Everything I needed to know about the menopause… No One Told Me

Today’s guest blog comes from Oxford academic June Girvin, who shares her experiences of the menopause, the taboo and the information gap. Today is NHS Change Day and June, along with the rest of our guest bloggers in this special series on the menopause, is backing Menopause UK’s grassroots campaign for Change Day to #changethechange. You can read more about that here.

It’s Menopause Week on Evidently Cochrane. I wasn’t sure whether that required an exclamation mark, but decided, all things considered, that it didn’t. My contribution to this week of menopause related blogs is a personal one – or a phenomenological one as this is a blog for ‘Evidently Cochrane’ – and I think my lived experience of the ‘last taboo’ or the ‘Big M’ (thankfully one rarely hears it called ‘THE CHANGE’ anymore with all its doom-laden, metamorphic overtones) might be useful out there in the ether where women are searching for something that relates to their own experience.

I am post-menopause. I am out the other side. I have become the Crone, the Wise Woman. I prefer the latter for obvious reasons. My last period (unless there is just one more lurking in there to surprise me) was about eighteen months ago and that was two years after what I would call my ‘regular’ periods stopped. And it’s only within the last six months or so that some of the more common symptoms of menopause have begun to subside. I still get night sweats for instance, and occasional flushes during the day. No one told me that I would still sometimes feel menopausal, post menopause. And that’s why I agreed to write this, because No One Told Me.

There is some real suffering out there, and mostly in silence

Like every woman, I had a general idea of what to expect from being menopausal. Hot flushes, irregular periods, moodiness. These are the symptoms most commonly discussed when you do a general search, or read about menopause in women’s magazines – which, incidentally, I suspect are a major source of information for a lot of women. What I didn’t realize, or read about, was how disruptive, intense and severe some of these symptoms can be. I know that not everyone has a really bad time, but from speaking with friends and colleagues (those who were prepared to talk in any detail – some were in a state of definite denial about it all, some embarrassed to talk detail) there is some real suffering out there, and mostly in silence.

I wasn’t expecting this…

For instance, the hot flushes and night sweats didn’t really bother me. The development of severe migraine that disabled me for 24 hours at least once a fortnight did. I was expecting irregular, heavier periods. I wasn’t expecting to bleed three weeks out of four, or to have such excruciating period pain that I was given IM Pethidine by a sympathetic GP. I wasn’t expecting bouts of dizziness and nausea requiring me to lie down for an hour at random times of the day. I was expecting to feel a bit tearful, a bit snappy. I wasn’t expecting to be completely out of control of my emotions. Crying at criticism, at imagined slights, at the television for God’s sake. Or being angry and sharp, irrationally boiling with rage over really small things. Being within a hair’s breadth of walking out of work, of leaving home and twelve hours later thinking ‘What on earth, was that all about?’ It was about peri-menopause. No One Told Me it could be like that. No one warned me that these symptoms might be severe and intense so that I could recognize and work through those times to minimize the disruption to me, my colleagues, my family, my work. And then there were the myriad other relatively minor things – forgetfulness, poor concentration, weight gain (and how it just creeps on…and creeps on…and creeps on), forgetting what I wanted to say mid-sentence, aches and pains, fatigue. There really is a seemingly endless list.

The search for reliable information

The problem for me was that I couldn’t find anything that helped me to decide on what might help. I thought HRT wasn’t an option for me because of the migraines and looking for alternatives was fraught with marketing claim and counter claim, hearsay and opinion.

