📚 Everything You Need to Know About the Menopause

There are some things that happen in life that people don’t talk about, despite the commonality of the experience. Recently, a group of my online friends started discussing their, and their partners’, experience of the menopause. One person shared with the group, and all of a sudden the stories came pouring out. I knew the basics, but I didn’t realise how much of a difficult — and sometimes devastating — experience it could be.

My wife and I are both 45 so it felt like a good time to learn a lot more about it. Kate Muir’s book, Everything You Need to Know About the Menopause (but were too afraid to ask) is an excellent place to start.

The key points I took from the book were:

• Dealing with the effects of the menopause over a long period of time is a relatively recent phenomenon. In the Victorian era in the UK, people used to die at the average age of 59. With average life expectancy now extended by thirty years, women have to live in a post-menopausal state for much longer.
• There is nowhere near enough education about the menopause. We learn about puberty at school but not about what happens to half of the population in later life. Given how reluctant people are to talk about it, access to information can be difficult.

The divide between those who have menopause support and knowledge and those left to suffer is massive.

• More worryingly, the lack of education also extends to the medical profession. The book contains horrific stories of undiagnosed and misdiagnosed patients, including the case of one woman ultimately being given electroshock therapy after being diagnosed with ‘treatment-resistant depression’. It turned out that her symptoms were caused by hormone deficiency:

Although the menopause will happen to every woman in the world, and has massive health consequences, according to a Menopause Support investigation, 41 per cent of UK medical schools do not give mandatory menopause education.

… in one study of around 3,000 British menopausal women, after complaining of the onset of low mood or anxiety, 66 per cent were offered antidepressants by their doctor instead of hormones.

• Some good news is that there is freely-accessible information out there for medical professionals, for example this 90-minute video from Dr Louise Newson on assessing perimenopausal and menopausal women, and safely prescribing HRT during remote consultations:

• Menopause leads to other major health issues — osteoporosis (brittle and fragile bones), Alzheimer’s (dementia) and heart disease. There are some things you can do to combat a reduction in bone density, such as high-impact exercise, but on their own they are not as effective as when they are combined with Hormone Replacement Therapy (HRT). Using body-identical transdermal estrogen after the age of 50 halves a woman’s chances of breaking a hip and reduces her chances of having a heart attack.
• A Women’s Health Initiative study in 2002 made people extremely wary of HRT. It turns out that there are different types of treatment; compounded ‘bioidentical’ tablets are awful as there is no reliable way to know what they contain, whereas body-identical hormone cream does not carry the same risks:

We need to question the conventional wisdom, which says that HRT causes breast cancer and that the risks of taking HRT outweigh the benefits. What most people – including me, until I began my investigation – think they know about HRT is wrong on two counts: every form of HRT is not the same, and the terrifying cancer-scare headlines which erupted with the Women’s Health Initiative Study back in 2002 refer to the older, synthetic forms of HRT that have now been superseded by a completely different products.

The bad news: In the general population, 23 cases of breast cancer will be diagnosed per 1,000 women. If women take the old, synthetic HRT, an additional 4 cases appear. If women drink a large glass of wine every day, an additional 5 cases appear. If women are obese (BMI over 30), an additional 24 cases appear. The good news: If women take 2.5 hours of moderate exercise per week, 7 cases disappear. If women take estrogen-only HRT, 4 cases disappear.

• The experience of the menopause is yet another burden for women that can hold them back in their careers. It typically turns up at a time when they already have a lot on their plates, trying to sustain a career whilst dealing with moody teenagers and ageing parents. Hot flushes can be debilitating. Thanks to reports on COVID-19 we have heard a lot about ‘brain fog’; unfortunately this is another symptom of the menopause:

When scientists ask menopausal women about their symptoms, 80 per cent report hot flushes, 77 per cent report joint pain, and 60 per cent memory issues. Aside from these three, further plagues of the menopause include: heart palpitations, sleeplessness, anxiety, depression, headaches, panic attacks, exhaustion, irritability, muscle pain, night sweats, loss of libido, vaginal dryness, body odour, brittle nails, dry mouth, digestive problems, gum disease, dry skin, hair loss, poor concentration, weight gain, dizzy spells, stress incontinence – and last but not least, something that might be from a horror movie: formication, which means an itchy feeling under the skin, like ants. I had that. Quite simply, the majority of women battle through the menopause, and only a lucky few are symptom-free.

• Suicide is at its highest for women aged 45–49, and at its second highest in the 50–54 age group.
• Some women have to deal with menopause much earlier in their lives than they would otherwise expect. Early onset menopause, and medical menopause (i.e. following a medical procedure), can both be extremely traumatic. One in 40 women experience the menopause before they turn 40.
• Women actually produce more testosterone than estrogen. According to menopause experts, testosterone is an essential hormone that should be replaced and yet it is not officially prescribed ‘on licence’ on the UK National Health Service as part of HRT. It shouldn’t be considered a ‘lifestyle drug’ just used to enhance a person’s libido, but “a life-saving hormone that will preserve [women’s] brains, bodies and long-term health.” It enhances “cognition, muscle, mode, bone density and energy.”
• There is a ‘window of opportunity’ at the start of the menopause to begin estrogen replacement which reduces the chances of dementia and Alzheimer’s.
• However, promising research is growing on older women starting HRT a decade or more after the menopause.
• There is a small group of oncologists are looking at prescribing HRT to breast cancer survivors following a good recovery, used in conjunction with anti-cancer drugs such as tamoxifen. It may be that in some cases, the quality of a person’s life post-menopause outweighs the risks.

The book is a must-read. It has increased my knowledge from next-to-nothing to a broad, general understanding of something that half of the people around me will go through at some point in their lives. I’ve bought a second copy to be left in our book-swap rack at my office.