Menopause – what it involves and why we need to proactively self-care.
Have you ever thought to yourself why have I never received a talk about Menopause? Why do I have to research menopause myself and wade through so many myths and ill-informed pieces to get to the truth, when 50% of the population are affected by this issue? Why am I made to feel that this natural stage of our life will “pass”, so I need to suck it up, even when symptoms are really impacting my quality of life? If you have asked these questions you are not alone.
20% of women who go through this transition do not experience challenges or difficulties but the remaining 80% of women going through perimenopause and menopause can experience moderate to severe challenges, and 10% of those women experiencing severe menopausal symptoms will decide to give up their work as a result. This is such a loss for the woman herself but also for her employer, her family, and the wider community. At this stage of a woman’s life the skills/competence/ability she has gained are substantial and to have these assets removed from the workforce due to the impact of reducing hormone levels is quite tragic, not including the fact that this also contributes to the gender pay gap in Ireland, a point not often acknowledged.
In 2019, the UK Chartered Institute of Personnel and Development surveyed 1,409 women experiencing menopause symptoms. 59% said that menopause was having a negative impact in the context of work and reported the following:
• 52% said they felt less patient with clients and colleagues.
• 58% said they experienced more stress.
• 65% said they were less able to concentrate.
Furthermore, nearly a third said they had taken sick leave because of symptoms but only a quarter of those could be honest with their manager about the reason for their absence. Why is this the case? As businesswomen in this network, I would argue that this situation is not acceptable and needs to be addressed.
I developed the Menopause Maze programme because of my own experience of perimenopause, and my professional experience of coaching women. I noticed that many of the women I see as a coach highlight challenges which they do not initially see as being linked to the menopause, but it becomes apparent quite quickly that these challenges are in fact related to their stage of life. I think this initial lack of clarity is due to inadequate education regarding menopause compounded by the insidious, variable, and very personal experience of perimenopausal symptoms. Often the woman has not linked the symptoms (physical and emotional) she is experiencing as having anything to do with declining hormones, and the realisation that hormones may be involved only takes place when the most obvious symptoms of menopause (e.g., hot flushes) appear.
My focus in this blog is to provide factual detail on Menopause, and if women find this information useful to then provide further detail on specific issues such as sleep in menopause, exercise, mental health, HRT, heart health, brain health, bone health etc. Some of this information might seem negative but I think to deliver information that does not acknowledge the reality of the experience of menopause for most women does not help, and my aim is to support women in their own education and in so doing for women to be empowered.
There are things we can’t change about menopause. It is going to happen to all of us but there are also things we can influence and the choices we make at this stage can have a significant impact on our future health, specifically in terms of heart, brain, and bone health. This can be a liberating and rewarding stage of life for women. We have options and we have power as long as we claim it. My call to women is to get informed, so that you are empowered to make informed choices and be proactive in your self-care. If we are not informed, we cannot know what we do not know, and this is fundamentally disempowering and needs to change.
So let’s begin….
Education on what menopause entails is usually limited to: “It’s when your periods stop”, but menopause is so much more than the absence of periods, welcome and all as that may be!
All women who survive to midlife years will go through menopause, some even younger due to illness, surgery, treatments etc., but all women reaching midlife will undergo the hormonal changes of perimenopause and menopause. It is a completely natural process. The significant difference for women today is that, unlike a hundred years ago when we would have died in our late 50’s, we now live for 30-40 years post menopause. We therefore spend a third of our lives in a post-menopausal state.
What do the words perimenopause, menopause and post menopause mean?
• Perimenopause: this word is used to indicate the stage of a woman’s life where she is moving towards menopause. It is during this stage that women can begin to experience changes, and these can be many and varied. For some this stage can be a challenging roller coaster of physical and emotional shifts. For others they will sail through without being aware of many symptoms of their changing hormones. This period can last for several years, as the hormone levels adjust, and fundamentally decline, slowly.
• Menopause: is only a single day – the day you are one year post having a period. The average age at time of menopause is 51yrs. Early menopause is <45yrs and Premature menopause (premature ovarian insufficiency) is <40yrs.
• Post-Menopause: when a woman has not had a period for one year and one day, she is then post-menopausal; we remain post-menopausal for the rest of our lives.
The Hormones involved:
By and large, for most women, by the time we reach our mid to late 40s we begin to have noticed things changing, changes that are occurring due to shifts in our hormone levels. We move from our regular menstrual cycle, to perimenopause, menopause and finally post menopause, and our hormones are key to these stages, specifically oestrogen, progesterone and testosterone.
What do these hormones do and how does a declining level of these hormones impact our health and wellbeing?
