posted 28th July 2019
The menopause is no joking matter - believe me: Over the last few days I have spoken to women in various states of emotional distress due to their menopause symptoms and the way that they have been treated by their GP's, employers and even their own partners. This is not unusual, I hear similar stories every day of every week and I know that for every woman I work with there are thousands of others out there experiencing similar situations.
As a psychotherapist with medical menopause training I have spent the last few years specialising in providing menopause counselling, education and support for women and men both in and out of the workplace. That's how I know it's no joking matter (thanks, deputy Governor of the Bank of England for referring to the 'menopausal economy').
I can truly empathise with each and every one of the women I work with, as back in 2013, due to my own menopause experience, I came very close to taking my own life.
In April 2012 I hadn't given menopause a second thought, twelve months later I had become completely consumed by it. Hysterectomy surgery including removal of my ovaries put me into surgical menopause overnight. Having received no information or advice about the possible effects of my surgery at the hospital I was discharged and told to visit my doctor once I felt strong enough.
The hot flushes began almost immediately but I had booked an appointment with a nutritionist to discuss how I could cope with the symptoms. At my doctor appointment I politely refused HRT when it was mentioned but didn't explain why and the doctor didn't ask, with hindsight it is clear that had we discussed it further things could have been very different.
at a glance | the four types of menopause
>Few symptoms: Chinese women had a consistently low chance of developing debilitating symptoms throughout the menopause
> High chance of symptoms: Black women, those who drink alcohol moderately or heavily, and those who reported symptoms of anxiety or depression had a greater chance of experiencing symptoms throughout the transition
>Early onset of symptoms: Obese women, those with a history of depression or anxiety, those with poor overall health or who started the menopause at a later age were more likely to see symptoms begin up to a decade before menstruation finally stopped
>Late onset of symptoms: Women with a low BMI (body mass index), smokers and black women were more likely not to experience menopause symptoms until later in the transition process.
Reference: Women's Biobehavioral Health Lab, University of Pittsburgh 2016
A few months after my surgery things went very wrong very quickly; I seemed to lose my confidence overnight, I was constantly anxious, I couldn't sleep, I became increasingly emotional and irrational. I had never experienced depression but each day felt darker than the last and dragging myself through them felt like wading, waist deep, through treacle. I felt useless and hopeless, a complete failure and a waste of space. I simply couldn't cope; I had lost my joy.
On the day that I admitted to my husband coming very close to putting my car into the path of a lorry, in desperation, he took me back to see the doctor. I was terrified as I was convinced that I would spend the rest of my life on anti depressants or the animal derived HRT that I didn't want to take.
The doctor explained that the loss of natural estrogen when my ovaries were removed was causing the symptoms and only HRT could replace it. I explained my concerns and was told that there was a choice of HRT and I could have one that was plant derived. I began using HRT that day and started to notice an improvement about forty eight hours later. If only I had been offered factual, evidence based advice before my surgery.
It has become clear in my work supporting women that education for health care professionals in the menopause is poor and many GP's, often the first port of call, are simply not equipped to help. In 2015 NICE produced the first guidelines on menopause for health professionals but many are not aware of them and even fewer have read them.
In a recent communication to NICE I asked how the guidelines could be more widely implemented, I was told " there is no legal requirement for NHS Trusts to follow the recommendations in this guidance". Last year I was invited to my local university to teach a revision session on menopause to second year medical students, I was horrified to learn what basic information they didn't know.
"The age group for women with the highest suicide rate per 100,000 in the U.K
is 50-54 - the average age of menopause is 51"
I have counselled women who have been told they are too young to be experiencing menopause; told they are depressed and prescribed anti depressants when NICE guidelines clearly state that HRT is first line treatment for women who are clearly peri menopausal. Women are being told to wait for treatment until their symptoms worsen, refused HRT or in some very worrying cases incorrectly prescribed potentially putting them in danger.
Many of the women I work with have booked multiple GP appointments trying to find an answer to their debilitating symptoms and some have been referred for needless physical and mental health tests at hospitals causing distress to them and who knows what cost to a struggling NHS.
Over the past two years I have been campaigning the Royal College of General Practitioners to improve the curriculum for medical students and am regularly told that it is coming soon. In December in an attempt to secure advice for women who were struggling to get the right treatment and support from their GP's I wrote to the president of the College to express my concerns. Three months later a completely underwhelming reply finally arrived that offered no hope of anything changing anytime soon. Women and our NHS simply cannot afford to keep waiting for GP education to improve; too many are experiencing poor short and long term physical and mental health health due to a woeful lack of professional knowledge.
Many women are also struggling to come to terms with having to give up their careers. The one in 10 who have taken the decision to leave the workplace due to their physical or emotional symptoms, and in some cases both, felt unsupported and unable to discuss their situation with management. Some felt they had been performance managed out of the workplace others were made redundant, all believe, that their menopause symptoms were key as their concentration and capacity levels suffered but for many they felt unable to voice their concerns.
In recent years we have seen surveys, statistics and reports outlining the impact of menopause on productivity and profitability but the hidden costs are to family finances, personal confidence and the benefits system when women, who have always been in employment, find themselves relying on benefits for the first time in their lives. Supporting women to remain at work by implementing a few simple adjustments is not rocket science. Business needs to recognise that menopause awareness in the workplace is a win win situation.
The most heartbreaking stories that I hear are of those women who are struggling with symptoms and are receiving no support from health care professionals, have lost or felt unable to continue with their careers but have also experienced a breakdown of their relationship.
At a recent workshop I was talking about the subject of intimacy during menopause and how both physical and emotional symptoms can lead to a breakdown in communication when neither partner really understands what is happening. As I went on to describe some of the common symptoms one woman raised her hand and said "I wish I had known this two years ago, I think this information could have saved my marriage"
Surely it is time to make menopause education and awareness a priority for our health care professionals, business leaders and in schools as part of the national curriculum alongside menstrual cycle awareness and sex education, and for those who raise their eyebrows at this idea I will leave you with one final thought. A few months ago while doing some research I took a look at the most recent suicide figures produced by the only recording body in the U.K (shocking in itself) The Samaritans. The age group for women with the highest suicide rate per 100,000 in the U.K is 50-54, the average age of menopause is 51.
Is this the ultimate hidden cost of a lack of menopause education, information, advice and support?
