By Rachel Lankester
At 41 I found out I’d gone through early menopause. The doctor who told me was as shocked as me. At the time it was a devastating diagnosis because I was trying for another child. I was in a new relationship and had wanted another baby since my son was born nearly 10 years earlier. As we were both not exactly spring chickens, it seemed prudent to get a hormone check to see what the possibilities were. The results came as a huge shock.
There were several things going on that made it such a shocking diagnosis. Firstly the average age of menopause in the West is 51. So I was a whole decade early. I had absolutely no knowledge of menopause but had associated it with a much older woman, not who I considered myself to be. I knew nothing about perimenopause. So I felt catapulted into middle age. Gradually I realized that at 41 I was actually already middle-aged! With average life expectancy of 81 in the UK for women I was right smack in the middle of my life. So much for denial!
The second thing was that I’d experienced no symptoms whatsoever. Apart from the results of the hormone test, there was nothing to indicate to me that anything was amiss. I had a busy and quite stressful career, and I hadn’t even noticed my periods must have been either non-existent or certainly very patchy. So to be told I had the hormone profile of a postmenopausal woman was surprising to say the least. I’m now convinced my high-pressure career and my inability to manage stress levels better were contributory factors to my early menopause.
I suspect nowadays the diagnosis would be different. Or perhaps with a different doctor, the diagnosis might have been different. Since it happened, I’ve learnt the knowledge of doctors (GPs) in the UK, of menopause, is woefully inadequate. This is crazy considering menopause affects 50% of the population!
I’ve learnt over the last decade that hormonal fluctuations during the perimenopause years are normal and can be pretty extreme. Perimenopause is the years leading up to menopause. Menopause is defined as two years after your last period if you are under 50, and one year if you are over. Some doctors are reluctant to test hormones for menopause when a woman is in her 40s because of these day-to-day hormonal fluctuations. But it would appear my doctor didn’t know any of that when he told me definitively I had gone through menopause.
So began a long and at times quite tortuous journey to find out more about what was happening to my body. I had to come to terms with secondary infertility, re-evaluate where I was in my life and who I now was, and process everything that early menopause meant. Standard medical advice then was to go on HRT because of the early menopause. That’s still the case depending on when early menopause hits. The reason I was given for going on HRT was to protect my bones and my heart from the 10 years less protection from estrogen they would normally have had.
Initially I really didn’t want to go on HRT. Even though it had come early, I still saw menopause as a completely natural process in a woman’s life and I didn’t want to take a drug for something I didn’t consider a medical condition. I was offered Premarin which I discovered was made from pregnant mare’s urine so that put me off further. Premarin is still prescribed today which I find quite shocking given I now know there are other alternatives. So for a couple of years I didn’t take any HRT and started exploring other avenues.
The first thing I did was to reach out to the Daisy Network which offers support and information for women going through early menopause. I went to their Daisy Day in June and found it incredibly helpful. Not only did it give me lots of information and great contacts, but it also gave me a reality check. At 41 I was one of the oldest women going through early menopause. I already had one child. Most of the women at the event had gone through only menopause much earlier and before they had any chance of conceiving a child naturally. So what had seemed at first like a devastating diagnosis was quite abruptly put into perspective. The women at the event who had children, had done so either through adoption or egg donation. There were also presentations from women who decided not to try either of those routes and were creating a life that did not include motherhood.
At the event I was introduced to two people who would play a major role in what happened next. First Dr Marilyn Glenville, a nutritionist who specializes in women’s health and particularly hormonal balance. Secondly Dr Nick Panay, a specialist in early menopause who has a clinic at Queen Charlotte’s Hospital in London. Perhaps it was that someone mentioned Dr Glenville having some success in getting women’s periods back, I can’t remember, but I decided I wanted to meet her and get her advice. So my first action was a consultation with Dr Glenville.
This was very interesting and set me on my path towards wanting as natural a menopause as possible. Dr Glenville put me on a restricted diet, gave me a special tincture to take and within a month my periods had returned! This was quite miraculous for me and in retrospect shows how wrong the initial diagnosis was because of the possibilities around hormonal fluctuation in the perimenopausal years. So what did I do in terms of changing my diet? I was told to cut out all caffeine, sugar, alcohol, processed food and have regular meals and snacks so my blood sugar level remained constant. The only sweet thing I was allowed was manuka honey in a very small amount. Even fruit was limited and bananas were certainly off the menu. I was delighted to get my periods back and I quickly went for another hormone test. My doctor was astounded!
The hormone test came back showing a completely normal premenopausal profile. So we went full steam ahead on trying for a child again. But what Dr Glenville did not tell me is that even if I got my periods back, it might only be for a short while before my body resorted to what it actually wanted to do in the first place. Within nine months I was back to my postmenopausal state. Maybe I didn’t keep up with the restricted diet, I can’t really remember. Talk about confusing! When I went back to her clinic and spoke to her colleague, I found out the menopause reversal might not be a long-term one. Kinda wish I’d known that before!
