OUT AND PROUD
THIS IS OUR MISSION STATEMENT. When I say mission, I am not talking about the mission position – that comes later in a separate sealed section titled Menopause and Sex. (Oh yeah baby, contrary to all the jokes about dry vaginas and pain and women preferring soft furnishings and watching Grand Designs, there is a lot of sex during menopause. Or not. Some of us really do feel like a sealed section. You may go straight to that section now if you wish.)
The mission for this book is simple: To talk about menopause and dispel any fear of menopause.
We should not be afraid of menopause. It won’t do you any good if you are. We should be alert but not alarmed, forewarned, forearmed and, most importantly, informed: by one another, by people who know and like and trust one another, and by the occasional expert. But God forbid this should be the cause of another bloody government department. They will only start nagging us about ‘units’ of alcohol and ‘serves’ of vegetables. Then they will all go out for Thai food and white wine.
There are two milestones in every woman’s life, puberty and menopause; what happens in between them are matters of taste, preference, luck, judgement, biology, geography, skill and cunning. Puberty and menopause are givens, the start line and the finish line of the hormone marathon. They used to be trade secrets.
Not so very long ago, women didn’t menstruate, they didn’t flatulate, and they didn’t go through menopause. Happily times have changed, and we now know that women do have periods and we do fart (nicely), but apparently, for many women, we still don’t go through menopause. Why the silence? Why are so many women reluctant to talk about it? Not much with one another. Not across the generations. Not with our menfolk.
Even professional women who work in pharmacies treat menopause like an embarrassing affliction. When I first got symptoms of menopause I went to a pharmacy, since garlic and essential oils and wine wouldn’t fix them. I staggered in, delirious with sleep deprivation and with bags the size of cabin luggage under my eyes, and said to one of the well-groomed, kind, mature, possibly menopausal women: ‘I think I may be going through menopause. I am not sleeping because I get really hot at night and keep waking up to kick off the doona. And then I wake up to pull the doona back up. Now my husband has hypothermia and I’m confused. What’s up?’
She glanced furtively around the shop and mouthed the words ‘hot flushes’ as if she was saying ‘Your nipple is showing’. As if hot flushes were something to be embarrassed about. Like genital warts. In fact, most of these professionals will happily and openly talk about genital warts and herpes and haemorrhoids without flinching, and steer you to a shelf full of rainbow options, but they would no more say ‘hot flushes’ out loud than ‘Voldemort lives again’. Everywhere, in pharmacies and supermarkets and garages and bulldozer rental shopfronts, there are rows and rows of colourful tampons looking like the Darrell Lea display on the next shelf. But menopause? Huh!
Why won’t women talk much about it? Not in our culture and generally not much in any culture, even though all women, each and every woman usually in her forties or fifties, will go through menopause and has done since the beginning of time.
It is very likely that one of the reasons, perhaps the principal reason, for menopause being treated as a mystery is that it is part of, gasp, getting a little older.
But menopause is not about growing old. It’s about growing up.
Therefore as grown-up, mature menopausal women, let’s bring menopause out of the closet. It’s about the only thing left in the bloody closet.
I am menopausal and at peace with it, if not always peaceful during it. If we had a ribbon for menopausal women I would wear it proudly pinned to my bosom. Or perhaps a tattoo, of a beautiful feminine rose in its fullest bloom. Held in a clenched fist.
Happily, we who are now enjoying menopause are the generation that can talk about it. We have form. We are the generation who burnt our bras, then we discovered gravity and we put them back on again. (They weren’t called the Swinging ’60s for nothing.) We embraced body hair, not necessarily for long, or wisely, or hygienically, but we are not afraid of it any more. We are the generation who used the word ‘vagina’ candidly, out loud and without shame. We brought the vagina out of our undies and into the open, sometimes literally, as many of us hippies didn’t wear knickers and there was nothing quite so liberating as the thrill of a soft breeze up our skirts and the freedom to pee standing up, like a man. It was empowering. We viewed the vagina as a completely acceptable and beautiful part of the body. We viewed it literally, too, down on the floor with our legs in the air and a mirror. We felt as comfortable with our genitals as men felt with theirs, only with a lot less scratching and not as much to adjust.
Paradoxically, we are also the generation who grew up during the years when periods were still seen as humiliating, embarrassing, yukky and secret – above all, secret. As teenagers, we never talked about periods with each other or our mothers or anyone else for that matter. Certainly never with boys.
I remember the only time periods were ever mentioned was in Year 8, at school. It was part of sex education. The girls and boys were separated and the girls went into a darkened classroom that contained a screen and a slide projector.
I have no idea where the boys went for their sex education – to the car park probably, to learn how to put up curtains in a Kombi van.
To help us girls to understand what awaited the post- pubescent female and what changes might happen, we were given a small booklet. On the front cover was a soft-focus, black- and-white photo of a woman who looked a lot like Grace Kelly. She was incredibly glamorous and well groomed with perfect skin. Her hair was up in a French roll, she was wearing pearls and she was sitting in a strapless ball gown with a full white tulle skirt.
The message this image conveyed was straightforward: once you reached puberty, once your periods started, your girlish, chaotic and random life, your life of tie-dyed singlets, cut-off shorts, shoes made out of the treads of car tyres, all accessorised by a shark’s tooth hanging on a leather thong around your neck, suddenly metamorphosed into a life of sophistication, glamour and deportment, a world of debutante balls, with you in its calm, grown-up centre, in a bouffant hairdo and a rope of Paspaley pearls.
