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Smacked into Menopause! Thank God, I Learned Some More.
By Fiona Weldon
IMAGE photo shows Fiona Weldon with a broad smile at the Summit event and the room is lit in purple, she is wearing a flower design printed blouse and glasses.
On the 23rd of March of this year, I attended the first ever National Menopause Summit in Ireland on behalf of Independent Living Ireland Movement and it was just amazing! It was factual, empowering, serious and fun.
Pre-summit, I had a very vague idea on what menopause was. My mother went through it, my aunt went through it, and I used to hear my two friends go on about having the Hot Flushes, the Brain Fog, the not sleeping, the joint pain, the mood swings, the tiredness that you cannot explain and yes, the dreaded dryness “down below”. What the hell, I was smacked into Menopause a little over 2 years ago with the hot flushes and the brain fog and it is an Oh My God.
Ladies its 2023 and we are just starting to talk about Menopause, why, because it is actually a taboo subject for a lot of women and there is stigma, yes stigma, and particularly in work and for some women that do not feel comfortable with discussing “The Change” with their husbands/partners. It is somewhat assumed to be a “private issue” and not a medical one. Some of the stats are frightening - many Menopausal women feel that they have to leave work because of the brain fog, the hot flushes, the anxiety and if they seek accommodations they could be seen as incompetent…Seriously!
Women have been going through this since the beginning of mankind. How can it be right that a woman has to wait until they are in the crux of “perimenopause” (yes that’s a word and I will explain it to you a little later), to understand what the hell is going on with their bodies. It’s caveman land, even some of the doctors don’t know how to talk about it or even treat their patients and especially disabled women. I had a brief conversation with my doctor a little while ago about the possibility of taking Hormone Replacement Therapy (HRT) and she said, and I quote, well Fiona…, let’s talk about it in a few more months, your still having periods… and we need to do your bloods to find out more… seriously. Well thanks to ILMI, and thanks to the Summit, I am truly ready to “talk” about Menopause and more!
As a “gracefully maturing” menopausal disabled woman with an impairment label of Cerebral Palsy (CP), I didn’t put two and two together when I started to have Menopausal symptoms (almost 10 years ago, yes 10 f**ken years ago…) because I already had the tiredness, had the pain, had the not sleeping thing, (all these are part and parcel of living with CP). And I put my “not working brain “down to a side effect of taking anti spasm medication. Well, I got that wrong and for those of you that know me, I don’t like getting things wrong.
I am deeply concerned that disabled women are and feel disconnected from the whole Perimenopausal, Menopausal conversation.
- because we have to deal with all of the other side effects that we have due to our impairments \ conditions, in my case CP and the notion of Menopause is just “is on the back burner”.
- because of “Ableism and internalised Ableism and everything that it ensues”. Ableism is a form of discrimination / prejudice against disabled people. It can take many forms including ideas and assumptions that are not true but are manifested to keep disabled people in their place – on the outskirts of society, e.g., negative attitudes that, our non-disabled sisters hold about us, coupled with our non-disabled, uninformed health care professionals who are employed to keep us healthy and have little or no practical experience of accommodating our needs when treating us…and then societal barriers, it’s a Holy God... and then the Internalised Ableism thing, and yes, it is a thing, and it is endemic within society. It happens when a disabled person discriminates against themselves and other disabled people by holding the belief that “being so called disabled” is a bad thing, that being disabled is something to be ashamed of, or something to hide, or doing everything for yourself by yourself is better than needing access or needing support. Most of the time this happens unconsciously and it is not the fault of the disabled person. It is about being forced into using systems and structures that disempowers us and diminishes our belief that we have the right to the same life chances that our non-disabled peers take for granted.
I have come to the realisation (through researching / writing this article) that disabled women have been largely over-looked in mainstream menopausal studies. The little research that I did come across suggests that menopause can come to those with physical impairments much sooner and for those women with intellectual impairments, particularly those that have down’s syndrome this is also the case. This is huge, so why did I have to go and dig it out. Are these women not women too. Many are in the same boat, many do not understand what is happening to their bodies. So, I am calling all the disabled women of a certain age that live in Ireland to start talking, to have the conversations, to get informed. And moreover, encourage our non-disabled sisters and doctors to start engaging with us, and start listening to us about our accommodation needs because disabled women are not looking after themselves and it seems that disabled women are unconsciously left out of the conversation because we are not talking about it or its just lelt on the back burner!
