Like Gwyneth, I was lost when my menopause be­gan in my 40s

When the hot flushes and mood swings ar­rived early, Sarah Ivens sought com­fort from friends who knew what to ex­pect

The Sunday Telegraph - - Features -

As­trange thing has been hap­pen­ing to me and my friends over the past year. On the in­fre­quent nights we spend to­gether, away from our of­fices, chil­dren and hus­bands, small talk is out of the win­dow. In­stead, we delve straight into what is mak­ing us happy. And, more im­por­tantly, as we each hover around our late thir­ties and early for­ties, what isn’t.

Never was this more ob­vi­ous than a few months ago, just af­ter my 42nd birth­day, when I met four friends I hadn’t seen for 12 months for a cel­e­bra­tory meal in a Hert­ford­shire trat­to­ria. We didn’t gos­sip, moan about part­ners or over-an­a­lyse Meghan Markle’s self-con­fi­dence. I asked for ad­vice on deal­ing with a newly sprouted blonde mous­tache.

Then Nicola shared that she could only muster the en­thu­si­asm to have sex with her hus­band every other month and felt in­creas­ing as­ing alarm that she didn’t miss the he phys­i­cal con­nec­tion that once e kept her mar­riage in­ter­est­ing. . Lara un­loaded her dis­ap­point­ment oint­ment that af­ter sur­viv­ing two wo preg­nan­cies – one with ith twins – her tummy had ad started to slide to­wards rds her kneecaps, de­spite e the ex­tra ef­fort she was put­ting in to crunch and plank daily. We all swapped tales of sweaty, sleep­less nights spent racked with a heart­pump­ing panic.

“I guess that’s just the life stage we’re at now,” said Melissa. “We have young chil­dren and we’re jug­gling mother­hood with work, try­ing to main­tain a re­la­tion­ship and a so­cial life, and look some­what de­cent. No won­der we’re all para­noid about our ap­pear­ance and feel­ing stressed and ex­hausted.”

Lara coun­tered that this cat­a­logue of un­set­tling symp­toms wasn’t purely cir­cum­stan­tial, but med­i­cal, too. She’d been to see her doc­tor the week be­fore. “We’re per­i­menopausal, ladies. Our bod­ies are go­ing through big changes, only ex­as­per­ated by our cur­rent sit­u­a­tions.”

“What? I’m only 42 years old,” I replied. “I’ve got a decade be­fore all that starts.”

“You’re think­ing menopause,” she replied. “I’m talk­ing per­i­menopause, which starts up to 10 years be­fore you ac­tu­ally stop hav­ing pe­ri­ods and have of­fi­cially gone through the menopause.”

Last we week, the ac­tressturned turned-en­tre­pre­neur Gwyne Gwyneth Pal­trow re­vealed that sh she, too, had en­tered the ea early stages of meno menopause, at the age 46. In a video posted on her w well­ness com­pany Goo Goop’s home­page – to laun launch her lat­est di­etary sup sup­ple­ment, Madame Ov Ovary – Pal­trow spoke of the symp­toms she is ex­pe­ri­enc­ing. “I th think when you get i into per­i­menopause, y you no­tice a lot of changes,” she said. “I can feel the hor­monal shifts hap­pen­ing: the sweat­ing, the moods. You’re just like all of a sud­den fu­ri­ous for no rea­son.”

Ac­cord­ing to Dr Ali Ab­bara, aca­demic clin­i­cal lec­turer in en­docrinol­ogy at Im­pe­rial Col­lege Lon­don, Pal­trow may have got off lightly with hot flushes and the odd tem­per tantrum. “Per­i­menopause means ‘around the time of menopause’ or, in med­i­cal terms, cli­mac­teric, when the ovaries’ func­tion be­gins to be re­duced. Women may start to have symp­toms such as hot flushes, sweats, mood dis­tur­bance – but also vagi­nal dry­ness, de­creased li­bido and dif­fi­culty sleep­ing.” More dis­turb­ing side-ef­fects in­clude short-term mem­ory dis­rup­tion, a dif­fi­culty con­cen­trat­ing (of­ten at in­con­ve­nient times, such as dur­ing a speech, job in­ter­view or a mo­ment of pas­sion) and uter­ine bleed­ing.

