Dr Louann Brizendine is the best-selling author of The Female Brain and is here to talk to me about her latest book, The Upgrade: How the female brain gets stronger and better in midlife and beyond. The Upgrade amounts to a celebration of how women can step into their power and an entirely new—and radically positive—understanding of aging.
We talk about:
Why Louann wrote The Upgrade
How our brains get stronger and better as we age and especially after menopause
How menopause impacts our brains
What the post menopause (upgrade) brain changes enable us to do
How women can sometimes sabotage the upgrade
How life gets better for women with each passing decade
Alexandra Pope and Sjanie Hugh Wurlitzer are the founders of Red School and the authors of Wild Power: Discover the Magic of Your Menstrual Cycle and Awaken the Feminine Path to Power and Wise Power: Discover the Liberating Power of Menopause to Awaken Authority, Purpose and Belonging.
This is such an empowering conversation about the innate power of women. I hope you enjoy it as much as I did!
We talk about:
What their book Wild Power is all about
The importance of Menstrual Cycle Awareness (MCA)
How menopause prompted Alexandra to change course and focus on menstruality
How Alexandra and Sjanie met and how Red School came about
How Red School is preparing for Sjanie’s menopause
How being in tune with our menstrual cycle can make menopause less of a trial than it’s usually portrayed as being
The Red School view of menopause
What women can do to prepare for a good menopause transition
The awakening that comes with menopause
Changing the narrative around menopause and making self-care non-negotiable
The changes that come with menopause
What Alexandra and Sjanie hope to achieve with their new book
Books: Wise Power: Discover the Liberating Power of Menopause to Awaken Authority, Purpose and Belonging and Wild Power: Discover the Magic of Your Menstrual Cycle and Awaken the Feminine Path to Power and
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I want to share some thoughts on menopause, HRT (hormone replacement therapy) and a new narrative in the UK that most if not all women should be on HRT for menopause issues and long term health, because of HRT’s potential preventative impact on heart disease, osteoporosis and Alzheimer’s.
It’s evident that systemic and localized (vaginal) HRT can be enormously helpful for many women in managing their menopause, but I don’t believe, unless absolutely necessary, most women need to be on systemic HRT long term.
Davina McCall presented a ground-breaking documentary about menopause. In it she talked of having two episodes of shame around menopause, the first when she was initially diagnosed and the second when she took HRT. It’s tragic that she felt shame over either of these and I commend the program for exposing this as something which simply shouldn’t happen anymore. There is nothing shameful about menopause nor taking HRT to help with it!
I too experienced these kinds of shame. After failing to conceive a long hoped for second child, I was told I had gone through early menopause at 41. It was crushing. I gave in to taking HRT at 44, because I was found to have borderline osteopenia in my hip. I felt I was succumbing to a narrative of downhill to the end.
At the time, menopause specialist, Dr Nick Panay, and his early menopause team were looking after me and had been advising me to go on HRT until average menopause age of 51, to give my bones and heart the extra 10 years of estrogen protection they’d missed out on because of early menopause. It took me three years to accept their advice.
I chose to come off systemic HRT as advised and at 53, another bone density scan showed no worsening in my bones. Now I occasionally take localized vaginal estrogen to help with vaginal dryness. I use a cream as vaginal pessaries come with individual plastic dispensers which I consider unnecessary plastic waste.
Women are rightly indignant they’re not getting the care they need from our National Health Service (NHS). The documentary was a powerful reminder of the sad state of play and lack of awareness both within the medical profession and for women themselves.
One thing about the documentary I do struggle with though, is that it failed to mention the obvious, that menopause is a natural and transformative life stage. To not highlight this reality underpins the emerging narrative that menopause is a bad thing and that HRT is the answer.
Peddling HRT as the ‘must have’ for all women in menopause, such are its life-saving properties, protecting against heart disease, osteoporosis and Alzheimer’s, AND that most women should be on it well beyond menopause, smacks of snake oil sales with bells on. Women are now even asking if they need to be on HRT to protect themselves from dementia!
This narrative is taken up by some leading menopause professionals who, to my mind seem to be as damaging as the doctors who prescribe anti-depressants for menopausal women.
