Until I met the menopause and its dastardly precursor, the perimenopause, I thought I was capable of coping with anything. My passage through midlife’s magnificent shitshow has been an education which both put me in my place, and helped me understand how tough that place is for others. The more I find out about what happens to women in menopause – physically, mentally, medically and culturally – the more I am on a war footing.
The more I find out about what happens to women in menopause – physically, mentally, medically and culturally – the more I am on a war footing.
I’m making a documentary for Channel 4 about the menopause, presented by Davina McCall, and writing a revolutionary menopause book out from Simon and Schuster this summer. The catalyst for both was my own menopause experience – less a journey and more a full Thelma and Louise car crash – and a realisation that menopause hugely heightens health inequalities.
My story begins with palpitations of the heart. In my late forties, as my oestrogen levels went haywire, I started getting lots of erratic heartbeats in the night: sudden, fast, panicky pounding in my chest and tightness in my throat, for no reason at all. I still had my periods, but I also had a few hot flushes. My GP said: “Oh you’re too young to be menopausal. They can’t be hot flushes,” and she sent me off for an electrocardiogram, at some expense to the NHS. I’m a runner. My heart was fine. The doctor’s diagnosis was “too much coffee.” Of course, now that I’ve read umpteen menopause manuals, I know that those harmless palpitations were a classic sign of falling oestrogen levels, and reported by 11 per cent of women. My doctor, however, did not. That’s because menopause – and perimenopause – is not a compulsory module in GPs’ training. Yet.
If fluctuating hormones are sending erratic electrical signals to your heart and internal thermostat, what peculiar messages might they be sending to your mind?
No-one told me the perimenopause was a thing. But it’s the elephant in the Powder Room. I somehow thought perimenopause was a relatively symptomless pre-menopause, and wasn’t worth worrying about. But there are oestrogen receptors in every part of your body, and if fluctuating hormones are sending erratic electrical signals to your heart and internal thermostat, what peculiar messages might they be sending to your mind?
Not long after my mother died after a long haul with Alzheimer’s Disease, and I’d juggled going up to Scotland to care for her, a full-time job as The Times film critic in London, and raising three children, I suddenly needed to be free of all responsibility. I walked out of what seemed to be a stable marriage, which we probably could have looked after better, and let chaos reign. It felt selfish, shameful and unstoppable. I also unexpectedly changed jobs, risking my career. I just couldn’t cope. As the psychotherapist and writer Suzy Orbach puts it: “The menopause arrives, seeking out our vulnerabilities like a guided missile, just as we need all our strength to cope with daily life.”
“The menopause arrives, seeking out our vulnerabilities like a guided missile, just as we need all our strength to cope with daily life.”
In perimenopause, unless you’re one of the lucky women whose body cruises as smoothly and smugly as a Tesla, there is a feeling of being puppeted by forces beyond your control. Hormones play good cop, bad cop: soothing you one minute, abandoning you the next, depriving you of sleep, breaking you down. It can really mess with your mental health. When the nurturing hormones oestrogen and progesterone start disappearing, that often leaves testosterone powerfully dominant, until that goes too.
“As your perimenopause gathers pace, you experience what I can only describe as increasing sobriety,” Caitlin Moran, who is 45, wrote in The Times. “Suddenly the poor behaviour of other adults comes into focus, as you deal with your hormonal hangover. You don’t have any ‘lady forgiveness’ left in your tank.” Instead there’s growing anger: “You want to meet up with your coven of similarly menopausal friends, all of you stoking each other’s fires of outrage.”
“You want to meet up with your coven of similarly menopausal friends, all of you stoking each other’s fires of outrage.”
This mid-life rage is the butt of jokes: “Behind every menopausal woman is a man who has no idea what he has done,” goes one Instagram meme. But sometimes the build-up of frustration goes beyond that. Most women have spent a couple of decades putting their kids, ageing parents, employers and sometimes partners first, and the self that emerges after the caring mummy-hormones begin to disappear can be liberating as well as terrifying.
…the self that emerges after the caring mummy-hormones begin to disappear can be liberating as well as terrifying.
Some have graceful midlife transitions, use the jealous-making phrase “Oh, I sailed through menopause,” and communicate brilliantly with their partners. Many recalibrate their lives, frolic with natural remedies, and embrace the idea that the menopause is a “Passage to Power”. In Leslie Kenton’s book of that name, she suggests that during this transformation of her body and her life, a woman “needs the knowledge of the soul – access to myths, symbols and rituals which help her reconnect with the deepest levels of intuition and instinct.”
I didn’t need symbols. I needed three letters: HRT.