So my friends and I aren’t just feel­ing rub­bish due to be­ing at a dif­fi­cult life stage? “It can some­times be dif­fi­cult to dif­fer­en­ti­ate be­tween symp­toms which are specif­i­cally due to the hor­monal changes of menopause and those which are co­in­ci­den­tal to the time of menopause,” says Dr Ab­bara. “But it is widely ac­cepted in the med­i­cal com­mu­nity that symp­toms in the lead up to menopause are both gen­uine and trou­ble­some, and are due to the changes in hor­mones as the ovaries cease to func­tion.”

I found this in­for­ma­tion help­ful in two ways. First, I wasn’t go­ing mad. The changes I felt could be sci­en­tif­i­cally ex­plained. I wasn’t lack­lus­tre in a self-im­posed vac­uum, and my symp­toms wouldn’t con­tinue to get worse and worse; my med­i­cal man­i­fes­ta­tions had a time­frame and an end date. Se­condly, I now knew I wasn’t alone. Not only were my friends ex­pe­ri­enc­ing sim­i­lar mal­adies and wor­ries, but my en­tire peer group would be, too, if not now, then soon.

‘Once I knew why I felt like this at the age of just 42, I knew I could get through it’

Once I un­der­stood why I was feel­ing these things, from jet lag-like tired­ness to ir­ra­tional worry, I knew I could get through it. Knowl­edge is power, and as my friends and I shared in­for­ma­tion, we felt more in con­trol over our minds and bod­ies. We talked openly about this pre-change part of our life and gladly swapped ad­vice on what to ex­pect and what could help: week­end walks in na­ture and morn­ing med­i­ta­tion to deal with anx­i­ety, Bach’s Res­cue Sleep Rem­edy and no caf­feine af­ter mid­day for in­som­nia, a fan and a cot­ton nightie for the hot sweats.

The de­creased li­bido was the hard­est thing to self-med­i­cate and the most em­bar­rass­ing to dis­cuss. “Li­bido goes up and down, and it’s hard to feel sexy when you’re a par­ent,” ad­vised a wise friend who, at 51, had been there, done it (or, rather, not done it). “In­ti­macy is much more than sex – fo­cus on that. And also re­mem­ber, most peo­ple don’t have sex as much as they used to, un­less they feel they have to, and if they say they are, they’re prob­a­bly ly­ing. When I ac­knowl­edged that, at your age and stage of life, I felt like a huge weight had lifted from my shoul­ders.”

At the mo­ment, I’m at a healthy, work­able level of ac­cep­tance and eval­u­a­tion of the symp­toms Dr Ab­bara had warned me to ex­pect. When I’m unusu­ally ir­ri­ta­ble with my pre-schooler, I can catch my­self, take a breath and ap­pre­ci­ate that it’s my hor­mones lead­ing me to feel that way.

“There is no ques­tion that per­i­menopausal symp­toms are not a real con­di­tion,” Saffron White­head, emer­i­tus pro­fes­sor of en­docrine phys­i­ol­ogy at St Ge­orge’s, Uni­ver­sity of Lon­don re­minds me. But can a doc­tor help when self-aware­ness and self-care aren’t enough?

“The ob­vi­ous treat­ment for per­i­menopausal symp­toms is to re­place oe­stro­gen,” White­head says. “This is known as hor­mone re­place­ment ther­apy [HRT], which can be oe­stro­gen only if women have had a hys­terec­tomy, or oe­stro­gen plus pro­ges­terone in women with an in­tact womb to prevent en­dome­trial can­cer.”

But doesn’t HRT have ter­ri­ble side-ef­fects? “In the Six­ties and Seven­ties, HRT be­came a panacea for the menopause to treat symp­toms, prevent os­teo­poro­sis and to stay young and sexy. In the Nineties, sev­eral very large stud­ies showed links be­tween long-term HRT, breast can­cer and blood clots, although some of this data was sub­se­quently dis­puted. The cur­rent ad­vice is that HRT should be pre­scribed to women who have more se­vere menopausal symp­toms that re­duce their qual­ity of life. This should only be for about two years. Os­teo­poro­sis, which re­sults from oe­stro­gen de­fi­ciency, should be treated with other drugs.”

Know­ing I have HRT as a back-up if my symp­toms be­come too se­vere – and that the med­i­cal com­mu­nity un­der­stand this time in a woman’s life bet­ter than they did when my mother was go­ing through it a cou­ple of decades ago – has re­duced my anx­i­ety about it. For now, I feel peri­nor­mal again, much to the re­lief of ev­ery­one who lives with me.

Changes: Gwyneth Pal­trow re­vealed she al­ready suf­fers hot flushes and mood swings – just like writer Sarah Ivens, left

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