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A simple guide to the Menopause

Yes, we will be mentioning periods, hormones, breast tenderness and PMS, so if you're someone who knows it all, you don't really need to read any further, however, if you feel you need to learn some of the basics, I hope you read this and find it a useful guide.

So, as a good starting point, we'll begin with a very simple guide to the average woman's biological health time line:

  1. *Born with upwards of 1 million eggs (eggs which in later life can be fertilised by sperm to make a baby). The number of eggs naturally reduces throughout a woman's life.

  2. During puberty the number of eggs reduces to approximately 300,000 and there is an increase in the body's production of hormones.

  3. In puberty, Periods begin and come approximately every four weeks. During this four week cycle, a woman is most likely to become pregnant only during a few days, somewhere near the middle of the cycle. This time is called Ovulation.

  4. Women are at their most fertile in the 20-30 years age range.

  5. During the 30's, fertility reduces, because of the reduction in the number of eggs.

  6. Menopause is when the possibility of natural fertility (because the number of eggs which are good enough to be fertilised) has significantly reduced and hormone production (hormones send signals to other parts, to make them do things) significantly reduces too.

*All the above have been adapted from the website, "Stages of puberty".

So, let's skip straight to puberty, a tricky time for everyone I think. For me, I remember my voice breaking (and showing off about it a lot, especially since I've always tended towards having a gentle quiet voice), facial hair (very dodgy moustache!), pubic hair (where did that come from and where was it going!?), muscle growth (like many boys aged 14 in the gym, I made the classic mistake of mainly training my chest and arms) and all of this whilst feeling uncomfortable in myself, because I wasn't really a child anymore and I definitely wasn't an adult, was just an awkward teenager.

Like most teenagers (and now I realise most adults too) I was trying to figure out who I was. I was trying to find out where I belonged in the world. I also remember thinking that no matter what I said, or thought I had an opinion on, I always thought I was right! And I would always do what I could to win arguments, oh the arrogance of my youth! Sorry mum and dad! For me it was both a brilliant time of life and a roller coaster ride too. I think it was a challenging and often difficult time of life, I often made it more challenging and difficult for those around me too, so my sincerest apologies to anyone who knew me back then, if I was mean or unkind to you in any way I am very sorry, especially my parents.

So if puberty was like that for me, what would puberty be like for girls? Each girl will of course have a different personal experience, just like each boy. Each girl will have challenges growing up which are unique to them and their circumstances, each experience being significant and important to each individual.

As far as the biological processes of female puberty are concerned, below is an outline:

  • *Mood changes: unexplained mood changes, low self esteem, aggression and depression

  • Breast development; sometimes with aching and tenderness

  • Pubic hair growth: starting on the legs, arms and top lip. This starts slowly and over a few years the hair becomes coarser and curlier

  • A growth spurt: often becoming taller than a lot of boys the same age

  • Increased sweating

  • Weight gain

  • Vaginal discharge: which is normally white, or clear in appearance (if healthy)

  • Periods: a monthly bleed which is timed according to the increase and decrease of hormones

*Adapted from the website. Stages of puberty.

That's a lot of physical change to contend with as you transition from being a child to a teenager. I can only imagine what it would feel like to be experiencing puberty today; navigating friendship groups, social media, a worldwide pandemic, the internet, schoolwork, family life and all whilst trying to find out who you are becoming in this world. Puberty can be an unforgiving time for some and for girls to cope with all of the biological changes happening as well as teenage life, sounds way more challenging than anything I had to go through when I was younger.

So what happens during the menopause? Well one of the things I have found surprising over the last 23 years of working in clinics is that most women don't actually know what happens. In general a lot of women don't know much about their own gynaecological health, and why would you if you don't have any medical issues? If your periods aren't troublesome and having children was a pretty smooth process too, then you just don't pay much attention to it. A lot of women don't know when their last period was, how long their cycle is and whether they have any discharge, all questions I ask regularly, especially of anyone coming in for gynaecological health reasons; fertility issues, or menopausal issues.

A lot of women do not know what to expect during the menopause, as most of us didn't know what to expect during puberty. And like the stories we were told when pre-pubescent of what it would be like as a teenager, the stories women are told about the menopause can be partially truthful, to completely wrong. Often women hear stories of others with differing experiences; terrible night sweats and having to change the bedding every morning, skipping periods, not sleeping for nights on end, having embarrassing flushes at work in front of colleagues, having to change their hair styles and clothes to accommodate surges in heat which leave people drenched in their own sweat, all of these are stories which would worry any person approaching "The Change". Although some of this may be true for some people, some of the time, it is not what all women experience all of the time. Below is a list of the symptoms of the menopause, as listed on the *NHS website.

