Friday, January 27, 2023

The ‘M’ Word: Why We Need To Talk About Early Menopause

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Menopause? Something we might whisper about. Early menopause? Something we don’t talk about enough. Perimenopause: what even is that? Well, today is World Menopause Day and Sarah Lang has looked into menopause and the different impacts it has on different stages of life, plus the value in finding a ‘menopause mentor!’

Menopause: something you don’t need to worry about until your early 50s, or at least your late 40s, right? Well, not exactly. Though the median age for reaching menopause is around 50, it may well happen to you sooner.

Imagine that one day in your early 40s, or maybe even in your late 30s, you start to notice irregular periods, hot flushes, night sweats or other symptoms that might line up with those of menopause. Unfortunately, it could be menopause coming to call earlier than you expected or wanted.

Among women experiencing it, menopause is often something only discussed quietly with other women (if at all)

‘Premature menopause’ (sometimes called Premature Ovarian Insufficiency, or Premature Ovarian Failure) is when menopause occurs before the age of 40. It happens to 1% of women. That might not sound like a lot, but put 100 women aged under 40 in a room and one woman will experience it; she could well be a friend of yours. Meanwhile, ‘early menopause’ (menopause before the age of 45) occurs in about 5% of women.That’s five women in that room, so odds are that you’ll know one – and may even be one.

To backtrack just a bit, menopause itself refers to a single point in time: when you have haven’t had any periods for 12 months. Your ovaries have stopped releasing eggs, and you’re no longer fertile. However, many people use the term ‘menopause’ to signify the process that surrounds that single event, particularly its aftermath.

If we’re not ‘there yet’, we might want to just avoid thinking about menopause, because otherwise we’ll dread it – which is understandable. After all, there’s the prospect of experiencing symptoms including hot flushes, night sweats, vaginal dryness, sleep problems, mood changes, thinning hair, etc.

Among women experiencing it, menopause is often something only discussed quietly with other women (if at all) – and often not mentioned to men apart from their partners (if they have one). Menopause is gross, like periods, right? No, but that notion can stop women talking about what they’re experiencing. One study found that six in 10 women don’t discuss menopause for fear of being judged or shamed.

But if the topic isn’t discussed, women may not be prepared or supported enough. Might we try to talk about it more openly, especially when it comes to premature and early menopause?

Finding support

Nicole Evans, who experienced premature menopause, is the coordinator of the New Zealand Early Menopause Support Group (NZEMSG) – initially established by Dr Andrew Shelling, a University of Auckland obstetrics and gynaecology professor (who was researching premature ovarian failure) as a response to affected women’s unmet emotional needs.

The online forum, which has 782 Facebook followers, is a place where women (and, if desired, their loved ones) can share their stories, worries, ups and downs – or just get some good information. As the website outlines: “There are a lot of things to consider following a diagnosis of early menopause and you may be feeling overwhelmed right now. You may be feeling worried or uncertain about what this means for you and perhaps also for your partner. We certainly don’t believe we have all the answers… but our experience has been that a friendly ear and a shared story with someone who has been through a similar experience can help a lot.”

“Premature menopause and infertility is unexpected, unwelcome and interrupts planning of life’s goals. Some changes in mood are closely linked to menopause – probably related to the fall in oestrogen levels. Most of the emotional distress is related to infertility, and the grief at the loss of what is supposed to be one of the normal stages of a women’s life. Some women are also concerned at the perceived ‘loss of femininity’ or ‘loss of youth’ signified by the early menopause.”

“There is no evidence to suggest that premature menopause is becoming more common. However, it is certainly becoming more important, particularly as women are delaying having children until later in their lives. There is still a lack of information about premature menopause, and there needs to be more awareness in society that premature menopause is a common condition.”

What IS Perimenopause?

What about perimenopause? What exactly is it? Perimenopause is when your body starts transitioning toward menopause and your menstrual cycle becomes erratic. During perimenopause, especially its latter stages, you may experience menopause-like symptoms such as hot flashes and mood swings (though this can vary) because of the reduction of estrogen and progesterone levels. You’re ‘perimenopausal’ until you’ve gone 12 months without having a period. The average onset age of perimenopause is 45, and the average length is four years, but it may last a few months or as long as (argh!) 10 years.

Mel*, a Wellington civil servant aged 42, is experiencing perimenopause brought on by having chemotherapy to treat triple-negative breast cancer. “I was 39 at diagnosis, 40 when I completed treatment. It took about nine months after treatment for my period to come back – so I’d started to think it wouldn’t come back at all. But since then I’ve only had three or four [periods] – extremely irregular with very little flow. Symptoms? I get quite warm at night, but haven’t had the classic hot flushes. I do get tired easily, but it’s hard to tell whether that’s influenced by having been through cancer treatment, or by being 42 and juggling work, kids and ageing parents.”

When diagnosed, her children were seven and three. “Straight away, the oncologist asked whether we wanted more children. We didn’t. If we had, we’d probably have had to quickly have fertility treatment to freeze my eggs before starting chemo. But I was nearly 40 and triple-negative breast cancer is a particularly aggressive type – so it was urgent for me to commence chemo as quickly as possible.”

“I really feel for women who haven’t had kids yet when they’re diagnosed – triple-negative breast cancer seems to strike younger women more frequently than other types do. It doesn’t always kill your fertility – some women from my TNBC [triple-negative breast-cancer] support group have conceived without IVF after treatment – but there are certainly no guarantees.”

