Feel­ing off your game?

Women who are oth­er­wise boss­ing life are hav­ing their ca­reers, fit­ness goals and sex lives scup­pered by the per­i­menopause. Never heard of it? Ex­actly. WH re­ports on the hor­monal head­wind no one sees com­ing

Women's Health (UK) - - JOIN THE DOTS - words SARAH GRA­HAM photography MITCH PAYNE il­lus­tra­tion BILL MC­CONKEY

Forty. The big 4-0. When life re­ally be­gins. It’s a decade that’s been re­branded as ef­fec­tively as the Bri­tish monar­chy; and if you’re not there yet, you’re probably pretty chill about en­ter­ing a life stage where you no longer have to fake it, you know your own mind (no more pre­tend­ing you know who Wiz Khal­ifa is) and you’re smash­ing more goals than Harry Kane when Eng­land’s World Cup hopes were still alive. It’s how Women’s Health Editor-in-chief Claire San­der­son felt in the months be­fore her Big Birth­day. That is, un­til some­thing be­gan to feel a lit­tle... off.

‘At first, my symp­toms were phys­i­cal. My pe­ri­ods – which had al­ways come like clock­work – started to be­come ir­reg­u­lar, my breasts were re­ally painful and I was start­ing to carry more weight around my waist. Things felt so off that, even though my hus­band has had a va­sec­tomy, I be­gan to think I must be preg­nant.’ Af­ter months of strug­gling to fall asleep, PMT that was off the scale and ridicu­lous ar­gu­ments with her hus­band, Claire be­gan to open up to other women – and once she did, their sto­ries kept com­ing. Daily tasks mak­ing you feel as if some­one’s upped the in­cline on a tread­mill; a body that feels straight-up weird; about as much in­ter­est in sex as you have in the finer points of tax law. Happy, suc­cess­ful women, in­ex­pli­ca­bly off their game. It wasn’t un­til Claire con­fided in a friend who’s a prac­tis­ing doc­tor that she heard the word per­i­menopause – the term used to de­scribe the process of tran­si­tion from men­stru­a­tion to menopause

– a di­ag­no­sis later con­firmed by her own doc­tor.

Here’s the thing about the change be­fore The Change: it can start some 15 years ear­lier than you’d probably think. ‘Per­i­menopause is the ad­just­ment from your ovaries work­ing nor­mally and pro­duc­ing the cor­rect bal­ance of re­pro­duc­tive hor­mones to main­tain reg­u­lar pe­ri­ods, to the point when the ovaries stop pro­duc­ing hor­mones al­to­gether,’ ex­plains Dr Heather Cur­rie, spokesper­son for the Royal Col­lege of Ob­ste­tri­cians and Gy­nae­col­o­gists and former chair of the Bri­tish Menopause So­ci­ety. As with all things hor­monal, tim­ings vary from woman to woman – just as you might have got your pe­riod two years ear­lier than some of your friends at school, you won’t all start the per­i­menopause to­gether, ei­ther. Given that the process can last be­tween two and seven years, and the av­er­age woman has her fi­nal pe­riod at 51, most women will start to ex­pe­ri­ence the first symp­toms of the per­i­menopause in their for­ties. The 1% of women un­der 40 who have pre­ma­ture

‘I’d al­ways been re­ally sharp in the of­fice, then this fog de­scended’

ovar­ian in­suf­fi­ciency – not per­i­menopause, but pre­ma­ture menopause – will be­gin the tran­si­tion phase in their thir­ties.

FOGGY FORE­CAST

Not only do th­ese am­bi­gu­i­ties in time­line mean per­i­menopause has a nasty habit of catch­ing un­sus­pect­ing women off guard, it also seems to be some­thing of a knowl­edge blind spot among even the most health-con­scious women. Like most con­di­tions that involve the fe­male re­pro­duc­tive sys­tem, it’s hushed up, gath­er­ing con­ver­sa­tional dust along with de­tails of your salary and who you vote for.

Plus, it presents the kind of symp­toms – we’re talk­ing weight gain, mood swings, mus­cle pain, trou­ble sleep­ing and fa­tigue – that, when taken in iso­la­tion, you could eas­ily mis­at­tribute to a bad day.

Katie Tay­lor did just that.

The first time the former char­ity mar­ket­ing man­ager ex­pe­ri­enced what she calls ‘the brain fog ’ at 43 years old, she put it down to get­ting out of the wrong side of the bed. When it hadn’t shifted weeks later, she be­came con­vinced she was los­ing her edge at work. ‘I’d al­ways been sharp in the of­fice, re­ally on the ball, then this fog de­scended and I couldn’t think straight,’ she ex­plains. ‘I felt over­whelmed by bud­gets and sim­ple tasks I used to do with my eyes closed. I’d be dis­cussing some­thing very ba­sic, then sud­denly I couldn’t con­cen­trate and I’d strug­gle to re­call spe­cific words.’

