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The Sunday Telegraph - Stella - - CONTENTS - il­lus­tra­tion: lana hughes

How to have a happy menopause. Re­ally!

It’s of­fi­cial: the menopause is be­ing re­branded. New re­search re­veals that women at this stage are feel­ing more fired-up and am­bi­tious than ever – and what’s more, symp­toms, from hot flushes to anx­i­ety, can be fixed. Lola Borg brings you all you need to know

MENOPAUSE HAS TRA­DI­TION­ALLY had a bad rap. A per­fectly nat­u­ral life tran­si­tion, it’s ei­ther glossed over or the butt of bad jokes such as Joan Rivers’ one about the menopausal friend who came to lunch and ended up steam-clean­ing the car­pet. No won­der women of­ten choose to ig­nore it – un­til they are con­fronted by shouty symp­toms that de­mand at­ten­tion.

But more and more women are now look­ing at ‘the change’ dif­fer­ently. Rather than bury­ing their heads in the sand, they’re choos­ing to ap­proach the menopause ac­tively and openly – not just striv­ing to break the stigma, but also to tackle the symp­toms.

Be­cause the same women who are hav­ing night sweats are hot in other ways, too. With chil­dren grow­ing up and gain­ing in­de­pen­dence, women in this life stage have more time and headspace than they’ve had in years: they’re set­ting up their own busi­nesses, run­ning coun­tries or cor­po­ra­tions, or sim­ply restart­ing their lives. Two thirds of menopausal women feel that they’re in the prime of their lives, with nearly 70 per cent con­sid­er­ing them­selves more am­bi­tious than a decade pre­vi­ously – ac­cord­ing to new re­search by fe­male-run mar­ket­ing agency Su­per­Hu­man, ex­clu­sively re­vealed to Stella. They found that the wider per­cep­tion of the menopause to­tally con­tra­dicts how menopausal women see them­selves – no won­der that 81 per cent feel they’re mis­rep­re­sented in so­ci­ety.

‘We re­ally be­lieve the menopause needs a rebrand,’ says Su­per­Hu­man co-founder Re­becca Rhodes. ‘It’s bang out of date. Its cul­tural, med­i­cal and so­ci­etal por­trayal is out of touch with how women live their lives to­day. We ini­tially did this re­search be­cause our agency helps brands en­gage with women. And this is a hugely im­por­tant uni­ver­sal life stage that has been to­tally ig­nored and isn’t ever fea­tured in mar­ket­ing cam­paigns in the way oth­ers are.’

Emma Ed­wards, 51, a com­edy writer and per­former, is an­other woman try­ing to drag the menopause into the spot­light. She de­cided to take ac­tion after wit­ness­ing her friend and writ­ing part­ner, Abi­gail Doo­ley, go through it a cou­ple of years ahead of her, and is her­self now in the mid­dle of what’s known as the per­i­menopause (the hor­monal Hi­malayas that lead up to pe­ri­ods ac­tu­ally stop­ping). She knew the menopause was on the hori­zon but ini­tially, like many women, failed to join the dots. For her, symp­toms have in­cluded ‘sponge brain’, mi­graines, me­mory lapses (‘I couldn’t re­mem­ber my child’s name’), brit­tle nails, strange rashes and dis­turbed sleep. Then there was what she de­scribes as oc­ca­sional fury. ‘You know when you have PMT and you get ir­ri­ta­ble? This wasn’t that: I was fu­ri­ous and found my­self walk­ing by the beach, shout­ing at the sea,’ she says. ‘When I de­scribed my symp­toms to Abi­gail, she said, “Oh yes, it’s def­i­nitely the menopause.”’

Emma re­searched what she could do to al­le­vi­ate symp­toms (see box over­leaf ), and she and Abi­gail chan­nelled their ex­pe­ri­ences into a two-woman show, En­ter the Drag­ons. Per­formed by the pair at Ed­in­burgh this year and soon to go on tour, it busts the myths around this stage of life. ‘I started writ­ing the show be­cause I got to 49, I re­ally wasn’t OK with it, and it was a way of ex­plor­ing that,’ Emma ex­plains.

