Bijgewerkt: 7 mrt 2019
I finally got around to watching the BBC's The Truth About Menopause. As a practitioner who treats many women experiencing the menopause, and as one of those women myself, I was interested in what this program had to say. I'm fortunate to have vocational experience of both allopathic and holistic approaches, and the methods and merits of both, so I was interested in its content from these perspectives too. Lifelong learning is essential for all of us as knowledge gives us the opportunity to make informed decisions and provides us with the power to have autonomy over our own lives. So, as I settled down to watch the show, with a cuppa in one hand and a notebook and pen in the other, I was open minded about learning something new. While I was reminded of some of the other programs I had seen in the BBC's The Truth Of series and my feeling on these, I admit that I was a little skeptical that it would actually provide me with much insight. I was wrong.
The show's presenter, columnist Mariella Frostrup, sets out to raise awareness of the menopause and getting us all talking more about it, with the aim of reducing its societal taboo. Frostrup has been taking HRT (Hormone Replacement Therapy) for 5 years and early in the program and we saw Frostrup looking over news articles outlining clinical studies which showed that women who take HRT were at a 26% higher risk of developing breast cancer than those who didn't. HRT has been the subject of much discussion and controversy for many years and it is because of this that it can often be difficult for women to receive accurate information on both its short and long term effects. Frostrup describes these statistics, and says that HRT may be 'dicing with death for the sake of a hot flush'. Within the first few minutes, we are presented with a bombastic and reductive sentence, reminiscent of a bad tabloid headline, which somehow manages to combine inflating an already concerning statistic, with reducing the menopause and its challenges to just one symptom. It's almost as if Frostrup has no real experiential concept of menopause.
The conclusion was drawn, after consulting with other medical professionals, that alcohol poses a greater cancer risk than HRT for women. While encouraging an increased awareness of our alcohol consumption is positive, side by side comparisons of the risks of both HRT and alcohol are not necessarily helpful, as it still doesn't address the question of why women on HRT are at greater risk of breast cancer and what kind of timescales on HRT increase the risks.
What Price Health?
We were introduced to Frostrup's own private Gynecologist, Sara Matthews, who Frostrup describes in one of her Daily Mail columns as 'a cross between Jessica Rabbit and a model from a Nineties Robert Palmer video. She wore a black dress that looked like it had been poured over her curves and a pair of killer heels. With her mane of fabulous wavy hair, crimson lipstick and soft Northern Irish accent, I wanted her to sing me lullabies.' We can be forgiven for thinking Frostrup's toe curling description of her doctor was actually written by a bad male author, one who has no idea of how to write female characters outwith the realms of their own fantasies. But, putting this to one side, the important piece of information that we are told in the show is that Matthews is an enthusiastic advocate of HRT, saying that she herself takes HRT, stating 'I'll be on it until I die'. This seemingly flippant, throwaway comment is actually quite telling and I'll explain why a little later.
We learn that Frostrup receives regular bone density scans along with annual breast checks and mammograms at a private clinic in London, and attends regular appointments with Matthews that often includes blood tests and hormone profiles. What the programme is failing to tell us is that with Matthews private consultations at £395 an hour and Frostrup's ongoing medication, scan and test costs, the example that has been given is of a supportive team of private medical professionals that is outwith the realms of accessibility for the majority of women and is not reflective of the average women's medical support.
So, why does this matter? Well, it reflects social and economical disparity and this really does matter in the scheme of health (and lots of other things) because not everyone is able to access the same level of care as Frostrup and therefore we are being given a false impression of the kind of support that is available to assess our health and ensure our bodies are showing no adverse effects of being on HRT. Let me give you an example.
One of my clients, Yolanda*, is a woman nearing 70 years old and she had been taking HRT for over 15 years. After experiencing menopausal symptoms in her late 40s, she was prescribed HRT by her GP with very little information available as to its long term effects. During this time, she did not receive requests to attend regular bone density scans or mammograms, neither did she receive recommendations to attend regular check ups for blood tests with her GP. Her HRT prescriptions were repeated without question because when Yolanda felt better, the role of the medical professionals appeared to be fulfilled, providing a prescription that successfully took her symptoms away. This is by no means an indication of any failings, nor indeed criticism, of the NHS which truly is a precious thing indeed. What I am outlining here is that the reality of an average woman's experience is to be on HRT for many years without any of the annual medical scans and regular tests that Frostrup is afforded to ensure there are no anomalies in breast tissue, reduction in bone density or any adverse effects which may be highlighted by regular blood tests. Yolanda's experience, not Frostrup's, is more akin to the reality for the majority of women.