The narrative needs balance. Diet and life changes are probably more important for menopause issues and long-term health than defaulting to synthetic drugs. Sadly, the documentary was void of any discussion regarding the impact of diet or lifestyle on hormonal balance and only passing comment on lifestyle in terms of fitness.
One-sided narratives from the evangelical can have darker sides. ‘Champions’ and ‘goddesses’ deserve scrutiny and the simplest and probably the clearest form of scrutiny is the financial trail. HRT and hormonal insecurity is lucrative business. We are in a culture of wanting our cake and eating it. Excess without consequence. We will pay anything for a panacea.
How many of us swallowed the lies of the cosmetic industry and have felt reduced by body image, hair type, greying hair, wrinkles, spots, skin colour or felt guilt for eating the wrong things, drinking too much or being the weaker, fairer softer sex?
Billions have been made by creating insecurities and ‘needs’, then exploiting them. We have been crushed, silenced, side-lined and lied to. Sadly, we do have a tendency to be shaped by the nonsense we are told. I was.
From puberty women live on a hormonal and societal roller coaster. By our 50s many of us have had and raised children, tried to make safe homes, we’ve been undervalued, objectified, underpaid. We’ve juggled, loved, strived and known fear. Menopause is a gift that takes us off the rollercoaster. Perhaps HRT keeps us its slave?
Menopause is a transition as major as puberty. It is not to be feared. It is not a permanent state. It is a gateway that takes us into deep calm waters where we can thrive in new ways.
Why am I passionate about diet and lifestyle changes? After my early menopause, I went to see a nutritional therapist who put me on a special diet. I was to have no alcohol, sugar, caffeine, dairy, processed foods, eat as organic as possible and eat a healthy source of protein every three hours to make sure my blood sugar levels were balanced.
Within five weeks of changing the way I ate and what I ate, I had a menstrual bleed, and a further hormone test showed I was back to being pre-menopausal. This only lasted another nine months, but it was a wake-up call that showed me the impact of diet.
I did not conceive and the effects didn’t last, I was just too late. Eventually I slipped back to a less healthy diet, although I’m still caffeine free, I eat better and exercise more. I don’t live an abstemious life! It was similar dietary and lifestyle changes that allowed me to transition off systemic HRT at 51 with no adverse side effects. I’m now post-menopausal and celebrating the liberation it brings.
Hippocrates (460-370 BCE) is perhaps a thorn in the flesh for ‘modern medicine’ and the HRT industry, as his wisdom regarding health tends to mindfulness, which is free, as opposed to intervention, which is costly and profitable. ”If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” “Let food be your medicine and medicine be your food.”
Food for thought?
On reflection, my resistance to HRT was bound to resisting the negative sexist and ageist narratives about women and ageing. Like most women, I was never taught about health, perimenopause, menopause and being post menopause. As a consequence, my work has now become sharing what I’m learning, being alongside other women experiencing menopause and living life beyond, and to help challenge the narratives that enslave us.
With HRT it is women with money who pay to go private and keep paying, if that is the only way they can access HRT. The more women can be persuaded HRT is the golden ticket, the more money can be made.
HRT clearly has a crucial role in menopause care and should be more readily accessible in the UK, but why are we now told most women would benefit from taking it to keep us healthy into older age? We can do other things to keep ourselves healthy. What about women in countries without money for basic medical care let alone hormone therapy? Will women worldwide be lead to believe HRT is crucial for their long term health? That will lead to a lot of insecurity but also new untapped markets…
“Let me underline that the primary indication for MHT (HRT) remains relief of hot flashes, night sweats, and vaginal dryness. MHT is not recommended for prevention of heart disease, Alzheimer’s, cognitive decline, or any other conditions.”
Dr Mosconi goes on to say:
“I must reiterate that prescription medicines come with many potentially dangerous side effects of their own, and the last thing any of us needs is to accidentally exchange one negative side effect for another. Another reason to look beyond estrogen replacement is the fact that estrogen is not always a friendly and helpful substance—especially when it’s not your own. It doesn’t cost much to start with the safer strategies that focus on ameliorating hormonal levels by means of diet, exercise, and other natural therapies. These methods are known to boost hormonal production in the brain as well as in the body, while improving memory, sharpening our minds, and supporting resilience, all the while reducing risk of dementia for all women, no matter what stage of the game they’re at.”