So what can be done about the plethora of symp­toms? Quite a lot, ac­tu­ally. And it starts with learn­ing what’s go­ing on in your body. Su­per­Hu­man’s re­search found around two thirds of women have no idea how to man­age the symp­toms. Some 69 per cent of women suf­fer in si­lence, and 71 per cent don’t feel com­fort­able talk­ing about it.

Pretty scary. So here’s the sci­ence bit: at ac­tual menopause the ovaries stop func­tion­ing, pro­duc­ing no oestrogen, pro­ges­terone or testos­terone, and it is no longer pos­si­ble to be­come preg­nant nat­u­rally. This is pre­ceded in most (al­though not all) women by the per­i­menopause, start­ing at any age from around 45, but on av­er­age in the late 40s. This can be a time of roller-coaster hor­monal fluc­tu­a­tion – the ovaries’ last hur­rah as it were – typ­i­fied by menopausal symp­toms such as night sweats. Many women find this stage harder than the menopause it­self, which of­ten is con­sid­ered to be one year after pe­ri­ods stop, or when the ovaries more or less cease all hor­mone pro­duc­tion.

Hor­mone re­place­ment ther­apy (HRT) was the go-to treat­ment to al­le­vi­ate menopausal symp­toms un­til around 2002, when stud­ies – now largely con­sid­ered to have flawed con­clu­sions – linked it to an in­creased in­ci­dence of breast can­cer, heart dis­ease, stroke and blood clots. But more re­cent think­ing sug­gests HRT is ben­e­fi­cial. ‘NICE guide­lines now state that it’s safe to give women HRT if they need it,’ says Dr Jan Toledano of the women-run Lon­don Hor­mone Clinic. ‘It’s im­por­tant to stress that women do not need to suf­fer – they can get HRT if they want to.’ HRT, she ex­plains, works by top­ping up the hor­mone that is not be­ing made – she com­pares this to treat­ing di­a­betes with in­sulin.

Blood tests are some­times pre­scribed by GPs, and it is cru­cial to get the di­ag­no­sis right in or­der to pre­scribe the cor­rect HRT. How­ever, the symp­toms alone can of­ten be enough to make a di­ag­no­sis.

Many women pre­fer BHRT (us­ing bodyor bioiden­ti­cal hor­mones, de­rived from more nat­u­ral sources such as plants; see lon­don­hor­moneclinic.com for more in­for­ma­tion), of­ten pay­ing for pri­vate treat­ment, al­though some bioiden­ti­cal hor­mones are now avail­able on the NHS. ‘For ex­am­ple, all the oe­stro­gens you get are body-iden­ti­cal now, which didn’t use to be the case,’ says Dr Toledano.

So far, so log­i­cal. But ev­ery woman’s ex­pe­ri­ence of the menopause dif­fers – not just med­i­cally but emo­tion­ally and cul­tur­ally. Much has been made of stud­ies that show Ja­panese women suf­fer fewer symp­toms and, in­deed, don’t even have a word for hot flush. On the other hand, in the UK the high­est rate of sui­cide for women is among those aged 50-54, with the num­ber slightly creep­ing up this year. Ten per cent of women ex­pe­ri­ence de­pres­sion dur­ing menopause. There is, says Toledano, still fear and shame about this life stage.

Among women I spoke to, a com­mon theme emerged: most wished they had been bet­ter in­formed so they were not hi­jacked by pesky per­i­menopausal symp­toms. ‘I still have up to 10 hot flushes a day,’ says He­len Brewer, 56, who runs her own com­pany. ‘I haven’t worn a polo-neck jumper in six years. Who knows what’s go­ing on? Not me.’

Many women ex­pressed how truly fright­en­ing it is to be held hostage by mood swings, off-the-scale PMT and de­pres­sion. There was a com­mon feel­ing of ‘not be­ing my­self ’. Pretty much all of them seemed un­sure when their menopause or per­i­menopause started, when it might stop and which pre­cise stage they were at.

