Menopause and life stage

Menopause is a topic of interest; shortages of HRT and access to it, prescriptions for women at reduced cost and workplace policies to support women are all in focus. There was a lot of scare mongering about HRT in past decades and risks of medication were magnified. Now HRT is produced in different ways to mitigate risk and access to HRT is getting easier. Most women won’t need HRT and there are other complimentary therapies and herbal treatments that can reduce troubling symptoms alongside life style changes. But the cessation of menstruation goes beyond the diagnosis and medication of physical and mental symptoms. It goes beyond the quick-fix reasonable adjustments at work by ‘buying up fans’ for the offices for female workers ‘of a certain age’.

Menopause does not occur in isolation – it takes place within a gradual process of physiological change and socially determined developmental and changes which are all interconnected at this stage of life.

There are cultural differences in the reporting of common physical and emotional symptoms from hot flushes, night sweats, irregular and/or heavy periods, depression, headaches, insomnia, anxiety, fatigue, brain fog and weight gain. In Western culture, women tend to report such symptoms, but they are less reported in India, Japan and China (Freeman & Sherif, 2007). This may be partly attributed to underreporting in certain societies where stigma of women’s health issues continues. In Japan, headaches, chills and stiffness are the most troublesome menopausal symptoms.

In other studies, the onset of menopause is seen more positively. There is increasing evidence that a range of culture-related factors, such as lifestyle (smoking, diet e.g. soya, exercise and reproductive history), socio-economic status, body mass index, mood, climate and cognitions (attributions of symptoms to the menopause, beliefs and attitudes towards menopause and beliefs about the status of older women) might explain cultural variations in reports of menopausal symptoms and wider perceptions (Andrikoula & Prevelic, 2009).

Impact of history, attitude and beliefs on menopause

Menopause can worsen mental health and impact those who are already struggling worse. Women who have lower mood tend to report hot flushes as more problematic. Some evidence suggests that adverse childhood experiences (Thurston et al., 2008) and stress influence hot flush reporting possibly because of the increases of cortisol levels (Cooper, 2007). Women with moderate or high anxiety levels were three and five times more likely to report hot flushes than women in the normal anxiety range (Freeman et al., 2005).

Life stage

Attitudes that can support more positive experiences of menopause symptoms include notions of this as a natural life stage where benefits are clear e.g., loss of troublesome periods, coming of age and increased liberty. However, many women report that this life stage is very burdened with teenage children or young people in the family moving out or remaining at home longer than expected or elderly parents taking up free time. There may be a biological urge for mothers to work harder to ‘fix’ their young adults in preparation for their increasing independence at the same time as young people seeking more autonomy to lead their own lives. Additionally, some women change relationships and risk increased isolation (likelihood of divorce or separation increases as children approach higher levels of independence). Women can find they are more removed from sustaining social groups they made around their children as they move further away from their children’s lives.

Physically, women in the menopause are more likely to be putting on weight and less likely to be exercising and more likely to drink more alcohol. These things can impact mental health. Alongside sleep interference, the impact on mental health can be doubled.

In some societies women in mid-life gain status as wise and respected, ‘grandmothers’  or with greater access to pursue careers without the burden of childcare but the change in sexual attraction, lost youthfulness, declining reproductive capacity and physical changes may be viewed negatively. Some women describe they feel like they are ‘disappearing’ and are not heard. Other women in one study, were concerned about ‘falling apart, decline and aging, the loss of work, not being needed and reducing career opportunities and decline and decay.’ Agism and sexism in western societies may impact how women feel about themselves in this context and life stage.

What can work do to help women

• Build awareness about menopause, impact and support available.
• Whole person approach to menopause within a wider understanding of social and developmental factors.
• Provide an environment where individual women can feel supported in this and every life stage. (Avoids stigmatising women and blaming them)
• Encourage conversation about what helps women with impacted women– encouraging them to identify their own issues and solutions.
• Flexibility and adjustments to meet their needs.
• Promote a bio-psycho-social-cultural approach to this stage of life.
• Ensure women are aware of opportunities for development and selection within Equalities policy irrespective of age/gender.
• Appreciation of wider care roles – support for parenting and carer roles
• Wellbeing for women – Mindfulness, exercise, discussion on menopause issues, social networking and social activities which strengthen bonds of friendship.

For those who need more help

Employers can encourage women to access their GP for support and can steer them towards coaching and wellbeing, counselling or NHS Talking therapies. There are a range of interventions that can support women in their struggles. Cognitive behavioural therapy or coaching has been developed with promising outcomes, suggesting a 40–50 per cent reduction in hot flushes and their problem ratings. The CBT blended approach is psycho-educational with individual goals and a focus on cognitive and behavioural changes. The benefits of cognitive behavioural therapy and integrative counselling go beyond the physical symptoms of hot flushes to the underlying worries and experiences of individual women navigating the challenges of a complex life transition. The evidence is, that when we support women through this stage, they go on to experience one of the happiest periods in their lives.

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References

Andrikoula, M. & Prevelic, G. (2009). Menopausal hot flushes revisited. Climacteric, 12, 3–15.
Cooper, I.A. (2007). The hypothalamic–pituitary–adrenal axis: Cortisol, DHEA and mental and behavioural function. In A. Steptoe (Ed.) Depression and physical illness (pp.280–298). Cambridge: Cambridge University Press..
Freeman, E.W., Sammel, M.D., Grisso, J.A. et al. (2001). Hot flashes in the late reproductive years: Risk factors for African American and Caucasian women. Journal of Women’s Health & Gender-Based Medicine, 10(1), 67–76.
Freeman, E.W., Sammel, M.D., Lin, H. et al. (2005). The role of anxiety and hormonal changes in menopausal hot flashes. Menopause, 12(3), 258–266.
Freeman, E. & Sherif, K. (2007). Prevalence of hot flushes and night sweats around the world. Climacteric, 10, 197–214.
Thurston, R., Bromberger, J., Chang, Y. et al. (2008). Childhood abuse or neglect is associated with increased vasomotor symptom reporting among midlife women. Menopause, 15(1), 16.
Thurston, R.C., Sowers, M.F.R., Sternfeld, B. et al. (2009). Gains in body fat and vasomotor symptom reporting over the menopausal transition. The Study of Women’s Health Across the Nation. American Journal of Epidemiology, 170(6), 766–774.