Why do so few doctors realise that the run-up to the menopause can be worse than the real thing?
Black moods. Crippling anxiety. Exhaustion...
The transformation happened almost overnight, starting with an explosion of tiredness. Suddenly, I was inexplicably exhausted day and night.
I put it down to a busy life working and juggling the needs of two children, elderly relatives and pets. except this wasn’t like any tiredness I’d had before. At 42 I felt like an old woman, not the mum of a ten and a 12-year-old.
Before, I’d enjoyed five-mile runs during the week, heading out on long walks with the dog at weekends and family bike rides whenever I could. Now I could barely summon the energy to get out of bed. My legs ached and walking up stairs felt like an endurance test.
Then there was the anxiety. I’ve always been a worrier, but the odd flash of mild unease about an unpaid bill turned into a daily knot of gut-clenching panic.
I was waking at 4am, my heart racing and my mind full of irrational ‘what ifs’. Sometimes I’d barely be able to make conversation, I was in such a state.
The combination of anxiety and dark moods left me feeling increasingly out of control at least two weeks out of every four. I could no longer relate to the happy, sociable ‘old me’.
But as my periods were still regular and I was more prone to a bout of the shivers than a hot flush, it never occurred to me that my hormones might be to blame. I thought the menopause was at least a decade away.
My GP insisted that I was most likely to be suffering from depression and suggested taking antidepressants.
Yet new research has discovered that eight out of ten women experience hormonal disturbance years before the menopause, with a quarter suffering moderate to severe symptoms — and that’s what was happening to me.
So why are we being ignored? The dismissive attitude of some GPs doesn’t help, as Nadine Lewin can attest.
The 48-year- old lives in Dorset with her husband and two children. She was 45 and had just started a new job as a teaching assistant in September 2014 when she noticed patches of dry skin around her neck and under her arms.
She recalls: ‘I put it down to stress at first, but the crippling fatigue that accompanied it was harder to explain. It seemed to come out of the blue. My appetite disappeared and I felt increasingly anxious and depressed, too.
‘Soon, when I wasn’t crying uncontrollably, I was apathetic and uninterested in life. I hardly recognised myself and that was the most frightening part.’
Nadine went to see her GP. ‘She was a woman so I hoped she’d understand but she was very dismissive and blamed stress, sending me away with steroids for my skin,’ she says.
‘As my doctor pointed out, it couldn’t be the menopause because my periods were regular. She also offered me antidepressants but I didn’t want them.’ NADINe
tried various cures, cutting out alcohol and overhauling her diet but nothing worked. Fifteen months later, in a state of exhaustion and with red raw skin that prevented her from sleeping, she saw a dermatologist.
‘This doctor took a biopsy of my skin and also suggested running some blood tests to check my hormone levels. When the tests came back showing worryingly low oestrogen and progesterone levels, I felt an overwhelming sense of relief. I was pre-menopausal, not depressed!
‘She prescribed me immunosuppressant medicine to tackle my skin and suggested I consider hormone replacement. She told me everyone reacts differently to the approaching menopause and my skin issues were very likely linked to my hormone imbalance.’
Now 50, Zoe Parkin was also in her 40s when she ‘began to feel like a completely different person. I was having head-
aches and wasn’t sleeping well’, she says. ‘I felt generally unwell and really not at all my usual self.
‘In the months that followed I didn’t tell anyone. I was too embarrassed in case they thought I was unhappy with my life, even though the bouts of anxiety could be overwhelming at times. Looking back I don’t know how I coped with the fluctuating moods.’
When she eventually did see her Gp, Zoe, an office manager, was told ‘in no uncertain terms’ she needed antidepressants.
‘I’d never been depressed in my life so none of it made sense to me.
‘The idea that I might have to live the rest of my life in this state was too awful and I became increasingly stressed, which compounded the problem.’
Two years later, after moving house and changing doctor, Zoe met her new practice nurse, who recognised her symptoms straight away — because she had experienced something similar.
