Irish Times – 9 February 2010
BY SYLVIA THOMPSON
AN ESTIMATED 260,000 women in Ireland are currently experiencing the menopause. About two-thirds of these women are having regular symptoms including hot flushes, night sweats, mood swings and forgetfulness. Although a completely normal stage in every woman’s life, the menopause is still rarely talked about in public, and even in private it is usually whispered about in moments stolen from other conversations.
The study found that although only one in four adults considered themselves to be well informed about the menopause, most people knew that hot flushes, night sweats, mood swings, irritability and depression were all associated with the menopause. The difficulty is working out whether the symptoms – particularly the psychological ones – can be attributed to the menopause or not.
“It’s difficult to say exactly how long the menopause will last because it varies so much from woman to woman. Some women will have a regular cycle and then miss one period and never have another, while others will have irregular periods for five years. Some will have night sweats or hot flushes for even longer,” explains Dr Caitriona Henchion from the Irish Family Planning Association.
The GP, a family planning clinic or Well Woman Centre is where most women go if they are seeking out confirmation of whether they are menopausal or not. “If a woman comes to us and says that she finds she is losing the head very easily, it’s hard to say if it’s menopausal or just that she is dealing with difficult teenagers,” says Henchion.
“What we do first is that we rule out other things and check that the woman’s health is good and there are no underlying illnesses such as thyroid problems. Then, we look at what clinical symptoms are present.
“A blood test to check FSH can confirm the diagnosis, but only if you get two high readings of it,” she explains.
When it comes to deciding whether a woman is still fertile, Henchion says the advice is very clear. “If you’re under 50 and it’s two years since your last period, or if you’re over 50 and it’s a year since your last period, then you no longer need contraceptives,” she says.
In the 1980s and 1990s, Hormone Replacement Therapy (HRT) was the treatment of choice for women suffering from menopausal symptoms. But, more recently two large studies linking HRT to an increased risk of breast cancer has put a lot of women off it.
“Almost every menopausal woman was on HRT in the late 1980s and 1990s for as long as 10 to 15 years,” explains Dr Sam Coulter-Smith, Master of the Rotunda Hospital, which has one of the two hospital-based menopause clinics in the Republic.
“HRT was a great marketing success for the companies that manufactured it. More recently, it has come into question because prolonged use of it is associated with breast cancer. It doesn’t deliver as much as it promised and it isn’t prescribed as readily now, but there are still some women who will benefit from being on it for one to two years.”
The Women’s Health Council study found that HRT is still the preferred choice of treatment for about 20 per cent of menopausal women but doctors are much more cautious about prescribing it.
Women who do choose to take HRT now tend to take a very active role in managing the distressing aspects of the menopause, according to an Irish study published in Menopause , the journal of the North American Menopause Society.
HRT is still strongly considered not suitable for those with a history of breast cancer, heart disease, stroke or blood clots.
“For those who are suitable for HRT, there can be a dramatic effect. Women will come back to us and say, ‘I feel like a different woman, I’m so grateful”, says Henchion. “There can be a rebound of physical symptoms after coming off HRT but this can be dealt with by coming off it more slowly,” she adds.
Six monthly check-ups are required for women who are on HRT, specifically to monitor any potential changes to their breasts or blood pressure. Side effects include breast tenderness, nausea, unexpected bleeding and premenstrual-like symptoms.
Many women now turn to complementary therapies such as acupuncture, reflexology, homeopathy and aromatherapy to help them through the menopause. Herbal remedies such as black cohosh and ginseng have also been found to decrease anxiety and ginkgo to improve memory. Concerns remain, however, about over-the-counter remedies which might mimic the effects of oestrogen in the body.
“I would be very cautious about alternative remedies which relieve physical symptoms because if they work, they must have oestrogen-like substances. It is not wise for any woman to take such remedies without having regular breast and blood pressure checks,” says Henchion.
While menopausal symptoms can be severe for women no matter what their work/life balance is, some symptoms can be particularly difficult to deal with in shared offices, busy retail outlets and open-plan factory floors.