Last year ILMI hosted an online forum for disabled women to talk about their lived experiences of accessing healthcare, and what they told us was stark. I was shocked, but I should not have been. Our healthcare system is broken and extremely broken in relation to disabled women’s health care needs. We know from what disabled women have told us that some of us have experienced sexual and domestic violence, are treated as asexual, our access needs are largely ignored, some worry and have great difficulty with even the idea of transferring onto an examination table, and of course not being listened too. So, the important smear and breast checks that we need don’t happen. I could go on and on, but I suspect that the disabled women that read this are acuity aware of what I am talking about.
Menopausal Disabled Women’s Live’s Matter 2! If you are interested in this topic and you want to find out more, please get in touch with us, our doors are wide open – email: fionaweldon@ilmi.ie
So, What is Menopause and Perimenopause – My Learning From the Summit – What You Need to Know – Please Be Informed!
Menopause happens to most women and it is when a woman stops having periods completely. Your periods stop due to your ovaries producing less hormone (Oestrogen, Progestogen and Testosterone). You reach menopause when you have not had a period for 12 months. Periods usually start to become less frequent (usually between the ages of 45 and 55, although some women experience symptoms earlier) over a few years before they completely stop but in some cases they can stop suddenly. For some women, periods can become very heavy in the year coming up to menopause. Menopause is immediately diagnosed if women have no ovaries – this is called surgically induced menopause.
Perimenopause is the time leading up to a woman's final period. It is when your body starts the transition to menopause, sometimes it’s called “The Change”. Perimenopause ends 12 months after the last period. The symptoms of perimenopause have been reported to last up to 12 years.
Perimenopause is diagnosed by the presence of menopausal symptoms and / or a change in periods. If a woman aged 40-45 experiences changes in her menstrual cycle and has menopausal symptoms, then Follicle Stimulating Hormone (FSH) blood tests may be done if the diagnosis is uncertain. FSH bloods are taken on day two and day five if a woman is menstruating. A normal result does not exclude menopause.
A minority of women transition through perimenopause with very few symptoms, most women experience a mixture of symptoms, not just hot flushes and night sweats.
Symptoms of Perimenopause and Menopause:
- Vasomotor symptoms - hot flushes, night sweats and disturbed sleep.
- Musculoskeletal issues - joint pain, muscle pain or / and stiffness.
- Mood changes - anxiety, low mood, feelings down.
- Cognitive symptoms - brain fog, forcing many of us to make lists on top of lists.
- Urogenital symptoms - urinary frequency, urgency, painful sexual intercourse, vaginal dryness, vaginal itch, or discomfort.
Less Common Symptoms of Perimenopause and Menopause:
Burning Mouth Syndrome; fatigue; palpitations; loss of libido; headaches; dry skin; dry eyes and weight gain around the middle.
Post Menopause
This happens when a woman has no menopause symptoms, lifestyle interventions are crucial at this point. A Cardiovascular Osteoporosis Risk Assessment should be completed. The biggest presentation to GPs at this stage is with a woman having a Urine Infection, this is most often not an infection but Vulvovaginal Arophy or dryness. This can be treated with Topical Oestrogen.
Supplements of calcium (1000 to 1500 mg per day) and Vitamin D (800 to 1000 IU per day) are also recommended - this is assessed per individual, as certain populations, for example, Asian, Afro, Caribbean women may require more vitamin D.
