When it came for me, I was not ready for it. I was anticipating it, but far from ready for it. As a medical doctor, I had read all about it, I knew the details of its physiology, symptoms, endocrinology, clinical and physical implications, but it still caught me off guard. Maybe because it came to me earlier than the average expected age, or because it came at a time when I was feeling physically fitter and healthier than I had done in my 30s. Then again, maybe you can never really be ready for something that announces your entrance to the silver age so loudly, rudely and abruptly.
It was difficult for me to accept menopause or to talk about it to anyone - my husband and even my girlfriends. I turned to online resources for support groups, to find reconciliation with strangers in the forums. But that further alienated me. Staring back at me out of web pages were short, silver-haired women, dressed in conservative, grandmother-style clothing, a faint smile of acceptance brightening their faces. There's nothing wrong with that image, but I could not identify myself with it. I had two small kids in school, with long lists of extracurricular activities. I was working full time, mastering my headstand in yoga, could not walk without my high heels, Forever 21 and Abercrombie & Fitch were still two of my favourite stops at malls. How could I be one of them?
Hot flashes came to me unannounced and so shamelessly that I was left speechless. I learnt in medical school that sleep disturbance is one of the symptoms of menopause. But nowhere did it mention the sudden jerky awakening at the exact same time (2.20am for me) every night, feeling as if an army was marching in my heart, being so restless and agitated that I had to convince myself the apocalypse was not happening at that moment. Drenched in sweat, I would spend up to two hours pacing the house or tossing and turning in bed like a fish out of water, my thoughts straying to the darkest corners of my life, until the savage fluctuations of hormones took its toll and I would slowly and numbly drift back to sleep. I would wake up drained and more tired than when I went to bed.
The next logical step was to take action; I had to do something about this before I went nuts. I visited my gynaecologist, made phone calls to friends who are family doctors practising in Canada and the United States, and talked to some health-conscious, up-to-date friends who I knew had their own battles with menopause.
What I got were pats on my back, sympathy for my going through menopause so early in life and reassurances that it would get better with time, and in the meantime I could try meditation, soya, primrose oil, acupuncture, sleep-aid medicines, antidepressants and so on.
The most confusing and diverse reactions came when I asked about hormone replacement therapy, which can increase the risks of cancer, stroke and heart disease. I got astonished looks from colleagues, asking: "You are a cancer doctor and you really want to have HRT?" And on the other end of the spectrum, I got a full-fledged, carefully tailored plan.
I was confused. May I emphasise that I am a doctor, and I was confused - on many levels. I was confused about which doctor to go to: gynaecologist, family doctor, endocrinologist, or maybe internal medicine? Whether I should start with acupuncture and mindful breathing or continue with yoga?
Then there were the lifestyle-modification recommendations, which are always easier to preach than practise: exercise more, reduce weight, reduce your coffee intake, stop smoking and reduce stress. I am not overweight and do not smoke, but I cannot imagine a very relaxed state of mind resulting from these two modifications alone when you are already a wreck. Take my morning coffee away and I will be stressed the whole day.
Hormone replacement therapy, considering the controversy surrounding it, came with a longer list of questions - oestrogen alone, or combined with progesterone? Oral, gel, transdermal or patch? What about bioidentical hormones? Is it all just hype or is it worth the money? Does HRT really increase the chances of cancer? After how many years, what is the percentage? And what about the dose of testosterone that many menopausal celebrities such as Kim Cattrall and Jane Fonda are swearing by?
Menopause has become a word more unmentionable than "period" these days. Periods are what young, fertile women have. Whereas menopause. well, we just don't talk about that, darling. Get some work done, work out more, stop eating carbs, hate your body and lie about your age, just don't talk about menopause.
For those of us who break the social taboo and start to openly speak about our experience, it is very common to hear: "You are fussing too much", or "Aren't you relieved not to have the code red in your life?" I have been gently, and sometimes sarcastically, reminded that I should take it easy, accept the natural process of ageing, that hot flashes are going to subside and my body will adjust to this new phase.
I would like to ask these people, what should I adjust to exactly? Continuous loss of mental sharpness? Gradual deterioration of my many valuable organs? Help, anyone?
I was not ready to settle for all these horrible body changes. If I am fortunate enough to enjoy the average life expectancy for women, about 73 according to the United Nations World Population Prospects 2012 Revision, I have a third of my life ahead of me. I want to maintain the best body and mind to enjoy my life, to enjoy my kids and see them grow up. Since when has it become so acceptable in modern medicine to settle, accept and observe?