  • *Periods may change to being very light or very heavy

  • The frequency of periods may alter to being very 2-3 weeks, or every few months

  • Hot flushes – short, sudden feelings of heat, usually in the face, neck and chest, which can make your skin red and sweaty

  • Night sweats – hot flushes that occur at night

  • Difficulty sleeping – this may make you feel tired and irritable during the day

  • Reduced sex drive (low libido)

  • Problems with memory and concentration

  • Vaginal dryness and pain, itching or discomfort during sex

  • Headaches

  • Mood changes, such as low mood or anxiety

  • Palpitations – heartbeats that suddenly become more noticeable

  • Joint stiffness, aches and pains

  • Reduced muscle mass

  • Recurrent urinary tract infections (UTIs)

The menopause can also increase the risk of developing certain other problems, such as weak bones: Osteoporosis.

That's a lot to take in for anybody and a lot of change! And all women will experience some, or all of the above to varying degrees during their menopause.

The issues I see in clinic and what I wanted to highlight here are some of the psychological and emotional effects some women experience. Some of the women I see and speak to in clinic feel that they are no longer the people they were prior to the menopause and are often a state of low level shock and surprise at how their bodies have changed.

Some women describe not knowing who they are any more and grieve for the loss of the person they had been their whole adult lives, who they now feel they no longer are. That change can be devastating for some women, as the identities they had built up of themselves as adults, which had been certain and constant for decades are now one they are having to re-establish, re-affirm and become comfortable with again. This would difficult for anyone to do after any particular life changing event, but for some women, their identity, self esteem, relationships to their families, friends, themselves, community and the world at large (which has been one thing for such a long time) is now a very different thing. And what this now means for them and their relationship to themselves and others, is a fairly daunting and scary prospect.

If the new physical feelings inside your body make you feel uncomfortable, then you can feel quite discombobulated with the world around you. If you don't know when your next period is going to be, then you may not know whether the tummy ache you have is pre-period cramping, or a digestive issue, so you have to be prepared for both; keeping on your person both sanitary products and medication for gastrointestinal issues. Not knowing where or when you will have a hot flush can also be disconcerting, especially in social or professional settings.

Hot flushes vary in intensity from person to person and some women never experience them ever, whilst others may be woken by them throughout the night. And no, you don't always wake up with drenched bed sheets and pillow cases. For some women they may only experience the heat symptoms without the sweats and this is also the same for day and night flushes, which may or may not lead to a poor night's sleep, or a throwing off and on of the bed covers throughout the night. A lower sex drive, coupled with less natural lubrication can mean uncomfortable or painful sex, so the frequency of sexual intercourse may diminish or stop altogether. Mood changes or anxiety may become a new issue and can stop people from going out to see friends, or going out in social situations because they just don't know how they may feel with people around them.

Whether women experience all, or some of these changes to whatever degree they face them, it can be a lot to deal with, for some women there may be a lot of uncertainty in their daily lives, which would be very difficult for even the strongest of people to cope with if some of the symptoms are recurring and constant. These changes can take some time to figure out and get used to and women need the time space and understanding from others as to how they are changing and what they need from the people around them at any given time. All of this whilst they are learning about their new selves and how they relate to the world outside of them.

It's obviously not all doom and gloom and many women experience very few mild changes, some experience nothing at all except a cessation to their periods and a lot enjoy and celebrate their new selves, in fact studies show that women in different cultures report their experiences of menopausal symptoms differently. Some cultures report more the issues of flushes and headaches, whilst other tend to mention more their psychological changes, which tends to indicate that there is not one clear universal experience of menopausal syndrome.

Regardless of how women report their experiences of the physical and psychological changes they experience, or how their cultures celebrate or ignore the changes experienced, having a little knowledge on how people feel, what they experience during this time and empathising with what they may be experiencing, is useful for everybody to know. If we can all think back to how we would have all wanted a little more understanding and kindness shown to us when we were teeenagers and going through our first major hormonal shift, hopefully we can show some empathy towards menopausal women and a full appreciation of how the wonderful women of this world experience life.

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