The Daily Telegraph - Features
Ten menopause myths – and why it’s not as bad as people say it is
A new study finds that many health problems are being blamed on a natural rite of ageing, as big pharma uses it as a marketing opportunity. Liz Hoggard speaks to the experts to separate fact from fiction
It was November 2008 and I was sitting in the surgery of Dr Marion Gluck, a women’s health doctor, as she explained I was almost through the menopause. I was 46 and had barely experienced any symptoms.
I had gone to interview Marion, a pioneer in the treatment of hormonal imbalances. At our first consultation, she did some blood tests – and I found out this key part of my own story. It was a slight shock. But not a catastrophe.
Yes, I occasionally felt a bit hot in those early years (but as a child, I was always hot) and I woke up more at night. But, like so many friends, I mostly ploughed on, wearing layers, opening a few windows. I didn’t take HRT, apart from local HRT (vaginal oestrogen used with a pessary) to keep my love life on track and avoid UTIs. And, oh my God, the joy of no longer worrying about periods.
Don’t get me wrong, campaigns led by Davina McCall and Mariella Frostrup have been important to break a major taboo. It’s great we can now all talk openly about this universal experience. “What age did your mother go through the menopause?” Dr Gluck asked me (almost half of women experience menopause about the same age as their mother). I have never had that conversation with my mother.
But I can’t help feeling it has been over-medicalised by big pharma, and that young women are being led to fear a natural rite of ageing. Many businesses have jumped on the bandwagon to sell us everything from “menopause” shampoo to eye drops. “It’s the nature of being in a capitalist society that once a taboo has been broken, people naturally see it as a marketing opportunity,” says Rachel Weiss, the founder of the Menopause Cafe, a UK charity.
Which is why I’m so relieved to read a new paper from experts at King’s College London and The Lancet saying that too many health problems are being blamed on the menopause. The international team of authors say that over-medicalising the menopause (when women’s periods stop, usually between the ages of 45 and 55 due to naturally falling hormone levels) could lead to over-treatment with hormone replacement therapy.
They found that while 20 per cent of women do experience symptoms such as hot flushes and night sweats, and that HRT is beneficial for treating hot flushes, there was no evidence it benefits women without that symptom.
When I talk to Martha Hickey, a professor of obstetrics and gynaecology at the University of Melbourne and the lead author of the study, she challenges the idea of menopause always being a medical issue that heralds a decline in physical and mental health. Prof Hickey found no compelling evidence to support the view that menopause increases the risk of mental-health conditions such as anxiety, psychosis, suicide or bipolar disorder.
They also found a lack of data on whether menopause was linked to long-term health risks such as diabetes, dementia and heart disease, or whether these were simply caused by ageing.
“By ascribing everything that might happen to you around that age as due to your hormones is inaccurate and potentially quite dangerous, because it could mean a serious illness like depression would be put down to hormones and treated with HRT, when that’s not an effective treatment, and it’s not a mental symptom.”
The demonisation of middleaged women is all too real; our knowledge and experience is often dismissed. There is a sense that by being “not young” we have committed some terrible crime.
Hence the need to take hormones to stay young and juicy. Yet, actually, far from being a time to mourn, the menopause is a chance to be free from your own biology – and others’ expectations of you.
It seems more important than ever to tackle those negative myths about the menopause, and celebrate the positives…
1
You’ll be full of rage
Yes, in midlife you will question your life choices – your sense of purpose. But the authors of The Lancet report say depression should not be “misattributed” to the menopause and may reflect stressful life events, such as caring for children and elderly parents. The bonus is you start to care less. As the bonding hormone oxytocin quietens, you feel less guilty saying no to friends and close family members. “Menopause is a kick up the backside to take stock,” says Weiss. “What am I doing with my life? Am I looking after my physical and mental health? And, of course, it’s tempting to just take the silver bullet [HRT] and think it will cure everything. And for some people it does. But a more holistic approach would be good.”
2
You’ll never sleep again
You will experience some sleep disruption in midlife, but it’s quite normal for humans to wake up many times, come briefly to the surface, then go back down again. I recommend wearing a sleep tracker at night – we tend to sleep more hours than we think. Experts say that in REM sleep we may even dream that we’re awake, when we’re actually fast asleep.
3
Sex is over
Yes, the libido may plummet for a time as the hormones oestrogen, oxytocin and testosterone go quiet. Some women may find they don’t care if they ever regain their desire. But, actually, this is a time to have honest conversations with your partner. When pleasure becomes your joint project – hurrah! This means a greater focus on “outercourse”, rather than “wham bam, thank you, ma’am” moments. “Sex isn’t just about penetration,” says Weiss.
4
You’ll pile on weight
Yes, middle-aged women do find they need to adjust what they eat and when. But exercise is the key.
5
Your vagina will dry up
Local HRT applied once a week or just before sex (plus lubricant) works marvels.
6
You’ll become a human furnace
The dreaded hot flushes can be debilitating, but it’s worth exploring a range of solutions: St John’s Wort, HRT (though don’t take them together), CBT, counselling, strength and resistance training.
7
You will suffer terrible anxiety
In midlife, women often become carers, and are juggling family and work, but that anxiety is not caused by hormone loss.
8
You will be debilitated by brain fog
Agreed, brain fog indicates a glitch in the oestrogen-regulated nervous system. We may mislay our keys more. But losing the ability to multitask means you will become more thorough and better able to concentrate, says the neuroscientist Dr Louann Brizendine in her latest book, The Upgrade: How the Female Brain Gets Stronger and Better in Midlife and Beyond.
9
You’ll have to leave work
Nonsense. With a little tact and generosity, all can be managed. “In an ideal world, we would treat it like any health condition, where you could go to your manager and have reasonable adjustments if you need them,” says Weiss. Clearly, it’s easier for middle-class homeworkers than women on the front line, adds Prof Hickey. “If you’re a woman who’s working in a care home, in a hot environment, lifting people, wearing a uniform and doing shift work, that’s a different situation from someone working from home.”
10
You’ll become an old crock
Although bone density is known to decline after menopause, the report could not determine whether menopause increases other chronic conditions such as diabetes, dementia, or cardiovascular disease. “The negative aspects of declining oestrogen include reduced bone density and muscle mass,” says Dr Francesca Jackson-Spence, a clinical research fellow in genitourinary oncology. “But there are things you can do to improve it. Strength training, regular exercise and resistance training can preserve muscle mass and are effective for reducing the risk of osteoporosis. It’s also going to help with sleep, any potential weight gain, plus boost mood and libido.”
‘Menopause is a kick up the backside to take stock. What am I doing with my life?’