I was 39 when Davina McCall’s Sex, Myths and the Menopause dropped on Channel 4 in 2021. And it did drop. Like an atom bomb. Seemingly overnight, centuries of silence and stigma were washed away, and millions of people were finally talking about menopause and the hell they had been dealing with in silence, and not just menopause, but perimenopause and early menopause. The release was like a tidal wave. Suddenly, the menopause was everywhere.
Hormone replacement therapy (HRT) is the gold standard for treating symptoms of menopause and perimenopause. So many women wanted access to this treatment following the documentary that demand soon outstripped supply, in what became known as “the Davina Effect”. Non-medical companies were quick to cash in. You can now buy vitamins for the menopause, herbal teas for hot flushes, self-testing kits, menopausal shampoos and conditioners, cookbooks for perimenopause, and all manner of lotions and potions for “menopausal skin”.
I find myself in a deep state of ambivalence about this. Of course, I am hugely relieved that so many people who have been struggling through menopause and perimenopause can get the help and support they need. I am thrilled the conversation around the big ‘M’ has been dragged out of the shadows and placed in the mainstream, which in turn has forced employers and healthcare providers to acknowledge the menopausal elephant in the room and damn well do something about it. But I must tell you, as a woman teetering on the very edge of perimenopause, it has all left me absolutely terrified about what is coming my way.
I have watched perimenopausal folk talk about feeling like they were going insane, of the “brain fog” costing them their jobs, the insomnia that almost broke them, and the hot flushes that could melt steel. Social media is now full of menopause experts providing lists of symptoms to look out for: a frozen shoulder, UTIs, a burning mouth, itchy skin, heart palpitations, dry eyes, a dry vagina, tinnitus, hair loss, anxiety, vertigo, mood swings, rage, shortness of breath, reduced sex drive, weight gain, incontinence, and your vagina might start to smell differently.
I have anxiously absorbed all this information. I have read the books, I have listened to the podcasts, and watched the documentaries. I want to know as much as possible about the terrible fate about to befall me. Before the conversation went mainstream, I thought of the menopause as something I would deal with in my 50s. There would be some hot flushes and vaginal dryness, but it would be ok. Now, I see it as the hormonal equivalent of an end of level boss that can strike me down at any moment. This thing is coming, and I will be ready for it.
Each day, I mentally scan my body, checking for any hint that my final egg has cracked, and my time has come. I long ago resolved to abscond from this inevitable nightmare entirely and at the first sign of perimenopause, I will be demanding HRT from my GP. Hell, I will bath in the blood of virgins to ward this wretched condition off. In short, I have been very, very anxious about the menopause.
Don’t get me wrong. I am so grateful to have this information. Forewarned is forearmed and all that, but I’m not sure my becoming deeply peri-paranoid was the desired goal of our menopause trailblazers. So, when The Lancet medical journal published a series of articles, just before International Women’s Day, asking for a more balanced conversation around the menopause, I was all ears. They write, “women’s experience of menopause varies hugely and there is no one-size-fits-all approach to management. Many women transition this stage of life uneventfully, whereas some experience prolonged or severe symptoms and need information, support, or medical treatment.” I don’t think that is particularly radical but, in my highly paranoid state, I welcome the reminder that menopause is fairly uneventful for many people. I do hope I am one of them.
The bit that really caught my attention was the statement that, “commercial companies and individuals with vested interests have overmedicalised menopause. The framing of this natural period of transition as a disease of oestrogen deficiency that can be eased only by replacing the missing hormones fuels negative attitudes to menopause and exacerbates stigma.” Has the menopause been “overmedicalised”?
This is a really difficult one to answer because, ultimately, it is a medical issue. In many ways, the menopause needs to be more medicalised, and people have been struggling precisely because there is a lack of understanding around hormone heath. But promoting menopause as a medical condition that requires interventions to avoid the accompanying horrors has become a lucrative marketing opportunity for many companies. Do we really need scented candles for the menopause? Or pyjamas for menopause? How about package holidays to help you with the menopause? All very real products, I assure you. There is a lot of money to be made by framing menopause as an illness that needs treating.
The Lancet article goes on to point out the limits of HRT treatment: it does little for depression, for example, and calls for a more “empowering” model of managing menopausal symptoms. “Empowering” in this context is defined as “an active process of gaining knowledge, confidence, and self-determination to self-manage health and make informed decisions about care.” To be clear, no one is saying that HRT isn’t a wonderful treatment for many people, who should have access to it. But The Lancet is concerned HRT is now regarded as a panacea and the only treatment for menopausal symptoms. They argue that, “additional strategies beyond medication are needed to effectively support women as they transition menopause.”
As you would expect the reaction to this has been highly divisive. There is already an online petition demanding the retraction of The Lancet article, and I can understand that. If your health has been transformed by HRT and medical support, you are going to react badly to any suggestion that what you have been going through has been “overly medicalised.” It feels dismissive and disempowering. But as someone who has been experiencing a considerable amount of anxiety around menopause and what will happen to me, I’ve got to say, I really welcomed the call for a more balanced conversation.
From where I am sat, the menopause looks truly terrifying. I can’t recall reading about any positive experiences or seeing anyone being interviewed on the subject who had something reassuring to say. We have swung from virtual silence, and a serious lack of understanding around menopause, to a minefield of information, most of which points to the worst of the accompanying symptoms. I wouldn’t want to suggest these experiences should be hushed up again, but by only focusing on the horror stories, a culture of fear and apprehension around menopause has been created, and companies are cashing in.
Right now, the menopause is not viewed as a good, or even neutral, experience. Yes, we are finally taking about menopause, but how we talk about it really matters. If someone is described as being “menopausal”, does that evoke anything positive? Does that make you think, “you lucky thing”? No, it carries connotations of ill health and instability. Not only does this create a lot of fear, but it actively harms women. Remember when the police were investigating the disappearance of Nicola Bulley? They said they thought she had alcohol issues, brought on by perimenopause, and were rightly accused of perpetuating the stereotype that women are hormonal and unstable.
I fear that framing menopause as a disease is becoming a convenient way to dismiss older women as inherently unwell. Women have been stereotyped as being irrational hysterics, at the mercy of their reproductive cycles since the Ancient Greeks and their theories about “wandering wombs”. I’d like to think we are well past such nonsense by now, but you have to ask how much progress has actually been made if I am living in fear of what the menopause will do to my body and mental wellbeing.
My anxieties that menopause heralds a physical and mental decline may be understandable given all the messaging around it, but it reveals a horrible internalised misogyny at work, nonetheless, not to mention a hefty amount of ageism. If I fear the menopause, what does that say about how I view those going through it?
I don’t want to fear menopause or perimenopause anymore. I don’t want to fear getting older and my body changing. Menopause is inevitable for anyone with a working set of ovaries, but what isn’t certain is how it is going to present itself. I don’t imagine I will sail through it completely unscathed; it will doubtlessly be a bumpy ride at times, but I do want to challenge my understanding of it as a condition to be treated.
Don’t get me wrong, if I need HRT, I will get it, but I for one really welcome a wider conversation around symptoms and treatments. As long as we are talking, we are still going in the right direction. For me, a more nuanced conversation helps to remove some of the stigma that has had me in a grip of fevered paranoia, chewing on yam roots because someone on TikTok said it was a natural source of oestrogen. It’s a relief to be reminded that menopause is an individual as you are, and it might not require a medical intervention.
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