‘The menopause is where mental health was 10 years ago’
80% of women who reach menopause suffer symptoms, but are often misdiagnosed
Many women who report menopausal symptoms to their GPs are misdiagnosed as depressed or anxious. Illustration: iStock
The floodgates opened on Ireland’s airwaves last week as women in their 40s, 50s, 60s and 70s lined up to describe their menopausal symptoms – night sweats, hot flushes, mood swings, joint pains, heavy periods, heart palpitations, dizziness, anxiety, depression, memory loss, urinary and vaginal issues, weight gain, lack of libido and anger or utter despair which nearly pushed some over the edge.
Many reported feeling like they were going crazy while struggling to work and manage their personal and home life as they grappled with a vast array of physical and psychological symptoms.
The women’s testimonies began on Joe Duffy’s Liveline programmes and continued across all media this week. It was taken up in the Seanad by Senator Pauline O’Reilly, and at a Fianna Fail Parliamentary meeting where the idea of a national awareness campaign on menopause was floated.
On Wednesday, Channel 4 aired a documentary, Davina McCall: Sex, Myths and the Menopause. The UK presenter said she began suffering from menopausal symptoms at the age of 44 but was advised not to talk about it publicly in case it ruined her image. The show’s producer, Kate Muir, is writing a book titled Everything You Need to Know About the Menopause (but were too afraid to ask) for “the tribe of menopausal women” who are the fastest growing demographic in the workplace.
The stories of the women who bravely described their years of suffering on the airwaves was disturbing enough, but what was concerning were the accounts of GPs failing to recognise and treat these symptoms as menopausal – or peri-menopausal (the 10 years or so before menstruation ends completely). Instead they are referring their patients to cardiologists, neurologists, rheumatologists or psychiatrists who also often fail to link the symptoms to the decline in hormones, oestrogen and progesterone and instead diagnose and treat women for conditions such as fibromyalgia, depression or anxiety.
How can confident, articulate women in 21st century Ireland be so misunderstood? And how has the medical profession and society arrived at the point when a life stage that affects 51 per cent of the population is not discussed openly and treated professionally so women can deal with symptoms without fear of being undermined or sidelined?
Loretta Dignam, who set up the Menopause Hub, a multidisciplinary medical clinic in Dublin in 2018 after experiencing three years of dreadful menopausal symptoms says “the menopause is where mental health was 10 years ago”.
“We live in an ageist society and many women don’t want to admit they are menopausal and won’t talk about it to their friends. I didn’t tell anyone when I was menopausal. You feel like you’re old and past your sell-by-date when your reproductive ability is over. We value youth in women. A grey-haired man is seen as wise but a grey-haired woman is seen as old,” says Dignam. Film-maker, Jane Campion put it more curtly. “We become invisible and unfu**able,” she once said in an interview.
Sallyanne Brady, who co-founded the Irish Menopause private Facebook group (its membership of 11,000 rose by 2,500 in the last 10 days) agrees that there has been taboo and silence around the menopause. Brady says that she lost five years of her life when she suffered from depression, tinnitus, migraine, vertigo, brain fog, digestive issues, exhaustion and insomnia.
“Every woman will go through the menopause and we need to bust the myth that you can get through it alone. We need to help women realise that they are not imagining or exaggerating their symptoms. The GPs and specialists I went to didn’t have a clue even though I said it was the menopause. Many of them aren’t trained or equipped to help women in the menopause,” says Brady who now mentors women through the menopause.
Brady has set up a petition for education on the menopause to be part of standard sex education in schools and to have specialist menopausal clinics throughout the country.
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In the UK, Dr Diane Danzebrink, psychotherapist and founder of a menopause support campaign has started a similar campaign #MakeMenopauseMatter to petition the UK parliament to demand mandatory menopause training for all GPs and medical students as well as menopause policies in the workplace.
Hormone replacement therapy
Dr Deirdre Lundy from the Bray Women’s Health Centre is one of only four doctors in Ireland who is accredited by the British Menopause Society. She also trains doctors in reproductive and sexual healthcare, which includes the menopause, with the Irish College of General Practitioners.
She links the confusion about how to treat the menopause to the flawed 2002 Women’s Health Initiative study in the US which found a tiny link between hormone replacement therapy (HRT) and breast cancer. “So during the last 20 years, everybody thought HRT caused breast cancer and GPs became deskilled in its use,” says Dr Lundy. Not only that, according to Dr Lundy (who has been taking HRT for 18 years), an older, less effective form of HRT made from pregnant mare (horse) urine (branded as Premarin) continues to be prescribed in Ireland.
