Ever since I have been plunged into the medically-induced perimenopause and been punched daily by each of the ever growing list of symptoms as in my case perimenopause is definitely a gift that keeps on giving, I have made it my mission to learn as much about it as I can, and help get the conversation going. We as women do not know much about menopause and if we don’t know what to look out for, we cannot catch the first signs of it and prepare for it – physically or mentally.
Perimenopause. Menopause. Postmenopause.
Menopause is just one moment in time marking 12 months since your last period. Once you hit that, you are a postmenopausal woman and will remain one for the rest of your life. The 2-4 years before that, you are likely to be perimenopausal – you may be experiencing a whole array of symptoms as a result of your sex hormone levels fluctuations.
When I sat across the desk from my surgeon when he said I would be going on this drug for 5-10 years and that it would bring on the menopause, all I associated with the word was no periods and no fertility. In fact, this is all that he said following that statement – do you want to consider putting some measures in place to save some eggs before you start the medication? I didn’t, and I was overjoyed that I got away lightly and remember saying to him that I would happily take on the menopause instead of chemotherapy. Oh, the ignorance of that statement.
I didn’t know what menopause symptoms were, so when I started Tamoxifen, I Googled its side effects and thought I knew what was potentially coming.
The first year to eighteen months weren’t too bad. The hot flushes, night sweats and memory issues were pretty much it, but as the time went, my body started malfunctioning in many different ways. Sometimes I wasn’t even putting the weird symptoms down to the menopause. I did not get any information on this topic from the hospital or my GP so I assumed menopause was nothing major, as you would, right?
With time, the most debilitating symptom affecting every area of my life was the inability to fall asleep and stay asleep. Lack of rest means you don’t recover properly from anything. The stress that comes on as the clock is ticking and the 7 or 8pm approaches and you start wondering: what will this night bring? How many hours before I fall asleep? Will it be nightmares again? Will it take 1 or 3 hours of listening to meditation music before the mind quietens down?
The pivotal point for me was finding a book called Roar by Dr Stacy Sims which was recommended by a FB friend who is a cycling coach in the USA. And a man at that. I realised that as a woman, I knew nothing about my own physiology and my own menstrual cycle.
Reading it I felt like a weight was lifting off my shoulders as I finally realised I wasn’t going mad and all those tens of weird things that my body was exhibiting, had all to do with the fluctuating oestrogen and progesterone. My symptoms were not only listed but EXPLAINED. I became an avid follower of Stacy and started spreading the word about the book. I started tracking my periods. I listened to many podcasts where Dr Sims was a guest and found the whole lack of research into women and women athletes outrageous.
“Women are not small men”, you cannot simply take the same training or diet approach that is used for men and just “shrink it and pink it” and voila! I was shocked to learn that 99% of training approaches and new diets that come up are only tested on men because women have menstrual cycle and then menopause which make them so hard to study. Therefore it’s easier to study men, then just adjust the results according to the rule: “shrink it and pink it” – all it takes is to make the recommended numbers of whatever smaller and you can apply the methods to women and expect the same results.
Next major point in my educational journey was discovering Dr Louise Newson who is a menopause specialist in the UK, and her podcast My Menopause Doctor. From one of the episodes I learnt about a free app called Balance (you will find it in the app store when searching for menopause). Up until that point I was using Fitr Woman app which was great for tracking some symptoms and periods but it had two major shortcomings: this was not aimed and menopausal women and the data gathered could not be seen/extracted into a report that could be printed or e-mailed.
Balance is specifically aimed at menopausal women. Every day you log your periods, mood, sleep (duration and how many times you woke up), food, activities, and symptoms. You choose which ones you want to log. What was real revelation was the list of symptoms you can choose from – there are dozens! You select the ones that apply to you and track them daily. You can then see how they fluctuate within a month, every three months, or 6 months. The graphs are easy to read. But most importantly, you can print these reports out and take them to your GP or specialist appointment. This is of utmost importance for a few reasons.
Firstly, with brain fog and memory issues, it’s very hard to remember what happens and how often, when you are sat in front of your GP.
Secondly, many GPs unfortunately do not have special interest in menopause and their general training boils down to: menopause happens, it causes hot flushes, antidepressants should help. Therefore, they even may not be aware of all the symptoms that relate to menopause, but which are wreaking havoc in your life.
Thirdly, sometimes when seeing your GP, you feel rushed or even patronised when your story elicits: well, tough, just grit your teeth and get on with it. It will pass. Will it? Yes, it surely will. But what if you knew that you would have to live with insomnia, crippling joint pain, heart palpitations, painful sex etc for 3, 5, 10 or more YEARS?
Many GPs (like women who have not experienced this issue yet or men, who never will) are dismissive of all these symptoms and will never fully appreciate what living through this time of your life can do to you, your career, relationship and life style.
Hence my advice: educate yourself. Podcasts are great, like the one I have already mentioned. The Balance app have many articles and loads of advice and info on how to alleviate some of the symptoms. There are books on the topic of oestrogen like Oestrogen Matters: Why Taking Hormones in Menopause Can Improve Women’s Well-Being and Lengthen Their Lives – Without Raising the Risk of Breast Cancer by Avrum Bluming.
Both the book and the podcast as well as Roar (in the chapter on menopause) raise the issue of HRT. Many women are petrified of taking it because of the media storm years back that quoted a study saying that HRT increases the risk of breast cancer. You can do your own research on this article and its consequences, but all you need to know is that it is not true and the study’s authors actually dismissed the initial results – pity that that didn’t make the front pages. It wasn’t deemed newsworthy. Scaring millions of women by publishing the first article was much better for the sales of the newspaper that retracting it ever would.
