Menopause – the topic that has become my passion.
I am passionate about changing the way women understand and experience this natural and normal yet potentially highly volatile stage of life.
I am passionate about opening up the conversation, talking about the things that have been silenced for years, busting the myths, changing the paradigms around this topic and making menopause something less scary and more accessible for all women.
And if you have been following the menopause conversations in the UK over the last 2-5 years you will have noticed a seismic shift. Because the UK has become the global leader in bringing the menopause conversation to the general public.
It really is amazing and something to be in awe of.
With thanks to some very vocal celebrities, some key menopause doctors and specialists, menopausal women in leadership roles who have suffered, some actively engaged Members of Parliament, journalists, media and morning TV shows, there is a major shift in the awareness and understanding of what women’s experiences are, increased access to good clear information, open conversations about HRT accessibility and its relevance for treating symptoms, and a general deeper understanding for women who suffer and struggle through menopause.
Campaigns such as Menopause in the Workplace, new HR guidelines, the Menopause Workplace Pledge, the new Menopause Mandate which is supported by the UK government, and Menopause education in the school curriculum only enhances the seriousness of the debate and how it has really filtered into all areas of society.
However, as the UK menopause conversation has grown and expanded, so have the different voices and opinions in it.
I personally see this as a good thing, but it means there is more nuance to the conversation and this sometimes ruffles feathers and requires an intelligent thoughtful response.
A great example is the latest article in the BMJ.
The June 2022 edition of the BMJ, featured an article entitled “Normalising Menopause”.
I will talk about the article below, but just taking a look at the comments from some of the “big names” in the UK Menopause conversation shows how much it has touched a nerve!
In it, the author states “medicalisation of menopause risks collapsing the wide range of experiences at the average age associated with this natural process, into a narrowly defined disease requiring treatment.”
When I read this I literally did a fist pump in the air!
The article gets to the heart of the challenges that are beginning to be levied at the UK menopause conversation:
1. That it is very one-sided, namely using a middle-class white female narrative without bringing a variety of different socio-economic, cultural and ethnic perspectives to it,
2. It doesn’t address the personal experience of women (including from the LGBTQ community) and doesn’t recognize the fact that every woman’s menopause experience is different (admittedly not an easy narrative to create messaging for)
3. And that there is a clear agenda of promoting HRT (Hormone Replacement Treatment) as THE way to manage your menopause symptoms.
Whilst I do NOT have an issue with HRT as a legitimate option for women to treat their menopause symptoms, the obsession that the UK menopause conversations has with promoting HRT as THE ONLY treatment option, feeds into the typical Western medicine narrative of a “pill for every ill”.
This narrative basically adheres to the Western medicine linear approach to illness and health – you go to your doctor with symptoms, you get diagnosed and now have an illness or disease, and the doctor prescribes medication that treats the original symptoms you were complaining about.
This approach, which may have its place for certain, specific health conditions, does not apply well to chronic illness or make space for identifying and treating a wide range of women’s health challenges. There are far too many stories of women suffering for years before being identified as having PCOS, endometriosis, IBS, or fibromyalgia to name a few.
More importantly, this approach definitely DOES NOT have a place in how to manage your menopause experience.
Futhermore, the UK menopause conversation is subconsciously (and sometimes explicitly) taking certain principles are given, in the language they use:
The author of the BMJ article expresses it such
“A systematic review of factors affecting attitudes towards menopause reported more positive attitudes after menopause compared with before, suggesting that negative socially mediated expectations do not always match the reality of women’s experiences. However, the positive aspects of menopause are rarely discussed in the medical literature. A systematic review of standardised menopause questionnaires found only questions asking about negative symptoms and experiences. Hence, there was no opportunity for women to report positive experiences of menopause.”
I identify 4 areas of mis-placed language in the UK menopause conversation.
1. Menopause is a disease. It is NOT. It is a natural normal stage of a woman’s lifecycle.
2. Menopause is a hormone deficiency that needs fixing. Yes, hormones are naturally fluctuating and changing and some women may need extra hormonal support, but why use the word deficiency? Let’s ask why some women are exhibiting hormonal imbalance and look at the ways we can support long term health and wellbeing.
