– By Sally Mathrick
Naturopath, Educator, Facilitator of Shape Your Menopause Program
Clear reflections on the menopause process
At 47-years old, neither my women’s health GP nor myself, then with 15-years naturopathic experience, recognised my random anxiety attack, as a symptom of my menopausal process.
A drop in progesterone and yo-yoing oestrogen can propel feelings of overwhelm and anxiety, and reduced capacity to cope.
Yet this hormonal cause was on no-one’s diagnostic radars. Had it been, I would have been saved from the disturbing thought that I was developing a mental health disorder for the first time in my life.
But really, I had it easy. Some women undergo orthopedic or gynecological surgeries, or dose up on a range of pharmaceutical medicines, due to this lack of recognition. We’re lucky lobotomies are no longer trending.
Our health care education and insight about the multiple manifestations and varying needs for a healthy menopausal process is historically very low. So, it’s not surprising that in 2015, 45-49year old women had the highest suicide rate for females in Australia. Women in the 50-54yr bracket claimed second place. The capacity to accurately diagnose “perimenopausal depression” was a huge challenge to medical system (Kulkarni, 2019).
During the menopause process, seismic shifts slowly unfurl inside middle-aged women.
The menopause process is a time when many women need additional support. Global changes throughout a woman’s entire being are still poorly acknowledged and comprehended by medicine and society. This deficit of understanding means the needs of these women aren’t met.
Fortunately, over the past 10 years, there have been improvements in how we understand, acknowledge, respect and support women’s menopausal process.
Women often have to “just get on with it”.
“It” generally means career, work, home duties, relationships, caring for children/pets/aging parents, having some semblance of a “life” while simultaneously experiencing profound hormonal shifts that impact emotions, thinking, energy levels and sense of identity. Oh, and did we mention the physical shifts, ranging from digestive function and blood flow, skin health and muscle function, to capacity to think and libido.
Significantly, the entire menopause process takes place right in the middle, possible peak time, of a woman’s life and career.
Menopause by name – Climacteric by nature
Strictly defined, menopause is the single day a woman hasn’t menstruated for 1 year.
This is one point in a process that occurs over 6 to 12years. The menopausal transition is far from single pointed and clear. Parts of the process can be a hot mess; an individual mix of heroic insight and wise capacity, peppered with sweaty hot flashes, profound confusion, billowing weight, and more!
This variability is hard for the scientific method to grapple with. The complexity of the transformation is hard to control and isolate, making it near impossible to measure and comprehend any single moving part. This lack of clear scientific evidences creates challenges to establish effective clinical supports. Women’s hormonal-nervous-psychological-immunological physiology is sophisticated.
Menopause is a bugbear for scientific method’s need for clarity and proof.
A more appropriate term for the stages of peri-menopause, menopause and post menopause is climacteric [climb-act-eric]. This phrase evokes a sense of tuning to a new internal environment.
A period of adaptation to a new way of being.
What is the menopause transition?
Before and during peri-menopause, the menstrual cycle starts to change because the ovaries reduce their egg and sex hormone production, notably oestrogen, progesterone and testosterone.
As reproduction gears down, other tissues adapt and produce sex hormones. Most notably, the breasts, brain, blood vessels as well as bone and fat tissues.
Scientifically speaking, it is the gradual adaptation from endocrine to paracrine and intracrine sex hormone production. Key sex hormones are locally produced and used, instead of coursing through the blood impacting the entire system. Eventually, the post-menopausal environment is stable.
I strongly challenge the notion that women become oestrogen deficient, or progesterone or testosterone deficient. This idea is akin to a little girl being ‘oestrogen deficient’. Neither life phase needs reproductive hormones in the blood stream, because we are not going to reproduce.
This sophisticated transition process is widely left undiscussed. Local sex hormone production in tissues is really complex. There are rafts of complex enzymes involved in multi-step lines of molecular transformations.
Menopausal transition is a sophisticated evolutionary process that needs extra support in our modern world.