Symp­toms had of­ten been mis­taken for other med­i­cal con­di­tions. One nurse as­sumed her anx­i­ety was a car­diac ar­rest (which sparked a sit­com-style se­quence of events). Anx­i­ety and de­pres­sion are a com­mon fea­ture but un­tan­gling these can be tricky, as the late 40s and early 50s is of­ten a time when ‘stuff hap­pens’: chil­dren be­come in­de­pen­dent or moody, so there are pos­si­bly two sets of rogue hor­mones at work; par­ents are needy; there are sep­a­ra­tions, divorces, work changes, be­reave­ments. Get­ting the hor­mones right, says Dr Toledano, can help women cope with what life throws at them.

So how does it feel to have a faulty in­ter­nal ther­mo­stat? Katie Phillips, 44, a trans­for­ma­tional life coach and founder of The School of Self Love, was taken aback by sud­den adult acne, ‘crazy pe­ri­ods’ and in­ex­pli­ca­ble de­pres­sion. When fe­male friends sug­gested she might be per­i­menopausal, she says, ‘I hadn’t even ever heard of it. Then I felt worse. I thought, “Oh my God, I’m go­ing to lose my sex drive and ev­ery­thing is go­ing to dry up.” Un­til I re­alised… hang on, I’m a life coach. If I be­lieve this is go­ing to be hor­ri­ble, it will be hor­ri­ble’.

Katie did see her GP for a blood test, but only after she had ed­u­cated her­self by mak­ing a se­ries of video in­ter­views with ex­perts on the menopause, which she posted on YouTube so that they might ben­e­fit oth­ers. What helped her, she says, was ex­er­cise (walk­ing, yoga), sup­ple­ments, med­i­ta­tions – but above all a change of mind­set to ap­proach the menopause pos­i­tively, which made her feel she was in charge of her own body.

It is clear there is no av­er­age tran­sit through per­i­menopause and menopause, and no stan­dard treat­ment. If only. But, HRT to one side, com­monly it is diet and ex­er­cise that women use to steer them through. Some swear by herbal reme­dies, some by up­ping their sup­ply of nat­u­ral phy­toe­stro­gens (such as soy), and most by tak­ing care of them­selves in a way they hadn’t, es­pe­cially through the child-rear­ing years.

‘Ev­ery time I got a symp­tom I worked re­ally hard to re­solve it. I’d think, “How can I make this bet­ter for me?”’ says Emma’s com­edy writ­ing part­ner Abi­gail, 55. ‘Some things have worked, such as herbal reme­dies for night sweats. Some symp­toms I had to sit out.’ For Emma, the trick is yoga three or four times weekly, an im­proved diet, far less al­co­hol and a week­end re­treat, Meno­heaven, which she went on as re­search for the show.

‘It re­ally helped me to think about menopausal symp­toms not as your body go­ing “wrong” but do­ing what it is sup­posed to do,’ she says. ‘As soon as I de­cided to make it a pos­i­tive ex­pe­ri­ence, that was the game changer.’ Bring on that rebrand.

Left Co­me­dian Emma Ed­wards, who is tour­ing a two-woman show about the menopause

feel mis­rep­re­sented in so­ci­ety

of menopausal women say they’re more am­bi­tious than they were a decade ear­lier

GET AD­VICE See your GP or a spe­cial­ist clinic to talk over symp­toms and treat­ments. HRT can be pre­scribed on the NHS, as can some bioiden­ti­cal hor­mones. HRT ap­pears to be the most ef­fec­tive treat­ment for symp­toms such as vagi­nal dry­ness and re­duced sex drive.NU­TRI­TION AND EX­ER­CISE This is 50 per cent of what a woman can do to help her­self, says Dr Jan Toledano of the Lon­don Hor­mone Clinic. Nu­tri­tion of­ten needs to change around the time of menopause be­cause the body man­ages blood-sugar lev­els less ef­fi­ciently, so car­bo­hy­drates are not metabolised as well. Eat­ing fewer high­car­bo­hy­drate foodshelp (for guide­lines

of women don’t know how to man­age the symp­toms

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