Seven Myths About Peri-Menopause
Introduction
I’m writing this in late January, when the sun is in Aquarius. Health wise, Aquarius rules the calves and lower legs, and to be honest I couldn’t think of much to write about peri-menopause and legs! So instead I’ve chosen to focus on the Aquarian trait of questioning the narrative and encouraging us to think differently. When it comes to peri-menopause, there are certainly a number of narratives to question! So here I am to bust seven myths about menopause.
What is Menopause?
In true Aquarian style, let’s start by questioning what menopause is. It really depends on how you look at it, but we’ll start with the basic biology and the official definition. Menopause marks the first anniversary of a woman’s last period. It’s the official closing of the reproductive window of her life, as the most potent version of oestrogen, oestradiol, starts to diminish, heralding an end to periods. But as you’ll see, it doesn’t mean we’re left without any oestrogen at all.
Women’s lives work in 3 phases. First there’s the ‘maiden’ phase, also known as childhood. Then we move into our first transition, which we call adolescence, and at some point there our periods start. The date of a first period is known as ‘menarche’ and it’s a very definite point in time, unlike adolescence which lasts for years and has no clear start or stop. During adolescence, oestradiol levels increase, playing a key role in regulating periods. It’s normal to take months or even years for periods to settle into a regular cycle, and sometimes they can be quite troublesome whilst they do. Teens often struggle with heavy periods, fatigue, fainting, pain and other symptoms as the hormones settle.
Then we move into our reproductive or ‘mother’ phase, where periods should be regular around once every lunar month. I love how our cycles are linked to the cycles of the moon, which is traditionally associated with motherhood and the sacred feminine. Our hormones are very finely tuned to make our cycles run like clockwork, and there are very intricate mechanisms that ensure we produce the right hormones, in the right amount at the right time. Hormones all link in with each other, so if one isn’t functioning, it will inevitably affect others elsewhere in the body. Needless to say, menopause isn’t all about the oestrogen – there are other hormones to think about as well, and in general messing around with hormones artificially can upser the regulation of so many body processes. This is why I don’t generally recommend hormonal contraceptives which interfere with the body’s natural rhythms. Unfortunately these days, our tap water is often contaminated with hormone residues, so most of us are exposed to hormones there whether we like it or not.
As we reach the end of the mother phase, we move into our second transition, affectionately known as the ‘crone’ phase. ‘Crone’ can have negative connotations for some, and I prefer to call it our ‘crown’ phase, where we put on our crown, or our Goddess phase. Depending on where in the world you are, post menopausal women are either highly revered or quite the opposite. In countries where elders are treasured, women experience far fewer problems with menopause than in countries where elders are seen as burdens on the rest of the population.
Anyway, the hormone changes that happen in adolescence, happen in reverse in peri-menopause. Like adolescence, peri-menopause has no clear start or end, and it can extend a little beyond the official menopause date. Likewise, there can be a few wobbles as the body gets used to life with a different hormone profile. Peri-menopause symptoms like heavy bleeding, mood swings, fatigue, skin problems, and worsening period pain are all fairly common, as they are in adolescence.
In the UK, around 20% of women breeze through menopause and barely notice it. Another 20% suffer debilitating peri-menopause symptoms, and the rest of us sit somewhere in between. Having specialised in supporting peri-menopausal women for a number of years, I would say that those who have troublesome periods, often for decades, tend to have a rough time in peri-menopause too. We also know that there’s a strong link between childhood trauma and severe menstrual/menopausal problems. Of course women with textbook perfect periods can also run into trouble. Our reproductive health is a good indicator of our overall physical, mental and emotional health, so we always have to look at all these aspects when treating peri-menopause symptoms.
I’ve also observed that women who are at peace with their femininity, and with aging, usually have an easier peri-menopause. This makes sense. Our nervous system is very closely intertwined with our endocrine system which regulates our hormones. Most of us have seen our cycles get disrupted when we’re stressed. I believe this is a really clever primeval mechanism designed to hamper conception when we feel unsafe.
Now, onto the 7 Myths About Menopause.
1 – Menopause Is A New Thing
We’re often told that statistically, all women would have been dead by the age of 45 and never reached menopause in the first place. Since healthcare, hygiene and life in general has improved, we’ve started to live longer and experience menopause. It’s therefore a new invention, and disastrous for our health as we move into our ‘crown phase’.
Where does this idea come from? Well, it’s true that until relatively recently the child mortaility rates were so high that making it to adulthood was quite an achievement. Then we had to survive multiple births, which was also a very risky business. The odds of getting to our early 40’s when we had all that to contend with were indeed slim.