I was a marketing person’s dream – slightly desperate, willing to try anything, unable to discriminate

I scoured bookshop shelves for information that was sensible, informed (perhaps even evidence-based) and accessible. There were books on ‘women’s health’ that included it as a section – usually a short and not very detailed section. One had a bibliography, there were rarely any references. In magazines and on web forums there were people enthusing about wild yams, black cohosh and red clover. In health food shops I felt like I was a marketing person’s dream – slightly desperate, willing to try anything and unable to discriminate.

woman of colour using laptop

Cochrane is a source of reliable, evidence-based information

As someone working in an academic environment I knew about Cochrane and that its reviews and websites are an excellent source of reliable and evidence-based information. I hoped they might be able to discriminate for me. I looked for the literature, but there isn’t a lot and what’s available is mostly geared around HRT, physiologically oriented and clearly aimed at medical scientists or clinicians. There was not much by way of good literature on effective alternative approaches to managing menopausal symptoms and for women for whom HRT is not an option, the temptation to spend an awful lot of money on products that, at best, have marginal effect, is huge. If menopausal symptoms are severe then you really do want to believe that something will help – however wild it may seem. There are Cochrane reviews – acupuncture (poor evidence), phytoestrogens (poor evidence) and black cohosh (poor evidence), for example, and you can find out more about these in the boxes below, but there is just not enough that is easily accessible to most women on which to base good, well-informed decisions. But all is not lost.

There was one book that was detailed and helpful and that was Miriam Stoppard’s ‘Menopause: The Complete Guide to Maintaining Health and Well-being and Managing Your Life’. It was, at the time, and in the bookshops I was looking in (high street), the only one that seemed based on real experience, was written by a female doctor who had clearly been there, and was evidenced-based. I’ve just looked up the latest edition, and it is better than ever and I would recommend it whole heartedly. It gave me a context to see my own symptoms in, was clear about where possible therapies were evidence-based and where they were not, and was accessibly and confidently written. I’m also now aware of work being done by the Health Experiences Research Group which has produced a range of materials, including films of women talking about their experience of menopause. Jenny Hislop, who worked on this project, has written about this in her blog for Evidently Cochrane. You can also find the site here and it’s terrific. If only I had been able to access it, it would have saved me a lot of worry and uncertainty, and stopped me thinking that I had become a wild, emotionally unstable woman for ever!!

So, from a three way conversation on social media, to disclosing my very personal experiences on this blog, I hope to be doing my bit to demolish the ‘last taboo’. I’m a bright, highly successful woman, a senior leader in my field. It’s probably a risk for me to talk about this, even though it’s in the past. A difficult menopause tested my confidence, my work, my emotional and personal life – but I’m out the other side and feeling good. I hope this resonates with some other menopausal women – and I hope it encourages more research and more sharing of the experiences.

Do phytoestrogen treatments reduce the number and severity of hot flushes and are they safe and acceptable?

Cochrane evidence: A Cochrane review includes 43 randomised controlled trials with over 4000 women, but many were small, brief and poor quality, and looked at many different types of phytoestrogens.

There is no conclusive evidence to show that phytoestrogen supplements effectively reduce the frequency or severity of hot flushes and night sweats in perimenopausal or postmenopausal women.

Click here to see the Cochrane evidence.

Does acupuncture reduce hot flushes?

Cochrane evidence: A Cochrane review includes 16 randomised controlled trials with 1155 women, comparing it to sham acupuncture, hormone therapy, relaxation or no treatment.

There was no difference for those having between acupuncture compared with sham acupuncture. Acupuncture seemed to be better than no treatment but less effective than hormone therapy. There was a lack of evidence on harmful effects.

The reviewers say these results should be treated with great caution as the evidence is poor quality.

Click here to see the Cochrane evidence.

Does black cohosh help control menopausal symptoms?

Cochrane evidence: A Cochrane review of black cohosh, a herb, to treat menopausal symptoms includes 16 randomised controlled trials with 2027 women.

There were many problems with the studies and there is no clear evidence on either the effectiveness or safety of black cohosh.

Click here to see the Cochrane evidence.

You can follow June on Twitter @JuneinHE along with the rest of our Menopause Week team: @anniecoops @SarahChapman30 @ukcochranecentr @menopauseuk @drhannahshort @GussieGrips @martinhirsch100 and @harry9bo. We’d love you to join in the conversation.

