Before, during and after menopause, your mind and body go through some significant changes. Menopause is a transition. It occurs when your body naturally starts to produce less hormones such as estrogen, progesterone, testosterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH), eventually causing your periods to stop. Any change to your hormone levels will cause your body to undergo changes. Due to damaging stereotypes, horror stories and stigma, many women fear menopause — but it doesn’t have to be the rollercoaster you’ve been led to believe it is.
Menopause has been in the media lately. On May 12, Channel 4 aired the documentary “Sex, Myths and Menopause” with Davina McCall, igniting new conversations around the massive hormonal changes that affect roughly half of the population. Despite how commonplace it is, menopause — as with many “women’s issues” — has remained a relatively under-researched field. Hormone replacement therapy, commonly known as HRT, was once a common treatment for managing menopause, but has dropped in popularity due to fears over breast cancer and heart disease risk. But as the documentary highlights, lack of awareness has left many people suffering through menopause without help. By opening up the conversation around menopause, removing sexist stigma and increasing research efforts, the way our society views menopause can change for the better.
Menopause usually occurs between 45 and 55 years of age, with the average age in the UK being 51. Symptoms can start several months or even years before your periods stop. This is known as perimenopause, which is when your hormones begin to change in preparation for menopause. It is also common for symptoms to continue for a while after menopause: four years on average. For many, perimenopause begins in their forties, but some women start to see signs even in their mid-thirties. Since menopause tends to be associated with aging, lots of people — patients and doctors — fail to identify the symptoms of perimenopause, leaving it untreated or misdiagnosed. This makes education all the more important.
A change in periods is the most common menopause symptom. This usually results in a disruption of a pattern — your periods could get either lighter or heavier, and happen less frequently. Eventually, your periods will stop altogether, but this could take a few years.
Going into menopause puts your body through incredible hormonal changes, which lead to some notoriously difficult effects. Common physical symptoms include hot flushes (affecting about 75% of women), night sweats, sleep problems, vaginal dryness, discomfort during sex, headaches, heart palpitations, tingles, stiff joints, reduced muscle mass and recurring urinary tract infections (UTIs). Menopause also places women at a greater risk for developing osteoporosis.
You may find your mental and emotional health affected, with symptoms including mood changes, low mood and depression, anxiety, difficulty concentrating, brain fog and reduced libido. Due to lack of medical awareness, many menopausal or perimenopausal women will be prescribed antidepressants right away, without considering that these sudden mood changes could be linked to something else. This is especially true for those experiencing early menopause or premature menopause.
The HRT debate
HRT has a long and complicated history with menopause. Originally made available in the 1940s, it experienced a boom in the 1960s as women were prescribed the treatment as a way to manage menopause symptoms. HRT works by introducing estrogen, progesterone or both to the body, and can be administered through taking tablets, skin patches, spray, gels or vaginal creams or rings. For women who have had a hysterectomy, estrogen can be introduced alone.
HRT was a popular menopause treatment until the early 2000s, when the results of two HRT studies undertaken in the 1990s were published. The results raised concerns over long-term use of the treatment, indicating a higher risk for both breast cancer and heart disease. These results caused a widespread panic amongst women taking HRT, and UK regulatory authorities recommended that doctors only prescribe the lowest effective dose for symptom relief. Many doctors stopped prescribing it altogether out of fear. Today, only one in ten menopausal women take HRT in the UK.
Since the publication of these studies, however, many researchers have poked holes in the findings, highlighting poor research design. One of the studies conducted by the Women’s Health Initiative (WHI), a US organisation, contained many women in their mid-sixties with prior health issues, thus not accurately reflecting the target group of HRT users, who are women aged 45 to 55. It was later found that only women in the 70+ age bracket were placed at a higher risk for breast cancer from HRT.
The WHI later went on to prove a significant reduction in breast cancer diagnosis in women using estrogen-only HRT, a huge contrast to the original findings. According to the National Institute for Care and Excellence (NICE), combined HRT may increase the risk of breast cancer, but this risk falls again as soon as you stop taking HRT.