After doing some research, I found evidence that HRT may help prevent and treat osteoporosis, for example, but even that research says:
“Therefore, in postmenopausal women at risk of fracture and younger than 60 years, or within 10 years of menopause, HRT can be considered as one of the first-line therapies for the prevention and treatment of osteoporosis-related fractures. Conversely, the initiation of standard HRT after the age of 60 years for the exclusive reason for fracture prevention is not recommended since the potential risk of long-term complications, namely breast cancer, can outweigh the benefits . Thus, the extension of HRT after the age of 60 years must take into account potential long-term benefits and risks of the specific dose and route of administration, compared to other proven non-hormonal therapies .”
We now know the breast cancer risk is much less than previously reported and current forms of HRT are safer than early versions, but are still not without risk. Some practitioners say HRT breast cancer risk is no more than drinking alcohol or being overweight. But what if you’re on HRT, drinking too much and overweight? Your risk load could get quite high.
Some say women need HRT now because we didn’t live long past menopause in the past. In parts of the world, some women have lived past menopause for hundreds of years. In 1680, life expectancy for a woman at age 15 (having survived childhood) in England and Wales was 56.6 years, rising to 64.6 years by 1780.
Women in the Blue Zones, where people live the longest, don’t rely on HRT for their long healthspan. I believe it pays to be wary of big bold claims, stay curious and continue to ask questions. We are all guinea pigs when it comes to long term use of HRT. No one knows.
I’m increasingly skeptical about studies that make big claims about drugs and menopause. I want to know who conducted the research, who paid for it, was it published and peer-reviewed, and even whether it actually happened.
My recent research found a 2016 survey attributed to British broadcasting entity ITV, who claimed to have worked with women’s research charity Wellbeing of Women. The latter told me that survey never took place. There’s an article on the ITV website claiming that one in four women considered leaving work because of menopause symptoms, based on a non-existent survey.
That statistic has become fact and even been quoted by a member of the UK parliament. Why is that false fact still on the ITV website? Probably because it helped get viewers to their program then and helps bring advertising revenue now. They don’t care about setting the record straight. I’ve asked for this to be looked at but no response. I’ve asked to see the source of the statistics in the latest Channel 4 documentary too, but no one has responded on that yet either.
In her book, The New Hot, Meg Matthews includes the menopause experience of Buck Angel, a transgender man. He talks about how taking testosterone for 10 years atrophied his reproductive system…
“…causing my uterus to fuse with my cervix, creating an infection in my uterus. That was the cramping I had been experiencing all these years… After three months on intensive antibiotics to get rid of the infection, I then had a full laparoscopic vaginal hysterectomy… All of this could have been prevented if any one of my endocrinologist would have given me an estrogen supplement… How can doctors be giving a very powerful hormone like testosterone without understanding the need to balance this out… I almost died because of the lack of medical knowledge, yet the doctors give testosterone out with little concern about the long-term effects.”
I’m not suggesting that long-term use of systemic HRT for women could cause similar issues. Of course not. I am suggesting there’s not enough knowledge about the long term effects of any hormone therapy, for practitioners to be so confident telling women it’s okay to be on it long term or even forever. We won’t know whether that’s true, until I probably turn at least 75, in another 20 years.
The narrative that most, if not all women, will benefit from being on HRT long term, also presupposes that life with our pre-menopause hormonal profile is universally better than being off the estrogen rollercoaster as an older woman. I don’t want older women to be split into those who believe good health into older age can best be achieved if we have the same hormonal profile we had pre menopause, and those who don’t.
Some people believe we should be able to replace the hormones we’ve lost through menopause. But that suggests menopause is a disease that needs to be fixed (some want it rebranded as Female Hormone Deficiency) not embraced for the powerful changes it naturally brings.
This harks back to the misogynist book Feminine Forever written in 1966, which affirmed a narrative about women being subpar post menopause and that we need to be on estrogen long term ‘to stay agreeable and attractive for our husbands’. We’re not less anything post menopause and can be healthy without synthetic hormones. I don’t want older women (let alone younger ones) to believe they are in any way less because of menopause, or in danger healthwise without HRT.
