Menopause, A Disease?
Every time the doctors talked to me, they made menopause sound like the most horrible thing to happen to a human being: It makes one depressed, anxious, fat, ugly, old, sick and like some Grinch of pleasure, stealing one's libido, giving them painful sexual intercourse due to vaginal dryness, killing women by causing hip fractures, dementia, heart diseases. Of course if I survived the inevitable depression in my fat, not anymore female and very ugly pear shaped body, menopause would probably kill me simply from the stress and fear.
One day I just couldn’t take it anymore, I was not going to sit on that chair with a muted facial expression while a doctor gave me ‘advice’ that I hadn’t asked for, instead of giving me an explanation.
‘You need to take hormone pills to keep your body healthy.’ 🤔
‘Don’t take hormones if you have family history of breast or ovarian cancer, or cardiovascular disease.’ 🤷♀️
‘If you want children, you can still adopt and become a mother.’ 😮
‘Keep exercising regularly to have stronger bones, and a healthy body.’ 🥴
‘You might have mood changes but the hormone pills will help you to keep a more stable emotional state and prevent the changes.’ 😡
The last comment did me in. My life had been shattered by a rare diagnosis, but any mood changes were to be medicated with hormone pills. When had I missed the memo that every person except for menopausal women were going to be always emotionally stable? So I should just behave, listen to all the comments from doctors, ignore my boundaries and forego my freedom to make a choice. I should not get frustrated, or sad or angry.
Also how did I not think of that simple solution before? I should just adopt a child to fulfil my urge to become a mother. They made it sound so easy! Why was I so sad and devastated for so long while the very easy option was just there… Adopt, and save a child. Seriously? That easy?
My spiral of fear, confusion and despair showed no sign of slowing. I needed help.
Unsurprisingly, the internet was not my saviour. Reading about menopause felt similar to reading headlines released by a controlling government. Today, nearly a decade later, despite all the new equality movements of recent years, the answers are still not that easy to find if you’re looking for an explanation. Here are some of the sentences repeated again and again:
Menopause marks the end of a woman's fertility.
The average age of menopause in the UK and US is 51. (But do not go into despair, the average age for the UK was 45 according to a survey made in 1845)
Around 1 in 100 women experience the menopause before 40 years of age. This is known as premature menopause or premature ovarian insufficiency. In many cases there's no clear cause. Premature ovarian insufficiency can sometimes run in families.
Menopausal symptoms need treatment.
Although the literature states that menopause is not a disease, the terms treatment and symptom make one feel like it is a disease and not a natural change in the hormonal values of a woman due to ageing. But are they the only use of language that needs to be changed about menopause?
The most common ‘treatment’ for menopause is Hormone Replacement Therapy (HRT), also known as Menopausal Hormone Therapy (MHT). These medications aim to replace sex hormones that a woman’s body stops producing or that diminish after menopause. It is either a combination of the hormones oestrogen and progestogen, or oestrogen on its own (ERT).
Menopause is a natural part of ageing that usually occurs between 45 and 55 years of age.
If menopause is considered natural, then why are we all afraid of it, and why are we trying to hide it from everybody, including its symptoms? And if it’s not a disease why do we need to “treat” it? We all are programmed to fear illnesses and diseases instead of taking them as part of life, embrace them and listen what our bodies are trying to tell us. We can accept that we need to take our cars to a mechanic to change its oil, or replace the brakes, but we cannot accept our bodies needing to have some rest when we have a flu, and we automatically take pain killers to repress all the symptoms and to sleep away the disease.
The related websites that come up as top results weren’t very helpful to me on how to make a decision on whether or not to take HRT, or how not to panic when/if I experience the symptoms of menopause if I stop taking the hormones… It all made me feel even more confused.
After all I was scared, I was vulnerable, I was going through the grief and loss of my unborn children. And now I had to make a decision that might be a matter of life and death, according to the web sites, or the doctors I have spoken to: I had to decide if I should keep taking the hormones, or die from a hip fracture, Alzheimer’s Disease or risk losing my libido forever.
To make a decision on whether to continue HRT, maybe I had to first understand why I had these symptoms in the first place. Is oestrogen the only hormone that is lacking in a woman’s body after menopause? And what was the function of hormones anyway?