Links:

Stoppard M. Menopause: the complete guide to maintaining health and well-being and managing your life. Revised edition. London: Dorling Kindersley; 2001.

Lethaby A, Marjoribanks J, Kronenberg F, Roberts H, Eden J, Brown J. Phytoestrogens for menopausal vasomotor symptoms. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD001395. DOI: 10.1002/14651858.CD001395.pub4.

Dodin S, Blanchet C, Marc I, Ernst E, Wu T, Vaillancourt C, Paquette J, Maunsell E. Acupuncture for menopausal hot flushes. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD007410. DOI: 10.1002/14651858.CD007410.pub2.

Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD007244. DOI: 10.1002/14651858.CD007244.pub2.

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June Girvin

About June Girvin

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Following a successful career in the NHS June joined Oxford Brookes in 2001 as Deputy Head of the School of Health and Social Care. She became acting Dean in 2002 and was appointed as Dean in 2004. In June 2010 she was appointed as Pro Vice Chancellor (Development and Alumni Relations) and Executive Dean of the restructured Faculty of Health and Life Sciences. June was awarded professorial title from Oxford Brookes in February 2015 in recognition of her professional achievements and academic leadership. June qualified as a Registered General Nurse in 1976 from the Queen Elizabeth School of Nursing, Birmingham and maintains her registration as a nurse with the Nursing and Midwifery Council. She holds a Masters Degree from Cardiff University College of Medicine, and a Postgraduate Diploma in Management Studies (with Distinction). June published extensively in the nineteen nineties on management and leadership and her book "Leadership and Nursing" (1998) is currently being revised. She believes strongly in the benefits of coaching for leadership development and personally coaches two clients per year. She is a mentor and role model for the Higher Education Leadership Foundation's Aurora Programme. She is a reviewer for The Contemporary Nurse Journal and a book reviewer for Palgrave Macmillan. She blogs at JuneinHE.wordpress.com and can be found on Twitter on @JuneinHE June has completed the Higher Education Leadership Foundation's Top Management Programme and in 2011 completed the CASE study tour of Canada, looking at Advancement and Alumni Relations practise in universities in and around Toronto, Ontario. In 2013 she was a participant in the Women's Leadership Forum at Harvard Business School. She is currently serving on a two year Lancet Commission on Nursing in the UK.

9 Comments on this post

  1. […] On my other, more personal blog, I wrote briefly a little while ago about getting older and sharing some experiences with a couple of colleagues on Twitter. Since that conversation I joined with a group of other women – health care professionals, academics – to contribute to the Evidently Cochrane blog site for its week-long look at Menopause and the evidence and resources that are available to women experiencing it. I had a particularly bad menopause, and I agreed to write about my experience for the blog and you can read that here. […]

  2. Love this blog. My GP has confirmed I’m in peri-menopause (despite being only 48). A couple of years ago I tried to find useful reading about this life phase, but gave up in disgust as it seemed every source merely told me to take lots of evening primrose oil/ black cohosh/ other random herbs. I would love to find a charity or organisation which provided quality information (and maybe even courses) to cover ALL the different periods of a woman’s reproductive life.

    Rachel / Reply
    • Sarah Chapman

      Thank you; I’m glad you like it. You are right, it is very hard to find reliable information about our health at different stages of our reproductive lives. Elaine Miller, who wrote the guest blog ‘No sex please, we’re menopausal’ has plenty to say about that. It’s here http://www.evidentlycochrane.net/no-sex-please-menopausal/ Do check out all our menopause blogs, if you haven’t seen them, and Elaine has also written about pelvic floor exercise for us, something else that doesn’t seem to get mentioned, or only when you’ve just had a baby.
      Sarah

      Sarah Chapman / (in reply to Rachel) Reply
    • June Girvin

      Hi Rachel,
      I’m pleased the blog resonated with you. Finding reliable information is really hard but I would recommend the Miriam Stoppard book if you can find it. It’s not all great, but at least it considers the evidence – or at least the edition I’ve got does. And it’s not written for clinicians/academics! I was about 45 when I started noticing symptoms but it’s only with hindsight that I recognise them as early peri-menopause. Good luck – I hope you’re one of the ‘sail through-ers’!