There are abundant natural sources of plant hormones, amongst many other things, that we can add to our healthy diets to help achieve hormonal balance and long-term health. These work for many women and are often important traditional components of the diets of women in places like Japan and China, where menopause often appears to be less of an issue than it is for Western women.
And, she whispered… are we not just a little entitled and privileged demanding a drug long term whose effect can often be replicated for a large proportion of women by living a healthier lifestyle? When NHS resources are at their most stretched and we are already so lucky to have free healthcare in the UK.
Did you want to keep on with the 5 cups of coffee a day to keep you going, lots of sugary food, burning the candle at 6 ends, smoking, drinking too much booze to wind you down, using products laden with 100s of potentially hormone-disrupting ingredients, sitting down all day, not sleeping well because of the sugar, caffeine and booze, and not dealing with your stress, but take HRT to stop those your hormones screaming for attention?
I see many midlife women doing that and wondering why their body is rebelling. We’d rather demand a fix-all, than get curious about other ways to feel better, longer.
I’m grateful to them for raising awareness, but I’d like a more balance, more discussion about other options and less reliance on HRT to mask symptoms, rather than sorting out underlying issues. I don’t want to terrify women coming up behind so that an awful menopause becomes a self-fulfilling prophecy. Be prepared not scared is my motto.
I think of menopause symptoms as the body’s early warning system, the canary in the coalmine, telling us we need to make changes if we want to live a long healthy life. We can take HRT and it may make us feel better. We may also miss the chance to make the changes our bodies are telling us to make, if we’d just start listening.
What is different about us or the way we live to make our menopause experience different to elsewhere or other women? To what extent does our society’s view of older women impact how we experience midlife and menopause? How is life different now to in the past? We need to talk about menopause more. And much earlier too.
The medical profession is woefully under-resourced for helping menopausal women. We need to increase medical and public education so doctors recognize perimenopause and women aren’t fobbed off with anti-depressants, or fear they have Alzheimer’s when it’s hormonal brain fog. Doctors in the UK need to understand the latest NICE guidelines for prescribing HRT and not withhold it unnecessarily from those in need.
I’d also like doctors to know about the role of diet, lifestyle, environmental toxins and stress when it comes to managing menopause. I want an holistic approach. I’d like women to see menopause as a chance to adopt a healthier lifestyle and embrace the different hormonal profile we’re supposed to have post menopause. Then we will find the true healing power and magic of menopause.
This post is in response to a request from the editor of Goldie Magazine on Twitter asking what the ‘menopause awareness community’ thought about informing everyone in the workplace about menopause symptoms. This question was inspired by a discussion thread on Mumsnet which started with someone posting that an awareness email had gone out to staff in her workplace about menopause, and had listed symptoms, including vaginal dryness and reduced sex drive.
A colleague had then apparently complained that mentioning vaginal dryness was inappropriate in a workplace email. The writer of the post disagreed saying that it’s a common symptom of menopause and therefore should be included. She went on to say that if one was raising awareness about prostate cancer, one would not leave out difficulty maintaining an erection from a list of symptoms.
I knew it would be difficult to explain my position in tweets but I tried to express I had mixed views on whether or not this was appropriate. Before I got into too much trouble with the community, I promised to write a longer piece, which this is, to explain my position.
I do have very mixed views on this. First some background on me. I’ve been talking and writing about menopause for the last four years, pretty much non-stop, since I set up my online magazine The Mutton Club. That was cited in the Huffington Post as being one of the top 10 websites where one could get help with menopause. I’m on podcasts talking about menopause and I’ve been on BBC Woman’s Hour talking about my experience of it. Women make a beeline for me at events to talk menopause.
I most certainly want to increase awareness, stop the taboo and change the narrative. But my menopause narrative is often very different to that of the majority. Perhaps it would be a good idea for me to start with my beliefs:
I do not believe menopause is a medical condition and that our first instinct should be to medicate for it.
I do not believe menopause is something that needs fixing. It may be challenging and women may need help to manage symptoms. But it’s a natural stage in every biological woman’s life, if we are lucky enough to live that long.
I believe menopause can be something very wonderful and that is a narrative I am keen to promote.