There are also women who do not want to take HRT as they want to go through the change “naturally”. Specialists in the field bring a great point to counter that argument. Hundreds of years ago, women were having children, and then at around 40-50 were going through the menopause and then that was it – they would die shortly after. It was not in the original design for women to live 10, 20 or 30 years after the menopause. Evolution is a slow process though, so it has not caught up yet with the new life expectancy so there is nothing natural in suffering through the years of change when there is medical or other help available.
If you have thyroid issues, you take tablets to replace the hormones and nobody is saying that they want to go through the condition naturally. But when it comes to sex hormones, it is seen as a badge of honour not to seek help or take HRT.
There are some women who cannot take HRT (or think they cannot do it), mainly in the medically induced menopause. However, I would still urge you to seek specialist advice from a menopause specialist. There is new research out there, new guidelines based in science but unless your doctor seeks them out, they are not made to keep up with it. Current NHS guidelines are still following advice from that damaging study mentioned above, so when a GP is about to prescribe HRT, they will get a warning on their screen saying that this medication increases the risk of breast cancer and heart disease. If they do not have up to date knowledge on the subject, they may be hesitant to prescribe it to you.
And here is where becoming an advocate for your own health comes to the forefront. If you have done your research (you may even give your GP links or printouts to some articles or studies), you know the benefits and potential side effects of HRT (in most cases when taken in perimenopause and within the first 10 years from menopause, any negatives are hugely outweighed by the positives) and come to your appointment armed with the reports from your Balance app clearly showing what you go through day in day out, you will feel in control. You will feel confident in what you want from the doctor and what risks you are willing to accept. You will not get confused by your GP if they don’t know as much about the condition as do, because it is you who is living with it and has done research on it. They won’t be able to say: well, maybe start going to bed earlier and exercise more, then come back and see me in 3 months and tell me if it got any better, because by the time you seek help, you have been monitoring your life and have all the data with you.
Some women want to do a blood test to determine if they are perimenopausal. It is possible, but as our hormones are going completely bonkers in that time, depending on when the test is taken, you may not get a definitive answer. Tracking your symptoms over time and doing a menopause questionnaire (also available on the Balance app) is the way forward.
I truly believe that the app is ground-breaking in its simplicity, and we need to spread the word about it, especially amongst women who are around 35 or older and are still not going through the perimenopause. Knowing what to look out for is the key. Doing the menopause questionnaire every 6 months or so will give you an idea if anything is changing.
For example you may not have hot flushes at all, or brain fog, but you notice that you wake up twice every night to pee or that when you pee it feels like you don’t empty your bladder fully, and 5 minutes later you go again. Did you know that this may be a symptom of menopause?
Or your joints, especially hips and back hurt so much at night, that they keep you awake. I spent weeks working with a physio that was making no change to the level of pain. In fact, it was getting worse – all my old joint injuries started resurfacing and my fingers started hurting which was a new thing. I would think it was arthritis, before I would put that down as a menopause symptom, yet it was.
Dry and itchy skin and dry eyes – these can also be cause by lack of oestrogen.
How can we get through it?
Be aware of what your body is experiencing and log it. Speak to women in your family – your mum, if you can, your aunties – and ask when they went through the process and how long it lasted for them. It’s highly likely that your journey will mirror your mother’s. Let’s hope it was a breeze!
Start educating yourself on the topic and your options. Read books, listen to podcasts and join groups on social media when the conversation is already taking place. My favourite two are two Facebook groups: Chilled Menopause (for general population) and Menopause Feisties (for women athletes).
If you work with women in as a PT, physiotherapist or women health specialist, I strongly recommend taking Stacy Sims’ online course Menopause for Athletes. Do not be put off by the price – to be able to understand this massive population and serve them in the best way possible, you must understand the physiological implications of menopause. Calories in vs calories out approach no longer applies. The type of training that your client was doing and nutrition plan they were following in their 20s or 30s no longer works and unless you understand how to offset it, you won’t be effective at your job.
If you or your clients are already going through perimenopause and your life is becoming a shitstorm of symptoms that have taken over your life, look into adaptogens (Ashwagandha, Schisandra, Rhodiola and Maca powder). These will not be effective for everyone (make sure you consult your doctor before taking any of these if you are on thyroid medication or any hormonal medication but be prepared that your doctor has never heard of these so take the info with you). They have been a game changer for me. The above mentioned course dedicates a whole chapter to this issue.
Finally, be aware that many women are going through the same thing as you are. And it will happen to every single one of us (it’s just that some may be lucky enough to barely be aware what is going on) so talk about it! Know that you are not going mad even when it feels like you do and learning that your friend is going through the same, may validate your experience. Yes, uncontrolled bursts of rage are another symptom of this beautiful process.
Someone said going through the peri- and the first 2-5 years of postmenopause is like going through adolescence in reverse: with all the mood swings, uncontrollable behaviours and emotional outbursts. It’s just that this time round you have to take care of your children, possibly parents, partner and a demanding job on top of all that.
Let’s stop the stigma of not mentioning the very word “menopause” because it means we are getting old, we are “past it”, and our life is over. Talk about it with your friends – even if they are younger and nowhere near it. It’s not about scaring them but making them vigilant for when the body start dropping little cues here and there.
At the end of the day, menopause is just another stage of every woman’s life, albeit sometime long and gruesome but then when you are on the other side, there is freedom waiting. You are no longer a slave to your physiology, and you become the wise woman, the elder of your tribe.