'Women know nothing about menopause, then it hits them over the head like a ton of bricks'
Not only do we not talk nearly enough about menopause – something that affects half the people on the planet, with menopausal women the fastest growing demographic section in the world – but most of the conversations we do have, are misplaced. We spend too much time talking about HRT versus no HRT, about breast cancer risks, even debating whether or not menopause is a ‘Thing’.
In fact, we should be talking about heart health, osteoporosis, and Alzheimer’s. We should be talking, at a most fundamental level, about what is a significant health occurrence, one that now, because of rising life-expectancy, comes roughly mid-way through a woman’s life, and that will have a considerable impact on physical and mental wellbeing.
The conversation we need to be having isn’t the slightly judgemental one around women’s ‘choices’, it is around the health impact of the menopause, and what to do about it.
At its simplest, menopause marks the end of a woman’s reproductive phase. The ovaries no longer release an egg every month, and menstruation stops. Production of oestrogen diminishes gradually in the years before menopause, accelerating in the last year or two.
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This is the point at which women will generally begin to notice symptoms – there is a check-list of over 40 possible, from the well-known (hot flushes, night sweats, insomnia), to the less recognised: panic attacks, painful joints, dry eyes. Some are life-threatening, and some are life-limiting.
Obviously the different reactions of women are dictated by the severity of symptoms – and every woman will have a different menopause, just as we all had different experiences of puberty and hormonal cycles.
However, symptomatic responses aside, the fundamental reality of menopause is that depleted oestrogen has consequences for the whole of a woman’s health, no matter how well she is managing her symptoms, and it is this that needs to be talked about, and understood.
“The problem is, women know nothing,” says Barbara Taylor (menopausetaylor.me), who was an obstetrician and gynaecologist at the Texas Medical Centre, before she retired due to severe arthritis, and threw herself into educating women about menopause. She is in Dublin to speak at Menopause No Taboo, organised by The Menopause Hub (themenopausehub.ie).
“They don’t know what menopause is, when it hits them over the head like a ton of bricks. They don’t realise it’s all one thing, that losing your oestrogen involves a whole list symptoms that make you miserable.
“It’s not even about the symptoms, it’s about the fact that when you lose your oestrogen, you are at higher risk of heart attack, osteoporosis and Alzheimer’s, simply by virtue of losing something your body needed to function.
“It’s a deficiency state. If you lose your insulin, you have 20 symptoms that make you miserable, and if you don’t do something about it, you die. If you lose your thyroid hormones, ditto. So why do we not respond when we lose our oestrogen? Your body is trying to tell you something. And if you don’t listen to it, it’s going to get worse.”
Barbara’s mission is education. “I help women manage their menopause whatever way they want. I have no agenda, no product. This is a purely educational resource for women, on all of their options – diet, lifestyle, vitamins, minerals, herbs, hormonal medications, non-hormonal medications, acupuncture… All I do is teach.”
She emphasises the importance of understanding personal risk factors. “For example, one glass of red wine is good for reducing your risk of heart attack. But that same glass of red wine increases your risk of breast cancer. So you need to understand – what are your personal risk factors? Are you more at risk of breast cancer? Of stroke? Of heart attack? And act accordingly.”
She emphasises that “one in every two deaths of post-menopausal women in America is from heart disease” – low levels of oestrogen pose a significant risk of developing disease in smaller blood vessels – “compared with 1 in 29 from breast cancer. And yet we talk far more about the breast cancer risk. We’re looking the wrong way.”
Women, she says, consult with her from all over the world, and the two biggest complaints are:
“One, their vaginas are on fire – vaginal irritation is the biggest, most bothersome symptom – and they won’t talk about it. They will talk about hot flushes, but not vaginal discomfort.
“Two, is insomnia, because when you don’t get sleep, everything else is off track and awful. But, once they get some information, what they want to know is, ‘How can we be at such huge risk of heart attack, Alzheimer’s and osteoporosis, and not know it?'”
Many women come to Barbara determined against HRT, and many of those reconsider in the light of the information.
“I see more converting to HRT than anything,” she says. But the endgame is not conversion – to anything – it’s education. “Each woman has a journey, finding what works best for her. When they do find it, they are so shocked at how different their lives can be.”
How do you know if you are in menopause?
■The bad news is that there is no one test you can do to show you where you are in your fertility lifespan. GPs will do a blood test to establish your levels of follicle-stimulating hormone, FSH, and to rule out other possible causes, such as thyroid issues or vitamin deficiencies.
■ If your FSH blood levels are 30 mIU/mL or higher, together with absence of periods for 12 months, that suggests you have reached menopause.
■However, testing during the years before menopause (known as peri-menopause), when FSH may be within normal range but oestrogen is dwindling, is more a question of symptom-checking, as blood tests are unreliable: hormone levels fluctuate constantly, so a blood test is a snapshot of a particular moment, rather than an overall picture.
■Instead, it’s a question of a balanced assessment of a woman’s age, her symptoms, including changes to the menstrual cycle, and how she feels, after having ruled out other possible causes.
How important is diet and lifestyle in menopause?
Most women who come to see Nigel Denby, dietitian and nutritionist at the Hormone Health clinic (hormonehealth.co.uk), come because of the weight. He explains: “They find this extra stone, stone-and-a-half, all in the mid-section. Often, they aren’t eating more, they haven’t stopped exercising, so why is this happening? Oestrogen levels are falling, and the way your body lays down its fat changes. This is a symptom of menopause.”
⬤ Diet won’t “give you a ‘natural HRT’. It just won’t. Let’s lay that to rest.”
⬤ In terms of diet and lifestyle, you need to “take care of your bones, look after your heart, and sort out this menopausal midriff weight gain.” The reasons are compelling: “50pc of women over 50 in Ireland will fall and break something,” he says. “20pc of those will die from that, and another 20pc won’t make it past a nursing home.”
⬤ “The second your oestrogen starts falling, your risk of a heart attack goes up to the same as a man’s. You’ve had protection all your life, until now. This is the second biggest killer in Ireland, and nobody talks about that.”
⬤ Essentially, you may need to learn to eat and exercise differently. “What you’re trying to do is wind back time,” he says. “Your body is ageing. You’re losing muscle tissue, laying fat down in a different way. You need to reverse that. And you’re not going to do it by a couple of gym classes a week. It has to be every single day. It’s hard work.”
⬤ “First, get yourself active. Look at your day-to-day stuff. Are you getting your 10,000 steps in? If not, nothing you do in the gym is going to make a difference. Combine it with resistance exercise, focusing on thighs, gluts, abs, upper body and arms. Do squats, abdominal curls, box press-ups, 4×10 reps every day. Work until your muscles are tired. That’s going to generate muscle tissue that is going to speed up your metabolic rate.”
⬤ As for diet, “If you are going to lose weight, you’ve got to cut out about 300-500 calories a day. Start with a food and activity diary. For most people, the extra calories come from booze, and large portion sizes; most of us are eating way too much.” But, he emphasises, “all of that needs to happen while taking care of your bones and your heart health. You need two to three servings of dairy, and consider supplementing with vitamin D. Try and eat more fruit and veg, more oily fish and soluble fibre.”
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