Menopause is not something to be fought against any more than puberty or pregnancy. We’ve been dealing with our wombs all our lives. Menopause is not the time to start fighting them. We would do better to embrace menopause!
There are lifestyle changes that can help the majority of women with their menopause experience and I want these to be given more airtime, rather than simply sticking Band-Aids on symptoms. I believe these changes should be tried first rather than automatically reaching for HRT when symptoms prove difficult. Education here is key and not enough is said about how we can help ourselves.
I think menopause symptoms are nature’s way of telling us how we live our lives may have to change if we want long term health. Of course it’s all about choice, but menopause gives us an opportunity to start listening more to our bodies and making positive changes.
Being post menopause is great for most women, myself included. When I asked in my private community on Facebook for reassuring words about life post menopause, the overwhelming themes were of liberation, calm and a renewed sense of energy and purpose (not to mention the second creative peak we apparently reach in our 50s).
I do not believe HRT is something women should be on forever nor that it’s good for a woman in her 80s to enjoy having ‘periods’ because she is still on HRT (a prominent private gynaecologist is the source of those ideas).
I believe the insidious combination of sexism and ageism also impacts women’s sense of well-being and ease at work. Stressful jobs and hormonal changes are not a happy combo. I think menopause gets a bad rap and it’s not always to blame.
So what’s my menopause story? I went through it early at 41. At the time it was devastating. I was trying for another child and it was only after a fertility test that I found out. I hadn’t noticed! I had no symptoms and I thought I was right as rain. The doctor who told me was equally flabbergasted to discover my hormone profile was that of a postmenopausal woman.
I spent a long time coming to terms with this and initially got a lot of help from the Daisy Network. Through them I came across Dr Marilyn Glenville, a nutritionist and Dr Nick Panay who specializes in early menopause. I had consultations with both. With Dr Glenville’s help, a change in diet and lifestyle and a special tincture, I got my periods back for 9 months but not long enough to deliver the desired-for baby.
I resisted medical advice to take HRT to protect my bones and heart, but eventually went for a consultation with Dr Panay. I still didn’t have any noticeable symptoms but was referred by his team for a bone density scan because I didn’t want to take HRT. It was only after the scan showed borderline osteopenia in my hip, that I decided to finally suck it up and take the HRT.
Knowing what I know now about how to protect and improve bone density, I don’t think I would do that again. But I took HRT probably for about six years. I made sure I took the body identical version, made from yams rather than pregnant mares urine (which is still prescribed today). I’m always keen to make sure women in the UK know this is available on prescription and there is no need to get so-called bio-identical hormones from a private practitioner. I was even offered testosterone by Dr Panay’s team if I had wanted it. But you do need to know what to ask for.
When I was 51, ‘normal’ menopause age, I came off HRT as that had always been my plan. I weaned myself off using a variety of other ways to minimize any negative impacts from doing this. I needn’t really have worried as there were none. But I believe it’s because I’d put in place all the alternatives I now know are effective, that the easy transition occurred.
You might imagine I would have a negative view of menopause. But I absolutely do not. I wouldn’t be doing what I do now without it. I have a lot to thank it for! But I now believe my stressful career for the previous 15 years was at least partly responsible for it coming early. We can’t have it all. There is always a price to pay. We would do well to listen better to our bodies and respond to what they need.
I’ve learnt that menopause is just another transition in a woman’s life. It’s puberty in reverse. I know many women have a difficult experience with it. But many women don’t. But as is often the case, the negative voices shout the loudest. And the media loves a negative headline as we know. (I don’t actually believe headlines that say 1 in 4 women have symptoms so bad they consider giving up work even if research suggests that. Was it for a hormonal day or a serious consideration? We’ll never know. When I asked that question in my Facebook community of 2000+ women, it was a small minority that said yes.) I went on Woman’s Hour because I wanted to wave the flag for a positive menopause experience despite my secondary infertility.
There are many questions we need to be asking about menopause and one of them is why is it other cultures don’t seem to suffer as badly as us? Why does research show that women in the UK have a worse experience of menopause than other countries/cultures? What is it about our way of life that makes that the case? I want to know!
So finally, back to the all staff awareness email that talked about vaginal dryness. Very well-meaning I’m sure.