In these cases, the menopause can totally undermine a woman’s confidence. “Hot flushes can be very embarrassing and women feel very uncomfortable going over to a window trying to get air or not feeling fresh and clean at meetings,” says Henchion.
It must, however, be noted that according to the Women’s Health Council report, up to half of all women have only mild menopausal symptoms. For these women, maintaining a healthy diet and lifestyle will help alleviate symptoms much in the way it helps relieve mild menstrual problems.
More specifically, taking regular exercise (swimming, walking and yoga offer a balance of aerobic, weight bearing and stretching exercises) and eating a healthy diet (lower salt intake, at least five portions of fruit and vegetables each day and plenty of fibre and water) will also help reduce the risk of heart disease, stroke and osteoporosis which increases following the menopause.
The presence of oestrogen during women’s fertile years protects them from these conditions, but from the menopause onwards, a woman’s risk is the same as that for men.
The good news is that many women openly admit that they look after their health better after the menopause. Many also feel more self-confident and relaxed.
'I FELT LIKE SOME ALIEN FORCE HAD TAKEN OVER BOTH MY BODY AND MY MIND': LOU McCULLOUGH
FOR ME, going through menopause was a profoundly destabilising experience. It wasn’t the irregular periods that bothered me. I felt like some alien force had taken over both my body and my mind.
The process started when I was 43. I began getting hot flushes. I had imagined this would mean I would just feel a bit pink and sweaty, but nothing could have prepared me for the sensations I encountered.
It was as though a runaway electric current was pulsing through my veins, buzzing up my back and through my arms. I was full of this sense of burning energy, but one that I couldn’t control, and that was frightening.
I work as a teacher, and I swear the children could feel the heat radiating off me! Several times, I had to leave the classroom.
I took to bringing one of those little battery-operated fans with me, so I could stand in the corridor, lift my shirt and try to cool my body down, hoping that no one would come along and see me. Afterwards, I would feel really weak and floppy, just totally drained.
Actually, secrecy was a big part of my experience of menopause. Now that it’s over, it seems odd to me that I didn’t talk about this with my husband and family.
I’m normally pretty open about things, but I had this absurd sense of embarrassment going on, as though my body was malfunctioning, rather than going through a perfectly natural process.
I know there were times, too, when I was irritable and unreasonable with my kids, snapping at them one moment, dissolving in floods of tears the next. Occasionally I’d fly into these red-faced rages that the kids started calling “Mum’s Wild Woman Moments”. The way I dealt with these overwhelming emotions was to grab the dog and just run from the house, feeling the fresh air on my face, trying to restore some sense of equilibrium.
During the night I’d wake up drenched in sweat, my heart pounding, my mind in overload with anxiety, obsessively going over the events of the previous day and dreading the one to come. It wasn’t like me to behave like this.
At times, it was as though someone else had taken over my personality, leaving me awash in this horrible hormonal soup. I resented the fact that I just couldn’t pull myself together.
Apart from the overt physical and psychological symptoms, one of the most distressing parts of my experience of menopause was hair loss.
I’ve always had quite fine, dark hair anyway, but it started looking really skimpy – in places, you could see my scalp.
In terms of appearance, the other thing I really noticed was that my waist virtually disappeared, going from quite well defined to a tree-trunk, straight-up-and-down shape. I think that the hair loss and the stodginess around my waist bothered me so much because they made me feel unattractive, especially at a time when I was feeling quite mentally fragile, too.
I felt very much alone, almost abandoned during menopause. If I had to go through it again, I’d be much more open about the whole thing, rather than trying to hide away as though I had a shameful disease.
In conversation with Fionola Meredith
MENOPAUSE: THE SYMPTOMS
Physical symptoms of the menopause include irregular periods, hot flushes, night sweats, heart palpitations, vaginal dryness and decreased sex drive.
Psychological symptoms include mood swings, irritability, increased anxiety, insomnia, poor sleep patterns and difficulty concentrating.
THE MENOPAUSE: WHAT DOES IT MEAN?
The menopause marks the end of female fertility and usually happens between the ages of 48 and 55.
Medically speaking, women under 50 who have not had periods for two years and women over 50 who have not had periods for one year are considered to be menopausal.
Most women use the word to mean the years before and just after the menopause.