Getting The Facts About Menopause Straight

This is based on Mutton Club editor Rachel’s solo Magnificent Midlife podcast.

I’m 56, 15 years post an early menopause diagnosis. I thought that by now, I could’ve moved on from menopause. But because of what’s going on in the menopause world, I keep finding myself dragged back. I’d hoped to move on now to the science of aging and how we can age better and how we can change the world view about aging, particularly for women and gender ageism. But there’s still so much I need to say about menopause because there’s so much work still to be done on redressing the balance.

More voices taking a different view

I’m very grateful that finally we are hearing other voices questioning the prevailing negative, HRT or bust narratives about menopause, certainly here in the UK, and I’m talking very much about the UK. But what alarms me is that some of what is being discussed and happening here is spreading elsewhere. If you’re not in the UK, you may be able to take on the mantle for me and stop it happening where you are.

We’ve heard recently from  Dr. Ellie Cannon in the Daily Mail. I’m not a fan of The Daily Mail. But I do like their recent menopause coverage. They’ve had two articles by Dr. Ellie who has really made the link between menopause advice and money. What is the motivating factor behind what somebody is saying about menopause? And who are they?

I think it’s very interesting that there are very few solely NHS (National Health Service) doctors pushing HRT, but there’s a lot of private ones. Every time the private menopause doctors write a prescription and or do a consultation, that’s money in their pocket. So the more  women they can convince that they need HRT for menopause, and they need HRT forever, the more money they make. Dr. Ellie made that link – she said, do the math yourself, work it out.

We’ve also heard from Dr. Anice Mukherjee, who’s had breast cancer. She was on at the end of the Davina McCall documentary about menopause and was the only person talking about diet and lifestyle. We’ve also heard from Dr. Liz O’Riordan who was a breast cancer surgeon who got breast cancer.  She’s been very alarmed at the narratives about HRT being safe for women to take if they’ve had breast cancer, or if not completely safe, then not too dangerous. She’s very concerned about that and she’s been writing about it and doing social media posts about it.

Negativity and deficiency

So we’re seeing some more narratives out there, but there’s still so much negativity and this idea that we are hormone deficient when we go through menopause – I can’t bear that deficiency word. Because as a postmenopausal woman who’s not taking synthetic estrogen, I do not feel deficient. What are we saying to the world about women post menopause who are not ‘replacing the hormones they’ve lost’?

We’re actually supposed to lose those hormones – so we’re not replacing with hormone therapy, we’re adding. But if we persuade the world that we can’t function, we can’t be vibrant, engaged, clever, magnificent women in the second half of our lives without topping ourselves up with synthetic hormones, then what does that tell the world about older women?

This is what really upsets me, because I’m not going to be told that I’m in any way less, because I don’t have these hormones in my body. I’m supposed to not have these hormones in my body. I like not having these hormones in my body. I’m always saying estrogen doesn’t go away completely, the body still creates estrogen. It’s just in a lesser amount and a different kind. But it’s what the body is supposed to do.

And when we get into not only this deficiency narrative, but that menopause is the gateway to a host of later life diseases, and that if we don’t take the HRT, then we’re going to be at risk of osteoporosis, Alzheimer’s, heart disease, diabetes, depression, even early death. Then what does that say about life after menopause? I can’t really get my head around it.

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Finding inspiration for alternative narratives

I haven’t quite got my argument crystal clear yet. But I always go back to two things in my head. I go back to the whales who go through menopause and they become the leaders of their pods. It’s a matriarchal society, the younger male whales, they die off, but not the female ones. Women are of more value to society as leaders than as breeders, when we go through menopause.

We see something similar in other human indigenous societies and cultures. If you look at indigenous societies and other cultures, when women stop being fertile, their status rises exponentially. In indigenous societies, a woman often experiences very little in terms of symptoms of menopause, other than a cessation of periods.

She might be looking forward to it because of that status change, because she’s fed up of bleeding every month, because she’s fed up of having to have responsibility for all the children she’s producing. She’s free of all of that, she’s free of any hormonal rollercoaster that she may have experienced month to month.

The other thing I go back to is the Blue Zones, the places around the world where people, men and women, live to a great age, and they live very healthy lives, and they have a healthy, older age. Women especially, they’re living into their hundreds.

Well guess what? They didn’t need HRT to get them there. They don’t have HRT. It’s about their diet,  their lifestyle,  their mindset, and their social interaction. They celebrate their age. They celebrate every day, they’re on the planet. They’re full of joy and exuberance. And they have a very strong social network in real life, not online.

Let’s take inspiration from the whales and from the women in the Blue Zones. And if anybody tells you that you have to take HRT for menopause, and you are menopause age or beyond, if you’re 51 be curious about why you’re being given that advice.  

