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Why is everyone suddenly talking about the menopause?

In the days after International Women's Day, is it time to talk about the menopause?

In the last few years, the menopause has moved from being a subject swept under the carpet, to one where women are no longer staying quiet about their symptoms and how they are coping. So, what has changed? And why is everyone suddenly talking about the menopause?

All women, if they live long enough, will go through the menopause. It happens to every woman, in every culture and every country. No one can avoid it, and yet no one talks about it. There has long been a stigma attached to menopause which has made women feel old, dried up, past their prime, and invisible. Even when they have experienced debilitating symptoms, which 25% of women do (1), they have suffered in silence.

But things are changing. Suddenly the menopause is a hot topic, taking centre stage in the media and even in the workplace.

Although the narrative around menopause has been overwhelmingly negative, the narrative about women in this demographic is changing. Women in their 40s and 50s are much more likely to have careers and some economic independence. Rather than disappearing into the background, women with older children are beginning to try new things. A 2017 survey by Barclays (2) revealed that the over 50s were the fastest-growing demographic for starting a new business. That speaks of an entrepreneurial generation who are ready to take risks.

If there is one thing the #MeToo campaign has taught us, it's that women are no longer prepared to suffer in silence. The menopause can be a challenging time for many women, both physically and emotionally, and talking about it can help to stay better informed about the symptoms and how to manage them. Celebrities like Meg Matthews speaking out about her own experience, and assisting women in navigating this time of life, does much to bring menopause out from under the carpet.

What is menopause?

A woman is said to have been through the menopause when her periods have stopped for 12 months. Typically, women experience menopause in their early 50s, although some women will be younger, and some older. However, many women are shocked to realise that the process actually starts much earlier than that. The perimenopause is the period leading up to menopause; it can last from a few months to 10 years but is on average around four years. During perimenopause oestrogen levels start to drop, causing many of the symptoms associated with menopause like hot flushes, brain fog, loss of libido and vaginal dryness. It is a period of fluctuating hormones, and one of the first things a woman might notice is irregular periods and mood swings – some women describe this like more pronounced pre-menstrual tension (PMT). Because symptoms can appear in the early to mid-40s, many women don't attribute them to perimenopause and get worried that there may be something wrong with them. Usually, a visit to the GP can reassure you that your symptoms are menopausal and part of a completely natural process.

Is there a test for menopause?

A menopause test will typically measure follicle stimulating hormone (FSH), which rises to stimulate egg production. More comprehensive tests also measure oestradiol which falls as you get closer to menopause, as well as luteinising hormone (LH) which will also be higher than normal.

Your GP is unlikely to offer you a blood test to diagnose menopause, especially if you are over 45 and your symptoms indicate that menopause is the most likely cause. This is because your hormones can fluctuate significantly in the years before menopause and you could get a misleading result. Being perimenopausal means that your reproductive system is declining, but it doesn't always mean that you can't get pregnant. Even if you are experiencing symptoms, you should continue taking your usual contraceptive until your periods have stopped for a year.

A menopause test is more useful if you are experiencing symptoms of the menopause at a younger than expected age (under 45); or if you want to rule out other conditions, like a thyroid disorder, which share similar symptoms.

How is menopause managed?

Symptoms for menopause can range from mild to severe. Women who only experience mild symptoms may transition through the menopause without needing any help, whereas women who experience more pronounced symptoms may be offered hormone replacement therapy (HRT). HRT aims to restore hormones to more youthful levels and can alleviate common symptoms.

Menopause is an entirely natural process and, far from indicating the end of useful life, can mark the beginning of a new era. Being able to talk openly about symptoms, having an understanding and accommodating workplace, and getting support if you need it, are all essential factors in coping with the physical and mental changes that accompany menopause. This generation of menopausal women have pioneered new attitudes by removing stigma, raising awareness and having their voice heard.