– By Sally Mathrick

Naturopath, Educator, Facilitator of Shape Your Menopause Program
Considerations of 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 peri-menopause. 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 neither of our diagnostic radars. If it had been, I wouldn’t have entertained the disturbing thought that I was developing a mental health disorder for the first time in my life.

Given the lack of insight about the multiple manifestations, complexity and needs for healthy menopausal process, it should come as little surprise that in 2015 women between 45-49years old had the highest suicide rate for females in Australia. Women in the 50-54yr bracket claiming second place. The capacity to accurately diagnose “perimenopausal depression” is a huge challenge to medical system (Kulkarni, 2019).

Seismic shifts slowly unfurl inside middle-aged women.

These global changes throughout a woman’s entire being are poorly acknowledged and comprehended by medicine and society. This deficit of understanding means the needs of these women aren’t met.  The menopause process is a time when many women need additional support.

Fortunately, there’s a growing groundswell seeding how we understand, acknowledge, respect and support women’s menopausal process.

Women often have to “just get on with “it”.

“It” being career, work, home duties, relationships, caring for children/pets/aging parents, having some semblance of a “life”, etc,  while simultaneously experiencing profound hormonal shifts that can impact emotions, thinking, energy levels, sense of identity, as well as body systems as diverse as gastrointestinal function and blood flow, to cognition capacity 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 speaking, menopause is the day a woman hasn’t menstruated for 1 year.

This is one point in a process that unfolds over 6 to 12years. The menopausal process 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 sweaty hot flashes, profound confusion, billowing weight, and more!

This variability is hard for the scientific method to grapple with. Variables are hard to control and isolate, making it near impossible to measure and comprehend any single moving part. This creates challenges to come up with effectively clinical supports. Women’s hormonal-nervous-psychological-immunological physiology is sophisticated. It challenges the 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 process?

Before and during peri-menopause, the menstrual cycle starts to change because the ovaries reduce their egg and sex hormone production. Gradually, other tissues, most notably the breasts, fat, bone, brain, and blood vessels, adapt and produce sex hormone. Eventually, the post-menopausal environment is stable. Key sex hormones are locally produced and used, instead of coursing through the blood impacting the entire system.

This aspect (there are other aspects to the menopause process, as I mentioned, it’s sophisticated) involves a shift from sex hormones produced by a gland (primarily the ovaries) influencing the entire body, to sex hormones produced in tissues or inside cells influencing a local area.

Scientifically speaking, it is the gradual adaptation from endocrine to paracrine and intracrine sex hormone production.

A key aspect to support this adaptation is to care for the adrenals, 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 adrenal glands that provide the building blocks needed for the local hormone production. If we feel regularly stressed, our adrenals get caught up responding the stress stimulus, 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. More unusual ones, include itchy skin, feelings of anxiety or depression, brain fog, vaginal, 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 microbiome
  • her muscle, bone and fat mass
  • her dietary and lifestyle habits

What solutions are there?

The solutions must be multifaceted to be supportive for each individual women.

The reality of an individual woman’s experience doesn’t fit neatly into a bubble pack or patch. Undoubtedly, Menopausal Hormone Therapy (MHT) can be life-saving for women experiencing intense climacteric signs and symptoms. However, positing hormones replacement as the only and best solution, and using it not months but years, smacks of a commercial goldmine and maintaining everyone else’s happiness. I wonder how much does long term MHT actually supports women’s tissues to adapt to local hormone production. And if the menopause process is a time of deepening into wisdom – as many first nations cultures see it – how does MHT impact woman’s capacity to access the innate gold of this maturation process?

Women going through the climacteric require space for reflective time in.

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, selfcare and manage stressors. They need to fill their own cup up first.

This is the opposite to the oestrous years of endless giving.

A society that valued women’s menopause process could develop:

  • Paid menopausal sabbatical
  • Career and life counseling
  • 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

It 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”.

It is not a time of “oestrogen deficiency” as many scientific papers refer to it. A woman in the climacteric is no more estrogen deficient than a pre pubescent girl. It’s a natural state of being a woman.

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; I 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. Deeper understanding is slowly evolving. 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.

The climacteric doesn’t need to be fixed.  We simply need to embrace the sophistication of it. And celebrate it.

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 their sphere.

Certainly, wisdom, resourcefulness and capacity are things our planet needs a lot more of right now.