3. Menopause is about symptoms and all the “bad” stuff is that going to happen. This could not be further from the truth (see below).
4. HRT can stop the decline and allow you a “symptoms-free” menopause experience. HRT is NOT a one-stop shop for stopping your menopause symptoms. If you are still living a stressed out life and not nourishing yourself physically and emotionally, HRT won’t help in the long term.
Let me say here – there are many, many women who do suffer with menopause symptoms. Their symptoms and experiences are very real and significantly impact their daily life, their work and their relationships. They need support, clear and available information, and treatment options. As a menopause coach and educator I know the reality of women who just want to feel like themselves again. And their experiences are exacerbated in part by lack of medical, social and familial support. The UK menopause conversation is giving them a voice.
However, based on the current language being used in UK menopause conversation, I think that there is a missed opportunity of creating a paradigm shift, and to deeply and profoundly change the narrative around women’s health in general and menopause specifically.
Your menopause journey (peri-menopause, menopause, post-menopause) is not just about the symptoms! It’s not just about taking HRT to treat the physical changes you are experiencing. It’s not even about making sure our doctors have better menopause training (which is desperately needed), or ensuring support for menopausal women in the workplace.
As important and necessary as all these things are, it misses the essence of what the menopause journey is for the woman experiencing it.
Your menopause journey is a significant and necessary stage of life, the journey that each woman has to take to discover her true authentic self, who she wants be and how she wants to show up for the next stage of her life. It is the opportunity to connect to yourself, to listen to your body, to reassess, to reevaluate, to put practices and strategies in place that support your physical, emotional and mental health.
Menopause is a natural biological stage of life where are hormones are changing to new levels to support us in our post-fertility years. As we enter post-menopause, our body is biologically getting ready to meet the needs of this new stage of life. When we understand menopause as ONE stage in our lifecycle, we don’t need to see it as a loss of relevance, hormone deficiency, or disease.
For many women menopause journey is a reset. And often that reset is accompanied by physical, emotional and cognitive (brain function) challenges. As part of this reset, women can be challenged by roles they have played in the past, be assumptions they have made of themselves or have been made by others, and by their new needs. This can shake the foundations of how they perceive themselves and how they want to be perceived going forward.
When you understand menopause in this context it profoundly changes your perspective of your experience. It also changes how you look for support, the strategies to navigate these years, management and treatment of symptoms, and the expectation you put on yourself.
Here are the guiding principles that I think the UK menopause conversation needs to consider. They are the guiding principles that I have set as standard practice for myself in my work with midlife women:
1. I deeply believe that you can and should be able to navigate your menopause journey with ease, joy and confidence. Pain, suffering and confusion are NOT a pre-requisite for a menopausal woman. If we use this approach as our starting point we can create a paradigm shift in women’s menopause experience.
2. I believe in an integrative approach to treating symptoms that starts with creating sustainable hormonal health and balance. It can include HRT if it is appropriate for you, but it should include much more! Understanding all the factors that can trigger or exacerbate hormonal imbalance can help women to start making different choices and implement better strategies.
3. I believe that the tools and strategies should be deeply personalised and resonate with your needs, experience and lifestyle. There is no one-size fits all when it comes to symptoms management and treatment.
4. We should encourage inter-cultural menopause conversations to understand different perspectives and approaches to this transitional stage of life. Not all woman view menopause as a depressing sign of aging. And women from different ethnic and socio-economic backgrounds will have very different experiences.
5. We need to have more open and honest conversations about women’s experiences. We need to share our stories so that every voice is represented, understand the different ways that menopause shows up and the wide range of menopause symptoms.
6. Post menopause needs to be recognized for what it is – the next stage of a woman’s life full of potential for all that she can do and achieve. When menopause is seen as the journey to reach this next stage, we can start changing the language, narrative, support and recommendations to serve women better!
As I said at the beginning, what is happening in the UK is pioneering and should be celebrated. However this conversation is in its infancy, and as more voices join the conversation we need to ensure it becomes a mature and nuanced conversation taking ALL aspects of a women’s menopause journey into account.
Jacqueline Rose is a Menopause Educator and Coach.