You know, as in M is for Menopause.
“It’s under reported” my swimming mate, 10 years ahead of me, comments in the changing room. That feels like the understatement of the year. It feels like a full-frontal assault on women by Mother Nature. She goes on to say, “I feel like I’m only coming out of it now.”
That’s alarming. She tells me her main symptom is anxiety. I think it’s currently mine too, so I’m horrified. I can tell you right now I can’t do ten years of this emotional roller coaster. The last month has been awful enough.
We’re all of an age, my friends and I, where we are suddenly just not quite ourselves. We’re hot and sweaty, or bleeding insanely, or forgetful, or weepy or anxious or short tempered, or can’t sleep or full of weird aches. It takes a while to work out that we might not be going mad or dying. That this is normal for women of our age. We have to seek this information out, furtively it seems, gleaming what we can from websites and passing conversations.
The laundry list of symptoms conveniently packaged under the casual heading of “menopause” is long and not particularly well defined. Did you know anxiety is a symptom of menopause? What about joint pain? Brain fog? Headaches? Heavy, endless periods? Unless you’ve arrived at this illustrious phase of life, I bet you didn’t. As I make my initial foray into this new life stage, I’m sceptical about this. It feels like the word menopause is just shorthand for “stuff that happens to women of a certain age that we can’t otherwise explain”.
Every time I mention something – anything going on in my body or mind – older women nod sagely and smile with hard earned knowledge. “Ah, that will be menopause,” they say. As if that is all that needs to be said. Menopause impacts half the population, and yet when we arrive at the doorstep of menopause, not only are we surprised by the variety of symptoms we are subjected to, but there is also no definitive diagnosis. No clear plan of action to follow. No certainty. Everything is wrapped up in a glib phrase that seems to lack any associated action, said with an air that implies all this upheaval is something to be stoically endured.
Menopause itself is formally defined as the “spontaneous, permanent end of menstrual bleeding”, and when you’ve had 12 consecutive months without periods, then “ta-da” you have successfully completed menopause. This might be the official medical definition, but it hardly seems to capture the essence of what is going on here for the people who have to live through it. Periods seem to be the least of it. No wonder we’re confused by it all.
Menopause is complicated. I get that. The hormonal fluctuations that drive these changes are, apparently, difficult to measure. And there isn’t a one size fits all experience. Not everyone gets everything. According to the Jean Hailes website, about 20% of women sail through this phase of life with no symptoms at all. Lucky things. Despite it perhaps being the most oft cited symptom, only 57% of women have the dreaded hot-flushes (other sources cite this at 80% – a stark lack of consistency that is, in itself, telling).
Of course many of these symptoms can be attributed to other things related to ageing – having to re-evaluate our purpose as our children leave home, facing the reality that we’ve passed the midway point in life and are on the downhill stretch to inevitable death, and having to work out how we now fit into a society that is desperately preoccupied with youth.
But the hormonal changes that result in (or perhaps from) menopause, and impact on the rest of our minds and bodies, also feels poorly understood. As in so many medical fields, it feels like an area subject to gender bias, and oversight. Like there hasn’t been enough work done to understand it properly. And it seems appallingly poorly integrated into general care.
The narrow lens of medical definition surely does nothing to help women through this long and arduous stage of life. Maybe a better way of conceptualising menopause would be as a period of transition and fluctuating hormonal levels, and less on a retrospective measure of period-free attainment. More focus on the experience from the women’s perspective, less on whether they are bleeding or not.
Things have vastly improved since my mother was my age. There are resources and specialists to consult if you know where to look. Although concerns linger in our collective conscience about hormone replacement therapy, much work has been done to ensure its efficacy and safety. The “M-word” and its impact on our ability to work is being raised at governmental and corporate levels. But there is a way to go.
My friend is taking hormone replacements. “I just had enough,” she explains. “My GP was dismissive, so I went to a specialist doctor. Then I took her recommendations and got a second opinion.” You can get a list of specialists from the Australasian Menopause Society. It’s fabulous that such resources exist, but wouldn’t it be better if our GP referred us at the right time? The notion that we haveˆ to “do our own research” in matters of health, where we have close to zero appropriate knowledge or qualifications, feels like a medical cop-out.
I wonder how much internalised ageism and sexism impact on our willingness to stoically cope, and to not talk too much about it. Menopause can be debilitating for many, but even if your symptoms aren’t severe, it’s confronting. A very definitive signal to ourselves that we are ageing, and which, unlike wrinkles, Botox injections can’t hide. Maybe that is why it is so under discussed. As a society we’ve not worked out how to celebrate age in women. As women we haven’t worked it out either, I don’t think. We’re out there Botoxing our faces into plastic parodies of youthfulness, in the hope that we’ll be seen as younger than we are. We spend endless amounts of money on cosmetic procedures that entrench the notion that young is good, and old is bad. The image of the crone, with her shrivelled up womb, still seems to march through our own minds, despite what we say with words, trailing with it a deep seeded fear that, with menopause’s arrival, we have become irrelevant.
Of course, nothing could be further from the truth. The women I cycle, swim and run with are further down the path than I, and they are revelling in their freedom. They’ve got time and energy to spare. They’re curious and going back to study things that pique their interest. They’re finding work, and a way to work, that is fulfilling but not all consuming. They set clear boundaries as to when and how their child-minding services can be utilised. They travel a lot. Maybe that’s why they don’t need to talk about it anymore. It’s in their past.
We should be celebrating the freedom and opportunity that comes with age. Research into wellbeing and happiness generally shows that life satisfaction across the lifespan is a U-shaped curve. It declines into middle age, but then picks up again as people renegotiate what life means to them. This is not a blanket statement – it depends on personal circumstances and attitudes. But ageing can bring with it a capacity for perspective and reflection, and opportunities to do things for enjoyment, rather than necessity. To age is to be lucky. The alternative is not youth, it’s being dead.
From the perspective of myself and my friends, that’s someway in the future. We’re still working and juggling teenagers, paying mortgages and school fees and sky-rocketing energy bills. We still feel young at heart, even if our bodies have decided we’re no longer reproductively useful. But we shouldn’t have to negotiate the 10-year transition to the next phase of life in ignorance and confusion. Nor should we, in this day and age, have to stoically grin and bear it because that’s just what women are supposed to do.
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