We’ve come a long way with the menopause conversation, and yet experts say women are still soldiering on and waiting for symptoms to pass. There might be a better way – and it starts with something we all know how to do.
When writer and speaker Jo Pybus was approaching the middle of her life, she thought she knew what was coming. “Hot flushes and the gradual slowing of my period until it stopped,” she says. “What I did not expect was four years of more frequent, heavier periods and anxiety.”
On reflection, it’s perhaps no wonder she wasn’t prepared. “The only conversation I’d ever had with my mother was when she said, ‘Oh well, at least when you get to your menopause you can keep things cleaner down there’.” They both had a giggle and the subject didn’t come up again.
Even though she had Dr Google and her GP to get informed, Jo wondered why she’d never talked about it with the three friends she walked with every morning.
“We bare our souls on this walk, and yet we’d never touched on menopause… ever.” Being a talker, she began to share her symptoms and discovered her friends were all facing their own unique set of challenges. “I was blown away by the fact [we] had all been soldiering on in silence.
Perimenopause symptoms can be easy to ignore
Perimenopause, or the lead-up to menopause, arrives when we’re so busy that the symptoms are easy to blame on other things. Pat Duckworth, author of Hot Women, Cool Solutions, attributed the onset of insomnia and brain fog to stress at work. “It took me a few years to realise it was all part of menopause.” she said on the podcast On My Last Eggs.
For Jo, sharing on those morning walks made a huge difference. “When you feel like an island, it’s easier to catastrophise things,” she says. “And because there is a mental element to the hormonal changes we go through, it helps to have that validation that you’re not going nuts. The fear is real when you are feeling fragile.”
All of which is compounded by the fact that every woman will have her own unique set of symptoms and circumstances, says Dr Elizabeth Farrell, a gynaecologist and Medical Director of Jean Hailes for Women’s Health.
As our hormones see-saw, rage and irritability can become common, as well as breast tenderness, bloating and, as Pat experienced, brain fog. Add to the list painful joints, vaginal dryness, forgetfulness and even panic attacks. Some women will have them all, while others will sail through with none.
How speaking up can help
The benefit of speaking up, say experts, is that it helps you see more clearly when it’s time to stop white-knuckling your way through the symptoms and seek help.
“There is often a feeling among the women I speak to that because menopause is a natural process, they should let it runs its course,” says Dr M Talat Uppal, clinical director of Women’s Health Road in Sydney and a clinical senior lecturer at the University of Sydney.
“But when I meet a woman who exhausted because three years of heavy periods have left her anaemic, or who is in pain because she has had vaginal dryness and hasn’t realised she could be using a vaginal moisturiser, it’s clear that putting their own well-being at the bottom of the pile is not working.”
Dr Talat often shares the teapot analogy with her patients, who lead busy lives and may never have sat down with a doctor to share the many symptoms they are experiencing. “I tell my patients, ‘You are the teapot that is pouring into all these cups. You can’t do that if you’re empty.’ I have to keep saying, ‘You are important too.’”
Medical support for menopause
The caveat when it comes to getting help and support from a doctor is that you need to speak to a GP with experience in women’s health. The truth is that not all doctors will have a deep understanding of menopause or empathy for what you’re going through. “It’s a complex and layered experience, and it takes time to really understand what a patient needs,” says Dr Talat.
One problem is that there is still a lot of confusion out there, says Dr Farrell. “We have done a lot in the area of menopause since Jean [Hailes] opened her clinic in 1972, and I see women talking about what is happening with their bodies. But there have been mixed message too,” she says.
Back in the ’80s, there was a strong message shared with women that menopause was being over-medicalised and that they shouldn’t see their doctor. “And then in 2002 research came out that said HRT doubled the risk of cancer.”
Despite the fact we now know this is not true, the scary headlines still inform women’s opinions about HRT, and have made a whole generation of GPs reluctant to prescribe it.
How menopause can be a positive experience
According to Pat, menopause can be a very positive time and pivotal moment for women, who often see it as a chance to take stock and figure out what they really want to do with the rest of their lives. “If you get educated and see it as a reboot, then the whole thing can be transformative.”
Still, it’s not all doom and gloom. In fact, it’s quite the opposite. “We live in a youth-oriented culture that tells you that getting older and going through menopause is something to be ashamed of,” says Dr Farrell. “Whereas the truth is that we are living half of our lives after menopause, and you can be a vital and healthy person well into your 90s. I’m still working as a doctor at 73 and loving life.”