I wish I knew this before I plummeted into menopause
For some unlucky souls, the blood, sweat and tears can last more than a decade. We’re rarely told how the experience is hardly noticeable for some, and life-derailing for others.
When people find out you’re writing a menopause book, everyone has something to say. The most common response from any woman over 40 was to grab me by both biceps and shout into my face, “HURRY UP!” Unnerving, but understandable.
Another thing some people did when they heard I was writing it was to make a wincing face when they heard the word “menopause”. I suspect they’d like a book saying, “I’ve found a way to abolish the menopause. We shall never speak of it again, let alone go through it.”
Most of us don’t know that perimenopause – the first signs that menopause is coming – will probably start in our early mid-forties, possibly with invisible symptoms we mistake for going bonkers. Some of us experience complete menopause before we turn 40 when our ovaries stop producing the levels of hormones they used to, for unknown reasons or because of surgery or medication side-effects. And most of us don’t know there are more than 35 full-on symptoms that perimenopause and menopause can throw at us with varying degrees of awfulness. We’re rarely told how the experience is hardly noticeable for some, and life-changing and derailing for others.
It made me emotional to read the tens of thousands of answers in the Menopause Survey I conducted online for my new book, It’s The Menopause. More than 9000 women (most in their fifties, closely followed by late forties: peak perimenopause and menopause times) did the survey and 75,000 answers were in words rather than checking a box.
The Survey wasn’t a scientific study; it was an online thing that women opted in to, so these shouldn’t be viewed as scientific, peer-reviewed findings. But it’s the biggest collection of data so far in Australia showing women’s thoughts, feelings and experiences of perimenopause and menopause. It’s about what women want to share, or investigate, or shout about.
As I scrolled through all the responses, I laughed, I gasped, I said things like “Oh, no” or “Oh my God”, and sometimes I felt the prickle of tears. Thousands said they thought menopause only happened to old women; they had no knowledge of any symptoms of perimenopause except hot flushes; and they didn’t realise they were experiencing perimenopausal symptoms until they read the Survey.
So many surprising things came out of the Survey: more women identify mental issues, heavy periods and lower self-esteem as their main perimenopause symptom rather than hot flushes. So many women had been suffering mental and physical symptoms for years with no end in sight and had given up on getting help. Older women, all the way through and on the other side of menopause, shared their struggles and what they’d learned or regretted.
Tens of thousands talked about being blindsided by symptoms that up-ended their personal and professional lives; they lost relationships, jobs, confidence and faith in themselves and the medical profession. Women were by turns furious, curious, sweary, sweaty, frightened, angry, determined to tough it out and desperate for information. Lots of us didn’t know there were hormonal reasons for feeling awful about ourselves, and the sudden, bewildering mental health problems. Some of us had firm expectations of perimenopause based on a mother’s experience or our philosophy of medical or natural approaches, only to have those expectations totally exploded by the real thing.
Common themes included the assumption that menopause didn’t happen until you were an old woman. Many people thought the symptoms lasted for five years, perhaps an easy number to remember or a mix-up with outdated advice on how long you can stay on hormone medication.
A lot of us were sad and freaked out about how much the symptoms affected our relationships with our kids, partners and work colleagues. Some of us were so unprepared; we didn’t know about the higher risk of dark thoughts and self-harm in the perimenopause years, and that this can be alleviated with help and medication.
Many women wanted a “natural” solution to menopause symptoms but weren’t sure if there was any evidence. Many had tried one and found it didn’t work for them, or were absolutely convinced it helped, or wondered if it was a placebo effect or their symptoms coincidentally dissipated. It was notable that nobody who said they had severe, difficult or debilitating symptoms reported success with a “natural” treatment. Still, lots of non-medical approaches have also eased the way for many of us.
There was a lot of talk in the Survey results from women who said perimenopause or menopause means they no longer care what people think about them. Literally thousands of answers started with “I don’t care” or “Not caring anymore about...” And goodness, there was a lot of serious swearing and people who said they swore more since experiencing perimenopause.
More women said they felt wholly negative about menopause (they came to the Survey because they wanted to share, so that’s no surprise), but lots of women also said getting through perimenopause to the other side, enduring menopause, was a totally positive experience. Thousands said they truly thought they were going crazy; hundreds more talked about the relief in no longer being prey to street or other sexual harassment; hundreds said they’d gained wisdom or used a variation of “I know myself now”. So many felt they’d moved to a better place of knowledge, experience, wisdom and freedom.
Blood, sweat and tears: menopause has it all. For some unlucky souls, the symptoms can last more than a decade, and even 15 years or more.
But if we’re lucky to live long enough, we’ll all eventually stop having periods and need to deal with any side-effects that come with it. And even if you take medication forever and get into lifestyle changes that make things easier, you’ll still technically be in menopause.
I can’t tell you how much I wish I knew all of this myself before I plummeted into perimenopause. In many ways I was the textbook example of the clueless perimenopausal woman, flailing around for years. Women are told we can expect menopause at the average age of 50, and yet it’s totally average and normal for menopause to happen any time from age 45, with mental and other symptoms happening up to five years earlier. That immediately changes the timeline of when we should suspect the possibility of perimenopause symptoms.