1 - All hormones (not only oestrogen) are important to an understanding of menopause. Or more correctly, hormones are important. They send messages to various parts of our bodies and influence the functioning of almost every cell and organ. We generally consider hormones mainly working around reproduction, but they are fundamental to all the systems in our bodies: Our growth, transport of nutrients and waste products, to breath, how our bodies use food, to give us the order of fight or flight, our well-being, our moods…
Hormones keep things simple by communicating only with their own receivers (hormone receptors). With these messages, they tell our bodies how to use its energy. Please take a moment to re-read this sentence out loud.
Hormones tell our bodies how to use its energy.
So our hormones prioritise body functions and, given that we have a limited level of energy every day, the body’s survival becomes the key function of hormones.
For instance, insulin, helps regulate blood sugar, adrenaline is secreted in the event of a fight or flight situation, oxytocin is involved in orgasm, social behaviours (low levels of oxytocin have been linked to autism and autistic spectrum diseases.), sleep cycles, childbirth and mother and baby bonding. Oxytocin also helps regulate body temperature by redistributing heat from one place in the body to another. Melatonin tells our bodies when it’s time to go to sleep, but also very high and very low levels of it can prevent ovulation, leading to infertility. Age-related decrease in melatonin levels coincides with the menopause. Cortisol is primarily associated with ‘fight or flight’ instincts, but also controls our sleep/wake cycle and regulates blood pressure.
2 - There are also sex hormones (or sex steroids). Females have three sex hormones produced in their bodies: Oestrogen, progesterone and androgen. These help control metabolism, immune functions, reproductive and sexual development. Traveling in the bloodstream they regulate appetite, sleep, growth, fertility and secondary sex characteristics like breasts, pubic and armpit hair and widening hips.
There are three different types of oestrogen in the female body;
Oestrone (E1) is the major type of oestrogen hormone produced in postmenopausal women. Although the first steroid hormone to be discovered (in 1929) and led to the development of birth control pills, very little is known about this hormone, but it comes from the ovaries, as well as the adipose tissue (fatty tissue) and adrenal glands. That’s why if a woman has more fat on her body, her E1 levels will be higher. After menopause, oestrone becomes the predominant circulating oestrogen. It is converted to estradiol in the body when in need. And since there is not much investment in understanding menopause, some potential outcomes of too much and too little of this hormone are known however, the results are not known. There is also no definite link found between the ovary hormone and postmenopausal symptoms like hot flushes, fatigue etc. *
Oestradiol (E2) is a steroid hormone made from cholesterol and is the most potent of the three naturally produced oestrogens. Its levels in women reduce slowly with age, with a large decrease occurring at the menopause when the ovaries ‘switch off’. However, oestradiol is also made in much smaller amounts by fat tissue, the brain and the walls of blood vessels.
Oestriol (E3) is produced during pregnancy mostly by the placenta.
Progesterone: Mainly secreted in the ovary during the second half of the menstrual cycle, progesterone supports the fertilised egg (embryo) should pregnancy occur and helps maintaining the early stages of pregnancy, stimulates development of the milk production glands in the breasts. If progesterone is absent or levels are too low, irregular and heavy menstrual bleeding can occur.
Androgen is known as the male sex hormone, but it’s also produced in a woman’s ovaries in small amounts. Combined with oestrogen, androgen helps with the growth, maintenance, and repair of a woman’s reproductive tissues, bone mass, and behaviours. Its levels decrease naturally with age; it peaks during puberty.
3 - With age not only the sex hormones and melatonin but many other hormone levels decrease or increase naturally in the body. Cortisol level for example increases with age, and large amounts of cortisol in our bloodstream for prolonged periods of time might be toxic for our brains and possibly increase the risk of developing Alzheimer’s disease. So not putting ourselves under a lot of stress as we age is very important.(ref) In addition, rising cortisol levels are associated with more severe hot flashes.(ref)
So ageing and the change in all our hormone levels are the main reason why we feel different sensations. Our hormone levels keep fluctuating while finding the perfect balance in our bodies after our oestrogen, melatonin, oxytocin levels drop, while e.g. cortisol levels increase with age starting from our 30s.
So perhaps the question I need to answer was not if I should keep taking the hormone pills.The real question became was I treating my body and soul with compassion or was I putting it under a lot of stress? Was I aware of my emotions or repressing them?
Maybe menopause was a very big signal to start treating my body with compassion.