No… not menopause

“A woman must wait for her ovaries to die before she can get her rightful personality back. Post-menstrual is the same as pre-menstrual; I am once again what I was before the age of twelve: a female human being who knows that a month has thirty day, not twenty-five, and who can spend every one of them free of the shackles of that defect of body and mind known as femininity.” 
― Florence King

The strong, stoic women before us all endured it and made it to other side, softer, wiser, and more confident in themselves. Menopause is unavoidable, and preferable to the alternative (dying).  Almost all animals reproduce then die soon after their last offspring; other than women and killer whales.

Menopause is a natural part of female life history and we need to stop approaching it as a disease. Just like puberty, it can be a time of new and exciting possibilities and an empowering phase of life.

Often referred to as the crone years (sounds inviting doesn’t it?), menopause can be considered a time when a woman arrives at her full power and the title crone is given to impart a sense of respect. It’s not a title I particularly like and the transition to my ‘full power’ was always a transition I wanted to avoid. But I can’t run and I can’t hide. I’m experiencing the beginning now. Because I have a mood disorder I expected to be a raging, chaotic mess who started throwing things at my family at the drop of a hat. So far so good, there have been zero causalities as yet (I’m referring to broken crockery… not my family). 

There are many books that can help us navigate this scary transition. One such book by author Dr. Christiane Northrup is The Wisdom of Menopause[ii] and through it she makes some interesting points.

One point is: today women between the ages of 44 and 65 are a huge demographical population, therefore, we can view menopause as a major cultural event. Funnily enough, we rarely discuss it, let alone consider it to be life-changing. Menopause changes our physiology in such a way that we can feel a completely different woman at the end; hopefully one who has reclaimed herself.

Menopause is a time where women can become who they truly are. There are some psychological aspects that are not easy in this transition. Because women have such a tremendous focus placed on them during fertility years, they may feel that once fertility has left, they are not feminine anymore. In many cultures the years of fertility are the years that women are so vital to the planet, so during the transition many women can feel a sense of mourning and redundancy.

“Our mothers were largely silent about what happened to them as they passed through this midlife change. But a new generation of women has already started to break the wall of silence.” 
― Trisha Posner

Menopause is referred to as ‘The Change’ by many, but Dr. Northrup disagrees.  She highlights that in an 80-year life span a woman is fertile for about 25 years (between 15 to 40 years). It’s not a lengthy period in the scheme of a life span, is it? She proposes it is not menopause that is altering our state, changing us and disturbing all we know.  Rather the disturbance and change is fertility not menopause. Fertility is ‘The Change’. It is during the years of fertility that we lose ourselves. We are filled with eostrogen from puberty to menopause and there is good evidence to suggest that hormones affect everything from food choices, learning, stress coping, social interactions, and mate attractiveness. [iii]Northrup suggests that as we enter the new stage of life we reconnect with who we really are; we become our power.

During fertility we are primarily caregivers who are also attempting to squeeze in career, with no natural space for ourselves. In later years we can focus on nurturing creative ventures and other pursuits, caring for ourselves as opposed to everyone else.

Okay, so I have just presented the positive aspects all wrapped up in a rose coloured bow, but we can’t ignore that there are uncomfortable aspects accompanying peri menopause (the initiation of the end). Hot flushes, emotional roller-coaster rides, anxiety, headaches, and feelings of impending mortality. While these symptoms can be debilitating, and as we are so averse to discomfort, we rush to try hormone replacement therapy. We should consider that it is not menopause itself that is producing unpleasant symptoms; rather they are a sign of something going awry, such as a hormone imbalance.

While hormone replacement can alleviate symptoms it’s not for all women, and there are links with breast cancer and heart disease.  The Women’s Health Initiative (WHI) evaluated the risk of menopausal hormone therapy on cancer, cardiovascular disease, and osteoporotic fractures, however the study was terminated early (July 2002), as the researchers felt the risks outweighed the benefits. The study reports indicated that menopausal hormone therapy increased the risk of venous thromboembolic disease, stroke, breast cancer and myocardial infarction. [iv] A follow up study published in JAMA in 2013, reported that although there are risks, there are also benefits, and it may be appropriate for some women, but not all. [v]It is certainly the most effective in reducing symptoms but I would personally like to try to get through the coming years using only natural methods. My stance is that it is a natural process that has been endured by women throughout history and that any therapeutic intervention should not carry such risks (ask me how I feel in a couple of years).

Women of different cultures have used many different strategies to manage the uncomfortable symptoms accompanying this transition to our ‘power years. In saying that there are no accounts of how our hunter - gatherer ancestors coped with menopause as the official title menopause was not coined until 1821.

“For many women who have been caring for and putting others first, midlife is the time when there’s finally space to start thinking about you. You may feel compelled to make room for you, to live with greater purpose, or to answer the call to do something big in the world. It’s during this time that we can begin to define what legacy we want to leave.”

― Terri Hanson Mead, Piloting Your Life

Louise Foxcroft who wrote Hot flushes, cold science: a history of the modern menopause [vi] gives accounts from the early to mid-1800s. Before 1880, treatments for menopausal symptoms consisted of herbal concoctions, along with a selection of belladonna, cannabis or opium. There were also strategies such as a pre-meal mixture of carbonated soda, a large belladonna plaster placed at the pit of the stomach and…. Wait for it… vaginal injections with a solution of acetate of lead. In the 1890s Merck offered these chemicals along with the flavored powder Ovarian for the treatment of menopausal symptoms and other ovarian ills. Ovariin was made by drying and pulverizing cow ovaries, and may have been the first substance commercially available for treatment of menopausal symptoms derived from animal sources. Testicular juice also was used as a treatment. [vii]

By the 1930s, menopause was described as a deficiency disease. Emminen, the first hormone replacement therapy, became commercially available in 1933. Diethylstilbestrol (DES) was first marketed in 1939 as a far more potent estrogen than Emminen. In 1942, Ayerst Laboratories began marketing Premarin, which would eventually become the most popular form of estrogen replacement therapy in the U.S. Then came Prempro, a combination of Premarin and Provera, which eventually became the most widely dispensed drug in the U.S.

