Essential Menopause survival guide
Menopause-related anxiety can have a huge effect on women's lives, at home and at work, and it is being worsened by the pandemic. It's vital women in midlife are correctly diagnosed and given the support they need, say health experts.
hen TV presenter Davina McCall recently revealed that she feared she had Alzheimer’s disease because of memory lapses due to the menopause, there was an outpouring of support and much recognition from women experiencing similar symptoms.
Speaking to Gabby Logan on The Mid.Point podcast, McCall, 53, said her doctor had told her she had ‘cognitive overload’. A mother of three, McCall added: “And at our stage in life often our kids are all older. We thought it was going to get easier. It does not,” she said.
Cognitive overload is a term that will chime with many multi-tasking women who are experiencing the perimenopause or menopause. The menopause occurs when a woman’s oestrogen levels decline and she stops having periods and typically happens between age 45 and 55. The perimenopause is the phase leading up to the menopause, when a woman’s hormonal balance starts to change, but a woman still has periods, which may begin to fluctuate in occurrence, duration or flow.
While some women will get through both relatively unscathed, for others, it can bring a host of unwelcome health issues. While hot flushes are the most well-known — and joked about — there is a long list of symptoms which many women are unaware of, including brain fog, palpitations, joint pain, fatigue and poor sleep.
As McCall pointed out, many women will be dealing with these issues while also juggling work, home, childcare and often caring for elderly or unwell parents.
hile anxiety is recognised as one of the symptoms of perimenopause, research in Britain carried out in 2019 found that over a third of women going to their GP with symptoms of the menopause were being offered antidepressants, with many experts arguing that hormone replacement therapy (HRT) or talking therapies such as cognitive behavioural therapy (CBT) might be a better option for such women.
This is a view backed up by Dr Deirdre Forde, founder of Ceile Medical, a dedicated women’s health and menopause care clinic in Athlone, Co Westmeath.
“Because anxiety can be one of the main initial features of perimenopause, women are often automatically given anti-depressants, which is horrendous. I see a huge number of women who say their GP wanted to give them antidepressants, they were told they were too young to be having the menopause. These were women in their 40s.”
Forde says she sees women who often think they are mentally ill rather than experiencing perimenopausal symptoms.
She says women’s relationships are also suffering because of such symptoms, and she will often invite their partners to a joint consultation to explain what is happening.
“There are a huge number of marriages that have broken up because of these issues, there is no doubt. Women say to me: ‘My marriage is going down the tubes, and my husband doesn’t know what is going on’. I tell them to bring their partner in and I will talk to them. I explain exactly what is going on, I educate both of them.”
Dr Aoibhe O’Driscoll runs a dedicated menopause clinic at the Blackrock Medical Centre in Cork, and is a certified menopause specialist with the British Menopause Society. She says while doctors are trained to take care of their patients, the variety of symptoms of the menopause can be difficult and complex to assess without specific menopause training which can lead to patients being frustrated. While most of the women she treats have hot flushes and sweats, only a small percentage present solely for management of those symptoms.
“The psychological symptoms cause most of the distress. Women capable of running a very efficient home or even their own companies complain of new onset poor concentration, difficulty retaining information, forgetting their colleagues’ names, having to write everything down, making simple mistakes at work, anxiety, being overwhelmed easily and subsequent poor self-confidence/low esteem,” she says.
s for women being prescribed antidepressants when HRT might be a better option, O’Driscoll cites the results of the much-debated Women’s Health Initiative trials in 2002, which linked HRT to an increased breast cancer risk. “Interestingly, after the preliminary publication of the results of the WHI trial in 2002, the prescription of HRT dropped as expected and there was an almost parallel increase in the prescriptions of antidepressants. The cause of menopausal symptoms is due to oestrogen deficiency and it is oestrogen that should be prescribed if there are no contraindications to same.
"Oestrogen relieves these symptoms but it also has so many other benefits. In some cases where oestrogen is contraindicated or a patient is reluctant to take HRT, antidepressants have some evidence of improving vasomotor symptoms and improving mood,” says O’Driscoll.
Deirdre Forde says each patient is treated on an individual basis and she goes through the risks and benefits of HRT.
“A lot of GPs were running scared from HRT, telling women if they were a certain age, they couldn’t take it or could only take it for five years. At the end of the day, I go through it all with women. Women over the age of 50 will have a baseline increase of breast cancer risk anyway. There is about 23 per 1,000 women who will develop breast cancer over a five-year period so they will have regular mammograms. A woman who is on a combined HRT, oestrogen and progesterone, that risk will go up by another four, to 27, but that risk is the same as someone who smokes or is on the pill.
"The risk also goes up with women who drink alcohol every day, or those who have a BMI over 30. Women can reduce their risk by doing some kind of exercise, cutting the amount of alcohol they drink, all of that. You do have to have a life at the end of the day too.”