How’s she doing after cancer treatment? “I’m 2.5 years clear, and if you get to three or four, you can usually breathe a little easier.”

The Fertility Flipside of Menopause

It’s absolutely possible to get pregnant during perimenopause, even if you’re not menstruating regularly. And who knew that so many pregnancies in women aged 40 and over are unplanned? There may be a link.

Kate*, a 53-year-old lawyer from Christchurch, thinks she probably started experiencing perimenopause in her late 30s, without realising what it was. “I’d always had reasonably bad PMS [premenstrual  syndrome], which made me feel low and irritable – and in my late 20s, I had some endometriosis removed.” (Endometriosis can affect fertility.) “We had our first child when I was 34. I had postnatal depression [PND] at about 35.” When she started feeling significant mood swings, she thought it must be her PMS getting worse. But it was likely perimenopause. When Kate was 38, she started trying for another child – but had multiple miscarriages, and tried IVF

It’s absolutely possible to get pregnant during perimenopause, even if you’re not menstruating regularly.

“I was 40 when a male gynaecologist told me ‘your right ovary is completely shrivelled’. (No, not the best choice of words.) “I was told I hardly had any chance of conceiving again. We decided to be a happy three-person family, and my periods suddenly stopped. I thought ‘this must be menopause and actually it’s not that bad!”

She discarded contraception – but, to her shock, got pregnant aged 43. She wasn’t happy about it initially. “We’d come to peace with being a three-person family. And our 10-year-old liked being an only child! It was challenging being older parents but ultimately I’m glad we had him.”

In the years following his birth, actual menopause kicked in. Kate got hot flushes, felt freezing in the evenings, and her insomnia got worse (though other factors may have contributed to the latter).

Her late mother, who went through early menopause, had never talked to Kate about what it was like. “I didn’t have strong expectations about menopause, because I didn’t wanted to face up to what it could be.”

“There’s definitely a lack of information about menopause, early menopause, and perimenopause out there. It would be great if women were, well, not warned exactly, but informed about how they might approach it – and, also, that it’s a kind of a ‘becoming’. No, you can’t reproduce but you’re still useful to society.”

“My male GP, who is a good feminist, says there hasn’t been enough research into women’s bodies and especially into how menopause affects women’s bodies. He said ‘maybe in 20 years’ time’.”

Another Lens: People Who Are Happy To Say Goodbye To Periods

Are any women like, yes, I’m ready for no more periods and no contraception, and I know what menopause symptoms are, so bring it on? Or who are just accepting of it and ready to go with, er, the flow?

‘I’m currently in a complicated negotiation with my ovaries who seem to think they need to pump out eggs fast to try to squeeze in one more baby.’

Samantha, a 48-year-old teacher from Auckland, has felt that way since their mid-30s. “Mind you I [initially] didn’t wish to know much about menopause. I thought it just means your periods stop. I’ve also been ready for that FOREVER because many post-menopausal people with ovaries seem confident and more serene.”

Samantha, who identifies as they/them and has three adult children, thinks they’re currently in perimenopause. “At 48, I should be at least peri, right? My periods are irregular. Sometimes they lull me into thinking they’re ending. Mostly they’re VERY heavy and VERY frequent, sometimes every two weeks.” They have some insomnia and night sweats, but isn’t sure if that’s down to perimenopause or another health condition. “I also seem to have the perimenopausal symptom of saying what I think and being more confident, but I’m not sure if that’s down to hormones or my stage of life.”

“I’m currently in a complicated negotiation with my ovaries who seem to think they need to pump out eggs fast to try to squeeze in one more baby, despite the fact I haven’t been with a man for well over a decade and don’t have the slightest inclination to do so. The only thing I want less than another child is a penis anywhere near me so I think we’re all right, thanks, ovaries!”

“Whenever people try to tell me about menopause they have a ‘being a woman’ lens on it, often even a heterosexualised lens, which frankly isn’t useful for a non-binary person. So if there’s anything I need to know, I want to know it through the queerest, trans-est lens possible.”

“Older women are my ‘go to’. They go ‘yep that’s normal’, or ‘it’s [peri]menopause, eat more chocolate’ or ‘maybe see a doctor about that’. They’re menopause mentors or something! Also, when I tell my kids ‘I’m menopausal and everything sucks’, they say ‘let’s get pizza then’. Some older women have told me they couldn’t wait for menopause to stop all the bleeding and all the nonsense and just pursue their interests.”

To bring some positive energy and, yes even some celebration to menopause, Wellingtonian Frances Shoemack – who runs international natural-fragrance business Abel – developed the perfume Pause alongside perfumier Fanny Grau, after both women experienced perimenopause. They knew little about it until they did some reading and discovered the different symptoms. Menopause and perimenopause should be talked about more openly, Frances says. “I hope Pause will open up conversation, encouraging women to better understand and feel prepared for perimenopause”.

Released on World Menopause Day (18 October), Pause isn’t just symbolic. It has essential oils selected for their impact on hormonal wellbeing. Abel is launching a resource centre on its website where the team and friends collect and curate podcasts, books and articles that help improve hormonal and menopausal knowledge. Hopefully this article will be one of them. We hope World Menopause Day raises awareness, provides more knowledge, and sparks some conversations.

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