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Menopause

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Menopause

This last week, I officially hit menopause.

On Wednesday 24th August, it was 12 months since I last had a period.

Warning: post menopausal bleeding

This is important, so I’m going to put it right here so that hopefully, more people see it.

Any vaginal bleeding post menopause needs to be referred to a doctor with a degree of urgency. If your doctor doesn’t take you seriously, go to another doctor.

Bleeding after menopause can be disconcerting, but the good news is, more than 90% of the time it’s not caused by a serious condition, according to a study in JAMA Internal Medicine. That said, the study also reinforces the idea that postmenopausal bleeding should always be checked out by your doctor to rule out endometrial cancer, a cancer of the uterine lining.

Dr. Ross Berkowitz, William H. Baker Professor of Gynecology at Harvard Medical School

Everyone goes through changes as they age, and there is a huge taboo around it.

Yes, I said “everyone”; male menopause is a reality, although calling it that is a bit of a misnomer. I’m not going to write around that too much because it’s not my personal lived experience and it’s not in my wheelhouse of professional expertise.

However, here are two links (more links at the end of the blog).

Male ‘menopause’

I would be super interested in any blog posts from male bloggers talking about their experience with hormonal changes, so if you know any, have written any, or care to share your experience – drop a comment.

Definition

Menopause is defined as 12 months from your last menstrual period.

The average age for women hitting menopause in Australia is 51.

The seven or so years leading up to menopause is called perimenopause, a time of hormonal transition.

For 10 per cent of women the perimenopause stage can be symptomless but 90 per cent of women will get some symptoms.

Kim Berry and Kayte Murphy Podcast “The Hot Flush”

Myths and facts

Stages

This is the thing I didn’t know about until I started getting migraines – perimenopause.

Peri, post, or just plain meno – here’s the lowdown on your stage of the ‘pause’

Perimenopause is the period before menopause – you are still getting your periods, but your hormonal levels are starting to change. I kind of think of it as ‘reverse puberty’. A lot of what I experienced through puberty, I experienced again through perimenopause.

Since getting my head wrapped around it when I started perimenopause towards the end of 2018, I’ve talked to several women about it, and I have found that women don’t know anything about it. They know menopause will happen, and there’s a whole genre of comedy based around it, but there’s not a lot of understanding about the process.

That would be that taboo aspect kicking in. The taboo starts with puberty, and menstruation, and continues through to menopause, and it is a tragedy because so many women do suffer alone and it impacts every aspect of their lives.

Perimenopause could be causing suicide in women between 45 and 54 years of age. Or it might not. It could be causing chronic insomnia in midlife women, which in turn can lead to all kinds of physical and mental health problems. Or it might not. It could be causing all kinds of physical and mental problems for women as young as 35 right through to women in their 50s. Or it might not.

We know enough to know that perimenopause is real, it can have significant impacts on some women, and it needs to be taken seriously by women, their families and their doctors. We also know this is not always the case.

Article: The lead up to menopause can be very uncomfortable and poorly understood
By Jane Gilmore
Stages of Menopause

Perimenopause

For me, perimenopause was marked by a general decline in my health and vitality, a flare in my allergies, asthma, and fibromyalgia, and some of the most severe depressive episodes I have experienced since my teens.

My GP was great – they are the ones that identified perimenopause. We couldn’t test for it because I had a Mirena in place, so there was no way of testing my hormone levels.

I had been using the Mirena IUD since my late 30s – for me, it had the added benefit of basically reducing my periods to spotting, which I considered a bonus.

Then I was diagnosed with breast cancer

110% do not recommend.

My cancer surgeon advised that I could remove the Mirena before or after my surgery. I decided to remove it before, and I’m very grateful that I did that. After surgery, I was just very over people touching me, to be honest!

I had my Mirena removed on the 15th of June 2021. Surgery on the 12th of July 2021. My first full period for over a decade started sometime around the 22nd of July, and another around the 17th of August. The first chemotherapy infusion was on August 19th, and my oncologist advised that I probably wouldn’t get another.

In January of this year, I started endocrine therapy. I will be taking a daily tablet for the next decade. Technically, my menopause is therefore regarded as medical menopause.

Hormone Replacement Therapy (HRT)

Therefore, HRT is not appropriate for me. I have had to explain this to several women who have suggested it. Once again, knowledge is power, and educating yourself about your body and your health is important. These people had the best of intentions, but they weren’t speaking from a place of professional expertise on medical menopause or a place of lived experience. I recommend talking to your GP or Gynecologist about HRT, perimenopause, and menopause if you are in your 40s. If they brush you off, find another GP. Don’t just start yourself on any kind of hormone-boosting supplement.

Hormone replacement therapy is controversial and complex, but for now it is generally not recommended for women with a history of breast cancer, or those at higher-than-average risk. HRT is also not recommended if you’ve had ovarian or uterine cancer, a history of blood clots, and conditions affecting the heart, such as a past heart attack or evidence of coronary artery disease (blockages in vessels that feed blood to the heart).

Research on Hormone Replacement Therapy and Breast Cancer Risk

This information is provided by Breastcancer.org.

I do point out that most women seem to go through perimenopause and menopause blind, with very little support, whereas cancer has meant that I have an entire oncology team supporting me. I have had great advice about which supplements to take and which to avoid.

For example; do you know that folic acid is contraindicated for people with breast cancer or a history / high risk of breast cancer? Guess what is in an awful lot of skin, hair, and nail formulas? There are lots of supplements that are not appropriate during chemotherapy as well, so my recommendation is to talk to your oncology team and be very careful of well-meaning but uneducated advice from people outside your wellness team.

So I’m officially menopausal now

I will concede, that the first three months on the endocrine therapy medication were rough. My emotional regulation was out the window. Again, I had the support of my oncology team, my psychologist, and my GP. I was also very comfortable telling friends what was going on. Some of my friends may have wished that perhaps I was a little less comfortable 😉

At this stage, it’s hard to tell what are menopause symptoms and what are ongoing deficits from chemotherapy, if I’m honest.

One thing I will highlight is something that people don’t talk about: vaginal dryness. It is a consequence of both chemotherapy and menopause. It’s not a concern for me as I am not in a sexual relationship, but it is an important thing to accommodate if you are. Use lube. It is that simple. There is no reason to suffer or be ashamed. More than 50% of women don’t report this to their wellness team despite it being easy to treat with either over-the-counter lubricants or vaginal moisturisers or prescribed therapies.

Again, it is time to deconstruct this taboo.

“My central message is: menopause is the last taboo because it is still hidden and it only affects women and it only affects older women. It’s ageism, it’s sexism, all rolled into one.”

Conservative MP Rachel Maclean
House of Commons UK

Not embracing the crone archetype

I do feel like I am in a new phase of my life. I suspect it is more due to my cancer experience than menopause, but menopause plays a part in it due to the very nature of my hormone-positive breast cancer.

As a pagan of any stripe, there are a lot of Maiden/Mother/Crone archetypes floating around. If that works for you, terrific. It does not work for me. Never has. Here are some links that explore why I won’t be having a croning ceremony anytime soon.

In conclusion

I’m super interested in anything that people might be interested in sharing around their own lived experiences, so please feel free to comment.

I’ve also included links to articles that I have found valuable around perimenopause and menopause. If you have any that you would like to share, drop them in the comments.

Perimenopause

Menopause

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