To the average teenage girl this booklet was about as useful as a knitting pattern for a tea cosy. Most of the booklets ended up blowing around the schoolyard, covered with rude remarks scrawled by the boys. They never contained any information that would have been useful, such as how you might feel when you menstruated and what were some of the things you could do that might make managing your periods easier and what you could do if you got cramps and what were the tell-tale signs that you might be about to menstruate (i.e., things we might also like to know now about menopause).
There might have been some girls who knew the answers to these questions, girls with older sisters, for example, but because no one shared anything, apart from their Marlboros, we knew nothing. Consequently your period was always a surprise and instead of swanning about in a ball gown, you regularly leaked all over the back of your school uniform and you hid it by tying your school jumper around your waist. Which is what school jumpers were for. Then you went home, humiliated, and your mother gave you a beautiful white ball gown and some pearls that had belonged to your grandma.
No, she didn’t. She gave you a horrible elastic thing that you tied around your waist called a suspender belt from which you hung your sanitary napkin – or ‘surfboard’, as it was then called, because that’s how big they were.
My first job, at 14, was in a chemist shop. Back then you couldn’t even buy tampons or pads over the counter. Our sanitary napkins were kept under the counter, next to the condoms, and they were pre-wrapped in brown paper. If you wanted some, you came up to the counter and you whispered, ‘Modess, please’, like a code word. Even the name was discreet. And we would quickly slip them into another paper bag before anyone could possibly tell you were probably menstruating and therefore probably a woman. The shame! And when I say ‘slip them into a bag’, bear in mind that a packet of Modess was the size of a small pillow and slipping them into anything was as discreet as slipping a bolster into your briefs.
Well, we have come a long way since then. Periods nowadays are seen, amazingly, as natural and normal and – judging by the ads for sanitary products on the telly – a wonderful entree to the world of horse-riding and tennis and blinding white cocktail frocks and fun and laughter and pert young men and things involving sand dunes. Forty years later, boyfriends who used to tuck Marlboro packets under their T-shirt sleeves now happily tuck in packets of tampons, for girlfriends who don’t want to spoil the line of their skinny jeans. In fact, now that smoking purses lips everywhere, young men probably carry their Marlboros in tampon packets. Periods are even a plot device, such as when she finds tampons in his pocket and it’s not her time. Of course, women on TV never get cramps, do they? Perhaps they’d fall off their horses.
The women who are not talking about menopause now are the same women who once never talked about periods with their boyfriends. Now young women do. They know that talking about periods with your boyfriend is not an act of indelicacy intended to intimidate. It does not betray the mysteries of womanhood. It is not a cause for embarrassment. It is simply part of sharing what’s going on and what is not going to go on for the next few days. It is all part of a greater understanding of each other. It no more crosses the line than young couples buying one another’s underwear, or even wearing one another’s underwear when the mood is upon them. Nowadays girls are taught to be prepared for puberty and to carry packs of brightly coloured funky emergency pads. Soon tampons will come in bandoliers and be worn casually over the shoulder. Brilliant. Just as it should be. Menopause should be part of this acceptance also.
Menopause is natural and normal and manageable. Menopause can be incapacitating and inconvenient, it can be draining and a drag, but it is also interesting and life-changing and it is actually liberating. Not just because a world of horse-riding in polo whites really is now open to you.
FREQUENTLY ASKED QUESTIONS
In the spirit of supplying information – while taking into account many of you may be thinking, I just don’t want to know any more, my head is about to explode, and who can remember any new information anyway, the hard drive is full – I am only answering frequently asked questions. Not weird, random questions that people seldom ask, like, Why do I like the feel of shiny books in my underpants?
Do hot flushes mean I am menopausal?
Yes. Probably. It could mean a rare allergy to Lindt chocolate (bummer), it might be a tick bite, but these things clear up fairly quickly. They do not recur a dozen times a night. It’s menopause.
How long will it last?
What am I, psychic?
Does lack of mental focus come with menopause?
I paid $6.99 a kilo for bananas, when I knew they were $1.99 just up the road, what is that all about?
Does menopause make you masculine?
You want to step outside and say that again?
Can I go through menopause naturally?
Of course. You may not need any ‘unnatural’ treatment at all. For some of us, in the first world, to be natural is our deepest wish. For example, both my births were natural. The first one hurt, so naturally I had an epidural. The second one was going to hurt even more, with possible critical side effects, so naturally I had a Caesarean section.
One friend, who is alternative and new age, shows a pleasingly sensible and flexible approach to being natural. She didn’t go to the doctor once during her entire pregnancy. She just hung around the commune and ate nuts and berries and was happy. She wanted a water birth. The local river, although filled with lovely magical swimming holes, was a little cool and had a rather strong current. So she decided she would have the baby in the bath. She found herself a biggish spa bath, of the type that was very popular in the ’80s. A sort of peach-coloured, corner-fitting thing.
The day she had a feeling the baby was due, she filled the bath and lit candles and had rose petals (hah!) strewn on the top of the water. She got into the bath and her other two kids got into the bath and so did her partner and, for all I know, the plumber and a pair of Mormons who were in the neighbourhood. Her partner played songs on the guitar and for quite a while everyone was blissfully centred and in the moment. After about an hour nothing had happened and the kids were getting hungry so they went and bought some chips, and got back into the bath and another hour went by. By then the bath was cold and the candles had burnt down and the rose petals had sunk and the only thing floating on the bath were bits of chips. My friend pulled the plug. Literally.