Another symptom of perimenopause is vaginal dryness, due to the reduction in oestrogen, which can affect sexual intercourse, while the decline in testosterone can also contribute to lower libido. In US research carried out in 2018, it was found that 45% of women in midlife have sexual problems. However, as the National Women’s Health Network in the US puts it, this does not condemn a woman to “entering a sexual desert”. Indeed, research has found that many women actually experience an increase in libido. The British National Survey of Sexual Attitudes and Lifestyles, carried out between 2010 and 2012, found that relationship satisfaction, and how much a couple communicates about sex, was the biggest contributor to sexual desire.
Forde has been consulting remotely during the ongoing lockdowns, and has seen a huge increase in queries from women whose symptoms are being exacerbated by the stress of the pandemic.
“Covid has really thrown up all sorts of problems for women going through the varying stages of menopause. Many continue to juggle work, family and other commitments but perhaps now there is the huge impact of greatly reduced finances, entire families working from home, the fear of elderly loved ones contracting Covid, fear of the unknown and the fact that everything, for all of us, is just that bit harder. It can have a crippling, paralysing affect and women going through the menopause just feel as if they can’t cope, they are totally overwhelmed.”
orde has also seen many women who are struggling in the workplace, often at a time when their careers are most demanding. She says she has written to the HR managers of some of the women she has treated, informing them of the issues and says they have been understanding, and made changes when required.
While such individual actions are welcome, broader policies and legislative changes to help women dealing with menopausal symptoms in the workplace have been slow to materialise. Kathleen Kinsella is a former nurse who now runs her own business, Kinsella Management Solutions, In 2019, she drafted a position paper on the issue for the Irish Nurses and Midwives Organisation, which represents one of the biggest cohorts of female workers in the country.
She says that for some women, going through the menopause may be uneventful and may not impact on their working life but others find it difficult to function effectively at work.
“A lot of women feel they can’t say they are in menopause, that they have a fuzzy head, they are feeling the heat or their thought processes have changed, because they feel they will be discriminated against. They do not feel comfortable disclosing it to employers or managers — including managers who are women.”
The taboo around the menopause may be diminishing in society at large, but it is still a huge issue in the workplace. “You don’t want to be seen as not being able to cope with something that is supposedly sold as a natural process. It may be natural but so is labour and period pain, it doesn’t make it less awful,” says Kinsella.
She adds that research carried out by the British Menopause Society also found that some women did not want special treatment in the workplace.
In terms of taking action, Kinsella says workplaces should have a menopause policy to show they are committed to the issue. “That could include flexible working hours, a mental health or ‘duvet’ day, time for medical appointments. As well as simple things like being given a fan, access to cool water, even sitting by a window or turning the heating down during a meeting,” she says.
However, Kinsella says legislative change is required to ensure workplaces cater for women who need flexibility and understanding around the menopause.“
There are some organisations that are forward-thinking that might take it on for employee health and wellness but unless it is provided for in legislation, like maternity, it won’t stick,” she says.
In Ireland, the Women’s Health Taskforce, established in September 2019, has cited improved supports for menopause as one of its priorities. However, the fear is that any legislative proposals will be put on the back-burner because of the pandemic. Kinsella also observes that women with menopausal symptoms working in the health services are under even greater pressure now due to pandemic working conditions.“
Can you imagine the heat, wearing the PPE, the anxiety around all of it,” she says.
“One of the things that women consistently say to me is that they feel that they are finally being listened to,” says Forde. “Women need time. My first consultation is usually 45 minutes to an hour. Often a woman will be in floods of tears, not able to talk. It makes such a difference that I understand what they are going through. They cry, laugh and curse in front of me. They feel normal and listened to, which takes a huge burden from them. It is very rewarding when you see women coming back to normal.”
When Emma Purcell’s periods started to decrease in frequency, a raft of other ailments she had been experiencing began to make sense.“
I do some running and in March last year, I started to get lots of heartburn and really feel uncomfortable. I was wondering what was I eating that was affecting me. When I looked it up, I realised it could be a symptom of the menopause. The more I looked into the menopause, the more I realised what was impacted by the drop in hormones. It was a big shock for me.”
“had started a new job last year - I was so anxious and on edge every day. I was thinking: ‘Am I too old, should I have changed my job?’. I felt really unhappy with myself. For someone who had always been confident and pro-active at work, I was struggling. I was struggling at home too.”
In her hunt for more information on what could help, she came across the Irish Menopause page on Facebook.“
It’s a really good resource and it’s private, which is great,” she says. “I realised that HRT wasn’t what I thought it was anymore and I started looking into it. I thought that HRT increased your cancer risk, from all the publicity around the studies that were done years ago. All that stuck with me was that it was dangerous and it wasn’t to be taken.”
After a remote consultation with Dr Deirdre Forde of Ceile Medical, Emma was prescribed HRT, which says had a significant impact on her symptoms.
“I would worry about things so much, second-guessing myself the whole time. Once I started on HRT, all of that went. My thinking is clearer. I feel like a completely different person, I feel like me 20 years ago. You have to see what works best for you, it is not one-size-fits-all but for me, I am in a far better place now.”