Are you afraid to be seen reading about menopause in public?
Do you think, “Meh. Hot flashes for a while. Tough it out and you’re done.”
Do you hear HRT and think, “Danger! Cancer!”?
If you answered yes to any of the above, READ ON! You owe it to yourself to find out more about the one thing (besides death and taxes) that all women will experience. There are dozens of symptoms associated with menopause and perimenopause, they can last for decades, and we do not have to tough any of them out; the association of hormone replacement therapy (HRT) with increased risk of breast cancer has been grossly overstated and misrepresented.
These are just a few of the things I have learned after many, many hours of reading and listening to research on this topic over the last year, and I can preach with the zeal of the newly converted. We arm our kids with so much information about puberty, but we don’t know nearly as much as we should about menopause, a period of our lives with as much or more hormonal turbulence. We don’t talk openly enough about it, research is ill-funded or poorly designed, and the cultural scripts for menopausal women are insultingly narrow. It’s time to start talking openly about menopause and demanding better and dismantling the equation of menopause with disease and frailty.
Dr. Jen Gunter, of The Vagina Bible fame, has a new book out, and it’s a tonic in troubled hormonal times. The Menopause Manifesto: Own Your Health with Facts and Feminism does exactly what it says on the tin: it’s both a call to arms and a no-nonsense manual to the medical and cultural issues surrounding menopause. Armed with the knowledge she provides, a woman can seek out and be empowered to demand the best care for her needs. She pulls no punches in her condemnation of the patriarchal marginalization of women’s health, she has no patience for the sham treatments that would profit by our desperate search for care. I admired the level of medical detail she provides, and I appreciated being treated like an intelligent person capable of digesting it. I felt well-informed before reading this book, and it still had a lot to teach me. It’s not light reading, and it’s densely packed with hard science, but because it’s well-organized, you can skim the sections that do not apply to your immediate concerns.
What is Menopause?
So, where should you start if you want to learn more? Begin, as Gunter does, with reframing the definition of menopause. A woman enters menopause after going 12 months without a period, a uniquely useless definition since your hormones will begin a rollercoaster ride of ups and downs long before your final menstrual period (FMP), long before you’ve even missed a single one. The average age of the FMP is 51, and the menopause transition, as Gunter prefers to call the period before, during and after the FMP, begins in the mid-forties. The symptoms of the hormonal disruption can last for decades, and different symptoms will appear at different times. The more you know and the sooner you know it, the better prepared you will be.
Next, learn about all of the possible symptoms, and track them. The Balance app, created by menopause specialist Dr. Louise Newson, is a fabulous (and free) resource. You’ll find listed there all of the symptoms of menopause, and you can track your period as well as the symptoms you are experiencing. It will then generate a report that you can take to your GP, an enormously useful tool for getting the treatment you want and need.
With symptoms as wide-ranging as dry eyes and depression, insomnia and joint pain, painful intercourse and hair loss, brain fog and weight gain, it can be easy to silo each concern rather than seeing them as a suite of symptoms that are hormone-related. As Dr. Newson points out, women are often sent to specialists to address individual symptoms, and this can delay treatment for the hormone deficiency that may be the root cause of them all. Pain during intercourse and low libido may be really difficult to talk about. Alone, hair loss or dry eyes may not seem significant. Put them all together, and there are quality of life and health issues that have a huge impact. Do not accept the message that any of the symptoms are something you have to put up with. If your health care provider tells you that, find another one.
If after tracking your symptoms you decide that you would like to try HRT, be warned that it may take a few attempts with your GP to get a prescription. Don’t give up. Arm yourself with knowledge and be ready to challenge your doctor. Sadly, the misinformation about the link between HRT and cancer has had an enormously negative impact on the treatment of the symptoms of menopause. If you want to learn more about this, hear it from the source. Here is an interview with one of the doctors on the Women’s Health Initiative study in the early 2000s that made the headlines that scared the public as well as medical professionals. Dr. Robert Langer explains exactly how their work was misrepresented and the cascading negative outcomes. The fact that HRT offers protection from heart disease, osteoporosis, and dementia, all serious health concerns for women after 50, adds insult to injury.
In her book, Gunter is careful not to make estrogen a panacea for all that ails us. She does prescribe HRT, or Menopausal Hormone Therapy, as she prefers to call it, but she is wary that it will be seen as a miracle cure. Partly this is an ideological stance and partly a medical one. I appreciated her cautions that we not fall into the trap of seeing femininity equated with the presence of estrogen and its replacement via HRT as the only way forward. There are lots of ways to manage symptoms, and she seeks to inform not to insist on a single route to better health.
The Big Picture
Cardiovascular disease, osteoporosis, diabetes and dementia are among the medical conditions most likely to kill you after 50. One very good reason to manage your menopause symptoms is so that you have to energy to lift weights, exercise and make good food choices, all proven to help prevent these medical conditions. Women will spend 1/3 to 1/2 of their lives post-menopause. You want to spend those years fighting fit.
I have found and enjoyed many other reliable resources on this topic. Dr. Louise Newson’s website is full of useful information. She also hosts a weekly podcast, and she speaks to medical professionals as well as women from all different walks of life about menopause and its treatment. Postcards from Midlife is another podcast from England with an emphasis on empowerment and celebrating midlife.
Gunter suggests that rather than doing an open search for information, you search on reputable websites, like the Society of Obstetricians and Gynecologists of Canada. There, you will find medically sound advice rather than rolling the dice with Dr. Google.
If you know of any great resources, please share! And please tell your menopause stories. Tell your kids and partners about your “power surges,” a lovely replacement term for hot flashes. Tell your girlfriends about how you’re feeling and what treatment you’ve found. The more we can learn from each other, the sooner we can move past the taboo and start getting the care we need.