A good number of women still made it past their teens, and were infertile. Not having to risk childbirth meant that they often lived way beyond menopause. Likewise nuns who took vows of chastity and lived only with other women, were safe from the perils of childbirth. They too often lived well into old age. Austrian Abbess Hildegaard von Bingen was well versed in the herbal treatment of menopause symptoms, and her texts describing it still survive today. Likewise there are references to menopause in the Bible. If you wander around any old cemetery you’ll see graves of elderly women from centuries ago, proving that there were plenty who not only survived menopause but lived to a ripe old age!
2 – Menopause is a one-way ticket to heart disease, dementia and osteoporosis
It is true that oestrodiol has a protective effect on most tissues in the body, including heart, brain and bone. However, it’s just one piece of very large jigsaw and we need to take the recommendation of HRT in context. As I said, in years gone by, plenty of women lived well into their 80’s and 90’s. Some may have been in decline, but not all, and none of them were on HRT. What we do know, but are rarely told about, is that there are proven risk factors for all of these diseases and more. In a nutshell, the further humans drift from how we were naturally designed to live, the sicker we become. Risk factors include:
Being sedentary.
According to Alzheimer’s Research UK, almost half of dementia cases are preventable. It begs the question then of why we’re not told about this research and how to minimise our risk, but anyway, exercise is key. This article describes a study showing that we can reduce risk by up to a staggering 70% simply by exercising for 2 ½ hours a week. Our bodies are designed to be active and with the lives we live nowadays many of us have to make a concerted effort to get out and move every day. It has multiple health benefits including improving bone strength, balancing hormone levels, managing weight, releasing endorphins, improving heart health, and reducing the risk of certain cancers. It really does become non-negotiable in peri-menopause.
Being isolated
Isolation can become a real problem as we age, but I’ve seen it in younger people as well. It’s associated with much higher risks of dementia, heart disease, chronic inflammation, diabetes and more. On the Greek island of Ikaria, dementia is virtually unheard of, likely for a number of reasons. One though is that they have strong communities where everyone is included in communal meals and events. Many people there don’t retire, so
they remain physically and mentally active as well as keeping some social interaction. Those who do have some spare time usually spend it in cafes playing board games, or teaching.
During peri-menopause it’s normal to feel the need to retreat from friends, family and hobbies. Whilst that’s ok occasionally, I always encourage my patients to get out as much as possible, even when they don’t want to. That’s because as time goes on it becomes harder to socialise and we can very easily end up alone.
Long term use of antidepressants, statins and PPI’s
I know that antidepressants for some people are a lifeline, and they can be absolutely necessary. However, SSRI antidepressants when taken over a long period of time can drastically increase the risk of dementia. It worries me that peri-menopausal women are often offered anti-depressants, and that virtually everyone taking them is doing so without being offered any other supportive treatment. Almost 9 million people in the UK take antidepressants, and most will be SSRI’s. If you’re one of them, please don’t feel bad about taking them, but do look for other ways to treat your depression alongside.
Statins and PPIs which are used to treat acid reflux can also contribute to the risk of dementia developing post menopause.
3 – Menopause leaves us with a ‘lifelong hormone deficiency’ which needs to be medicated
No it doesn’t. Our bodies are very clever and our oestrodiol levels are exactly where they need to be at each stage in our life. Saying we’re ‘oestrogen deficient’ implies that we have a major design flaw, but would you still want to run the risk of falling pregnant in your 80’s? The whole point of menopause is to move us out of our reproductive phase and it’s true that levels of our strongest oestrogen will drop. But weaker forms of oestrogen made by the adrenal glands climb at the same time. Their purpose is to help protect our bodies, but without making us menstruate every month. It’s all very clever, and in most cases, there’s no need to force feed your body oestradiol when you’re trying very hard to cut down. Too much oestrogen is not necessarily a good thing.
You’ll see some people use the argument that if someone has type 1 diabetes, they replace insulin artificially. Likewise thyroxine is used by people whose thyroid is underfunctioning, and therefore we should replace oestrogen when the ovaries malfunction. Yes it’s true that when there’s a medical condition causing a gland to malfunction, we may need to replace those hormones. The thing is, in menopause, the ovaries are not malfunctioning; they’re simply moving into a new phase.
4 – The only way to protect your health through peri-menopause is to take HRT
HRT is just one of many ways to try and relieve peri-menopause symptoms, but it’s the one with the loudest voice. Peri-menopause gives us a narrow window of opportunity to get our health in order for our 3rd phase, so it’s important to step up your self-care whether you choose to take HRT or a natural alternative.
Besides some potentially drastic changes to diet and lifestyle, there are lots of natural alternatives to HRT available. A Nutritional Therapist can assess your nutrition needs and prescribe very precise doses of key supplements to help relieve symptoms. Then there are the herbs, which were made for menopause! Where nutrition is our body’s fuel, herbs are the mechanic. They tweak and nudge the body’s processes and shift us back towards our optimum state of health. You can learn more about how I use herbs for menopause here. There’s growing evidence to suggest long term protection of brain, bone and heart health after menopause when we use herbs.
