I’m full of admiration for the women who’ve shared their experience of menopause, so others can get the support they need. We’ve seen a dramatic change in the UK, culminating in the menopause revolution campaign that took menopause to the heart of government and resulted in big changes which will benefit all women. It’s good that we’re talking more about menopause, that it’s being discussed in the workplace and organisations are embracing menopause policies. I’m delighted menopause is now included in the school curriculum so women’s sex education no longer ends with childbirth. It would be good to see more in the med school curriculum but there is gaining momentum thanks to those campaigning for change. It’s important that women who need HRT have access to it and are not penalised because of where they live or whether they can afford a regular prescription.
There are good things happening. But I question the overwhelmingly negative narratives about menopause, that seem to be getting worse not better, as well as the over-selling of HRT as the panacea to ‘fix’ it. Respected menopause specialists and campaigners are describing menopause as a hormone deficiency and promoting long-term use of HRT as a preventative measure against age-related disease. Women are becoming scared that if they don’t take HRT long-term, they’ll be at risk of Alzheimer’s, osteoporosis, heart disease and even suicide.
This narrative harks back to the book Feminine Forever published in 1966 which described menopause as a deficiency that could be cured with hormone therapy. In his best-selling book, Robert A Wilson maintained that menopause was a serious, painful, and crippling estrogen-deficiency disease that should be treated with estrogen replacement therapy to prevent the otherwise inevitable “living decay”. He promoted the use of a drug that healthy women would take every day for the rest of their lives, so they could remain feminine forever.
Wilson wrote, “All postmenopausal women are castrates.” With HRT, “a woman’s breasts and genital organs will not shrivel. She will be much more pleasant to live with and will not become dull and unattractive.” It was later found that the book and promotional tours were financed by the drug companies producing HRT. Have we really not moved on from this ageist, misogynistic narrative about menopause and the place in society of post-menopausal women? Are women to be disempowered about how they manage their own health in later life? Is this the menopause revolution?
To add to the gloom, Carolyn Harris MP and Penny Lancaster wrote recently about a correlation they saw between menopause, depression and suicide. They quoted a 16-fold increase in depression in women aged 45-52 and a “staggering” 7-fold increase in suicide in women aged 40-50. They said that around 20% of perimenopausal and menopausal women present to their GP with symptoms of depression. Where did they see this headline grabbing data? Is it from peer-reviewed research? What country or region does it relate to and over what time period? Or rather, does the use of unqualified data to make a point that needs making, also undermine the very point being raised?
If we assume all women 45-52 (or 55 or later) are either perimenopausal or menopausal, does that mean that 20% of all women in that (undefined) age group are presenting as depressed to their GP? How many women is that? Maybe what was meant is that of the women who go to their doctor with problems when they are perimenopausal or menopausal, 20% of those women present with symptoms of depression. That’s a different number but equally ambiguous.
Where does this unqualified data come from? I tried to find out how many women there are aged 45-52 in the UK, for example, to see how many 20% might represent. There was a census done in 2021 in England and Wales, but the results have not been published. So I can’t even get the total number of women in this potential age range, let alone how many go to the doctor. Is there some public data on what women discuss with their GPs that I’m unaware of? The information is powerful, but it helps to know where it comes from, as well as its context.
I’ve seen similar data about suicide and menopause presented as fact in the past, again without referencing a source. The Office for National Statistics (ONS), reports that women aged 50-54 exhibited the highest rate of suicide in England and Wales (specifically in 2019), but the actual rate was only 7.4 women per 100,000 population. This rate compares with 6.9 women per 100,000 in the 45-49 age range, 6.6 aged 40-44, and 6.1 aged 35-39. From age 55, the suicide rate for women decreases until age 80-84.
Of course, any rate of suicide is awful. But these are tiny increases between age ranges, and the rate of male suicide is far greater than that of women in every age group. The ONS also noted a significant increase in suicide rates in males aged 10-24, 25-44 and 45-64, in England and Wales, since 2017. All data needs context. We should most certainly be asking questions about suicide rate change. But we need the full picture.
Suicide rates are higher for women around menopause, but can we conclude menopause is the cause? Other factors that peak at that time are redundancies, divorce and the death of a parent. Women may also be dealing with children leaving home, looking after elderly parents, and feeling the weight of the insidious combination of ageism and sexism that exists in our society and in the workplace especially. Not to mention the negativity and fear around menopause already mentioned. Big birthdays and their ‘over the hill’ cards can also be painful as we grapple with status anxiety and what we have achieved in life so far. The U-Curve of Happiness states that 47 is the unhappiest age for men and women. We’re also being told that over a million women could leave work because of menopause but again, is menopause the main culprit? How reliable is that research? Menopause may be hard for some, but no data I know of states it is the predominant cause of this increase in suicide rates for women.