‘She gave me the number for Dr Louise Newson, who runs a private menopause clinic at the parkway Hospital in Solihull,’ Zoe says.
Blood tests confirmed that her hormone levels were ‘ all over the place’ and she was prescribed HRT.
Like me, neither of these women suspected that hormonal changes could be to blame for their symptoms.
I was 42 for goodness sake, and it didn’t seem so long ago that I’d had my children, so how could the menopause be looming already?
Besides, after summoning the courage to open up to a doctor, I was told that the brain fog, muscle aches, lethargy, black moods and anxiety all sounded like a classic case of depression.
But it didn’t make any sense. I’d survived ten years of a rocky marriage, a miscarriage and the death of my dad without showing any sign of depression.
Now I was financially secure, in a happy, loving relationship with a kind, devoted partner and had two lovely, well-adjusted children. How could I have become this depressed literally overnight?
My partner, Jo, meanwhile, struggled to keep up with my rollercoaster mood swings; tearful and needy one minute, cold and distant the next. I didn’t understand what was happening, so how could I explain it to him?
I was worried he’d think I was going mad so I hid much of what I was going through. I started keeping a diary and the symptoms were worse at certain times of the month. Could I be menopausal?
It was very unlikely, the doctor said. I was still having regular periods. The FSH blood test I had, which measures levels of follicle- stimulating hormones, came back ‘normal’, suggesting that I was still ovulating in the expected range. So no early menopause. Was I sure I didn’t want to take antidepressants? BUT
every instinct told me depression wasn’t the issue. So I fought on — and my online research led me to an appointment with Dr amalia annaradnam, a Gp who specialises in the treatment of hormonal imbalance and menopause symptoms at the London Hormone Clinic.
She related to my experience immediately and explained that, even though my periods were still regular, a pre- menopausal hormone imbalance could still be the problem.
Many women begin to experience these changes in their early 40s, she said, but they are often not correctly diagnosed. She ran more blood tests, reassuring me that even if they came back normal I wouldn’t be sent away to suffer. Hormone levels can fluctuate so much that one set of tests may not offer proof of anything.
a week later Dr annaradnam told me I wasn’t going slowly mad, or suffering with depression. I had low levels of the ‘ happy’ hormone, progesterone.
She prescribed a low dose of bioidentical progesterone cream — bio-identical means something that mimics your natural hormones — to be applied daily.
a week after starting treatment, the morning stomach knots unravelled and I began to get my energy back. ‘When women are still having regular periods and their FSH levels are within the normal range, many Gps won’t even consider pre-menopause hormone imbalance as the issue,’ says Dr annaradnam.
‘as this hormonal change also often occurs at a time of life when women are under strain from lifestyle factors, such as coping with work pressures, elderly relatives and growing teenagers, many assume they are feeling this way because they’re not coping.
‘Depression can seem the most likely culprit but even when premenopausal hormonal imbalance is suspected, the options available to an NHS Gp are limited. progesterone cream, for example, is not available on the NHS.
‘ Gps may be inclined to prescribe antidepressants because there is some evidence to suggest that they can be beneficial in the treatment of certain menopausal symptoms, such as hot flushes and mood imbalance.
‘But the problem is that these drugs don’t address the cause of the imbalance and can have unpleasant side-effects for some. Weight gain can be one, as can loss of libido, and for others these drugs can actually exacerbate low mood symptoms.’
Nine months after starting the progesterone cream (which I get from a specialist pharmacy), I’ve got my life back — and wonder how I coped for as long as I did.
My treatment works out at about 50 pence a day, which seems a small price to pay, and it should keep my natural levels balanced until I reach the menopause.
I feel like one of the lucky ones, as there must be thousands of women who are suffering in silence or are fobbed off with antidepressant drugs that don’t address the real cause of their symptoms.
‘Looking back, I lost almost three years of my life,’ says Nadine. ‘I’d encourage any woman my age to stick to her instincts and push for a proper diagnosis.
‘I just wish I’d done it sooner.’