She realised this was not going to work. So she walked along the beach to the local hospital and booked herself in. A practical approach, sensible, flexible. (Just make sure you do have a hospital at the other end of the beach, and a beach, or you could find yourself giving birth in the back of a friendly surfer’s station wagon.)
And so it is with menopause. If you one day find yourself, against all expectations, floating in an existential cold bath of soggy chips and lost hope and bad music and loved ones, and you can no longer remember why you love them, it is time to abandon ship. Time to try a little treatment. I hope that answers your question.
Should I have a hysterectomy?
Certainly. Allow me to book your appointment. Are you crazy? What are you, menopausal?
Hysterectomies are major operations and should only be done with the advice of the top gynaecological surgeons. Always, I repeat always, get a second opinion from another top gynae specialist. Take the time to seek them out.
I remember that my mother, after I left home, ended up with a hysterectomy for some reason or other. She is not even sure today why she had one and it was performed by the local chicken farmer, or might as well have been. She was in a regional area and went to a tiny bush hospital, and there were complications. She is lucky to be alive today and dying (only on those occasions when she wants the family’s attention, see page 16).
Be careful mucking around with yourself, or blaming your parts for doing what they do naturally, or letting other people remove things. The medical wisdom about such drastic remedies changes all the time. Until relatively recently, oophorectomy (removal of the ovaries) was considered a good option. That has now changed. New research indicates that if you remove your ovaries under the age of 60 you may have a reduced life span. If you need your ovaries removed for something like ovarian cancer then, of course, yes. It’s the old risk/benefit weigh-up. But for menopause symptoms? No. There really is no need.
Will I ever get my libido back again?
Maybe you will, maybe you won’t. Maybe you will and you will pick up where you left off. Maybe you won’t and you will be troubled and either adapt or get treatment. Maybe you will and it will be inconvenient. Maybe you won’t and it won’t matter. Mother Nature is only interested in your libido as a spur to your reproductive usefulness. Mother Nature is not interested in your personal arrangements, needs, feelings, or your state of mind. Mother Nature moves on. Mother Nature can be a real bitch sometimes.
There is not a lot to be done about this, although there is a lot to be said about it later on. Whichever option befalls you, the old Australian quip about the Aussie bloke’s preferred chat-up line will still apply: ‘Darling, I’m home. Brace yourself.’
Menopause came as a complete surprise to me. As it does with many women, even if we think we have heard all about it and we are braced. A little bit like your first parachute jump, I expect, or the first time you have sex, or childbirth, of course, or crow’s feet, or the first time you ate an oyster, or liver.
I was really looking forward to menopause. I thought, I got through puberty, I got through 35 years of menstruation, of leaking on school uniforms and leaking on my jeans and leaking on the train and leaking on the white upholstery of a BMW that belonged to the mother of the nice young guy who picked up my girlfriend and I hitchhiking in England, and leaking on the white upholstery of a couch at my friend’s parents’ house and leaking on thousands of pairs of sheets and thousands of pairs of undies, of forking out thousands of dollars’ worth of tampons and pads and Napisan and new sheets and new undies and car-cleaning products. I got through years of pains and stains, of flooding and spotting, and even more disconcerting, no spotting, and now my periods are easing off so I must be peri-menopausal and soon they will stop all together and I will be menopausal and I will be free!
Free to accept lifts in BMWs with ostentatious upholstery! Free to go out with nothing more than a car key, a credit card and a winning smile tucked into my Nancy Ganz! Free to swim all year round, without fear of attracting sharks! I will be boating, not bloating. I will be leaping, not leaking. And just think! All that money I will save from not buying sanitary products I can now spend on wine and facials and movies. Yippee!
Much of which actually is true.
You are liberated from ‘The Curse’. You do not have to routinely ‘Get The Rags On’.
If you are French, you no longer have to tell your partner, ‘The Redcoats Have Landed’. (True, they did say that.) You do save money on sanitary products, which you can now spend on wine. Which is just as well because for many women menopause hits like an earthquake and you need the wine just to stop the place rocking.
Because menopause is not a pause, it is a full stop. It is a full stop on the body clock, and a full stop to fertility, which comes with its own set of feelings. Sometimes feelings of relief and sometimes feelings of grief and sometimes women are just at a loss to describe their feelings at all. Also, the body clock stops but time marches on. You will not Put Your Feet Up and Let Your Hair Down. With menopause your feet will hit the ground running (possibly in circles) and your hair will run wild also. Our lives, our work, our demands, our anxieties seemingly crank up and there is no time to spend that saved sanitary money on facials and movies.
No, menopause is not a pause. Menopause is a shift, a change – The Change, in fact – in thinking and in being.
Emotionally, you change. You feel anxious, you feel angry, you feel sad, you feel lonely, you feel tired, you feel manic, you feel panic, you feel confused, dammit! These are all perfectly normal human responses to people and circumstances and events, but with menopause they don’t need to be responding to anything. They are auto-generated, much as fits of madness are. And, as we shall discuss calmly later on, menopause in less enlightened times was often regarded as a form of madness.