It’s a sim­i­lar story for Jane Hal­lam, founder of Es­teem menopause cloth­ing and a former man­ager in ed­u­ca­tion. For Jane, it was the mood swings that hit hard­est. At 47, she was mother to a self-suf­fi­cient 16-year-old daugh­ter and, af­ter a tur­bu­lent few years dur­ing which she be­came a widow, life at last felt pleas­antly pre­dictable. But al­though she ap­peared sorted, some­thing wasn’t quite right. It was on her drive home one evening that she sud­denly burst into un­con­trol­lable tears. She put it down to de­layed grief, but when symp­toms per­sisted for weeks, she be­came con­vinced she was hav­ing a ner­vous break­down. ‘I wasn’t in­ter­ested in work and I couldn’t en­joy any­thing. I ex­isted in a state of to­tal ap­a­thy,’ she re­calls.

So what’s go­ing on? A lot. ‘Dur­ing the per­i­menopause, your oe­stro­gen lev­els fluc­tu­ate in the run-up to the post­menopausal pe­riod, when they are con­stantly low,’ ex­plains Dr Cur­rie. Es­sen­tially, per­i­menopause sends your hor­mones on a roller­coaster ride – the kind that’ll have you run­ning in hor­ror from a mid-ride photo. And con­sider

that hor­mones are to your bod­ily func­tions what a con­duc­tor is to an orches­tra and you be­gin to un­der­stand why your oe­stro­gen lev­els tak­ing a nose­dive can cause so many symp­toms. ‘You have oe­stro­gen re­cep­tors through­out your body, so changes in lev­els can trig­ger many changes,’ adds Dr Cur­rie. ‘You have them in your skin and joints, which ex­plains why lower lev­els can lead to dry or itchy skin or aching joints. But oe­stro­gen also in­flu­ences sero­tonin, which then af­fects your mood.’

AGE CON­CERN

This cock­tail of symp­toms – about as welcome as Don­ald Trump on Bri­tish soil – is made all the more galling by the fact that it hits dur­ing a life stage when you fi­nally feel like you’ve got stuff sussed. For Katie, her bad month at work turned into a bad year, and the con­fi­dence crash that came with feel­ing like she’d lost her edge drove her to leave her job – then, months later, she re­signed from an­other role. ‘It reached the point where I con­vinced my­self that my col­leagues would think I was stupid, a fake. The day I quit my third mar­ket­ing job in the space of just a few years, I came home, sat on my bed and just cried.’

From avoid­ing so­cial plans for fear of snap­ping at friends to choos­ing out­fits based solely on how well they min­imise sweat marks, life has changed for mother-of-two Toni-marie Downes-con­nor since she started the per­i­menopause at 39 – and even her rock-solid re­la­tion­ship has ended up in the fall­out zone. ‘I’ve lost my li­bido, I’m con­stantly sweat­ing and grumpy, which isn’t very sexy, and we ar­gue all the time,’ she says. ‘It’s hardly sur­pris­ing that it’s af­fected our dy­namic as a cou­ple.’ But it’s con­fronting the re­al­ity that she is age­ing that has been the big­gest chal­lenge for Toni-marie. ‘To me, it feels like the end of be­ing a “real woman”. Even though my part­ner and I weren’t plan­ning to have any more chil­dren, the idea that that phase of my life is end­ing makes me feel old, like it’s all over for me now.’

Il­log­i­cal as it might sound, it’s an all-too-com­mon re­ac­tion to be­ing dealt a di­ag­no­sis that in­cludes the ‘M’ word. ‘There’s still a big taboo around age­ing, and the menopause car­ries a badge of “I’m old” that many peo­ple find hard to ac­knowl­edge,’ ex­plains Dr Carla Croft, a clin­i­cal psy­chol­o­gist spe­cial­is­ing in women’s health at The Mind­works, a ther­apy clinic in Lon­don. And accelerated age­ing isn’t the only rea­son why per­i­menopausal symp­toms can trig­ger men­tal health is­sues. ‘Difficulty with mood and anx­i­ety is one of the most com­mon symp­toms of per­i­menopause,’ says Dr Croft. ‘Aside from your hor­mones, the sit­u­a­tion can be com­pli­cated by all the other things that of­ten af­fect you dur­ing midlife – be that hav­ing young chil­dren, age­ing par­ents or a high-pow­ered job. Con­sid­er­ing per­i­menopause can im­pact your weight and your sleep – both of which in­flu­ence the way you feel about your­self – it makes sense that a num­ber of per­i­menopausal women de­velop low mood, stress or anx­i­ety. They be­come so ground down from try­ing to man­age it.’