In 2012, a Danish study found that healthy women taking combined estrogen and progesterone HRT for 10 years immediately after menopause actually saw a reduced risk of heart disease and of dying from heart disease. Other research groups including the WHI have also come to similar conclusions, and it is now widely considered low-risk for women starting HRT before the age of 60, as most do. HRT tablets have shown a small risk of increasing the likelihood of a stroke, but patches and gels do not, according to NICE.
“Sex, Myths and Menopause” explores the HRT debate in further detail.
“Menopause needs to be thought of as a long-term hormone deficiency,” says Dr Louise Newson, a leading menopause specialist, in the documentary. “So when we give HRT, we’re topping up those hormones.”
HRT has been proven to help prevent osteoporosis, diabetes, heart disease and dementia by replenishing hormones, making it more than just an effective reliever of menopause symptoms.
As with any medical treatment, though, it is important to weigh the risks and benefits. But for many people of menopausal age, the benefits of HRT tend to outweigh the potential risks.
Despite much of the controversy surrounding HRT having been debunked, there are still reasons why some people may not want to take it. For example, having a family history of breast cancer or deep vein thrombosis will make HRT a higher risk treatment.
Herbal medicine such as St John’s Wort and primrose oil can help ease some symptoms. Natural estrogen also occurs in red clover and soya, and can be found at your local health store. Plant estrogen can help with mild menopause symptoms, as can implementing basic lifestyle changes such as keeping a healthy diet and exercising regularly. There are also alternative treatments such as acupressure, acupuncture and homeopathic treatments. These treatments can be used on their own as well as alongside medical treatments such as HRT.
For mental health, non-hormonal treatments such as antidepressants can also be prescribed if desired, alongside therapy or counselling. It’s important to note that antidepressants are not a “cure” for mental health issues caused by menopause, so make sure to discuss all options with your GP.
Menopause with endometriosis
For people with endometriosis, menopause may be a different experience. Having a hysterectomy or inducing menopause are sometimes used as methods to treat severe endo. Menopause can be induced temporarily by taking a gonadotrophin-releasing hormone (GnRH), a synthetic hormone which slows down the pituitary gland and reduces estrogen levels. Both induced menopause and a hysterectomy will trigger menopausal symptoms, regardless of your age. As a result, many people with these endo treatments are given HRT, especially younger women who are below the average menopause age.
Women’s health stigma
One of the major talking points in “Sex, Myths and Menopause” is the stigma attached to menopause and aging. Many women feel embarrassed. For some it’s the shame of aging, fear of losing their sexuality or of discussing their experiences openly. Many of the most common menopause symptoms, such as hot flushes and mood swings, already colour the public imagination in a derogatory way. Stereotypes of women as overly emotional or erratic creatures are pervasive in our society; for many, it’s impossible to forget them. This can make it hard for women to talk openly about menopause, even with those closest to them.
Not only does this stigma make it difficult to seek out help for symptoms, but it also creates a knowledge gap wherein menopausal women are not educated on symptoms, and doctors are not confident in treating their patients. The consequences are huge, leading to less research in the field and little improvement for menopausal women. Menopause is one of the areas in which the gender health gap is made most apparent. The UK government is currently trying to address this gap through a national Women’s Health Strategy, a tentatively positive step in the right direction.
More and more, the stigma around menopause and HRT is starting to disintegrate. However, many GPs still have little or no menopause training, and the fear around HRT still persists in many medical communities. Often, if you suspect you are perimenopausal or menopausal, you’ll have to fight for your right to receive proper care. This might mean asking for a referral to an NHS menopause clinic, or booking an appointment at a private menopause clinic. You do not need to suffer in silence.
As always, Syrona has a few ways to support those individuals going through Menopause from tracking symptoms & lifestyle; accessing specialists for help and reaching out to community. Download the app (iOS & Android) here.