Once a medical student, we are students for life. We are always looking for an excuse to study, and I could not find a better reason than the one that was confronting me. I started researching so I could sharpen my knowledge in an area that was not my speciality. I read articles, the latest publications, used online resources, followed blogs and bought books.
In the 1950s, the global average life expectancy for women was 50 years, in perfect harmony with the age of our ovaries. Not very long ago, our hormones used to serve us until the last breath. In the past half century, thanks to advances in therapeutic and preventive medicine, our life expectancy has climbed quite high and pushed to above 80 years.
But wait, 30 extra years and no oestrogen? Do not underestimate the power of oestrogen. Besides giving women their dreaded monthly periods and helping them get pregnant, oestrogen affects almost all the important physical and mental functions: memory and nervous system, cardiovascular system, gastrointestinal and urogenital tract, skin, musculoskeletal system and liver, just to mention a few. A lack of it will adversely affect every one of those systems. And this will obviously continue even when your hot flashes fade and your sleep goes back to normal.
Nature is so wise. Those tough and intolerable first few months (to years) of pre-menopause, with the sweating, palpitations and mood swings, is a red alert for a system about to fail. A warning to be proactive, to do something about what's to come.
The more I studied, the more it became clear how complicated and multidimensional the issue is. The great revelation, of course, was that we do not have to settle, suffer, accept and adjust. There are options. Effective medical and non-medical remedies, founded on evidence-based and experience-based medicine, both hormonal and non-hormonal, are out there. But this has to be tailored to one's medical background, needs and priorities.
Considering the number of organs affected by menopause, many medical specialities could be involved to manage the condition. Traditionally, women tend to visit their gynaecologist, with family medicine doctors and general practitioners coming is as the second and third choice. But endocrinology, internal medicine and plastic surgery are specialities that could also be involved. And important contributions can come from alternative medicine and para-medicine including homoeopathy, psychiatry, nutrition, fitness consultation and acupuncture. It is indeed a multidisciplinary case, better to be carried out under one roof.
I was able to tailor my treatment plan, which has helped me tremendously - physically and mentally. But I have come to realise how frustrating an experience it can be for those who seek medical help. With so much confusion about how menopause can be managed, some ultimately tune out of the discussion.
I believe women deserve some guidelines and helpful tools. They should be aware of the options so they can engage their doctors in meaningful conversations about the choices available to improve their menopausal symptoms.
It's a new chapter in your life and there are ways to make sure you are healthy and happy in the lead-up to and during menopause, as well as in your post-menopausal years.
Aslani's advice:
Increase your awareness. Knowledge empowers you to shape the situation and ignorance empowers the situation to shape you. There is a wealth of information available just clicks away on websites and blogs and there are many good books. Before visiting your doctor, educate yourself.
Choose the right doctor. Preferably a menopause practitioner or someone who has experience in handling menopause. Look up CVs, get recommendations or search online forums. On your first visit, let your physician know that you want to be proactive and take charge. He/she must have an open mind about exploring options that best suit you. No matter your medical history or your future priorities, there are alternatives available. Consider getting a second opinion, or switching doctors if you have any doubts regarding management, are feeling rushed, or if you cannot establish a favourable connection with your doctor. Remember that sometimes finding what is best for you is a delicate process and a matter of trial and error. Just be sure to maintain an open communication with your provider.
Speak up. It is hard enough to go through menopause, but it could be intolerable if you feel alone. Many women feel isolated and withdrawn as a result of the mental, physical and psychological changes, partly because their husbands/partners, children, colleagues cannot understand the changes in behaviour that accompany menopause. Share with your loved ones what you are going through, let them know how and when they can help. Start with someone you trust and you know will listen without judgement. Seeking support during menopause from our family and friends is just as important as considering the many options for symptom relief.
Support groups. Find them - whether in your local community or online - they are invaluable. It's where you can discuss your experiences, share ideas and provide support. It has scientifically been proven that participation in support groups improves the quality of life. It modifies attitudes and beliefs of the participants, expands their knowledge and promotes critical thinking. Probably the biggest advantage of support groups is helping you to realise that you are not alone: this is often a revelation by itself and can be a huge relief.
Maryam Aslani is an Abu Dhabi-based radiation oncologist and host of the Facebook page Menopause and Me.