“Premarin is not the first line of treatment for discerning menopausal patients,” says Dr Lundy. She prescribes “body identical” HRT made from wild yams which she says is similar to natural human forms of oestrogen and progesterone.
Many of the women who called RTÉ Radio One’s Liveline programmes spoke about how taking hormone replacement therapy dealt with their symptoms and made them feel like they were “back to their old selves”. Many also said that complementary and psychological therapies, a healthy diet and exercise – while all very valuable – weren’t enough to clear their symptoms.
Advocates of HRT point to the fact that by replacing oestrogen, women also protect themselves against cardiovascular disease and osteoporosis – both of which increase significantly after the menopause.
However, the British Menopause Society recommends non-hormonal options first for women with a history of breast cancer because women over 50 who use HRT for more than five years have a small increased risk of breast cancer. It can also take time to get the dose right and patches and gels can be more effective than tablets for some women.
Menopause experts do, however, say that many women going through the menopause won’t need to take HRT and that it won’t suit some women who do want to take it. According to research, 80 per cent of women will have menopausal symptoms, 45 per cent will have moderate to severe symptoms, 25 per cent will have severe to debilitating symptoms, and 10 per cent will have to give up work because of their symptoms.
The menopause is diagnosed retrospectively one year after a woman’s periods stop completely if she is over 50 and two years after a woman’s periods stop completely if she is under 50. The peri-menopause, which can last for up to 10 years, is the time before the menopause when oestrogen and progesterone begin to decline.
Fiona Robinson (56) who is peri-menopausal, says that there are things she wishes she knew 10 years ago that she knows now. “I wish I knew that blood tests are not indicative of whether your periods will stop soon because hormones fluctuate during the peri-menopause. I only went on HRT two years ago after I’d exhausted everything else.”
Robinson says that she would like to have considered HRT earlier. “My doctor diagnosed me with anxiety and gave me anti-depressants before I realised my symptoms were due to the peri-menopause. I then went to a menopause specialist who prescribed HRT which has made a substantial difference. It’s so important to go to a doctor who understands the menopause.”
Robinson says that information and education about the menopause is needed more than ever now as many women aged between 40 and 55 are working full time and don’t have the flexibility to manage their symptoms. “Most of our mothers didn’t work outside the home. I remember my mother went for a lie down every day around 2pm and then got up to continue with her day,” says Robinson.
There is so much misinformation out there and a whole industry built around supplements without reliable evidence.
So as well as needing all doctors to recognise and treat menopausal symptoms (remembering that premature menopause – when periods stop before the age of 45 – affects five per cent of women), we also need workplaces to acknowledge that this natural life transition can be fraught with difficulties.
Loretta Dignam from the Menopause Hub gives menopause workshops to businesses. “The menopause impacts on everyone whether it’s your mother, sister, daughter, line manager or co-worker. If a company becomes a menopause-friendly workplace, it gives people permission to talk about it and offer things like flexible and agile working and easy access to rest rooms,” says Dignam.
Vodafone became one of the first workplaces to talk about the menopause after a survey of 5,000 employees found two out of three women said the experience of the menopause impacted on their work. “One third said that they hid their symptoms at work and one in two said there was a stigma about the menopause at work,” says Julie Mernagh from Vodafone Ireland. The company will launch an online toolkit on the menopause and peri-menopause in May.
“We realised education was important and this will give information to employees on how to support colleagues, family or friends who are going through the menopause,” adds Mernagh. In the summer of 2021, the company will begin training on the menopause which will emphasise their flexible working policies and all medical/sickness policies.
One hundred years ago many women didn’t live much longer after their menopause but now, most post-menopausal women have decades still ahead. Dr Caoimhe Hartley, a Dublin GP who runs a menopause clinic and trains healthcare professionals in the menopause says, “it is vital for women to talk about what they are going through in order to receive the right help and get on with living their lives”.
“There is so much misinformation out there and a whole industry built around supplements without reliable evidence. For some women, making lifestyle changes such as reducing caffeine and alcohol, doing weight-bearing exercise, taking Vitamin D and/or doing cognitive behaviour therapy will be enough but women who need HRT shouldn’t be embarrassed or ashamed about using it. Taking HRT is not about giving in to your symptoms, it’s about taking control of your health.”
Dr Hartley says women need to embrace the privilege of ageing. “There is so much life and love and living after the menopause and we need to empower women to enjoy every minute of it.”