‘I now have an im­plant and it’s like I’m back op­er­at­ing at full ca­pac­ity’

GAME PLAN

So, how can you get back to your A-game? While many women re­port mul­ti­ple GP vis­its be­fore the word ‘per­i­menopause’ is men­tioned, once you have a di­ag­no­sis, treat­ment will fol­low, the most ef­fec­tive of which, ac­cord­ing to Dr Cur­rie, is hor­mone re­place­ment ther­apy (HRT), which re­places depleted oe­stro­gen in the body. For Katie – who was even­tu­ally di­ag­nosed as per­i­menopausal af­ter half a dozen vis­its to her doc­tor – start­ing HRT ‘changed ev­ery­thing ’. ‘I now have an oe­stro­gen im­plant and it’s like I’m back op­er­at­ing at full ca­pac­ity,’ she says. ‘I’m work­ing full-time again and run­ning a busy fam­ily home. I’ve got so much en­ergy; I re­ally feel like I’ve got my life back.’ She has since founded a Face­book group and web­site – lat­telounge.co – which is an on­line re­source and com­mu­nity for per­i­menopausal women who, like her six years ago, have all the symp­toms and none of the an­swers.

But HRT doesn’t come without con­tro­versy. Many women re­sist the treat­ment be­cause it’s been shown to in­crease the risk of breast, uter­ine and ovar­ian can­cers, as well as heart dis­ease – though it car­ries a smaller risk than smok­ing or be­ing over­weight. It’s the rea­son Claire didn’t feel HRT was the right op­tion for her. ‘My mum has had breast cancer, so I’m wary of tak­ing it; I’d like to de­lay go­ing down that route for as long as pos­si­ble,’ she ex­plains. In­stead, she be­gan to make some life­style changes on the advice of Dr Mar­i­lyn Glenville, a nutri­tion­ist spe­cial­is­ing in women’s health and author of Nat­u­ral So­lu­tions To The Menopause (£12.99, Ro­dale). ‘Your hor­mones are al­ready on a wild ride, so adding fluc­tu­a­tions in blood sugar into the mix is go­ing to make that worse; it’s about eat­ing reg­u­larly – lit­tle and of­ten – and avoid­ing caf­feine and quick sweet fixes like cho­co­late,’ Dr Glenville ex­plains. ‘I also rec­om­mend in­clud­ing phy­toe­stro­gens in your diet, which can be found in beans, lentils, chick­peas, soya and flax seeds – as th­ese have a bal­anc­ing ef­fect on your re­pro­duc­tive hor­mones – and omega-3 fatty acids from oily fish and egg yolks, which can help with joint pain,’ she adds. Since fall­ing oe­stro­gen lev­els lead to a de­cline in your bone min­eral den­sity, eat­ing foods con­tain­ing plenty of cal­cium (avail­able in broc­coli and figs as well as the ob­vi­ous dairy prod­ucts) and vi­ta­min D is ad­vis­able, too. You’ll find de­cent amounts in oily fish and eggs, as well as for­ti­fied foods like mar­garine and ce­re­als. It can be tricky to get enough from food alone though, so Dr Glenville rec­om­mends tak­ing a vi­ta­min D sup­ple­ment to keep your lev­els topped up, par­tic­u­larly if you’re sun-de­prived. And it’s not just about what you eat. Dr Glenville also rec­om­mends reg­u­lar ex­er­cise, in­clud­ing weight­bear­ing moves, as well as calm­ing meth­ods like yoga.

Since kick­ing her five-a-day cof­fee habit and in­cor­po­rat­ing re­former Pi­lates into her train­ing regime, Claire has al­ready no­ticed an im­prove­ment in her symp­toms. ‘I’m look­ing at my well­ness holis­ti­cally to try to de­fer symp­toms, or cer­tainly lessen them,’ she says. ‘I feel quite cool about it all be­cause I’ve achieved ev­ery­thing I wanted to in life be­fore this process started. It means I’m not strug­gling with it as I imag­ine some­one would if they were younger and it was af­fect­ing their fer­til­ity, for ex­am­ple. So I feel a cer­tain re­spon­si­bil­ity to other women to talk about this.’ And just like that, she’s back in the game.

IR­REG­U­LAR PE­RIOD ITCHY SKIN PAINFULB REASTS WEIGHT GAIN

MOOD SWINGS NIGHT SWEATS INSOMIA

LOSS OF LI­BIDO MOOD SWINGS NIGHT SWEATS FA­TIGUE SORE MUS­CLES LATHARGY HOT FLUSHES ACHING JOINTS VAGI­NAL DRY­NESS

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