Physically, you change. You get hot flushes and wet clothes and your hair sticks to your forehead and your face turns bright red and your makeup runs off so that you look like a Picasso painting. Your skin may crawl and for the first time in your life you may get acne. You may put on weight easily while getting it off is harder and, worse still, half the time you don’t give a damn. Because the way you think can change too.
Things you once cared about, you now couldn’t care less about, and things you didn’t ever care about are suddenly really fricking important. You can have big ‘Poor me, why me? Boo hoo’ moments that can last for months or years.
Or you can have Eureka moments when the meaning of life and your role in the circle and cycle of life becomes absolutely clear to you.
You think, what the hell is going on? Why is it so? Why do we women have to put up with all the painful, inconvenient, uncomfortable elements of life – bikini waxes and pap tests and pantyhose that squish and shoes that squeeze and tampons that leak and pads that migrate and children who won’t listen and husbands and partners who don’t either, and just when you think you are free to be yourself and not a woman at the mercy of your reproductive system and its cycles and urges and offspring, you get hit by Menopause Mania and all the changes it brings and the first thing you think is: Why didn’t anyone tell me? Or, more specifically, Why didn’t my mother tell me? She’s a woman and she’s known me all my life!
My mum was richly and colourfully informative about everything, except for menopause. Long stories in gory detail about how hideous childbirth was – the pain, the splitting, the stitches, the breaching and the bungles – which probably explained why I didn’t give birth to my first child until I was 36, when drugs were much more advanced and my mother had moved on to other topics, such as flan. She shared distressing descriptions of prolapses (something that happened to women after multiple births in the old days when women didn’t have a pelvic floor so much as a revolving door) and dentistry without painkillers causing paralysis of the jaw and haemorrhaging (she told me this story on the way to my first dental appointment).
Oh, yes, my mother told me many things: Clean your teeth twice a day. Make your bed. Pick up your wet towels. The best thing for pimples is metho. Your great-great-great- great-grandfather was the first white man to drown in Sydney Harbour. Stop frowning. You’ll get lines. Many other men wanted to marry me before I met your father. (Sigh.) This last one was not a hint to keep myself nice until I met the right man. This was something she told me only in front of my father, to suggest by word and gesture that their whole marriage had been a farce, a moment of appalling misjudgement that had persisted for a whole lifetime, so far.
I also remember clearly the day Mum tried to tell my sister and me about sex. It was the old birds and the bees talk. It could have been the old chicken and the rooster and the egg talk. We had chooks. But my mum has always done things differently. It was a Saturday morning and my younger sister and I were in the outhouse doing the washing, and Mum came in with a determined look on her face and said, ‘Girls, I want to talk you about something. Follow me.’ We glanced at each other. Perhaps we were getting a washing machine! Instead, we followed Mum up the backyard, past the Hills Hoist, to the pumpkin patch.
Wading through the enormous leaves and spiky stems, with us tiptoeing gingerly in her wake, Mum said sternly: ‘Girls, here is a male pumpkin flower.’ We had a look. OK, duly registered. Then off she waded to another flower. ‘And this is a female flower.’ We had another look, took notes: would there be a trick question? Then she paused and said, ‘Actually, this is the male pumpkin flower, and that is the female pumpkin flower.’ Then she said, ‘No, hang on, these flowers are both the same. Oh forget it.’ And she stalked off.
That was the end of our sex education.
Looking back she was probably menopausal and thought to herself, ‘Sex. Why do they need to know this? Better if they don’t know.’ Perhaps she didn’t know. Or perhaps she just had a hot flush and a surge of ill-defined anger towards pumpkins. Or perhaps this was what her mother had told her and she had confidently expected to harvest her kids from a pumpkin patch and the whole conception and childbirth thing had come as an alarming surprise to her, and she saw no reason why we should have it any easier.
Whichever the case, she did not tell us about menopause, even when she could have been Exhibit A. When I was menopausal and started getting the hot flushes and night sweats, I thought, I wonder if Mum went through this? And if she did, I wonder how long it lasted? I also thought (OK, hoped) that because Mum had never mentioned menopause, and we shared the same genes, she hadn’t bothered to tell me because it was a doddle for her. A breeze. A non-event. Excellent. This would apply to me, too. Yippee for me.
So I rang Mum and I said, ‘Mum, did you go through menopause?’
‘Oh, menopause!’ she muttered. ‘It was the worst five years of my life.’
I was shocked. I said, ‘Why didn’t you ever talk about it?’ She said: ‘We just didn’t.’
Did she ever discuss it with her friends? Or did they mutter about one another, ‘It’s The Change’, and look around quickly as if they were a coven of werewolves and didn’t want anyone to find out? Did she think she was enduring this alone? Many, many women did. Many still do. So if women weren’t talking about it, how did they find out about menopause? Perhaps they didn’t. Perhaps it was as much a surprise to Mum as it was to me.
My mother’s mother would never have talked about it. Never! And not just because she was still getting over her own pumpkin patch moment.
First, she was born in the 1890s and at that time menopause was called ‘climacteric insanity’ and the recorded symptoms included anger, wilfulness, irritability, depression, anxiety, fatigue, etc. (see a 10-page list of symptoms). Menopausal women were frequently carted off to asylums and had electric rods inserted into their vaginas to stop the bleeding and they were given oophorectomies (removal of the ovaries) and hysterectomies (removal of the womb) and cold baths and shaved heads and leeches and opium by the bucketful (which they not only needed by then, they’d earned it). They were locked up and dosed up and even well into the 1900s they were often given massive doses of radium to kill the ovaries.