Looking back, I feel I wasn’t just visited by the Menopause Fairy but a flying squadron of ’em. Like the winged monkeys in The Wizard of Oz, or a murmuration of sparrows with arrows. First they came for my self-esteem, and my eight hours’ sleep. Later, they took hair from my eyebrows and legs and put them on my chin and my top lip. And then, night sweats and oddly misbehaving periods, and weirdly itching skin that I had no idea was a menopause symptom.
I was by turns plummeted into feelings of anxiety, depression, rage and bewilderment. I couldn’t concentrate or find the right words when I was writing. I had brain fog, lack of mojo; one night I stayed awake all night. I had random heart-rate changes, sore finger joints, and the return of tendon conditions that had been dormant for 30 years. I would also wee a little bit if I coughed suddenly. It was frightening and inexplicable.
My GP at the time prescribed me antidepressants in a 10-minute conversation with no mention of perimenopause. Looking back, I’m sure I was experiencing the first hidden signs of it, and had I been prescribed hormone medication that targeted the reason for my problems I might have had a much easier time of it and known which symptoms were likely to be hormone-related: weird anxiety spikes that were hot flushes, recurring vaginal infections and the rest. Instead I thought they were all unrelated and I was falling apart.
Just as an estrogen patch picks up fluff on its edges, the menopause attracts connotations of the messy, the unglamorous, the unattractive, the over-sharing, and hairy bits in the “wrong” places.
I used to take estrogen pills but then another doctor told me it was safer to use a patch or gel; it carries a lower risk of blood clots. Every morning I smear one or two pumps of estrogen hormone gel (a bit like aloe vera) on my arms and wait for it to dry before I cover it with clothes. It’s cold in winter and annoying on the days I forget and then have to get undressed and dressed again after waiting for it to dry. I tried estrogen patches, but the brand prescribed was constantly “out of stock” that year, and when I could get them, each one would roll up off my skin at one corner.
I also take a daily progesterone tablet to make my hormone medication as safe as possible because I still have a uterus. And I take another pill prescribed by a dermatologist that combines a hormone and a hair loss medication to stop the genetic, galloping receding lady’s hairline of my dad’s side of the family, accompanied by a front-phouff situation. Turns out, the hair loss marked a bridge too far in what I could accept as “natural”.
I do pelvic floor exercises ... when I remember. And there’s a Mirena intrauterine device (IUD) in my uterus (best place for it), quietly dispatching progesterone. Two or three times a week I use a plastic plunger to deliver a small amount of estrogen cream to the top of my vagina. I originally wrote a typo in that sentence and it read, “I use a plumber to deliver estrogen cream to the top of my vagina”, and honestly, that would involve marginally more palaver and expense (so that I don’t have to deal with Mysteriously Irritable Vulva).
It feels embarrassing for me to write about my own experience here, where anyone might read it, even though I’m not ashamed of being menopausal. It’s just we’re so trained to be ashamed of what’s natural, and real, and out of our control. As if it were a weakness, or a confession. The details seem so wrongly intimate, TMI, and it goes hard against my journalism training to even mention my own experience. Despite a grown-up lifetime of writing books for women I’d not anticipated ever writing the phrase “top of my vagina” except perhaps as a jaunty morning greeting.
But what is the point of pretending I am one of the lucky few who experienced no troublesome perimenopause symptoms? Or that like a lot of women it took me years to recognise that what had been happening to me was perimenopause, and years more to work out how to manage it? To hide that truth doesn’t make me better or braver, or more useful to others. It just made me shooshier. And we should all stop being shooshier. Years after that first GP misstep, after finding new doctors and researching for this book, I find myself a lot more informed, and with symptoms much more manageable in ways that work for me (but may not be in your preferred buffet).
Two main groups have emerged as the loudest onesin menopause media and marketing: the “menopause is natural, not a hormone deficiency and there’s a scare campaign to make you take medication for its symptoms which are mild” group versus the “menopause symptoms are a bloody nightmare, and you have to take hormone medication forever to stop going mad and weeing on the bus” group.
There hasn’t been enough research into perimenopause and menopause, or even hormones themselves (which I kid you not a jot, doctors didn’t even know existed until less than 100 years ago).
But menopause-related research is happening more and more, in fields such as gynaecology, psychiatry, neurology and exercise physiology; it’s being done by many wonderful leading Australian and global specialists, and scientific researchers, and specialist doctors. I love them.
Women have been told to ignore their perimenopausal symptoms and menopause health risks for centuries. Imagine a man who goes to the doctor and says: I’ve put on 10 kilos while eating the same as I always did; I fly into rages; I think I’m a failure; I can’t concentrate, sleep or remember anything at work. I bleed so much without warning it soaks through my clothes; I have heart palpitations; I can’t sleep to the point of feeling demented; my penis is itchy all the time and it hurts to have sex. My fingernails are breaking off; I have unexplained fevers all the time, and I want to leave my family and live in a bucket.
Do you reckon the doctor would say, “Well, you’ll just have to put up with it”?
Menopause often coincides with the onset of autoimmune disorders or other conditions: similar symptoms can be experienced with a thyroid problem or coeliac disease and bleeding changes can have other dangerous causes, so a good GP is important when sorting out a possible diagnosis.
Please stop thinking you have to go it alone or try to be perfect, even at menopause. With the best available knowledge right now to make your own choices, you can concentrate on just being you, and on making the most of the rest of your life.
Edited extract from It’s the Menopause: Everything You Need to Know in Your 40s, 50s and Beyond by Kaz Cooke (Penguin Random House Australia), out on October 18, World Menopause Day.