5 – HRT Is Natural
I know that many people believe that HRT is natural, because 90% is made from the herb ‘Mexican Wild Yam’ (Dioscorea villosa). This plant can be processed in a pharmaceutical lab to make both oestrogen and progesterone HRT. Obviously the methods used are closely guarded trade secrets, but the Yam is so highly processed that there’s really nothing ‘natural’ about the end product at all. It’s like saying that aspirin is natural
because it was originally derived from Willow, or the chemotherapy drug Vincristine is natural because it comes from Greater Periwinkle.
Wild Yam cream is used by some women in the hope it will increase their progesterone levels, and some even want to use it alongside oestrogen HRT instead of taking progesterone. The problem here is that there’s a misunderstanding around what Wild Yam cream is and how it works. When we look at levels of progesterone in saliva of women who’ve been using Wild Yam cream against those who haven’t, there’s no difference. That’s because humans lack the many enzymes needed to convert the saponins (phytosterols) into useable progesterone. The pharmaceutical companies have ways of converting it to progestogens, which are useable for most women although some women can react badly to them in HRT. At the moment we believe that any symptom relief coming from using Wild Yam cream more likely stems from an oestrogenic effect. It’s also more commonly used for conditions other than peri-menopause by Herbalists too. There are other herbs which will help to normalise progesterone levels, but Mexican Wild Yam isn’t used in this way.
6 – You Mustn’t Use Phyto-oestrogens For Peri-Menopause If You’ve Had Cancer
This isn’t true, although it’s one situation in which you’d really need to be properly assessed by a Medical Herbalist. That’s because certain herbs will interact with drugs used to supress oestrogen levels post cancer, and obviously those herbs need to be avoided. Some phyto-oestrogenic herbs like Red Clover have actually shown to have a protective effect against oestrogen receptive cancers, blocking the receptors used by the oestrogen that feeds them.
I understand that despite new research backing the safe use of phyto-oestrogenic herbs post cancer, many patients are still nervous about using them. Where this is the case there are still herbs we can use which have no phyto-oestrogenic effects, although treatment can take longer.
7 – Post Menopausal Women Are ‘Living Decay’ and ‘Castrates’
This sounds harsh, but it’s the myth that kicked off the whole HRT movement. In 1966 Gynaecologist Robert A Wilson published his book ‘Feminine Forever’ with funding from the manufacturer of Premarin, one of the first forms of HRT. Premarin was short for ‘Pregnant Mare’s Urine’, and horses are still kept in appalling conditions to produce this HRT now. Anyway, the aim of the book was to terrify women into taking HRT using terms like ‘living decay’, and it worked. In fact some of the myths in this book, like women needing HRT because they’d never have lived long enough to get to menopause before, are still being peddled today.
You’ve probably noticed the frightening narratives around peri-menopause that have been hitting the headlines, especially since Davina McCall’s first documentary on it in 2021. Women are still being told that they risk heart disease, osteoporosis, dementia and more if they don’t take HRT. Little thought is given to those who can’t take HRT for medical reasons, or to the other reasons why these conditions are on the rise. We also have to consider what hormone changes in peri-menopause do to our personality. Oestrodiol is the mothering hormone. It gives us patience, tolerance, compassion and kindness, all of which are needed in bucketfuls when you’re raising young children. When that phase is over, we have less oestrodiol, and naturally become less patient, tolerant, compliant etc. This is ultimately a good thing: menopause was traditionally a time when we stepped into our power and became the highest version of ourselves. By adding that oestrodiol back in as HRT, we are pushed back into a more tolerant, compliant state of mind for the rest of our lives.
So I whilst I’m sure it’s not a rationale behind medicating women en masse, I do wonder what the effects are of so many women taking HRT? I’m not sure that everyone would want a global army of badass peri-menopausal rising up to tackle the world’s many issues. Adding in enough oestrogen to put millions of women back into a more easy-going headspace might not be intentional, but it’s an effect I’m very aware of.
There are also the environmental considerations. Oestrogen from HRT can’t be cleared from our water supplies. That has an effect on the fertility of fish in the rivers, and most women are now oestrogen dominant partly for that reason. Too much oestrogen is linked to all kinds of gynae conditions, including certain cancers.
I honestly honour every woman’s choice when it comes to navigating peri-menopause, but it needs to be an informed, empowered choice. What saddens me is the disempowering messages we’re constantly being fed, that we’re broken and have no chance of making old age in good health without HRT. It’s simply not true, and we need to be very discerning with what we’re being told. I believe that menopause still is a very special, sacred transition when we understand it properly and have the right resources in place.
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