Herbal remedies are my preference (I’ll pass on testicular juice thanks). Magnesium is good for stress and anxiety. Evening primrose oil is commonly used for the treatment of menopausal symptoms, and is reported to have potential benefits for improving psychological symptoms of postmenopausal women. [viii] One recent study concluded that evening primrose oil reduced severity of hot flushes and improved quality of life ratings.[ix]  In the same study Black Cohosh was more effective that evening primrose oil because it reduced the number of hot flushes as well as the intensity. Black Cohosh is presumed to have an estrogenic effect, but there isn’t substantial evidence of this as yet. Another study has also noted its beneficial effects on hot flushes. [x]

Don Quai is a Chinese herb I have recently started using and in an older study was shown to slightly reduce hot flushes compared to placebo, but the results weren’t statistically significant. [xi] Another more recent study of a product containing dong quai and chamomile found a significant alleviation of hot flushes. [xii]

Kava is a South Pacific herb used for treatment of anxiety and has shown significant improvement in reducing anxiety in perimenopausal women.[xiii] However, because of the possible hepatotoxicity you must take care with use. It can be legally prescribed by a doctor in Australia to help with your anxiety. Otherwise, possession is limited to 2 kg or less, as per the National Code of Kava Management. Because kava is a controlled substance, it’s illegal to sell in its pure form for personal use. However now it’s easy to source in supplement form.

What about other lifestyle strategies? Some research has showed that women who regularly exercise are less likely than their sedentary counterparts to experience severe hot flushes. In one observational study of 1,323 women in Sweden, percent of sedentary women experienced hot flushes, compared with only 5 percent of the subjects who exercised. [xiv]

The great anthropologist Margaret Mead said: ‘There is no greater creative force in the world than a menopausal woman with zest!’  As we embrace this adventure lets explore simpler ways of living, reignite our connection with nature, and approach menopause as our time of creative force. We just have to make our way through some unpleasant effects accompanying peri menopause then we are home free. No more hormonal roller-coaster; just a stable, powerful, wise woman who is secure in her place in the world.

“In the safest of places, there is death, divorce, economic recessions, and cancer. Accepting this fact helps you not know any better than to risk adventure in the second half of life.” 
― Cheryl Bridges Johns, Seven Transforming Gifts of Menopause: An Unexpected Spiritual Journey

[i] S Nattrass, DP. Croft, S Ellis et al (2019). ‘Postreproductive killer whale grandmothers improve the survival of their grandoffspring.’ Proceedings of the National Academy of Sciences. Vol 116 (52) pp 26669-26673.

[ii] C Northrup (2012). ‘The wisdom of menopause.’ Bantam Books. United States

[iii] RJ Nelson (2020). ‘Hormones & behavior.’ In R. Biswas-Diener & E. Diener (Eds), ‘ Psychology. Champaign, IL: DEF publishers. Retrieved from http://noba.to/c6gvwu9m Accessed 2020.04.28

[iv] JE Rossouw, GL Anderson, RL Prentice et al (2002). ‘Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial.’ JAMA. Vol 288(3) pp321-33.

[v] JE Manson, RT Chlebowski, ML Stefanick, et al (2013). ‘Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials.’ JAMA. Vol 310(13) pp1353–1368.

[vi] L Foxcroft (2010). ‘Hot flushes, cold science: A history of modern menopause.’ Granta, UK.

[vii]A Singh, S Kaur , I Walia (2002). ‘A historical perspective on menopause and menopausal age.’ Bulletin of the Indian Institute of History of Medicine (Hyderabad). Vol 32 pp121–35.

[viii] S N Sharif, F Darsareh (2020). ‘Impact of evening primrose oil consumption on psychological symptoms of postmenopausal women.’ Menopause. Vol 27 (2) pp 194-198.

[ix] M Mehrpooya, S Rabiee, A Larki-Harchegani et al (2018). ‘A comparative study on the effect of "black cohosh" and "evening primrose oil" on menopausal hot flashes.’ Journal of education and health promotion. Vol 7 p 36.

[x] K Raus, C Brucker , C Gorkow et al (2006). ‘First-time proof of endometrial safety of the special black cohosh extract (Actaea or Cimicifuga racemosa extract) CR BNO 1055.’ Menopause. Vol 13(4) pp678–691.

[xi] JD Hirata, L M Swiersz, B Zell et al (1997).’Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial.’ Fertility and Sterility.Vol 68 (6) pp 981-986.

[xii] C Kupfersztain, C Rotem, R Fagot et al (2003). ‘The immediate effect of natural plant extract, Angelica sinensis and Matricaria chamomilla (Climex) for the treatment of hot flushes during menopause. A preliminary report.’ Clinical and Experimental Obstetrics and Gynaecology. Vol 30 pp203–206.

[xiii] A Cagnacci, S Arangino, A Renzi et al (2003).’Kava–Kava administration reduces anxiety in perimenopausal women.’ Maturitas. Vol 44 (2) pp 103 – 109.

[xiv] T Ivarsson, AC Spetz, M Hammar. (1998). ‘Physical exercise and vasomotor symptoms in postmenopausal women.’ Vol 29 pp139–46.