      June Girvin / (in reply to Rachel) Reply
  3. I saw a presentation by HeathTalk Online yesterday – it was about women’s experiences of breastfeeding, but it prompted me to check out their menopause pages. I found this one good: http://www.healthtalk.org/peoples-experiences/later-life/menopause/what-menopause

    Rachel / Reply
  4. good blog thanks

    b / Reply
  5. I guess i am lucky that i didn’t have many hot flashes, migraines, or weight gain. I have suffered some bone loss but I am taking Glucosomine, but i really miss HRT, it made me look and feel better.

    Patricia Coldiron / Reply
  6. Lost in Menopause
    You hear the horror stories from older generational people, about how women use to go crazy while going through menopause. Except the terminology that they used then was “going through the change”. I now understand that it’s quite possible that these stories are true. Menopause can be debilitating and contribute to some women making decisions and doing things that they may end up regretting over their lifetime. It’s a subject that many doctor’s do not quite understand or just simply choose to brush under a rug. It normally happens when women have either had a hysterectomy or naturally when they have stopped their monthly cycle. Ages vary due to the hysterectomy factor, however typically around the age of 45 and up. I had to write something about menopause, so that I can simply get some relief for myself, as dealing with this is exhausting. Trying to communicate with individuals who have never experienced this is also taxing. Perhaps someone will read this and realize that they know someone who may be going through this and has said nothing. Maybe they will reach out and help or at least ask questions when they think that they may be headed in the wrong direction.
    Treatment is often limited to psychiatric medications especially when you feel like you are slowly losing your mind. People do not tend to talk much out in the open about this condition and I call it a condition because that’s exactly what it is. It’s a condition that many women endure it their lives that can literally consume them with overwhelming feelings of guilt, depression, and the sense of unworthiness. All too often these women hide their condition and try to pretend that things are just fine in their lives or they simply choose to blame whatever is happening to them on life. They start to question their purpose in life, they wonder why they are starting to put on so much weight, they wonder why they don’t like being around a lot of people or why they feel so sad and depressed. This is not to say that this happens to every woman in the world, as there are those who breeze right through this stage of their lives with no problems at all. I can tell you that these are the fortunate ones, because those of us who were not as fortunate have gone through some life changes or are going through some life changes.
    I am going to discuss some of the life changes that I have gone through in my life that I contribute partly to menopause. The sad part about menopause for me is that talking about it to someone is difficult because of fear that they will really think you are crazy and will not remotely understand what could possibly be making you do some of the things that you do.
    For years of my life I have always had some type of issue that resolved around my mental state that I felt involved how my body reacted to the hormonal changes that occurred in my life each month. I can remember when some symptoms started to occur in my life. I was in my early 30’s when I can remember walking into my house not even knowing how I got there. I couldn’t tell anyone the route that I took home or even driving for that matter. I just knew I made it home and that it was like I totally blacked out and was oblivious to anything. Thankfully there was a higher power that got me home safe and sound. Then there was a time when I up and traded my luxury car in for a not so luxury car on a whelm, to later find out that I was pregnant. My hormones have always sent me on a whirlwind, which may have a considerable effect on my hormones at this stage in my life. I had my last child in my late 30’s and shortly after that I started a tail spin with my hormones. It was issue after issue until in my mid 40’s when I had a hysterectomy.
    I am now 51 and I am confident that I am in menopause and may have been even prior to now. Over the course of dealing with my hormonal problems, I can tell you that this condition played a big part on my mental state. Doctor’s would always want to prescribe psychiatric medications, which I never took. One day I found clarity with a female physician who knew exactly what to prescribe me for my condition and it worked to keep me balanced for several years. She treated my hormone imbalance that I was dealing with from day to day. I was more confident, easier to get along with, less outburst and simply more content. Those were the best 7 years of my life or at least it felt that way, because I felt good.