I’ve been trying to imagine how I’d feel if I received such an email at work. Clearly I don’t know the exact wording, nor have any other background, but I worry that when something like this is taken out of context and there’s no opportunity to explain and bring more information to the discussion, it can potentially do more harm than good. It seems to me a very good idea to have an awareness raising seminar to which people are invited and these issues are discussed.
But I still have a problem with listing vaginal dryness as a menopause symptom in an all staff email. Why is it relevant? How will it affect our performance at work? For some women who have extreme vaginal atrophy, it may effect work. I’ve been reading My Menopausal Vagina and know this to be the case. But hopefully this is a very small minority of us.
I also don’t think the argument about including erectile dysfunction in a list of prostate cancer symptoms impacting what we include when talking about menopause, holds any water in this context either. It’s not possible to know a man is suffering from prostate cancer unless he shares that information with you. But all woman 50-55 (and much earlier in my case) will be either perimenopausal, or post menopause. It affects all of us. So there’s no hiding from anyone’s potentially misguided assumptions.
Unfortunately I also know enough about human nature to know, of all the things raised in this email, the ones that will jump out most are vaginal dryness and decreased sex drive. I’d be mortified to think 25 year old Paul in Accounts might be looking at me submitting my expenses and thinking about my dry vagina. Not to mention poor 30 year old Andrea in HR, who’s already feeling sensitive about turning 30, because of those commiseration birthday cards she received, and has just had it reinforced there’s not much to look forward to as an older woman.
These are some of the dangers of communicating things out of context. Each workplace is also different and a blanket approach will not work, no matter how well-intentioned. We want to raise awareness. We want women to feel able to raise menopause as an issue if they want to. But what we may end up doing, is increasing the endemic ageism in the workplace, adding in a nice dose of sexism, finding more reasons to question older women’s performance and getting an insidious and potentially humiliating combination.
So these are some of the reasons why I urge caution when raising awareness of menopause at work. The more we discuss menopause in the workplace, the more switched-on HR executives will want a menopause policy and awareness raising programs. This is a good thing, but it needs to be done sensitively and most certainly not as a box-ticking exercise, an issue raised by one of the Mumsnet commentators. In my view, sending out random emails without context is not being sensitive.
Including a list of symptoms and making it all sound dreadful is also not particularly helpful. Each woman’s menopause experience is different and many have little problem with their transition. I wince when I read sensationalist negative headlines about menopause and I will fight tooth and nail to stop younger women believing it is all doom and gloom ahead.
Deborah Garlick and her Menopause in the Workplace organisation is doing very good work in this area and she wrote recently about a new research paper published. Yes, women want awareness but they are also keen that menopause is not always seen in a negative light. They said managers should avoid drawing assumptions or generalizing, and never adopt a one size fits all approach. They want conversations to be kept strictly private. In fact, the research showed that it was seen as very important that employers do not draw any attention to a woman’s menopause or symptoms.
I believe exploring the underlying issues that may be making menopause difficult, is just as important as providing a work environment in which older women can function. Understanding and better ventilation are useful, but so also is awareness of the impact of changes in diet, exercise and mindset etc. For example, a BBC documentary found that CBT techniques could have a dramatic positive impact on both frequency and intensity of hot flushes.
Caffeine, sugar and alcohol are all known to exacerbate them. Natural phytoestrogens such as soy and flaxseed can help with hormonal balance. Exercise and meditation are beneficial probably for all of us. There are herbs like black cohosh and sage that can also help. These alternatives are equally worthy of awareness-raising but all too often, the focus is on just coping or taking HRT.
It’s also worth considering that a once manageable high stress, but now unfulfilling and ageist work environment, may also be affecting women’s general sense of well-being and even their performance. I’d like us to look more holistically at older women at work, evaluating all issues that affect us and why we may struggle. There is a lot more going on, not just the menopause.
Awareness-raising needs to include positive statements to enable us to re-frame our menopause experience and narrative, for ourselves and the women who follow on. Many women love finally being off the oestrogen rollercoaster and do great things both during and after menopause. It can be a catalyst for positive change for many of us, as it turned out for me, and a time to embrace all that being a woman involves, as we transition to the next exciting stage of life. Whatever we do to end the taboo, let’s do it with sensitivity, balance and discretion so we bring everyone along with us.
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