For most women three things are certain: Taxes, death, and the menopause. At the moment I know which one I would give almost anything to avoid.
When I was young and foolish (I’m still one of those two things) I used to say that when I no longer needed my womb I’d get rid of it. I always assumed this would be straightforward. Particularly in Manhattan where I was living,when I determined that I was definitely ready to be rid of the thing that was facilitating my gruesome, long term menorrhagia.
When I put this suggestion to my OBGYN (American for someone who deals medically with everything vagina related), she looked horrified. ‘That’s a terrible idea’ she said. ‘The womb, as I’m sure you know is constantly in direct communication with the brain. Oestrogen is important to almost all the tissues and cells in the body. We don’t want to stop that conversation unless we really have to’. I had to concede that I hadn’t really thought about it that way. ‘No’ said the OBGYN grimly, ‘most women don’t until they get to menopause.’
In an ironic twist of fate, I didn’t reach menopause with my womb intact. It turned out there was a reason for all of that heavy bleeding (pre-cancerous cells). And so, aged 50 I was womb-less and staring down the barrel of early onset menopause. There was a hope that my limp ovaries which had been spared, would recover from the trauma and produce enough oestrogen and progesterone to keep my reproductive ‘female’ system ticking over. If this happened then my body would be fooled into thinking that I was still ‘viable’ and worthy of the kind of things that oestrogen and progesterone prompt and provide: sleep, the power of concentration, libido, skin elasticity, hair growth, metabolism stability and equanimity of mood.
At first it seemed that the trick had worked. Four months out of my hysterectomy (for which read brutal, major surgery – that bit gets glossed over too by most gynaecologists male or female) I was, I thought back to normal. I was running again (not as fast as before), I was thinking again (though it was all a bit foggy) and my scar was healed.
But then I began to get sick. The jury will always remain out on whether or not the op kicked off my auto-immune disease, but alongside this development, my menopausal symptoms began to creep up on me. Because I was on huge doses of steroids for my autoimmune disease, it was at first hard to know what was causing what. But as the years have progressed I’ve come to understand which symptoms are menopause related – hot flushes and no sleep are definitely the menopause, foggy brain, fuzzy hair and osteopenia could be either, as could utter exhaustion, but more likely my AI.
My local GP was bent on prescribing me the dreaded menopause ‘tablet’, which I associated with non-bio identical hormones and a higher cancer risk (that theory as with so many others of mine turned out to be nonsense). But in those days I lacked perspective and frankly had more available cash than I do now, so I did what everyone else I knew was doing: I went to see one of only two Harley Street menopause ‘experts’ available at the time.
These ‘experts’ were making a name for themselves by prescribing so called ‘bio-identical hormones’ which were derived from plants and thus, it was assumed, better for you. The female was busy for months, so I reluctantly went to see ‘the bloke’, who talked to me as though he was fixing my car, not helping me through one of the most traumatic periods in a woman’s life. ‘It’s mud at a wall really this menopause stuff. We still don’t know very much,’ he said cheerfully (well, you would be cheerful given what he was charging).
What was true then and remains true today, is that every woman is different and we all have varying degrees of symptoms and react differently to the treatments on offer. In an ideal world, we would all have tailor made HRT prescriptions. But given that our hormone levels vary so radically at different times of the month, this, even if you have untold funds and are prepared for weekly blood tests, would be almost impossible.
For a while the treatment HRT man prescribed – oestrogen in the form of Estrogel applied topically – seemed to be working. Or maybe I was imagining it..? But three months later I found myself back where I had been, with all of my symptoms re-emerging. To cut a very long story, very short, after months of research and trialling various options, including additional progesterone, testosterone, oestrogen patches, various herbal remedies, folic acid, (and another expert – this time a woman – new to the scene) I gave up. I began to grow worried about my already vulnerable body, which was by then undergoing chemotherapy for my AI, taking another hit with these hormones.
For the last two years I’ve been HRT free and in full-on menopause. I’m still being treated still for my AI, which has meant I’ve had to find alternative ways to cope. Here’s what I know.
It’s a cliché, but it’s true that if men had the menopause we’d be well on our way to effective treatment. We really are at the beginning of the research cycle on menopause, which needs greater funding and attention.
See a female doctor to discuss any symptoms or treatment: Men can’t, don’t and won’t know about how you are feeling and what you are experiencing. Even a young female doctor will have likely seen her mother go through the symptoms and will have a level of understanding and hopefully empathy, which a male doctor will be lacking.
Don’t take no for an answer: If you are experiencing symptoms, then you are entitled to HRT. The all-singing, all dancing HRT pill prescribed by most GP’s seems to be as safe as anything else out there and it also contains hormones which are identical to our own (and it’s regulated). But bio-identicals which are derived from plant oestrogens (and might make us feel better about taking the drugs) are also available on the NHS – ask your GP.
Don’t be embarrassed: Talk about menopause at every available opportunity. Without bringing it out into the open and making it part of everyday conversation the stigma and lack of research and empathy will continue.
Exercise: Even a little will help the symptoms. Walk, swim, jump up and down on the spot, lift cans of tomatoes instead of weights. Don’t feel bad about not getting to a class or the gym. The way menopause can make you feel it’s a miracle you got out of bed this morning.
Cardigans: People this is big. Cardigans are your best friend during menopause – they can be swiftly and neatly discarded or buttoned up, depending upon your thermostat, without messing up your hair or causing a commotion in a meeting.
Always carry a handkerchief (see above): A swift mop of the brow can be reassuring. And sometimes even chic.
Fragrance: I’m going to recommend Chanel No 5 here. It’s not my favourite, but the aldehydes which make it fizz and sparkle when you first put it on may have a similar effect on you. I said may….
Lubricant: No, not for there, well alright also for there, but generally speaking your entire body is running out of moisture – apply liberally – everywhere. Obviously face cream should not be used below the neck…
Hair: I don’t care how much you have or if you don’t have any and are wearing a wig. Take care of it. Moisturise, cut, colour. I’ve tried the going total grey route. It didn’t work for me. I’m not saying it won’t work for you, but an hour spent at the hairdressers is an hour on your own without anyone bothering you.. You all know what I’m talking about.