Delaying The Inevitable?
For many years, Yolanda felt good - menopausal symptoms had all but disappeared - but she felt that perhaps it might not be best for her health in the long term when she started to read news articles about studies on possible adverse effects. She gradually stopped taking HRT and was overwhelmed with what followed, which was an unexpected return of her menopausal symptoms. Yolanda was going through the menopause in her early to mid 60s. What the program fails to tell us is that, in reality, HRT provides the body with large doses of hormones that trick the body into thinking that the menopause is not happening. However, our own natural hormone levels are still falling throughout menopause and essentially HRT is masking this natural process. When HRT stops, the menopause hasn't disappeared - we haven't rode out the menopause with HRT and got through the other side. Our natural hormone levels have been continuing to drop during the times of taking replacement hormones and without HRT we still have the lower levels of natural hormones. So you could say that HRT only halts menopause, delaying it for a later date when we stop HRT. On stopping HRT, this is when many women find symptoms returning.
For Yolanda, she felt that her symptoms were much worse after stopping HRT than they were when she began her menopause in her late 40s and she didn't feel as able or as resilient to deal with them in her 60s. I feel this is why Matthews had said that she intends to take HRT for the rest of her life, because there is a professional awareness of a high chance that stopping HRT will bring the return of menopausal symptoms. I feel that omitting this in the program was denying women important information, that women were being misinformed, affecting our ability to make informed choices for our health, and this is essentially reducing our own power. And I'm not on board with that.
Searching For The Alternatives
CBT (Cognitive Behavioural Therapy) was 'tested' on a handful of women as a means to help manage menopausal symptoms. While many of our behavioural patterns can be positively affected by a mindfulness of, and changes to, our thought habits, the program gave the impression that changing how we think can reduce menopausal symptoms, which is certainly not outwith the realms of possibility for some symptoms but not for all. My concern is that this may be misunderstood as menopausal symptoms being all in the mind and that if we only change how we think, they will go away. This misunderstanding does nothing to raise an awareness and a greater understanding of the challenges of menopause and it does nothing to help initiate changes in societal views of menopause.
While CBT may have had a positive outcome for some of the women on the program, one size does not fit all - a particular therapy which may resonate for one woman may not speak to another and this is why it is important for us to consider all options available to us. As hard as I tried to find them, there was no mention of any complementary or alternative therapies in the show and I feel this has done women a great disservice. Many therapies have hugely beneficial and supportive effects for women - Reflexology has been shown to help in both pain and stress management; Aromatherapy studies show that specific oils can help improve mental function and focus and Massage can help us reconnect with our own bodies, encouraging a respectful, compassionate appreciation for ourselves at a time when many women feel alienated from their physicality due to quite unexpected and often sudden changes.
Little Shop Of Horrors
We were told that oily fish and soya beans are beneficial during menopause but there was no discussion on the importance of the increased nutritional needs required during menopause and why we often need to supplement our diet with more protein, vitamins and minerals.
Phytotherapy received a fleeting, deeply worrying mention. Many women find phytotherapy - herbal medicine - to be an incredibly supportive approach to menopause, as herbs offer extracts that have an adaptogen effect, helping the body to adapt and adjust to its internal environment, and many herbs are useful in helping to reduce night sweats and manage stress. In a 1 hour long program, 40 seconds was dedicated to discussion on phytotherapy and not by a qualified, experienced, professional Herbalist. In those seconds, herbal medicine was on the receiving end of quite an incredible, inflammatory statement by the 'expert' voice of choice on herbal medicine, a Dietician, who stated that Black Cohosh, a plant that is often used by Herbalists in prescriptions for menopausal symptoms, causes liver failure; a scaremongering blanket statement from someone entirely unqualified to speak about herbal medicine.
It was clear that not only was the program uninterested in presenting valid options for supportive care, alternative approaches which many women find to be hugely beneficial, those that were raised were discussed with unnerving soundbites and without the input of professionals in that field. Not exactly balanced, unbiased reporting.