My early menopause diagnosis

I was given an early menopause diagnosis at 41. Who knows whether it was right or wrong, but that was the diagnosis I was given. I was advised to go on HRT and given a prescription for the pregnant mare’s urine HRT on my first interaction with a doctor about menopause. I didn’t fill that prescription. I didn’t want it. I didn’t want to have pregnant mare’s urine inside me.

The formulation is usually different now. I ended up going to see a menopause specialist, Dr. Nick Panay and his team at Queen Charlotte’s Hospital in London. I was put on the so-called body identical HRT which is made from yams, which felt better. But it’s still synthesized, it’s still synthetic, it still comes in plastic and metallic containers and doesn’t look particularly good for the environment.

I eventually went on HRT, because I was found to have borderline osteopenia in my hip. And I thought, okay, suck it up, Rachel, because the narrative was, if you go through early menopause, that I should go on HRT until the time of average menopause age of 51, to protect my bones and heart from less years of estrogen. So that was always my plan. So I did replace the hormones. I did have hormone replacement therapy, until 51.

But at 51, I didn’t feel I needed to continue with the HRT and I wanted to come off it because I don’t like being on a medication unless I absolutely have to. Because this is the other thing, nobody knows the long-term impact of HRT, because it hasn’t been around long enough. The formulations are changing.

The long-term impact of hormone therapy

We can’t really compare research about hormone therapy earlier with research from now, because now we have a better, safer formulation. And what each of us puts into our bodies in terms of other products is also completely different. And air pollution is worse etc. etc.

I was given the pregnant mare’s urine version just 15 years ago. Not that long ago. We don’t know the long term impacts of the old or newer formulations. The newer formulations have only really been available widespread for women since I went on HRT when I was 44/45. So that’s 11/12 years that some of us have had the new formulations. That’s not enough time to know whether something is safe when we get to our 70s or 80s.

We’re only now learning the impacts of the contraceptive pill. I’m the contraceptive pill generation, I went on it as soon as I legally could without my mother knowing. Then I went on it for quite some time. Who knows if that impacted my early menopause diagnosis, we just don’t know. So when anybody tells you categorically that something is safe, please question that.

Why are they telling you that? What do they stand to gain from telling you that? And is it true? I don’t believe we can possibly know what the long-term impact will be on me, for example, at 56 now? What will the impact of the HRT be when I’m 66? When I’m 76? When I’m 86? We can make some suppositions, we can extrapolate things, we can say yes, we think this is probable. But nobody can say categorically.

Symptoms and what else might be going on

I don’t believe the deficiency narrative helps older women. And I don’t believe the negativity around menopause helps us either. Because if we believe it’s going to be terrible, then it can become a self-fulfilling prophecy. And it will be terrible. Whereas if we believe it’s this amazing transformation that allows us to reconnect with who we are now, and who we are becoming, and embrace this amazing third chapter in our lives, then we may just breeze through it.

We may have some issues, but then we need to tackle them. I talk in the book about how I see menopause symptoms as the canary in the coal mine. I believe menopause really is a gift to us in midlife, because when our hormones start to change, our body is telling us that it can’t process things in the same way and that we need to make changes. So if we make those changes, we can have a better experience of menopause. And many of these things are still not being talked about.

I believe there really is a cost to modern life. I think there’s a reason why menopause is much worse in the west than in other cultures. It’s worse in so-called developed cultures than perhaps not so developed cultures. And I believe it is this cost to life.

We eat too much, we’re overweight, for example. Nobody wants to talk about weight in the context of menopause because women don’t want to hear it. Dr. Liz O’Riordan put a post on social the other day asking, “how do I tell women that obesity puts them at greater risk of a recurrence of breast cancer when they just don’t want to hear that”?

Women don’t want to hear it about menopause either. But if you’re hand on heart overweight in midlife, you’re likely to have a worse experience of menopause. It’s your body telling you to do something about it. But women don’t want to hear that.

Stress is massive, I find it really interesting that all the celebrities and politicians and everybody talking in very loud voices about how women have to be able to get their HRT, and it’s absolutely terrible that they can’t get it, and if men was suffering like this, there’d be HRT on every shop floor, and you’d be able to get it with a snap of the fingers, and the government needs to pull their finger out, etc… they’re all in very high stress positions.

I have no doubt that my early menopause diagnosis was brought on by me living a very stressful life. I worked in the financial City of London, I’d worked in London and New York, I worked in financial communications so it was Stock Exchange driven, really high powered. And I’d been doing it for a long time, I’d gone through a divorce, I’d gone through 9/11, I’d moved continents. I had lived a very stressful life.

Women are told we can have it all. I believe we can have it all, but not all at the same time. Menopause is a time when we have to stop – not completely, but from time to time to replenish. The body is telling us to stop, you’ve got to pause. In the book, I write about me, no, pause,  menopause.