When it became clear my body had again resorted to menopause, I decided I’d better at least consider other options and I requested a referral to Dr Panay’s specialist early menopause clinic. The only real symptom I’d encountered still at that stage was lower libido. So menopause had again just happened without much warning other than periods just disappearing. But who knows if my lower libido was actually because of all the worry about what was going on, feeling a shadow of my former self (having bought into negative menopause narratives) and other life events at the time.
Dr Panay and his team were sensitive, knowledgeable and very helpful. I thought it such a shame that outside of that clinic, there was so little knowledge of early menopause in the NHS. My experience since has shown it’s menopause in general that still seems to be a mystery to many doctors.
I reiterated I didn’t want to take HRT and was told that if my bones were in good shape, that would be okay. So I was sent for a bone density scan to check this out. The scan came back showing borderline osteopenia (the precursor to osteoporosis) in my hip. It was this news that finally made me accept having HRT as I thought, at that stage, it would be foolish not to. Since then I’ve learnt a lot about how to build strength in bones and protect one’s heart. So I’m not sure I would do the same thing again. But then it seemed a sensible idea. I was also offered testosterone for my low libido but I decided against that. That seemed a step too far down the HRT route for me!
It was explained to me that going on HRT would mean I’d start having a regular monthly bleed again. This was very distressing to me. When I’d recently been back to the doctors surgery, a new doctor was heavily pregnant and I found it very difficult talking to her about my problems. I had to actually make sure I never saw her again because I found it so distressing. That reaction from me told me I also didn’t want to be reminded monthly of my infertility by having a bleed that was just a bleed, and not anything suggesting my reproductive organs were still functioning. So I asked if I could take the HRT in a way such that I wouldn’t need to bleed. I was allowed to do this, by taking the progesterone component of the HRT constantly, rather than having a break every three weeks.
So then I stayed on HRT until so-called ‘normal’ menopause age of 51. It was always my plan to come off HRT at ‘normal’ menopause age and that is what I did. I weaned myself off it and have managed both the transition and any symptoms since coming off, with a range of dietary and lifestyle changes that I’ve written extensively about elsewhere.
So here are my key tips if you’re going through early menopause:
- Get yourself a hormone test if you can so you get an idea of what’s going on. But don’t assume the test reflects a permanent reality. As you can see from my story above, hormones can fluctuate wildly during the perimenopausal years, so bear in mind it could be just a snapshot.
- If an early menopause is confirmed, get in touch with the Daisy Network as that will be a very good resource for you to get information, support and contacts.
- Ask for a referral to a specialist early menopause clinic, especially if you are in the UK, or try at least to find a doctor who knows more than most about menopause in general and early menopause in particular.
- Read up on Dr Marilyn Glenville’s website about how to manage menopause symptoms and consider getting an appointment with her or one of her team.
- Make an informed choice about whether to go on HRT. Medical advice is still that you should if you are diagnosed with early menopause, at least until ‘normal’ menopause age.
- Get help with the emotional aspects of going through early menopause – the Daisy Network will be good for this and I saw a therapist to try and deal with my diagnosis and begin to accept it.
- If early menopause ruins your dreams of motherhood, consider ways to still achieve that – again the Daisy Network will be able to help.
- Get your diet sorted, change how you live if necessary and start putting in place things that will enable you to thrive long-term. There are many natural remedies to help and even if you are on HRT, these will be additional boosts for you. They will also help you transition off HRT when you are ready to do that. The changes I’ve made have, I hope, set me up better for long term health than before menopause.
- Find people who understand what you’re going through. Early menopause can be a very lonely experience as none of your contemporaries are likely to be in the same boat. So reach out to women who are, because they’ll be able to help and support you as you come to terms with what is happening.
- If you have a partner, take them on this journey with you. Don’t be tempted to try to cope alone. They may be as confused and upset as you are, and hopefully they will want to help.
- This book is a little out of date now I think, but it was a very useful starting point for me: The Premature Menopause Book – I also read Wanting Another Child – Coping With Secondary Infertility
Remember that, as with most things in life, it will get better. You will come to an acceptance of what’s going on, but be sure to give yourself time to adjust and grieve (I had to grieve the dream of the second child I was never going to have and I needed to be able to do that). Menopause is not the end of meaningful life – it can be a very powerful new beginning.
Early menopause may also turn out to be a gift – honestly! I certainly feel that way about mine. I wouldn’t be doing what I do now if it hadn’t happened. Life would have been very different!
Feel free to reach out to me too. You can find me at rachel @ magnificentmidlife.com. Good luck!
Rachel Lankester is the founder of Magnificent Midlife and editor of the Mutton Club online magazine. She’s had several careers, including banking and PR, but most loves what she’s doing now – helping like-minded women in midlife and beyond feel great and live life to the fullest. She’s rather introverted but still has lots to say, particularly about challenging the negative stereotypes associated with older women. She believes we just get better with age not worse. She loves yoga, running, singing, travel and most things techy. Find out more about Rachel at Magnificent Midlife.