The Bones Of The Matter
The show asked three groups of women to be involved in bone density scans - the first group did not exercise, the second cycled regularly and the third were runners. Now, we all know that exercise is good for our general health but exercise is a very individual thing. Have you ever tried doing exercise regularly that you don't like? It's impossible to incorporate it into your daily life for any effective length of time. For some, yoga works for them, for others its walking, jogging, the gym or gardening. Exercise is a very personal choice and for it to become a regular part of our lives, it must be something we enjoy because then it easily becomes an activity that is not so much about changing our physical bodies from something we don't like to something we do, but becomes more about enjoying the movement and expression of the physical body we currently have.
Women experiencing menopause find that one of the most common symptoms is fatigue, often to the point where it is debilitating and affects their quality of life. With disrupted sleep, nocturnal sweating, digestive upsets, nausea, reduced mental focus and emotional changes, many women are naturally unable to do anything much at all but try to function as best they can through the days and nights. At least one of the women in the group of 'non-exercisers' had said that she often feels so exhausted she has no energy or inclination to exercise.
If we add the bodily changes common to the menopause including weight gain due to a slowing metabolism, muscle pains and joint stiffness, many women are actually physically unable to do the levels of exercise that they did prior to menopause, leading into a vicious circle of continuing weight gain and worsening fatigue, and this is a source of increasing frustration and anxiety.
The bone density scans of the three groups of women showed that the running group had the best bone density results and the group who did not exercise with the worst bone density results and this was presented with what seemed to be intended as 'light hearted' competition. While there is a medical professional revealing the results, it seems there has been no consideration for hugely influential factors on bone density for each individual woman such as HRT medication, supplements, general diet and lifestyle, how long the women have been in menopause or whether there is any genetic predisposition toward osteoporosis. Even if we ignore these factors, which we shouldn't, the issue here is that we have a group of women being publicly shamed for not exercising under the pretext of dubious scientific results for the good of their own health. The women are then peer pressured into saying that they vow to become more like the 'winners'.
Shaming in any form is unacceptable but bone-shaming is a whole new low. It reminded me of some of the shameful tactics used in slimming clubs and fitness centres, who often employ competition and public humiliation and ridicule as motivational tools for the desired outcome. We cannot, and should not, ever shame each other and it should never be employed in a public broadcast as some manipulative tool to justify inaccurate measurement methods.
Women Of The Ages
Frostrup visited a laboratory where there has been some research and testing done on the validity of removing ovarian tissue from women, freezing it and re-implanting the tissue in the same woman at a later date. This appears to have shown some success in the realms of fertility for women who experienced menopause in their 20s. The studies indicate that the frozen tissue begins to grow and act just like the ovary did before it became 'inactive' and the medical profession is optimistic about its use in fertility in this way.
There was some discussion on how this could be a breakthrough for women experiencing menopause during the average age of 40s and 50s, and how this may affect women and the menopause in the future. The heavy suggestion is that this tissue, if surgically removed and frozen early enough in a woman's life, can be re-implanted in the woman during menopause and this tissue would encourage the existing, menopausal ovary tissue to grow in the same way as the 'younger' tissue, with the assumption of increased egg numbers and ovulation.
In my opinion, this is problematic on many different levels. Firstly, if procedures like this are successful in increasing the fertility of young women who have gone through menopause early, then we can assume, with the right hormone medications, the application can be repeated for women in their 40s, 50s, 60s and 70s, and while this is being raised in the program, what is not being said is that women may then have the ability to have children during an age when they would normally be experiencing menopause, and possibly for many years after menopause. The ethics of this are for each individual to decide their own path; what concerns me more are the ramifications of this on women's roles in society as individuals and how this could affect their identity, the value they place on themselves and their personal development.
Secondly, for years women have fought for equality and we are still fighting. We are not there. We are often still perceived in relation to what we are to others - daughters, sisters, mothers, grandmothers - rather than individuals with our own dreams, goals, wants and needs. There is the expectation for women to have children because society still considers this to be the most desirable and important role women will ever play in their lives, for our bodies to be vessels for babies and our lives to be dedicated to nurturing children. We need only look at the current UK parental leave to get a sense of society's expectations of the parental roles of men and women - statutory maternity leave is 52 weeks and paternal leave is either 1 or 2 weeks, and paternal leave must end within 56 days of birth.