One key aspect to support this adaptation is to care for the adrenal glands, the endocrine glands that cap each kidney. Adrenal glands produce an array of hormones, including cortisol, the hormone released when we experience chronic stress. During climacteric, it’s the adrenals that provide the key building block needed for the local hormone production. If we feel regularly stressed, our adrenals get caught up responding to the stresses, and less able to produce the building blocks. This reduces the capacity of local tissues to manufacture sex hormones.
This is why it is essential that women in the climacteric are supported to manage stress better.
Sign and symptoms associated with the menopausal process
These are so varied because sex hormones impact every part of the body.
The most common symptoms include hot flushes, night sweats, insomnia, and weight gain. Unusual ones include itchy skin, feelings of anxiety or depression, brain fog, vaginal, joint pain and digestive disturbances. Formal lists of symptoms that provide helpful rating scales include Greene Climacteric Scale, Kupperman Index (K1) and Menopause Rating Scale (MRS).
Each woman’s climacteric journey is individual, and influence by;
- any chronic illness she may have
- her previous journey through menstruation (from adolescence through to perimeno)
- her level of perceived stress (now and historically)
- her trauma history
- the accumulated body burden of toxins, from decades on our industrialised planet
- the ongoing exposures to xeno-estrogens, those chemicals that act like estrogen commonly found in plastics, pesticides, chemicals and water systems
- her gastrointestinal tract and microbiota
- her muscle, bone and fat mass
- her dietary and lifestyle habits
What solutions are there?
Menopausal solutions must be multifaceted to be supportive for each individual women. This requires patience and care.
The reality of an individual woman’s experience doesn’t fit neatly into a bubble pack or patch. There’s no question that (MHT) Menopausal Hormone Therapy, (the rebrand of HRT) is life-saving for some women experiencing intense climacteric signs and symptoms, for some of the time.
Positing hormones replacement as the only and best solution, and using it for years, smacks of a commercial goldmine for certain global corporations.
We don’t know how much long-term MHT impacts women’s tissues to adapt to post menopausal, local hormone production. Nor how MHT might impact woman’s capacity to access the innate gold of this final maturation process, if the menopause process is a time of deepening into wisdom – as many first nations cultures see it.
Women going through the climacteric require space for reflective time.
They need an environment of empathetic support. They need to feel connected and valued. They also need to eat nourishing foods, regularly partake in an enjoyable exercise regime, and connect regularly with the harmony inherent in the natural world. Essentially, these women need to prioritise local, self care and manage stressors. They need to fill their own cup up first.
Women caring for themselves is a bit disruptive to the current status quo… and the opposite of the endless, selfless giving inherent in the reproductive years; a nurturing tendency driven by oestrogen, progesterone and reinforced by oxytocin.
A society that valued women’s menopause process could develop:
- Paid menopausal sabbatical
- Career and life counseling, by specially trained practitioners
- Additional paid sick days allocated for climacteric women
- Cultural training to enhance understanding about the value of the menopausal process
- Media celebrating mature women, changing stereotypes
- Respect and equality for women
The climacteric is a power gathering process
The menopausal transition is an important process to be journeyed through by each woman, leading into the final third of her lifespan of, statistically speaking, 83yrs.
Traditional Chinese Medicine calls this third phase of a woman’s life “The Second Spring”. It is a time where “she becomes her power”.
At 47, I didn’t have another anxiety attack. I took an individualised blend of herbal medicines to support my nervous system and adrenal glands for a few months, practiced gentle yoga and meditation, and, supported by my GP, had a few sessions with a psychologist, which assured me I was okay and was simply a healthy, normal, hot mess of a climacteric woman.
The historical lack of healthcare insight about the menopausal process that all maturing women journey through is astounding and concerning, and sadly a reflection of medical misogyny, that is now being discussed.
The climacteric doesn’t need to be fixed. We simply need to embrace the sophistication of it. And celebrate it.
The X-gen women have picked up where the boomers left off, and are paving an easier way for the Y-geners, and hopefully all women in the future. As a society, we can dedicate space and support for it to unfold in a healthy, potentially hot and messy, way. We can celebrate the deepening wisdom, resourcefulness and capacity this maturation process can bring to women, and everyone in her sphere.
Certainly, wisdom, resourcefulness and capacity are things our planet needs a lot more of right now.
