Is menopause finally mainstream?

With increasing life-expectancy, women can now expect to spend at least a third of their lives post-menopausal. With everyone from Cameron Diaz to Gillian Anderson and Kirsty Wark talking about it, menopause is no longer the silent shame that women were forced to go through, with little knowledge.

In just a generation, menopause has gone from mystery to nearly mainstream.

However, many women are still plodding through years of symptoms without having a full grasp of how this seismic change in their lives is affecting them. Even the term menopause is inaccurate when we talk of “going through” it, because it represents the end of symptoms, whereas the stage that most women struggle through is called peri-menopause which can last anything from two to eight years until the last period.

As a woman ages, her hormone production level reduces, particularly oestrogen, which causes so many of the symptoms. Menopause is diagnosed after 12 months from last menstrual bleed before or after the age of 50, although contraception is still needed for a year after this if over the age of 50, and two years under that age.

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FSH (Follicle Stimulating Hormone) levels can be used to diagnose the menopause 12 months after the last menstrual bleed but is of little benefit in the peri-menopausal period. According to CSO figures, there are nearly 333,000 women in Ireland who are potentially peri-menopausal at any one time, but perhaps the vagueness around it can also be attributed to the fact it can vary widely in it's duration and symptoms.

Symptoms such as irregular/fluctuating periods, the dreaded hot flushes and night sweats, insomnia and fatigue (not unrelated) and unexplained aches and pains in joints. However, peri-menopause doesn’t just affect our bodies, but also our minds, with increased feelings of anxiety, a lack of confidence or feeling invisible, low libido, and worsening PMS symptoms such as feelings of irritability and frustration.

It is reassuring therefore to see the growth of dedicated menopause clinics at GP surgeries to help women through the minefield of symptoms and therapies available.

“There are huge changes happening within a women’s body during the peri-menopausal period, from fat distribution, blood pressure, and lipid levels,”says Dr Aoibhe O’Driscoll, who runs a Menopause Clinic in Cork, “so a menopause consult is an ideal opportunity to discuss diet, lifestyle, assess cardiovascular risks and breast cancer risk factors, and alleviate uncertainty and fears,”

Her advice would be that all women, from the age of 40, start understanding what will be happening to them and how to manage. “Women will live at least one-third of their lives with a lack of oestrogen and they must be aware of the implications of this in terms of conditions like osteoporosis, heart disease and cognition.”

Dr O’Driscoll is an advocate of HRT in the right circumstances, and prescribes it regularly to alleviate symptoms that are seriously affecting women’s quality of life. “HRT got a bad name after what has since been recognised as very flawed research claiming that HRT significantly increased the risk of cardiovascular disease and breast cancer. As a result usage stopped overnight, but what was interesting was the rise of anti-depressants increased.”

In November 2015, the publication of the NICE (National Institute of Clinical Excellence) guidelines, gave evidence-based information on menopause and how it can be managed, and have given doctors more confidence again to prescribe HRT as a safe treatment for severe symptoms. Being sedentary, over weight and drinking alcohol are greater risk factors for breast cancer than most forms of HRT between the ages of 50 and 55.

The use of HRT under the age of 50 is not associated with a potential increased risk of breast cancer (unless the patient has a history of breast disease or a genetic risk of breast cancer) as HRT is just replacing the normal physiological levels of oestrogen a woman is expected to have until the age of the menopause, and has a proven reduction in bone loss and cardiovascular disease.

“For years because of the fears of taking HRT, many women were too scared to ask for help, or admit they were not coping. The NICE guidelines should hopefully ensure women no longer suffer,” explains Dr O’Driscoll. However, HRT is not the only answer for woman.

Aisling Grimley established the My Second Spring website four years ago to provide practical advice for women going through peri-menopause. "No one was talking about menopause at the time, and information online and in the media tended to be quite negative. I wanted to provide a fresh perspective and to allow women to see this as a time to regroup and consider the next phase of their life as a new beginning. Last year alone, My Second Spring had over a million views from all over the world. I get constant comments from women saying, 'I thought I was going mad, and now I realise this is a natural phase of life and not a deadly disease'!"

The increase of information means that women now can not only get an understanding of their symptoms, but research a variety of options for dealing with them.

"There is a sea change," says Grimley. "When I think back to when I was pregnant 23 years ago, no one was talking about pregnancy, but that year Demi Moore was pregnant on a magazine cover. Now there are wonderful maternity clothes and pregnancy is 'cool'. The shift is now also happening around menopause. It's probably never going to be exactly 'hip' but it is coming out of the shadows because this generation are willing to talk about stuff.

“Menopause is similar to pregnancy in that it can become quite medicalised, and this can mean a lot of women don’t know how many options there are to help with distressing symptoms. There are lots of therapies available, from acupuncture to help with stress, insomnia and hot flushes, nutritional therapy, and homeopathy.”

Once you start experiencing any changes to your cycle, or other symptoms you can assume you have begun peri-menopause and the key is to manage symptoms.

“What’s important,” says Grimley, “is taking back your power and looking at all of the options and therapies available as we don’t have to put up with distressing symptoms. I see menopause as a time for transition to regroup and rethink, and evaluate your health and lifestyle.”

One of the most worrying symptoms of peri-menopause is the increase of anxiety and depression. Linked to hormones, it can also be exacerbated by insomnia and uncertainty about the future. At midlife there can be a lot going on that may challenge us psychologically, including career, ageing parents, children, divorce or bereavement. Not to mention our own visible signs of ageing.

“Women often present with anxiety and symptoms of depression in the peri/post menopausal period,” confirms Dr O’Driscoll. “They can describe low mood, no energy or interest in things, irritability, ‘not feeling myself’ feel overwhelmed, and even “going mad”. That is the reason why there was a surge in the prescriptions for anti-depressants when HRT was stopped. I advise patients that these are very common symptoms, and to speak to a GP about best options for managing them.”

Second Spring – so called after the Chinese name for menopause who see it as a positive time for women to start again – is about educating yourself.

“Read up on menopause and tune in to what makes you tick,” advises Grimley. “Spend some time on yourself, mentally and physically. This is a very important time to put yourself top of the list for a change. You’ve spent years focusing on jobs, children, husbands, parents and it can be hard to break the habit. This is a time for self -care.”