Menopause can be emotionally and psychologically challenging for some women. So what can women expect during this transition and what options are available to make it easier to navigate?
When we think of menopause, many of us think mainly of hot flushes.
But for some women this is not their greatest concern; for them it’s the lesser understood psychological and emotional symptoms that can be debilitating and life-changing.
“When I was told by my GP I was in the midst of menopause I fell apart. (There were) feelings of loss, feeling less of a woman,” says Jane Walker*, a Sydney-based management consultant.
Walker also suffered from insomnia, extreme tiredness, was often angry and upset and felt she was in a permanent state of ‘mental fogginess’.
“I had this feeling I was going crazy. I felt I wasn’t me, was not myself,” says Walker, almost 50.
She falls in the 20 to 25 per cent of women who suffer severe menopausal symptoms. Another 50 to 60 per cent experience mild to moderate symptoms, and 20 per cent of women pass through menopause without any symptoms.
Doctors and scientists are yet to discover why, but the fact is every woman’s body copes differently with the fluctuating level of hormones during menopause.
Menopause simply means the final menstrual period a woman has, peri-menopause describes the years leading up to the menopause, and post-menopause are those years after the menopause.
Most women experience menopause between the ages of 45 and 55, with the average age being 51. A fluctuation of hormones occurs in the four to five years before the menopause, but for a minority of women these symptoms last much longer.
Early menopause occurs when a woman’s periods stop before she is 45. If they stop before a woman is 40 it’s known as premature menopause.
Describing how the fluctuation of hormones can affect the body so significantly, endocrinologist-gynaecologist Dr Barry Wren likens it to a trombonist in a 110-piece orchestra playing a different song to everyone else.
“By stopping the production of certain hormones, the body doesn’t function so well, and it upsets many other functions,” says Wren, also a founding member and former president of the Australasian Menopause Society.
This interruption to the body’s systems can cause a range of physical and psychological symptoms, including:
- irregular periods
- hot flushes and/or night sweats
- aches and pains
- vaginal dryness, sexual dysfunction
- sleep disturbance and fatigue
But it is the poor concentration, foggy thinking, forgetfulness and severe mood swings many women least expect, and these changes can cause distress, anxiety, depression and the sense of being unable to cope.
The ‘symptoms of menopause can come as a surprise and the management of them is surrounded in confusion and controversy’, Wren writes in his book, Menopause, Change, Choice and HRT.
This was certainly the case for Walker. Despite suffering from many of the aforementioned symptoms from her late 30s, she was 47 before a doctor suggested she may be menopausal.
“I started experiencing symptoms quite early and what followed was something I was totally unprepared for,” she says.
“Here I was going through a normal stage in a woman’s life and I was clueless, and I consider myself to be a highly educated person.”
Fortunately, there are many things women can do to regain control of their physical and emotional health at this time.
Hormone Replacement Therapy (HRT) is recognised by the International Menopause Society as the most effective treatment for menopause symptoms. (While research shows an increased risk of developing breast cancer, it is small and dependent on the type of HRT and length of time it’s used. For women taking estrogen-only HRT their risk doesn’t increase for at least seven years of use; for women taking combined HRT it doesn’t increase for four to five years of use.)
Meanwhile, Australian research shows that the more positive our attitude and the greater our skills in recognising and regulating emotions, the better we usually manage the psychological and physical symptoms of menopause.
This is particularly important to combat the feelings of loss around womanhood, reproduction, age, beauty, etc.
Professor Jane Fisher, spokeswoman for the Jean Hailes for Women’s Health organisation, says a woman’s life circumstances at the time of menopause also play a critical role in how she copes.
“Most women enter the menopausal phase at the same time that other major changes are taking place in their lives … (such as) a transition from providing primary care for very young children or adolescents into a phase when their children are becoming more autonomous,” says Fisher.
“A woman whose identity has been focused on family life, caregiving, running a busy household can feel a real sense of loss when that passes.”
It is important, therefore, for women to engage in activities that are separate to their work as a mother, whether it is in their professional lives, a voluntary capacity or in other areas.
Another positive aspect that women can focus on at this time is a cessation of painful and heavy menstruation cycles.
“Often it can be a transition into a life phase of better health and freedom for women,” says Fisher.
Cognitive Behaviour Therapy (CBT) techniques can also help women ‘reframe’ their thoughts and promote problem solving and constructive thinking.
For example, thoughts that menopause diminishes our worth or makes us less womanly are counterproductive. It is better to look at this time as an opportunity to make a new start.
Adequate rest, diet, exercise and emotional support can also be very helpful.
For more information about menopause, contact:
- GPs who specialise in menopause medicine
- Gynaecologists who specialise in endocrinology
- Menopause clinics within public hospitals
- Jean Hailes for Women’s Health
- Australasian Menopause Society
*Name has been changed