I have found, with all of my female fertility clients - every single one - that peer pressure and society's expectations of them to have children is one of the main sources of stress, anxiety and depression in the fertility journey. I cannot emphasize enough how damaging this is to women, and, in turn, to the fertility process itself. Not only this, women become so focused on conceiving that they often lose sight of everything else. Fertility is a heartbreaking journey. It becomes the most important focus, often to the detriment of themselves as an individual and the qualities they once appreciated and valued about themselves. They can no longer see what an incredible artist they are or what an amazing teacher and mentor they are, or how they have created and developed their own successful business or even how their stories and experiences have positively affected the lives of others. All of this seems to fade into the background during a fertility journey, and this is where I have concerns about normalising an artificial extension of the fertility years of women, where pressures to have children could continue into our 70s. We may be actively encouraged to avoid the menopause and its important teachings.
Enter The Dragoness
The menopause offers us the opportunity to reflect on our lives - I talk about this a little more in the first part of my Enter The Dragoness blog series on alternative views of menopause - and many women find that menopause is a time where they begin to re-evaluate what sustains and nurtures them and what is important to them right now. What was right for us in our 20s will not adequately support us in our 40s or 50s. With changing hormone levels, we have different health and well being needs than we did 20, 10, 5 years or even 12 months ago. Menopause encourages us to look at the areas of our lives where we have been used to putting our own needs and wants last. And, no matter how much we might be used to this, it should not be overlooked. These are some of the teachings of menopause. It heralds in a new phase of our lives, one in which we have the opportunity to embrace our own unique life experiences and the knowledge we have gained from them. It allows us to understand ourselves better and to appreciate ourselves more.
Age Before Beauty
Lastly, Western society values youth; it is prized above experience and wisdom. This is sadly so commonplace for menopausal women and the program's visit to the laboratory did nothing to allay women's fears of naturally transcending youth. I hear so many women say that they no longer feel 'seen' by the world when they are in menopause. But by actively avoiding the menopause, we are feeding into this youth culture, reinforcing the idea that in order for us to be valued in society, we must retain the appearance of youthfulness, of fertility, of productivity, that we must avoid being seen as having nothing left to give, nothing to offer. This is a mindset that is damaging to all of us, not just menopausal women, and requires changing. Any attempts to keep us in the prison of striving to attain the impossibility of eternal youth and fertility so that we are seen to be of value to society must be eschewed.
By the end of the show, the conclusion was that Frostrup would continue with HRT, adequately supported by a dedicated healthcare team. Where this leaves every woman who is not afforded this level of support and guidance was clear; we were presented with no valuable information on avenues of accessible ongoing support, or professional advice on different approaches which encourage empowerment over our own health. We were seductively guided toward the impression that we too could actually be like Dr Jessica Rabbit if only we commit to taking HRT until we die.
Every woman has the right to choose her own path in supporting herself through menopause, whether that is HRT or otherwise. If we choose not to take HRT, for whatever our reasons, then we were presented with no information on alternatives, of which there are many. The message we are given is that if we also choose to continue to enjoy the occasional glass of wine, or to eat pasta with sauce instead of oily fish and soya beans, if we respect our limitations when we are physically, mentally or emotionally unable to do more exercise, if we are unable to exert control over our thoughts because our mental fog inhibits our focus, then there was nothing else presented to us that can be done for us. And every woman deserves more than that. While we all have responsibility for our own health, it is not your fault that you experience the symptoms of menopause and, when you are unable to control them, you should not be treated like you are failing. Menopause is a natural process of, albeit sometimes painful, transformation that happens to you, not something you choose to allow to happen to you. It is something we can learn to live alongside, embracing and supporting ourselves with an empathetic and compassionate understanding of its profundity and our own complexities.
While the show was attempting to portray the impression of the every-woman fearlessly investigating the depths of the menopause on our behalf, it is anything but; the privileged vantage point severely limits the ability to view the menopause and its symptoms from the experience of the average woman. While the let's-start-talking-about-the-taboos premise is signalled early on in the first few minutes of the program with some rather vague, and very quick mumblings of the phrase 'vaginal dryness' - with absolutely no discussions of its cause, the effects and possible treatment options - the message is the same old tired, uninspiring narrative that women have been hearing for decades. Take the drugs and get over it. This isn't the truth about menopause, it's the same old damaging lie.
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