The Greene Climacteric Score (GCS) – Important to Know About
The GCS was developed by J.G. Greene in 1976, the Greene Climacteric Scale is an analytic study of climactic symptoms. It can provide a brief measure of perimenopause or menopause symptoms and can be used to assess changes in different symptoms before and after menopause treatment. Three main areas are measured:
1. Psychological; 2. Physical; and 3. Vasomotor
The Contents of the Greene Score
| Symptoms |
Not at all
0 |
A little
1 |
Quite often
2 |
All the time 3 |
| 1. Heart beating quickly or strongly |
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| 2. Feeling tense or nervous? |
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| 3. Difficulty in sleeping |
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| 4. Excitable |
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| 5. Attacks of anxiety, panic |
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| 6. Difficulty in concentrating |
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| 7. Feeling tired or lacking in energy? |
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| 8. Loss of interest in most things |
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| 9. Feeling unhappy or depressed? |
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| 10.Crying spells |
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| 11. Irritability |
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| 12. Feeling dizzy or faint? |
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| 13. Pressure or tightness in head? |
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| 14. Parts of body feel numb or tingling |
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| 15. Headaches |
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| 16. Muscle and joint pains |
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| 17. Loss of feeling in hands or feet |
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| 18. Breathing difficulties |
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| 19. Hot flushes |
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| 20. Sweating at night |
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| 21. Loss of interest in sex |
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Understanding the Greene Score
Studies have shown that women who score over 12 on the GCS are more likely to be perimenopausal. It is possible to score lower than this and still be peri/menopausal. Night sweats and hot flashes are diagnostic over the age of 45. Isolated symptoms may not be symptoms of peri/menopause. See - https://www.mymenopausecentre.com/gp-resources/what-is-the-greene-climacteric-scale/
First Peri/Menopause Consult
Your GP should discuss your symptoms with you, using the Greene Score if you know about it. You should also discuss menstrual, gynaecological, and contraceptive history, your past medical history, including history of migraine and your screening history – cervical smears and mammogram if appropriate for age.
Pre-existing risk factors for long-term health cardiac/osteoporosis should be examined; and blood pressure, Body Mass Index, breast / pelvic exam (if indicated) bloods (non-hormone) should all be discussed.
Management of Symptoms
An individualised approach is recommended as each woman is unique. The role of HRT will be discussed if suitable.
A risk assessment should be carried out, with consideration for Cardiovascular Disease, Diabetes, Osteoporosis.
Screening programmes should be recommended; cervical, breast, colon, diabetic retina screening if applicable. Menopausal symptoms such as, vulvovaginal atrophy, sexual dysfunction should be considered.
Lifestyle Interventions
Lifestyle advice should be offered with information on dietary changes with an emphasis on nutrient dense, whole foods. Recommendation of physical activity that is liked (150 mins per week) Stop smoking. Limit alcohol consumption. All of these things will improve energy levels, improve sleep and well-being. Dressing in layers and using a portable fan can also help with hot flushes.
The Mediterranean diet is good for the female brain and get 20 minutes of exercise a day. We need protein and fibre, avoid smoking, limit alcohol and caffeine, eat foods high in Tryptophan to aid sleep and mood.
Look after your gut health, think about how to help digestion, probiotics, prebiotics, fibre, hydration.
Fodmaps – short chain carbohydrates that the small intestine absorbs poorly. Some people experience digestive distress after eating them, discuss this with a dietician. Engage in movement, yoga, resistance, balance, and weight bearing exercises.
We need to mind our bones; we can lose 20% of our bone mass during menopause. It is a good idea to increase your calcium intake look at including Vitamin D, Magnesium, Phosphorus, Zinc, and Omega-3.
We need to mind our hearts; lower cholesterol and triglycerides, take Omega-3, eat nutrient rich foods.
Managing Brain Fog, Anxiety and Stress
Brain fog is poor working memory, the symptoms are a lack of mental clarity, poor concentration, and a lack of focus. It could be caused by many conditions, and we do not know if it is caused by menopause until we look at associated symptoms, we need to have the conversation with our GP.
Menopause is a Biological Stage of life that can cause neurological symptoms and these cognitive issues can resolve once hormone levels balance – after menopause.
Women describing brain fog can perform poorly on tests for attention, verbal skills, and memory. Oestrogen drives our brain function and there is a “window of vulnerability” which begins with perimenopause and improves after menopause. When our cognitive function suffers it can be distressing, uncomfortable and hard to understand.
Many women are managing a home, family, and work, and sometimes work can suffer, as it is easier to let this go than the home and family. Women in the workplace are not a minority group. Work is important for fulfilment and financial independence. The importance of careers can be underestimated because of the other responsibilities that are placed upon women. Women leaving the workplace causes personal loss, losses to the company, decline of economic independence and a loss of expertise and experience.
Shocking findings around women and the menopause in the workplace include women disclosing feelings of insecurity, anxiety, and shame, along with a worry that they have harmed their professional image. The British Public Service Union found that “menopause is too often considered a private issue, instead of an occupational health issue”.
