Let's talk about menopause

KANISA GEORGE

It wasn’t very long ago that my mother sat me down and had that dreaded period talk with me. She held my hand, made me feel comfortable, and explained in as much detail as she could what most of us know as the dawn of womanhood.

Even before the highly anticipated conversation, “period talk” was a very live topic at both primary and secondary schools, and even more, there was so much information available and shared, it made the transition into womanhood a bit easier.

You would think that the deed was over after experiencing your first period. You learn to deal with awkward moments and manoeuvre painful cramps.

For some of us it gets better, and the rest of us merely put up with this monthly inconvenience until we no longer have to. But no one really thinks of that time. If I’m being honest, very few people talk about it.

Isn’t it strange that our period is ushered in with great fanfare when the start of the next stage isn’t?

Come to think of it, there is very little conversation around the end of our periods. So much so that one might be tempted to think that things would simply return to what it was before. We have all heard about hot flashes and bladder leaks but menopause is so much more than we’re told.

How many of us are given that sit-down talk before the inevitable happens? My guess, not many. And for those who have had that conversation, is it as in-depth as the one we had in preparation for our period?

In a grocery aisle not too long ago, I overheard two women talking about vaginal prolapse.

Intrigued, I continued to eavesdrop on their very loud conversation.

One of the women shared the shame she felt in having the experience, the effect it had on her public and private life, and the overall lack of information available for menopausal women.

That conversation got me thinking if this experience is an inevitability, why don’t we talk about menopause?

Menopause is commonly known as that period in a woman’s life when she stops having periods.

According to the Cleveland Clinic, menopause occurs when a woman has gone 12 consecutive months without a menstrual period. The age at which menopause occurs varies between cultures and ethnicities, but it typically starts between the ages of 45 and 55.

However, some women experience menopause much earlier than others. Several studies show that approximately two per cent of women under 40 experience premature menopause or premature ovarian insufficiency.

In most cases the cause is unknown, but studies suggest a possible link to chromosome abnormalities, autoimmune diseases, or exposure to radiotherapy and chemotherapy.

Women who experience early menopause have reported experiencing long-term adverse effects on cognition, mood, cardiovascular health, bones, and sexual health, according to a 2010 study by Rhodes and Rocca.

Contrary to what most women of childbearing age may think, menopause isn’t simply a one-off occurrence. It comes in three stages and involves perimenopause, menopause, and postmenopause. Perimenopause is the time leading up to menopause when hormones start to decline and menstrual cycles become irregular. Menopause occurs when you’ve stopped producing the hormones that cause your menstrual period and you have gone without a period for 12 consecutive months.

And postmenopause is the time after menopause has occurred when women are at risk for osteoporosis and heart disease.

Many are unaware that menopause lasts for about seven years and could go on for as long as 14 years. And it’s not just hot flashes and incontinence that are a concern.

While some women experience immense freedom and a sense of gratitude, for others it brings with it life-altering symptoms that completely change the scope of their existence.

A study conducted by OlaOlorun and Shen found that the physiologic changes associated with menopause can impact a woman’s physical and mental health for the rest of her life, as reduced oestrogen leads to thinning and atrophy of the vagina and bone resorption and loss. The study also found that the physiological changes caused by menopause predispose women to urogenital, skeletal, and cardiovascular symptoms.

The mental and physical symptoms associated with menopause are vast, yet very few women who aren’t experiencing menopause know about them.

Anxiety and depression are extremely common in women who are currently in menopause and can carry on for sometime, long after other symptoms have subsided.

A number of studies have tried to address these issues but merely sum it up to be a result of hormonal changes. Other typically unmentioned symptoms may include headaches, heart palpitations, difficulty sleeping, and brain fog.

Yet, of all the things that are seldom mentioned the most difficult to come to terms with for some women are the changes that occur to the very thing that makes the woman.

During menopause, both the vagina and the external female genitals are affected due to reduced oestrogen production.

As a result, the tissues of the vulva and the lining of the vagina become thinner, drier, and less elastic or flexible, a condition known as vulvovaginal atrophy.

With menopause, women can also experience a decrease in lubrication and an increase in vaginal pH, which makes the vagina less acidic. This makes sexual intercourse painful, especially if not maintained regularly after menopause.

As mentioned before, women can sometimes experience pelvic organ prolapse.

This is where the organs within a woman’s pelvis (uterus, bladder, and rectum) held in place by the pelvic floor, weaken and bulge from their natural position into the vagina. While it is not life-threatening it can cause a great deal of discomfort and distress.

Symptoms include feelings of dragging or heaviness in the pelvic area, difficulties with continence and discomfort, and lack of sensation during sex.

The journey to menopause is quite honestly a whole new world, and to deal with the onslaught of symptoms women opt for hormone therapy replacement. However, this comes with considerable drawbacks such as an increased risk of breast cancer and vaginal bleeding.

The journey, unfortunately, is also marred by a lack of information at all levels and insufficient supportive care by health care practitioners. Some women complain that they were made to feel like it was something to just get over, without being provided with much information and emotional support. Others felt rejuvenated by the entire process and were happy to put that part of their lives behind them.

The passage to womanhood is far more nuanced than we were taught. In fact, it doesn’t simply end when we get our period. It continues throughout each stage of our fertile years, whether we become mothers or not, and stays with us until the last drop and beyond.

The more we know about each stage of this journey the better prepared and open-minded we’ll be to embrace what simply must happen.