Irish Independent – 12 April 2010
We all know about the menopause so why is it that women are failing to recognise its symptoms — including mood swings and fatigue — attributing them instead to a hectic lifestyle
CHRISTMAS Day is not, by any measure, the ideal time for a menopause meltdown. Until December 25 last, I'd have considered myself relatively well informed about the condition. After all, who hasn't heard about the menopause?
Sure, I'd been having some sleep disruption. Sure, I was waking up in the middle of the night covered in sweat.
I'd put the insomnia and early morning anxiety overload down to everything from work worries to the stresses of parenting; the night sweats I'd blamed on an over-abundance of quilts. I'd attributed my occasional forgetfulness on stress, my low mood on the recession, and my loss of interest in literature to simply having too much to do. I never thought of the menopause.
The menopause, I'd airily assumed, was for, well, 'older' women (I'm 46) and (profound apologies) to people who didn't have enough on their minds.
Then last Christmas morning, I lost the rag.
It happened during the preparations for the same Christmas dinner I'd been doing for years for my husband and children and a small number of guests.
It was a well tried and tested routine and everyone knew what to do, but suddenly this year, the kids weren't helping enough. My husband's feet were in the way every time I turned around.
The mangoes for the starter were unripe, the roasting potatoes got boiled instead of par-boiled and although I was certain I'd asked him several times, my son had neglected to find the loaf tin for the chestnut stuffing.
This was too much, I shrieked; nobody was helping. I could feel a big red flush creeping up my neck and over my face as I burst into tears and stormed out of the kitchen, leaving the three of them speechless.
Well, wow, as my teenage daughter remarked afterwards.
I was, it later emerged, one of the estimated 260,000 women in this country who are currently believed to be experiencing the menopause.
We're not old — usually somewhere between 46 and 51 — and we're certainly not imagining it. According to the 2008 Women's Health Council Report, about 50pc of women aged 40 plus have either experienced or are currently experiencing the menopause.
The average age of onset of the first symptoms is 47, according to the study, which says the most usual age span for onset is 46-51 years.
"The official definition for menopause is when your periods stop, so the lead-up to that is the peri-menopause, which can last up to five years," explains GP Mary O'Flynn, who specialises in women's health.
About half of women experience severe menopausal symptoms, she says. Physical manifestations include the notorious hot flushes as well as palpitations or pounding heart, dizziness and migraine or tension headaches.
There's also a host of psychological symptoms which include mood swings, irritability, unwillingness to go out — agoraphobia — loss of confidence, poor concentration and disrupted sleep.
Women may also experience dryness of the vagina, associated with decreased libido — "in other words, sex hurts," says O'Flynn bluntly.
"The principal symptom of menopause, however, is tiredness and fatigue," she adds.
About a third of menopausal women suffer moderate symptoms, according to O'Flynn, while around five per cent will have none at all.
Family patterns are significant. If your mother had a late or early menopause, you're likely to have a similar experience, she warns.
And it does tend to drag on — the average duration of symptoms is one to five years for over half (56pc) of women. About 25pc experience it for over five years and 18pc either have no symptoms or have them less than one year.
For some women, particularly those in the workplace, symptoms like hot flushes can make life deeply uncomfortable, says Dr Caitriona Henchion, Medical Director of the Irish Family Planning Association.
"Women who are at work seem to perceive a stigma about having hot flushes in a work environment. They feel this panic sensation that 'everyone will look at me wondering what's wrong with me.'
"It's difficult, for instance, if they're holding a meeting or if they want the window open in the office and everyone else says it's freezing."
Some may mistake the symptoms of menopause as simply a case of life getting them down.
"Women who are menopausal can be pressurised from both ends — they may attribute tiredness, lack of concentration and even feelings of mild depression to the demands that are being placed on them," says O'Flynn.
"They're not realising that the risks associated with it, like the increased risk of heart disease and osteoporosis, are very real."
According to the Women's Health Council study, the GP is the top choice for women seeking information about menopause and O'Flynn strongly advises women to make that all-important visit.
It may first be necessary to rule out other things, and establish that there are no underlying illnesses, such as thyroid problems.
There is a blood test to check the presence of Follicle Stimulating Hormone, which is produced at high levels when oestrogen levels are declining.
If two separate tests show FSH levels above a critical level, explains Dr Henchion, it will confirm a diagnosis. If you're under 50 and your periods have been stopped for two years you are post-menopausal, she says. Similarly, if you are over 50 and haven't had a period for two years this means that they are finished.
Because of the negative publicity surrounding Hormone Replacement Therapy, which studies have linked with increased risk of breast cancer, stroke and heart attacks, many women don't bother to see the doctor, because they presume that HRT is all that's available, says O'Flynn.
This is a mistake because they may not discover that the long-term consequences of oestrogen deficiency, such as heart attack, stroke, high blood pressure and high cholesterol as well as osteoporosis, affect more than 50pc of women.
According to the Women's Health Council report, HRT uptake here is "relatively low", at about one in five women.
Many doctors have also become more cautious about prescribing HRT as a result of findings like those of the Women's Health Initiative, a US-based study, she observes.
Yet, although HRT is not believed to be appropriate for anyone with a history of breast cancer, or who has had cancer treatment or is a high risk of heart disease or stroke, for those to whom it is suited, it can work well.
"One thing that came out of the Women's Health Initiative Study is that short-term HRT is safe for certain women for about three years — however, that finding never got the media attention!" says O'Flynn.
"I feel HRT has received an undeserved bad press. I believe the figures from the WHI study should be reviewed."
Henchion says patients who are suited to HRT usually report a good reaction to the treatment — often within a month. They will generally remain on it for up to five years.
"It's gratifying to see people coming back after three months saying they feel like a new woman."