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Hot flushes should be a hot topic of conversation

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Cher. Photo: Getty Images

Cher. Photo: Getty Images

Cher. Photo: Getty Images

'MY mother was very unusual for the time in that she not only talked to us about sex, but she told us it was great. I know most of my friends weren't told anything, or maybe not until they were grown-up, but they certainly weren't told it was good fun.

"Actually, my mother claimed it was the woman in the B&B on her wedding night who had to get her up to speed on what she was expected to do."

Sarah is in her late 60s and has fond memories of what, by all accounts, was an unusually frank relationship with her mother in 1950s Ireland.

"I have a very clear memory of my parents being affectionate together," she tells me. "I also remember tensions, but I'm not sure if that is the older me projecting what I imagine they felt.

"My mother was pregnant 12 times from when she was 21 until she was 44, from the early 1940s until the mid-1960s.

"She told me that, because she was very fertile, the only way they could control the size of their family was by abstaining from sex – for years at a time.

"So that's what I mean when I say I don't know if I actually remember the tensions between them in those times, or if I'm imagining it from an adult perspective."

Lovebirds

What Sarah is very clear about, however, is that her parents were like teenage lovebirds from their late 40s onwards.

"I was an adult at that stage and vaguely embarrassed by it, actually, but they were clearly very happy and frisky. My mother had had her last baby at 44 and then I think the menopause happened very quickly – and easily and suddenly– so that for the first time in her married life she was able to enjoy sex without the fear of yet another pregnancy."

It is unimaginable what it must have been like to wonder every month for 20-odd years if you were pregnant.

Menopause is something that all women face, and as another fortysomething birthday lands, it's something we all consider with increasing frequency – is this . . .? Could that be . . .?

Yet, despite much more openness in the discussion of virtually every topic, menopause is something that women who have been through it often talk about with greater ease than women who are currently going through it.

Cher was one of the first famous people to say publicly that she had found the menopause horrible. She has since been joined by others such as Jane Seymour, Rosie O'Donnell and Whoopi Goldberg in discussing their experiences. But again, almost exclusively after the fact.

So why is menopause an in-hindsight discussion topic? In the Women's Health Council (now part of the Department of Health) survey, Women's Experiences and Understandings of Menopause (2008), it was clear that at least part of the reason lay in the difficulty in pinpointing what the menopause is actually like.

Experiences can vary widely, with between two-thirds and half of all women describing "significant symptoms".

The average age of onset in Ireland is between 48 and 55. Women can, however, be pre-menopausal, with fluctuating hormone levels and menstrual changes from their late 30s. Clearly, when periods stop, menopause has to be the first assumption if pregnancy can be discounted. But generally there is quite a run-up to that nice definite menstrual cessation symptom.

Almost everyone is familiar with symptoms such as hot flushes and mood swings, but there are other symptoms of menopause that, taken individually, can be rather difficult to attribute.

There can be a real slump in energy levels and menstrual changes such as very heavy or very frequent periods.

There can be a major dip in libido, depression, forgetfulness, anger, weight gain, head hair loss, body hair increase, night sweats, dry skin, vaginal dryness and incontinence. Oh yes, the menopause is the gift that keeps giving.

However, these often individually-difficult-to identify symptoms occur over a large window of time and often coincide with turbulent periods in women's lives, such as when they're dealing with teenagers or ailing parents and bereavement.

They may have financial, relationship and career issues or the beginnings of unrelated health twinges. A blood hormone test is the accepted way to diagnose menopause, but many women report quite major changes in their lives and health before those changes register in a blood test.

Most things are easier to handle when you know exactly what they are, so the uncertainty is an exacerbating factor.

Sarah says that while her mother and her sister had almost eventless menopauses, she was not so lucky.

"Both had babies very shortly before the menopause," she says. "I have heard that there can be a surge in fertility just before the ovaries stop producing eggs, but I had my last child at 33 so maybe that was the difference.

"My periods became very heavy – almost unmanageably heavy – when I was in my late 40s and I started getting night sweats, and I knew that these were symptoms of the menopause.

"But what I didn't think was part of it was the depression. I got terribly low and forgetful, and my doctor did actually diagnose depression instead of linking it to the menopause.

"I'd be fairly certain now, however, that it was very much linked to my hormones. The mood swings were awful. I could sit in my room and cry, or I could be trying to kill people who looked crooked at me. I honestly thought I was going mad.

emotional

"It was more upsetting than anything else. I did discuss the period stuff and the flushes with my friends and sister-in-law because we all had some variation of that.

"It never occurred to me to talk about the mental and emotional part, but afterwards – too bloody late – we talked about that and I was not alone feeling a bit nuts. It's actually the first thing I'd warn any woman about the change."

Cheryl, who is 58 now and "out the back of it, I hope", says she too found the mental and emotional symptoms most difficult to deal with. "I really, really hated the flushes because I would go so red. I'd feel it coming up from my feet, like someone had turned on a heater inside me, and I'd get anxious about it if I was in work.

"I have the kind of skin that really shows a flush, and I'd be sweating too and some idiot would always feel the need to point it out to you, just in case you hadn't noticed!"

The flushes contributed, Cheryl says, to a sense of feeling out of control. "I found it really affected my confidence," she tells me.

"I got anxious about the flushes as well as having them, but although I can put words on that now, I don't think I could have then, so that's partly why I didn't talk that much about it at the time."

Research done as part of the Feeling Flush campaign in 2010 discovered that many women felt embarrassed when they were going through the menopause.

Traditionally, the menopause has been linked with "empty nest syndrome", a sadness about children moving on, or an end of a major life phase being used to explain the mood swings. And while that may indeed be a factor, proportionally many more women still have quite young children when menopause happens.

Unlike the generations who lived in pre-contraceptive times, now an end to fertility can be a sad thing. Our perceptions about the window of fertility have changed dramatically during recent decades.

Forty is now considered a perfectly good age to have children, whereas it was not so long ago considered the end.

But, biologically, the window has not altered that much. So there can be a sadness when it closes. That sadness is almost certainly heightened by our rather altered perception of ageing. We are obsessed with fighting age, remaining youthful or, at the very least, not looking our age.

Fertility is an important signifier of youth, so when it ends, even though simply and naturally because the ovaries have shut down for business, it is a major life change.

It often comes with a loss of libido too, usually temporary, and many women describe grief for that missing sex drive.

Sexuality is another thing that we tend to associate with youth.

And to feel out of that game – something that defines many of us more than we care to admit for most of our adult lives – can bring on a significant identity crisis and a massive shift in how a person perceives their place in the world.

IMPORTANT

So, there are lots of reasons why menopausal women are less likely to talk about the menopause than post-menopausal women are. But it remains important to know, however, that the range of symptoms and those defined as "normal" symptoms fall on a broad spectrum.

It's also important to know that although pinpointing the end of the menopause can be as difficult as pinpointing the start of it, many women come out of the process welcoming a whole new phase of life.

www.dohc.ie offers menopause advice under the WHC section


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