This was for menopause! This was for women who were quite suddenly irritable and wilful. This did not happen to men of a certain age who became irritable and wilful. They were elected to parliament. No wonder women went quiet about menopause. I would have become very bloody quiet.
Opium? If I must, I must. Queen Victoria knocked back laudanum the way modern female CEOs knock back sav blanc, but leeches and rods up the vadge? I would not have told a soul that I was menopausal.
Quite apart from the superstition and misdiagnosis and stigma and sheer ignorance associated with menopause, there was also a lack of information. My mother’s mother and her grandmother were of pioneering stock. They went out into the bush and clear-felled 100 million hectares and parked one sheep under every remaining tree. They lived in wattle-and- daub cabins. They were surrounded by sheep and cattle and red-bellied black snakes. They had a full water tank in good times. In bad times they did the washing up with sand.
They had baby after baby after baby. They had Change of Life babies (today those little tykes are often known as ‘whoopsies’). They were going through menopause about the same time as giving birth – on their own – while their blokes were out droving. They probably didn’t know what the hell was going on. They may have put their menopausal tetchiness down to having 11 home births and no running water and no pethidine and no daytime television. They may have thought, Why am I suddenly getting a lot of pleasure out of killing red-bellied black snakes with an axe, with my baby on my hip? In fact, why have I started to go looking for them?
Tough? Huh! If my female forebears needed an oophorectomy they would have given themselves one. While breastfeeding. And inventing the stump-jump plough.
And so, down through the female generations of my family, menopause was a cause of silence and secrecy and fear and ignorance. And as a result my mother didn’t know anything about it either, even though she worked as a secretary for the local doctors. I recently asked her: ‘Didn’t those doctors talk to you about menopause?’ And she said, ‘No, of course not. Why would doctors try to help women with menopausal symptoms? They were all men and as far as they were concerned it was a woman’s problem.’ And Dad, who I thought was deeply involved in a Clint Eastwood western, or perhaps deeply asleep, said, ‘Women’s problems are men’s problems.’ (Then he rode off into the sunset.) Ain’t that the truth? We will call the men back into the room later and discuss this calmly.
When I look back, I realise my mother handled menopause really well. She would come home from work, grab a bottle of dry sherry and huddle in a chair in the corner rocking backwards and forwards, saying things like, ‘I didn’t get dinner. Why don’t you pick some chokos off the back fence?’ (It could have been more alarming. A woman told me a story recently about her menopausal aunt. One day they found her sitting on the stove in a fur coat. She had put her head in the oven to gas herself and then found it was electric.)
It was at this time that Mum decided she was dying. She called us all around her bed and said in a weak voice, ‘I don’t think I have much time left. I will probably die young.’ We were shocked and said, ‘Oh Mum, why? What’s wrong? What has the doctor said?’ She said, ‘No, I haven’t been to the doctor. I just have a feeling.’ Then she wept. ‘I’m not upset for me. It’s you kids I worry about. If something happens to me, I don’t know who is going to look after you.’ And we all said as one, in a very reassuring and cheerful chorus, ‘Dad will,’ and for a woman who was on her deathbed, she got pretty cheesed off. In fact she bounded up and went to the kitchen where he was getting dinner, to shout at him.
Around the time Mum decided she was dying, she also decided to go to bed early.
By early, I mean anywhere between 5 and 6 pm. When she got home from work of an evening she would have dinner and then go to bed. Or often go to bed and have dinner in bed. None of us worried about it and she was very happy in there with her beloved books. She would receive guests in her boudoir and we would bring in a cask of wine and some smoked oysters on Jatz. I am making up the part about the cask of wine. People in those days didn’t drink wine as we do now. They drank sherry. Sherry came in flagons and by people I mean women, because menopausal women were all on Valium and barbiturates and if the sherry didn’t have the necessary oomph, they drank gin. Come to think of it, that’s probably why Mum entertained in bed. (The smoked oysters are true. We found them down behind the wardrobe, under the bed, in her dressing-gown pockets, for years afterwards. Probably still a few around, and they’re probably still good.)
Not only did Mum decide she had not much time left on her mortal coil and she needed to spend as much of it as possible in bed, she also decided to dispense with nouns. (Once again in retrospect it could have been the Valium/sherry.) Mum would tell long stories without a single noun and funnily enough we all knew exactly what she was talking about. I would ring and she would say, ‘Hello … I have just got off the … I was talking to … because the … stopped working … I knew it would, it’s been playing up since … I have said to … it needed … but of course nothing has been done because … so I had to ring … and he can’t come till tomorrow because you know his … you know who am I talking about, she used to work at the … anyway she got … and she’s coming home tomorrow and then … can come around. Anyway, glad you’re … I’d better go, I have to see the you know … anyway … sends his … Say hello to … (forgetting the name of my husband). Bye … (forgetting my name).’
Of course, she really did work for military intelligence during the war, and this may have been a long-remembered code, or a deliberate way of denying the enemy secret and important nouns. (For lovers of code-breaking, this is what she thought she conveyed: ‘Hello Jean. I have just got off the phone. I was talking to the electrician because the washing machine stopped working. I knew it would, it’s been playing up since Christmas.