When researching my book, I discovered that how we feel about ageing affects how we age. If we feel good about ageing, we are more likely to look after ourselves and therefore age in a more healthful way. Perhaps the way women feel about menopause and getting older has a direct impact on their experience of the transition too. I’m not saying it’s mind over matter. Far from it. However, a positive attitude towards menopause enables curiosity about what is going on when we start to experience changes. Menopause may not even be to blame for what’s going on. It’s not an illness to fix, it’s a transition, much like puberty in reverse, from the monthly hormonal roller coaster to still, deep waters. Menopause expert, Dr Jen Gunter recently said on Twitter, “menopause is no more a state of estrogen deficiency than being a child is.”
I believe menopause issues are the body’s early warning system, the canary in the mine, warning us that all may not be right with the way we live our lives. How did I come to this conclusion? When I was 41 I was given a diagnosis of early menopause. I was trying for a second child and had a hormone test. I was told I had the hormonal profile of a postmenopausal woman and no chance of having a child. I did some research, changed my diet and how I live, and within three months of getting that diagnosis, I was menstruating again and had a pre-menopausal hormonal profile back for a while. I didn’t get the baby, but I did learn that changing my diet and how I lived, had a direct impact on my hormonal balance and general health. I learnt to be proactive not reactive when it came to my menopause transition.
The diagnosis was made all the worse because of my emotional response to it. I walked out of the doctor’s office feeling like a dried up old prune. No one had told me that my life was over, but I felt like it. On reflection I had succumbed, hook, line and sinker, to the negative narratives about menopause and aging that are fed to women all our lives and relentlessly promoted by the marketing assault of the global ‘beauty’ industry: that youth and looking young are best, that we lose our beauty and value as we age, that we need to cover up signs of ageing, and that midlife and menopause mark the end of meaningful life. We can also add ‘menopause as hormone deficiency’ to that long list of negative narratives. It was only because I discovered and created more positive narratives and different ways of living that I managed to bring myself out of my midlife depression. If I were going through that now, I could also be feeling terrified of what lay ahead as a hormonally deficient woman.
I took HRT for seven years because of early menopause, but weaned myself off at the average menopause age of 51, as I was advised to do, if I felt OK. I have managed any issues since with diet and lifestyle changes. I want women to have the whole picture about menopause. Especially now, when menopause is again being positioned as a deficiency, to fix with HRT, as opposed to a natural and freeing stage of life where HRT may help. Some women are currently also finding it difficult to get hold of HRT. I want women to know they can make changes that will help with or without it. These include reducing intake of sugar, alcohol and caffeine, eating good food regularly to maintain blood sugar levels, reducing toxins in food and personal products, reducing stress or finding better ways to manage it, increasing intake of natural phytoestrogens that can be found in soy, flax and other seeds, for example, increasing exercise and losing weight if, hand on heart, you know you’re carrying a bit too much.
There’s no doubt HRT can help many women, and some need it, but there are also many other more natural ways to help women through the menopause transition. Some menopause practitioners suggest we need hormone therapy now because we didn’t live long enough to suffer in the past and we’re in more danger of age-related disease as a result. This isn’t based in fact either. The loss of menstruation with age is noted in both ancient Chinese and Greek medical writings. In 1680, life expectancy for a woman at age 15 (in other words, having survived childhood) in England and Wales was 56.6 years, rising to 64.6 years by 1780. Clearly, life expectancy differed depending on location, relative wealth, health, race, and so on, but at least in the British Isles, many women were living longer a lot earlier than some commentators suggest. If age-related disease is increasing, I suspect modern life is to blame.
When I read of women again being advised to take HRT forever for long-term health, I can’t help thinking that Wilson’s book has had a lingering impact on how we as a society and individually view postmenopausal women. No one can claim that long-term use of HRT is completely safe, at least not for another 20 years. The HRT manufacturers must be delighted at the prospect of every woman taking their drug for life. As with global sales of anti-aging creams and hair dye, just imagine how much money that would involve! I always say, follow the money.
A true menopause revolution will happen when menopause moves from being a taboo subject brought to awareness through fear tactics, to being seen in its rightful place as a powerful transition in a woman’s life. When we embrace it as heralding a new and magnificent next chapter, rather than labelling it as a ‘hormone deficiency’ that will blight us to the grave. When we recognise that we don’t need to be reactive to menopause, but can take a proactive and empowered response to our experience of it. When we stop blaming lack of estrogen for every midlife and age-related issue, and instead scrutinize modern life and endemic gendered ageism. When women are not scared into believing they must have HRT to prevent them getting heart disease, osteoporosis, Alzheimer’s, or even suicidal. Maybe it’s a counter-revolution we need! Let’s empower women to feel prepared not scared.