• Oestrogen: we have oestrogen receptors throughout our body which means that changes in the level of oestrogens (there is more than one oestrogen) affect not only the breast and uterus, but also the brain, bone, liver, heart and other tissues. They control growth of the uterine lining during the first part of the menstrual cycle, cause changes in the breast during adolescence and pregnancy, maintain a lubricated and thick vaginal lining and regulate various other processes, including bone growth and cholesterol levels. Oestrogen is in fact the primary hormone regulator of the female brain. It influences maintenance of body temperature, sleep, and brain energy which results in some women experiencing brain fog, memory issues and mood swings during this time. Suffice to say “Oestrogen Matters” …as is the title of a book well worth a read by Avrum Bluming and Carol Tavris.
• Progesterone: is often called the “pregnancy hormone” as it prepares the uterus for a possible pregnancy and impacts on the availability of breast milk. Raised progesterone is linked with PMS, bloating, mood swings, and breast tenderness, while reduced progesterone levels in perimenopause and menopause are linked with irregular periods, infertility, headaches or migraines, mood changes, including anxiety or depression, hot flushes, and weight gain.
• Testosterone: along with oestrogen, helps with the growth, maintenance, and repair of
a woman’s reproductive tissues and bone mass, and has an impact on our emotions. An imbalance of testosterone can have damaging effects on a woman’s health and libido. Raised testosterone is linked with acne, deep voice, excess hair on face and body, increased muscle mass, irregular periods etc., while reduced testosterone is linked with a reduction in general quality of life, tiredness, reduced melatonin, depression, headaches, cognitive problems, reduced libido, osteoporosis, and loss of muscle mass & strength.
How do I know I am perimenopausal? There are several different symptoms to note as possible indicators of perimenopause.
As you see this is a varied list, and as I mentioned above, we all have different experiences, but the list in the table reflects the most experienced perimenopausal symptoms and these occur usually over a period of years before menopause itself is reached. What perhaps does not come across in the above list is how insidious these symptoms can be, meaning that they are sometimes missed as actually being a result of changing hormone levels. Women can find themselves referred for tests for palpitations, prescribed anti-depressants, prescribed repeat antibiotics, advised to have counselling etc. without anyone asking could this be the perimenopause?
Many women I have worked with talk about a loss of self-confidence, a feeling of invisibility, a questioning of their own self-worth, a lability of mood that is not usual for them, being exhausted, quick to anger and in tears at the next moment, experiences I can fully relate to as being part of my own journey but never once thinking these could be related to perimenopause. If we are educated to realise the symptoms of perimenopause then perhaps, we will access the correct support more efficiently, put in place the necessary lifestyle changes, and as a result prevent a prolonged, tiring and unhealthy journey into menopause.
Where do we go with this information?
If you think you are on this journey, then taking time to inform yourself is step number one. You deserve this investment in your own education and health. Liaising with your GP to have a full health check is important. Discussing the possibility of perimenopause with the GP or a menopause specialist or gynaecologist is also necessary and before doing this you should think about doing the following:
- Begin to keep a diary of your experiences/symptoms.
- Read the NICE menopause guidelines (2015) … you will find them here … https://www.nice.org.uk/guidance/ng23 These guidelines also have suggested questions that you might use at any appointment you have regarding your experiences.
- Decide who you are going to see…your GP or a specialist in menopause.
- If you are going to your GP ask if you could have a longer appointment …10 minutes will not be enough time.
- Make a list of all the symptoms you are experiencing and have all your questions developed in advance – if you have had a chance to keep a diary of your experiences that would be really helpful. This history is extremely important as it can paint a picture that cannot otherwise be evaluated. It is important to note that there is not a blood test that reliably indicates that you are in perimenopause. NB. Relying on a blood result to show declining hormone levels is inconsistent as they change considerably and yet remain in the normal range, so you could end up being told you are not perimenopausal when in fact you are. This is why history is so important.
- Make sure to tell the person if you are taking any medication, prescribed or over the counter.
- If you need support maybe bring a friend/partner.
- Ask the person you are seeing…what’s next? When can I review how things are progressing/how any treatments might be working or not, as the case may be?
- Get a second opinion if you are not confident that you have been heard and assessed appropriately.
- Working with a menopause coach (like me) can be helpful as it will help you gather your thoughts and prepare for any appointments etc. It will also help you put in place a plan to approach challenging issues such as sleep, nutrition, exercise, and your overall mental health and wellbeing.
This stage of life is directly linked with our health going forward into old age. Ask yourself is it enough to make this transition passively or should I be proactive and radically self-caring? That’s my question to you. I know what my answer is.
Let me know if the information in this blog is of any value and if it is, I will continue to blog on specific areas of focus in menopause, e.g., HRT, sleep, night sweats, hot flushes, mood, specific physical symptoms, vaginal atrophy, exercise, and nutrition etc.
If you would like to discuss any of the above, please do get in touch…I would love to talk to you. My email is [email protected] , my number is 0879197744 or DM me through the WIN group. My background is nursing, nurse education, training programme development and coaching. I also have further qualifications in cognitive behaviour practice including a certificate from the British Menopause Society in facilitating CBT group therapy for hot flushes/night sweats.