‘I have said to your father it needed an expert, but of course nothing has been done because he never remembers anything, so I had to ring Jerry and he can’t come till tomorrow because you know his wife, you know who am I talking about, she got a Manchester repair, and she’s coming home tomorrow and then he can come around.
‘Anyway, glad you’re alive. I’d better go, I have to see the doctor and pick up another flagon, so anyway, that’s my day. Your father sends his love. Say hello to George (forgetting the name of my husband, but hey, it’s a man’s name). Bye, Rachel- Bill-Jean.’ Importantly, it was in this way the wily enemy learnt nothing, and so we won the war.)
So there you have it. I come from a long line of women doing what they have to do to get through the day. And not complaining. Well, only complaining about everything and everyone except menopause. Just getting on with it. Which didn’t help me.
I knew nothing.
SOME DAUGHTERS DO HAVE ’EM
I remember the time when my mum thought my father was having an affair. She told us kids and we didn’t care one way or another really, but Mum was going on about it so we decided to find out by hiding my brother in the boot of Dad’s car and when Dad got to wherever he was going my brother would get out and report which floozy’s house he was at and what was going on.
The plan was working like clockwork right up to the point where my brother had to get out of the boot. He couldn’t. He was locked in. The only thing that saved him from being suffocated to death was the fact that because my dad was a car mechanic we always drove rusty old bombs. There was plenty of ventilation. In fact, he could probably have punched his way out, except that this would have given away our stealthy plan.
(My father, by the way, would not have been having an affair. He would have been hunting down spare parts for his cars. When you knock on a strange woman’s door and you are covered in oil and you ask whether the lady of the house has a gasket for a Morris, you are unlikely to be invited in for ‘coffee’. And not just because the clean and fresh-smelling milkman is already there.)
Oh, yes, Mum was definitely menopausal.
If she had understood menopause and been able to be open about it with her family and friends, we may have been able to help her get through what was a challenging time with confusing and sometimes incomprehensible feelings and anxieties.
Will I turn into my mother?
Probably not. Because we inherit the genes of both our mother and father, we are not all turning into our mothers. (In my case, I suspect that I am turning into my father. I certainly look more and more like him and I am developing a real fondness for pruning.) Some ‘studies’ have even suggested that the reason we have menopause symptoms is because we have inherited both our mother’s and our father’s genes. Your father’s genes are trying to tell you to get out there and reproduce, while your mother’s genes are telling you to put your feet up, and both sides are having a big barney about it. It is an interesting theory but when it comes to my parents they are quite capable of fighting without me.
An important exception, however, is that if your mother had early menopause then you too are very likely to have it early. It is also useful to know that there are many other influencing factors, such as weight. Because oestrogen is produced in fat cells, being overweight influences our oestrogen levels and therefore our menopause. This seems to be one of the big differences between past generations of women who ate a lot less processed food and were a lot more active, and this generation of menopausal women. But even if we and our mothers don’t have that much in common in terms of actual menopause, it is still useful and important to talk to your mother about her experiences. Having a good all-round family medical history helps your doctor to work out the safest and most effective way to manage your menopause symptoms, especially if your family history involves heart disease, cancer, an immune condition, an underactive or overactive thyroid, or rheumatoid arthritis.
Jean Hailes for Women’s Health (see Further Resources on page 230) recommends some questions for women to ask their mothers, or to discuss with their daughters:
‘Do we have a family history of any disease?’
Your chance of developing common gynaecological conditions such as endometriosis or Polycystic Ovary Syndrome (PCOS) is higher if a close female relative has it. Many older women may still not know they have particular conditions, so ask if your mother has/had a lot of pain with her periods, if she had any problems getting pregnant, or if she has trouble managing her weight or body hair.
(Also, and this is me speaking now, please don’t forget to ask your parents about Macular Disease. This is genetically linked and you should know whether or not it is in your family.)
‘Have you ever suffered from depression?’ (This is one for your dad too.)
Depression can run in families, but this doesn’t mean that if your mother has experienced depression you will. If she has, ask when and for how long. You may experience something similar, particularly if her mood was affected by her menstrual cycle, but your own life events and lifestyle (drug and alcohol use, physical activity, social support) are also important factors.
‘Have you ever had high or low blood pressure?’
If your mother had high or low blood pressure later in life, it could be lifestyle related, but if she was quite young it’s something you should ask your doctor to keep an eye on.
By now your mother should be ready to tell you anything: first boyfriend, first nude swim, men who proposed before your father did, secret sponge recipe, how to play office politics, anything.
A SHORT SELECTIVE HISTORY OF MENOPAUSE
Menopause has been around as long as women have been around. It has not gone unnoticed. And the treatment of menopausal symptoms by ambitious healthcare professionals has been around as long as recorded medicine. Yes, the very early diagnoses were often wayward guesswork and sometimes cruel (and sexist), and the treatments odd, to our modern eyes, but perhaps no more so than in almost every other branch of medicine as it has evolved. However, what is annoying – OK, infuriating – is that since then the understanding and treatment of menopause lagged far behind progress in other fields of medicine for so long.