I didn’t need symbols. I needed three letters: HRT. My hair was falling out, my memory was short-circuiting, my hot flushes were actually demonic possession, and I asked about hormone replacement therapy. Instead my NHS doctor gave me a Mirena coil which contains a small dose of synthetic progestins, and sent me packing, when clearly from the symptoms, my body was screaming for oestrogen. I didn’t fight her diagnosis, because I was also terrified of getting the old oral HRT pills, because the breast cancer risk headlines from twenty years ago were still seared in the back of my retinas. Stymied, I asked around my fiftysomething friends, and one by one they revealed their secret: they were on supposedly safer private bio-identical hormones from clinics in the vicinity of Harley Street. It cost £300 for an initial consultation, more for every prescription and hormone blood test. I paid up.
The bio-identical HRT made from yams worked brilliantly at first – within four days my hot flushes and palpitations disappeared forever, my memory returned and – unexpectedly – my mood lifted and my joints became supple again. Oestrogen was clearly the oil I needed in my engine, but it turned out the bio-identical hormones were from an unregulated pharmacy, and eventually I got sick. I detail the health dangers for women and my investigation into some of those glossy private menopause clinics in the UK and USA in my forthcoming book.
Doctors’ knowledge of the latest, safer brands is often 20 years out of date
Eventually, I discovered that safer body-identical (not bio-identical) hormones were available on the NHS: micronised progesterone and transdermal estrogen gel or patches, which the British Menopause Society says have “no or lower risk of breast cancer” compared to the old oral pills like Prempro, which are made of synthetic progestins and oestrogen from horse urine. I’m on the “gold standard” NHS HRT now, and it’s great. I just wish my GP had told me about it in the first place.
I’m on the “gold standard” NHS HRT now, and it’s great. I just wish my GP had told me about it in the first place.
During this HRT odyssey and investigation, I came across Dr Louise Newson, a campaigning menopause specialist with a clinic in Stratford-Upon-Avon with twenty doctors and a six-month waiting list – mostly from women who have been refused HRT by their GPs. Doctors’ knowledge of the latest, safer brands is often twenty years out of date, based on misinterpreted research. GPs hedge their bets when a menopausal woman walks in: “We found 66 per cent of women were offered anti-depressants, when they should have been offered HRT,” said Newson. Every week, she takes on emergency patients at the last minute. “They’re talking about suicide, they can’t cope, and often all they need is their hormones topped up.” Female suicide rates peak around perimenopause and menopause. Newson also offers women testosterone, the hormone we make more than oestrogen, which helps with energy and libido – but it’s not yet available on the NHS. Except to men.
The more I found out, the more I got incensed by the ignorance and inequality and the disregard for older women’s quality of life.
The more I found out, the more I got incensed by the ignorance and inequality and the disregard for older women’s quality of life. I’m now working with Dr Newson on The Menopause Charity, set up to help the 13 million menopausal women in the UK get access to evidence-based information, and safer HRT. It turns out the “gold standard” body-identical HRT I’m using isn’t available in all parts of Britain. The breast-safe micronised progesterone isn’t licensed by the NHS in Scotland, Darlington, Doncaster and most regions up North, while it’s much more easily available in London and the South East. It’s yet another health inequality thrown on the pile.
Inequality is coupled with medical sexism, which fails to take account of the latest medical research, and leaves women – 90 per cent of whom have menopausal symptoms – to keep calm and carry on. Researching my book, I discovered more about the grim toll of oestrogen deficiency in every women’s second half century, and the latest research on HRT’s extraordinary long-term health benefits for osteoporosis, diabetes and the special “window of opportunity” which may prevent Alzheimer’s Disease, which women are twice as likely to get as men.
But in a wider way, going through menopause has taught me something new and humbling: that I couldn’t always work to fix everything, I couldn’t always cope, and that sometimes an outside force, like a hormonal tsunami, is unstoppable. And it must be so for millions of women. I understand now that I was one of the lucky ones, able to get hormones – and a brilliantly feminist therapist who over a year gave me the emotional tools I had lacked for for fifty years. That’s a Scottish Presbyterian upbringing for you. This has certainly been a “passage to power”, but it’s not the passage I expected.
This has certainly been a “passage to power”, but it’s not the passage I expected.
To my surprise, I now have a new job, a new partner, a new home, some new and old friends, and even a new dog, all of which have emerged out of the painful chaos of the last few years of change. But I want to tell my story, and that of dozens of midlife, menopausal women in the book, so that others don’t need to drive off the cliff before picking themselves up.
Menopause should be about metamorphosis, not misery.
– Kate Muir
Kate Muir is writing a revolutionary menopause book, published by Simon and Schuster this summer, and making Channel 4’s upcoming menopause documentary. She has written three novels and was previously The Times’ film critic.
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