“Women have achieved so much in the last hundred years, juggling childcare, from boardrooms to the trading floor, we wanted to have it all! Indeed, we got it all, and we championed but what impact has this had on our health and the transitioning process of menopause” Monica Lascar (https://www.mariongluckclinic.com/blog/the-truth-about-menopause-our-hormones-dance-together.html).
Menopause- the cessation of our menstrual periods, is defined as a natural transition (much like puberty) and as such not recognised as a ‘medical condition’ and therefore un-supported for any medical claims by any of the insurance companies. A tenth of women are leaving workplace when they reach menopause and 25% find it hard to cope (refs), many navigating the change alone, ashamed and unsure how to find the support they need.
Our hormones decline 100-fold in the space of a decade, whilst men’s hormones gently slope down at 2% per year.
Women’s worst hormone fluctuations happen in perimenopause (5-10 years before the periods stop) and fluctuate much more than the natural fluctuations of the regular menstrual cycle. These peaks and throughs affect our brain and can result in significant and often frightening changes of mood, sleep (40-60%), migraine headaches (10-30%) memory as well as the better-known vasomotor symptoms (hot flushes).
Menopause has been a lot in the news recently and sustained campaigns have achieved a great deal of awareness driving towards menopause policies in the workplace and this year menopause has been added to the school curriculum.
Moreover, human-like hormones (bio-identical hormones) are now widely available and replacing them can do much good for relieving our symptoms (MGC refs), controlling hot flushes, maintaining bone density and cardio-vascular health as well as improving mood and sleep.
THE ELEPHANT IN THE ROOM- WHY ARE WE SUFFERING SO MUCH?
Are we simply more vocal about our needs as women or is the struggle more real now than it has been even a generation ago?
In my opinion, we are living through a mis-match between our environment and how we have evolved and thrived as a species, amplified perhaps by the specific social context of women gaining access to equal rights in the workplace.
We live more sedentary lives, with many hours in front of a screen, in more polluted cities and eating more processed fast-food.
Time has become a most precious commodity, and whilst we have taken on leadership roles, the mental and emotional load of bringing up children or running our households has often not been shared equally.
CORTISOL- THE STRESS HORMONE
Cortisol, the stress hormone, is released in perceived states of danger- ‘fight and flight states. Our biology is well equipped to cope with stressful events as long as they are short-lived, and we can return to a state of feeling safe- able to connect with a state calmness and replenish our resources in between threats. However, if the perceived ‘threat’ is maintained long term, this can lead to sustained cortisol release, which has an impact not just on our hormones but also on our immune function and can be a contributor to many medical conditions (cardiovascular risk).
In my experience, the most damaging type of stress to our health and biology is the state of hypervigilance, potentially leading to a state of feeling wired and tired. This is often triggered by long term feelings of stuck-ness, sometimes a consequence of being in an emotionally unsupportive relationship, not feeling seen/heard or having to be in a perpetual state of high alert, treading on eggshells at work or caring for a sick parent/child.
This leads to short and frequent bursts of cortisol and adrenaline, without enough of a return to a state of calmness and safety.
So, if you are feeling tired, can’t sleep and are gaining weight and you wonder if it is “stress or your hormones” – the answer is probably both! Individual circumstances make for a nuanced contribution of both sex hormones and stress and best results often occur by supporting and replenishing all hormones and addressing cortisol by cultivating states of calmness, replenishment and connection, prioritising sleep and eating a low sugar, whole food diet.
COULD IT BE THAT OUR STRUGGLE FOR EQUALITY HAS AFFECTED OUR TRANSITION IN MENOPAUSE?
In my opinion this is a resounding yes.
Cortisol and sex hormones (oestrogen, progesterone, testosterone and many intermediary hormones) are part of the same ‘hormone circle’, known as the sex steroid pathway and our biology has evolved to prioritise survival and therefore cortisol production over the production of sex hormones. Stress disrupts all hormones.
HAVE WE BEEN IN CHRONIC STATES OF HYPERVIGILANCE OVER THE PAST DECADES AND WHAT HAS BEEN FUELLING THEM?
A recent newspaper headline states “Banking giant lets in more women“ (https://www.bbc.co.uk/news/business-54876529”)- which is an interesting and perhaps telling use of language. As we have “been allowed” access to more workplaces – how often have we felt tolerated rather than fully accepted or celebrated? And how much have we tried too hard to fit in well in a system that had been largely designed for men? Perhaps we had to work twice as hard to feel seen and heard and to gain a place at the proverbial table, keen to please and appease everyone out of fear to lose it all. Subtle but sustained hypervigilance became the norm.
Our leadership style had to adapt to traditional male-defined values of power, sustained performance and productivity, leaving little room for self-care and the inherent hormone fluctuations that define our biology.
Meanwhile, unbeknown to us, our biology has silently and pervasively claimed it’s dues for this sustained drive towards relentless productivity, over-looking our inherent hormonal fluctuations and need for self-care. The 100-fold decline in hormones in the decade of peri/ menopause may be a last straw as we are “going through this and …living like it’s not happening” as Michelle Obama remarked in a recent interview.
I would not want the recent menopause campaigns to cause women to approach menopause with fear and dread.
Hormone therapies using human like hormones seem to be safer than previous synthetic hormones and access to information and high-quality can be further prioritised.
But above all, pausing to understand our specific biological differences, the role of cortisol and stress and the unique social context of the past decades may pave the way for a more mindful menopause transition for future generations.
Perhaps it is now time for us as women to look at new ways of to really celebrate womanhood by emphasising our nuanced contributions, often bringing together empathy, the capacity for nurturing and growing teams or being able to see the whole picture in a more intuitive way. It is no co-incidence that women led countries have been shown to have managed the COVID-19 pandemic more successfully.
Like every crisis, may our menopause crisis be the gateway to a higher level of understanding, both in acknowledging and supporting our female biology, but also cultivating and celebrating a next generation of women finding a new and more feminine power, “both empathetic and strong” (as Jacinda Ardem has already shown).
The world may just need it….