What to do to improve the symptoms – look at improved workplace strategies, HRT, other pharmaceutical options, reassess lifestyle choices, address diet and exercise, use talk therapy, Cognitive Behavioural Therapy, prioritise sleep and self-care.
Hormone Replacement Therapy (HRT)
HRT is a medicine-based treatment used to relieve the many symptoms of menopause. There are different types of HRT. Your Doctor will help you decide if HRT is right for you and give advice on the type that would suit you best. HRT medicine comes as tablets, skin patches, gels, and vaginal creams or pessaries.
Indications for Treatment with HRT
1. Management of symptoms
2. Reducing long term health risks under the age of 45
3. Treatment of osteoporosis under the age of 60.
Risks of Treatment with HRT include breast cancer, blood clots or stroke and bleeding.
The Benefits of Treatment with HRT
- HRT initiated before the age of 60 or within 10 years of the menopause is likely to be associated with a reduction in coronary heart disease and cardiovascular mortality.” (British Menopause Society 2020). Women are less likely to have heart disease before the menopause than men of the same age, but that protection is lost when our ovaries slow down. HRT can be protective for the heart and blood vessels, but once you have heart disease, HRT is not a treatment. Evidence from large observational studies have shown that transdermal administration of Estradiol is unlikely to increase the risk of stroke above that in non-users and is associated with a lower risk of stroke compared with oral administration of Estradiol.
2. Reduction in osteoporosis.
Why Talk About Menopause? – This is Important
1 in 8 people on the planet is a menopausal woman. In 80% of women the menopause negatively affects their work. 4 in 10 women take time off, and 80% of these do not say the real reason they need the time.
4 in 10 women consider giving up work, and 1 in 10 leaves work because of the menopause.
The top five menopause symptoms affecting a woman’s performance at work are:
1. Cognitive: Three out of four women experienced brain fog and memory loss.
2. Fatigue: 66% of women
3. Feeling overwhelmed: 57% of women.
4. Anxiety: 60% of women
5. Hot flushes: 46% of women
We need to increase awareness and break the taboos about Menopause. Become aware, the more you know the better. Your first port of call is your GP, if you are fobbed off, try another GP. You do not have to accept what your GP says. Visit a Well Woman Clinic or join Sallyanne Brady’s ‘The Irish Menopause’ for more information and support.
Supportive Resources
National Menopause Summit Advocation for Change – see - https://nationalmenopausesummit.com
The Change, Irelands Menopause Story – watch - https://www.rte.ie/player/movie/the-change-ireland-s-menopause-story/284612648248
Sallyanne Brady’s ‘The Irish Menopause’ see - http://www.theirishmenopause.com
Resources Relating to the Menopause and Disabled Women
Access to and Utilisation of Sexual and Reproductive Healthcare for Women and Girls with Cerebral Palsy: A Scoping Review, Sonali Shah, Julie Taylor & Caroline Bradbury-Jones - see https://www.tandfonline.com/doi/full/10.1080/09687599.2022.2060802
Menopause Healthcare for Women with Physical Disabilities, 2006, Dormire, Sharon L. PhD, RN; Becker, Heather PhD; Lin, Chia-Ju PhD(c), MSN, R – see https://journals.lww.com/tnpj/Citation/2006/06000/Menopause_Healthcare_for_Women_with_Physical.8.aspx
Women's Conception of the Menopausal Transition-A Qualitative Study, 2007, Lotta Lindh-Astrand 1, Mikael Hoffmann, Mats Hammar, Karin I Kjellgren, see - https://pubmed.ncbi.nlm.nih.gov/17335527/
Menopause Health Decision Support for Women with Physical Disabilities, 2007, Sharon Dormire PhD, RN, C (assistant professor) 1, Heather Becker PhD (Research Scientist), see -https://www.sciencedirect.com/science/article/abs/pii/S0884217515336637
What is Menopause, see - https://www.youtube.com/watch?v=af-356SbCkY
Signs and Symptoms of Menopause easy read – see https://www.nhsinform.scot/media/6932/02-menopause-signs-and-symptoms-november-2021-er.pdf
**** ILMI Disclaimer*****The contents of this opinion blog style article, such as text, graphics, images, and other materials created or compiled by Fiona Weldon are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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