay-at-home mother of three boys aged four, seven and 10 has entered peri-menopause, a period which takes place over several years in advance of menopause.

Based on the symptoms she’s been experiencing, discussions with friends and an informative visit to her GP, who said that the indications were that Catherine was peri-menopausal, she believes she has now entered The Zone.

“It’s hard to pinpoint peri-menopause scientifically, but over the last nine to 12 months I’ve had pre- menstrual tension which I have not had in decades, as well as heavy periods, bloating belly, tenderness and cramps which also I haven’t had for a long time,” she says.

Other symptoms include bouts of ‘flooding’.

“Peri-menopause is a hormone rollercoaster similar to what you go through at puberty and through adolescence.”

Catherine, has done her research and takes self-care seriously.

“I take evening primrose oil, omega three and a good multi-vitamin,” she says, adding that she monitors her iron levels and takes regular exercise and is careful about her diet, avoiding all sugar.

It’s not all plain sailing. She does experience irritability and mood fluctuations, all of which have resulted, she believes, from being in peri-menopause.

“I use omega3 and homeopathy to counter mood imbalances and find a combination of these, with diet and exercise, work very well.

“Peri-menopause is the second big chapter and the more preparation you put into it in terms of becoming knowledgeable about it — that is knowing what to eat and the importance of exercise and self-care, the easier the transition will be.”

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