Ancient Greek and Roman physicians believed the symptoms of menopause were caused by the accumulation of toxins, after menstruation ceased; menstrual blood, they surmised, rid the female body of ‘bad humours’. Fair enough, for the time. The theory of humours was tremendously popular for explaining a person’s personality, disposition and pretty much everything to do with physical and mental health right up until the 16th century. You can look it up for yourself and discover all about blood and phlegm and choler and melancholy and the need to ‘balance’ them. The best we can say of it now is that it was as good guess as any. More helpfully, symptoms that we now know are caused by menopause, such as hot flushes, mood swings, insomnia, sexual dysfunction and bone fractures, were all identified and described in early Egyptian, Greek, Persian, Roman, Arabic, Chinese and Indian texts. In about 200 BC, the first pharmacopoeia, the Shennong Bencao Jing, described a variety of plant and fungal extracts used to maintain and improve the body equilibrium. Chinese and Indian herbalists suggested chamomile, vitex (chaste tree), sage leaf, panax ginseng, licorice, tribulus, motherwort, dandelion and hypericum perforatum (St John’s Wort) to relieve menopausal symptoms.
In Europe, however, by the 12th century, the understanding of menopause was thwarted by prejudice and superstition and, frankly, fear of women and the female mystery. Early education about menstruation was taught by monks and philosophers, as they were among the few people in the community who could read or write, or who had anything to read to begin with. You may not wish to know how monks described menstruation in The Aberdeen Bestiary, a text on the physiology of animals, birds and flora: ‘When they come into contact with menstrual blood, crops do not put forth shoots, wine turns sour, grasses die, trees lose their fruit, iron is corrupted by rust, copper blackens, if dogs eat it they become rabid.’ You can imagine what effect this reputable volume may have had on the local doctor.
Until the 18th century, menopause was seen as part of the ageing process. People’s lives were comparatively short, compared to today. Reaching and managing menopause and adjusting to a post-menopausal lifestyle were often not options. Over the next 200 years, however, more women lived through menopause. Medicine responded by viewing menopause as a disease, leading to even more erratic and unfounded diagnoses, bizarre treatments and dangerous surgery.
Then in 1801 there appeared the first known use of the term ‘hysteria’. The word is from the Greek hysterikos (from hystera, meaning womb), and derives from the Greek notion that hysteria was peculiar to women and caused by disturbances of the uterus. And right there is a whole century in which progress in understanding and treating menopause did not, in any sense, take place. Many Victorians were deeply suspicious of women’s reproductive health. They thought there was a link between the womb and the brain that predisposed women to insanity, especially during menopause. Menopausal women who displayed what was considered to be undue sexual excitement or interest were likely to be sent to an asylum, diagnosed with ‘climacteric insanity’.
Fortunately, other minds were on the case, and in 1816 ‘la Ménés- pausie’ was described by the French physician C.P.L. de Gardanne, who observed a connection between the cessation of menstrual periods and symptoms such as hot flushes. (Good on the French! Give them some female pink parts to contemplate and plenty of time to think about them and they will always come up with some- thing.) The word ‘menopause’ comes from the Greek root men (meaning month) and the word pausis (cessation); literally the term means the ‘end of monthly cycles’. C.P.L. de Gardanne then prescribed some high-end fashion shopping and a little duck pâté and red wine, perhaps even a small but chic apartment in the 14th arrondissement. No, he didn’t, but at least he sought to identify menopause as a medical and physiological condition particular to women, and not as evidence that menopausal women were crazy people who should be locked away and tormented.
However, de Gardanne’s approach did not lead to immediate enlightenment among others in his profession. In the 1840s, the English physician John Edward Tilt, returning from medical training in France, identified the ovaries as the cause of peri-menopausal ‘madness’ and promoted their removal as a ‘cure’. The death rate was high, and among those women who survived there was no relief of symptoms, and a decline in libido.
In 1899, menopause was still described under the heading ‘Climacteric Insanity’. The article invited physicians to treat it as a syndrome in need of attention. Women were often advised to ‘rest’ as a way of combating menopausal symptoms, better described perhaps as ‘Go away somewhere out of sight and rest’.
This often meant being sent to a madhouse where the experts had you addicted to opium, and then gave you withdrawal. That should calm you down, but do keep the windows locked.
Nineteenth-century women strong enough to self-medicate could stay at home and chug laudanum, which was opium and brandy. Mind you, they also thought the bustle was attractive and practical. These facts may not be coincidental. And in 1903, A Lecture in the Mental Diseases of the Climacteric, by English physician
George Savage, was published in the medical journal The Lancet. Savage concluded that even women who were not mentally ill were likely to offer ‘insane interpretations’ of their menopausal symptoms. (Incredibly, this ‘raging hormones’ myth, which describes menopausal women as so incapacitated by hormone fluctuations as to be incapable of rational thought and behaviour, and unable to hold any kind of responsible position, still persists.) Throughout the first half of the 20th century, thousands of women were hospitalised for a ‘disorder’ called ‘involutional melancholia’, a ‘mental disease’ that occurred during or just after menopause.
Once the link was made between menopause amenorrhea (absence of periods) and failure of ovarian function (the production of hormones), medical science started experimenting with hormones. At that time this medical research was not for ways to treat menopause symptoms but for methods of contraception.
In 1938, German chemists Hans Inhoffen and Walter Hohlweg developed ethinyl estradiol, the first orally active oestrogen – it still forms the oestrogen component of most oral contraceptives. They also produced the first synthetic progesterone preparation. In 1942, American chemist Russell Marker used Mexican wild yam roots to produce progesterone. (For more on oestrogen and progesterone, see What causes menopause on page 46.)