    I am at a new stage in my life where menopause is truly taking over my life, my mind and my actions, the struggles are real. I do take hormonal medication for the condition but when you are going through menopause, it’s a good idea to limit the amount of stress that you take on. I have always been an on the go person, trying two three or four different ventures at a time. Until recently I realized that I am all over the place, starting and stopping things, lacking any type of patience, unreasonable in certain aspects and just not a pleasant person for my family. I started having ailments due to the type of work that I do and it started having effects on what I thought about my job. Explaining menopause or how you feel to even your spouse is challenging because they really have a hard time conceiving what you are going through, although they know that it’s something. Menopause was so overwhelming to me that I started relying more on my strength in God. I have always relied on him in life and realized that I needed help even more now because I literally felt like I was going to lose my mind.
    I ultimately gave my resignation at my job and I honestly think that part of it was due to this menopause factor, as my ailments became worse and I just did not want to deal with the stress factors anymore. Probably not the best way to have handled this, however the feeling was just so overwhelming and I had already taken leave due to my ailments. I rationalized that I was helping the company by not have to take any additional leave. Imagine that thought process, me helping the company and I’m sure they could probably care less about what is going on with me. The need for me to step back and try to gain some control over me was so powerful. I also decided to let some other outside ventures go until I could cleanse my thought process. My mind would run out of control and I would want to do and try any and everything. This just created more stress for me and although I hated to quit my job that paid very well, I did not think that I would be able to maintain without one day just simply losing it at work. This is just how badly I felt lost in this menopause condition.
    I am sure that there are many women out there who can honestly relate to what I am describing and I hope that each of you will reach out to someone for help. I realized that I needed to sit still for a bit to access my situation. Find you a doctor, preferably a female gynecologist who can relate to what it is that you are going through.
    Menopause is silent in a sense because of women not wanting to expose themselves to criticism. It can be devastating for many of us and cause us to make irrational decisions, lash out at people when we ordinarily would not, throw things, scream and cry a lot. I do not think that anyone not affected by this, can remotely imagine the emotional rollercoaster that menopause creates for some. The sense of feeling trapped in a body that you are not at all familiar with is just unimaginable. It can leave you feeling lost and trapped in your mind just trying to figure out what your next step should be. Menopause can cloud your thought process, causing you to question yourself time and time again.
    The physical aspects of menopause are also devastating for some of us. One day you’re a size 6 and the next day you’re a size 14. It makes you question why it is that some suffer so badly and others are fortunate enough not to have had to endure the baggage that comes along with this ugly word “menopause”. The lost feeling associated with menopause is debilitating and can leave you at a total stand still in life. It causes you to pull away from people, causes you to question your own abilities and can destroy your self-esteem. I found that reading positive words, help me to make it through those days where I simply feel unappreciated, sorry for myself and not wanting to be bothered.
    This is written for informational purpose and in hopes to help others who may be going through menopause to realize that they are not alone. Writing this certainly helps me to breathe and release all this stuff that clouds my mind. I hope that someone will find it worthwhile and for those that do not, may it does not apply to you.

    Anonymously written

    Sherri / Reply
    • Wow! I can’t believe this.you just described my life to a T. Everything you wrote I have done or been through. Quit my job of 27 years sold my house and moved after 22 years.dont want to be around people happy being left alone. Started menopause when I was 48.[ Just turned 53].so sure my family thinks I’m nuts but some days I wonder that myself. I just keep telling myself it will get better. And it is slowly I just try to stay positive read a lot and try to do things I enjoy not so eager to please anymore I think now that I don’t have to live by a schedule I have more time for me. I find the more I say no the better I feel . Some get very annoyed but I feel this is my time now. Thank you for your insight it has really uplifted me today now I know this is really real what I have been going through.

      Pam Beeson / (in reply to Sherri) Reply

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