Despite this scientific progress, in 1948, Dr Josephine Barnes, a noted UK gynaecologist and the first woman president of the British Medical Association, sparked a furore after she spoke about menopause on the BBC radio program Woman’s Hour. A BBC controller wrote to the program’s then editor: ‘We do not wish to hear about hot flushes and diseases of the ovaries at two o’clock in the afternoon. The women in my office agree.’ The Woman’s Hour mailbag told a different story. Two o’clock in the afternoon was fine. ANY hour of the day was fine.
In 1960, the first birth control pill was approved for regular use in the USA. It was realised that the same hormones used for contraception could be used to treat menopause symptoms and research began into treatments that would be suitable for women in their menopause years. By the end of the decade hormone therapy was in wide use among menopausal women.
In 1978, the International Menopause Society was established. In 1979, ‘involutional melancholia’ was removed from the Diagnostic and Statistic Manual of Mental Disorders. In the 1980s, the Australasian Menopause Society was founded.
Then in 2002, a report of a large study by the Women’s Health Initiative (WHI) of women taking Hormone Replacement Therapy (HRT) was published in the Journal of the American Medical Association. Women were urged to reconsider their use of HRT because it increased the risk of breast cancer, stroke, thrombosis and heart attack. A dramatic drop in the use of HRT followed. In 2011–2012, reassessment of the WHI study, and recognition of its flaws, found there actually were health benefits to women who began taking HRT within the six years after menopause, including a lower risk of osteoporosis, bowel cancer and heart attack. (For more on HRT and this report, see HRT: The fear and the facts, on page 111.)
Today menopause is known, recognised and accepted as a normal development in women. For all that it can be challenging and uncomfortable, it can be managed, and the symptoms can be treated. Where there is prejudice, this is really a prejudice against ageing, and menopausal women have the right, and certainly the energy, to tell those with prejudices exactly where to stick them.
Menopause and wild Western women
Our lives may not be threatened by menopause but our quality of life can be diminished or altered in ways great and small, including our happiness and the happiness of our families, friends and colleagues. It is demeaning to women for anyone to dismiss the symptoms that many of us experience. If you have symptoms, go for it. Speak out. Let everyone know. You deserve a bit of attention, a bit of sympathy, a whole lot of understanding, and, most importantly, a bit of help. It has an impact on our lives and we can insist on treatment. Luckily we Western women are not going to shut up about it.
There are many websites and articles and yabbering snobs who like to claim that menopause is a ‘cultural’ condition and only Western women complain about menopause symptoms. (There are also many websites that rant against the inoculation of children, and yet others that promote the idea that a secret group of reptilian humanoids called the Babylonian Brotherhood controls humanity, and that many prominent figures are actually reptilian. They all deserve one another.)
This is untrue. The fact is that ever since the invention of women and men, and possibly ever since single-cell amoeba stopped splitting to reproduce and started specialising, all women everywhere around the world, at all times and in all cultures, including Egypt, Rome, China and Tasmania have experienced menopause symptoms and have been treated for these symptoms. They just didn’t know until very recently that they were symptoms of menopause.
The subtext of the menopause symptom detractors is, of course, that only Western women get menopause symptoms because we are whingeing, weak and over-indulged.
All women go through menopause; not all women get symptoms. It is not divided along racial lines although the type and strength of symptoms may be.
Let’s look at a few cultures in which the wackos claim women do not get menopausal. Apparently Indian women don’t complain of symptoms. Really? I wonder why not? Perhaps it’s because it wouldn’t do them any good if they did. People are dying and there is no access to pain control or palliative care and complaining about menopause, or anything else, is out of the question. Lives are numerous and life is a struggle and women’s lives in particular are often held cheap. For example, the Indian government in recent years introduced the Cervical Cancer Vaccine and then stopped it soon afterwards. Why? Because it was expensive and it was decided that women’s lives are frankly not worth the cost.
In parts of the Middle East, women with life-threatening gynaecological problems are often ignored. There are few gynaecological services. It is virtually impossible for a male to practise gynaecology in the Middle East with a woman who is not one of his wives, and therefore it falls to female gynaecologists, and there are very few of those.
It boggles the mind to think that there are patronising twerps who write for women’s health pages, and who can say, and I quote: ‘Sudanese women don’t seem to get symptoms.’
Sudanese girls are regularly given clitorectomies. They can be arrested and lashed for wearing trousers. Anyone who is impressed that these women keep quiet about menopause is probably impressed by the health benefits of sleeping on a dried mud floor.
We should also remember that if many women from developing countries do not complain about menopause symptoms it is because life expectancy is so low they do not make it to that stage of life.
Menopause symptoms may vary in their nature and intensity, but menopause is a natural stage for every female human and it does not distinguish between races, cultures or creeds. The difference is that in Western culture women are permitted to initiate conversation and have other people prepared to listen. We are also permitted to drive cars, wear swimming costumes, order for ourselves in restaurants, and write for women’s health pages.
And we should talk about it. We have a responsibility, just as we have a responsibility to argue for equality for women, and for rights for women. Including the right to talk about BEING women. As the Dalai Lama has said: ‘The world will be saved by Western women.’ He did not say this in order to be allowed to leave the room. Western women can change the world: we have the resources, we have the opportunity, and we have the responsibility. We should speak up.
Excerpted from You’re Still Hot To Me by Jean Kittson. Copyright © 2014 by Jean Kittson.
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