I don’t do what the supplements advertising says –  me no pause, I keep going with my supplements. No, I say me, I’m going to start thinking about me, putting me first; I’m going to start saying no; and I’m going to pause. Because if I don’t, I’m going to get into trouble.

That’s why I see menopause as this gift. Because we can take the hormone therapy, we can mask those symptoms. But if we don’t deal with them, who’s to say that those things aren’t going to cause all the problems in later life that we’re having to take the panacea of HRT for, supposedly forever, according to some people, to protect us from all those things.

Because guess what? Sugar is bad. Stress is bad. Being overweight is bad. Not enough exercise is bad. Alcohol is pretty damn awful in menopause. At time of writing, I’m five weeks alcohol free. And if you’ve listened to my podcasts where I’ve talked about alcohol in the past, you’ll know I like a tipple. And I’m not very good at moderation.

So I’ve decided for now I’m going to have a break from alcohol. I feel fantastic. I feel really good. I’ve got less anxiety; I’m way more productive because I’m not sluggish the next day;  exercise is so much easier to do; I’m running better; I can do my yoga better. My head feels crystal clear.

These things are not being talked about. Because we’ve got used to wanting something to ‘fix’ it. We don’t want to do the work. In menopause, you have to do the work, you have to do the external work and you have to do the internal work because you are moving into a new phase of your life.

You’re moving into something quite different. So there’s quite a bit of work to be done. But I find that exciting. I find that interesting because if you do the work, it really can be a magnificent midlife and beyond.

Let me just reiterate that these diseases we’re supposed to be at risk of are associated with age. They’re not caused by menopause. There are women now who’ve had breast cancer and who’ve been told they can’t have HRT and are reading that if they don’t have HRT they’ll be at risk of Alzheimer’s, heart disease, diabetes, early death, depression, osteoporosis. They will be at risk at those if they don’t take HRT. How are these women who’ve had breast cancer supposed to function?

And guess what? If they get stressed and worried and anxious about their inability to take HRT because their doctor has told them they can’t take HRT because they’ve had breast cancer, what does stress do? It makes the menopause issues worse and potentially makes them more at risk of disease, because it can impact the immune system. So it’s a vicious circle. So we have to stop these negative narratives. We have to stop this vicious circle, we have to rebrand menopause, we really do.

The accuracy of data around menopause

I want to talk about data, because data is driving me nuts. There’s a figure that was quoted in a UK parliamentary inquiry, 900,000 women have left work because of menopause. Almost a million. This is still on the Wellbeing of Women website, as a way of getting companies to sign up to their Menopause at Work campaign. Menopause at Work is great. But using dodgy statistics to encourage people to sign up is wrong, but this figure is everywhere. It’s in the Guardian, Times Sky News, on HR websites.

The Financial Times head of talent acquisition quoted it on LinkedIn, in connection with the Financial Times being a proud signatory of the Menopause Workplace Pledge. Kudos to the Financial Times for signing up to the Menopause Workplace Pledge. Not kudos for quoting a figure that is incorrect. But if the figure is quoted in the UK parliamentary inquiry, and it’s on the Wellbeing of Women website, you’d think it was correct wouldn’t you?

I spoke to Wellbeing of Women and they told me it came from research done by Bupa. They gave me further links as reference. So I followed a link to an article I thought was the actual research but it was another article. I eventually tracked down a woman at Bupa Health Clinics, Alana Linney, who had written: “Our most recent research found that almost 1 million women have left a job because of menopause symptoms, exposing UK businesses to the threat of losing their most experienced female talent.”

There was no further link to any research. So I rang Bupa, and they then supplied a press release. What did the press release say about the research? They said it was commissioned by Bupa health clinics and conducted by a company called Censuswide. 1000 UK women were surveyed in September 2019. There was no demographic information other than that women were surveyed, there was no information as to how the women were selected.

The survey explored four main female health events that cause women to take long term leave. These were periods, fertility struggles, pregnancy and menopause. The women surveyed appear to have been aged 18 to 70. The survey press release reported only one finding specific to menopause. It said women who have taken long-term absence from work because of menopause take an average of 32 weeks to accommodate the symptoms which range from depression, anxiety, hot flashes and mood swings. During this stage of life, which can start in a woman’s early 40s, almost a million women have left their job completely.

So according to the press release, what the survey actually found was this, that 4% of their total of 1000 women had left their job completely during this stage of life. I asked Bupa about the question asked to reach the 4% figure. I was told it was, “Have you ever left your job because one of these events became unmanageable alongside work? The events researched were periods, fertility struggles, pregnancy and menopause, not just menopause.

So how did they get to a million? It seems they used their 4% figure and they expanded it to include the entire UK population of women aged 18 to 70. Spot the deliberate mistake, not just women of menopause age. There was no source quoted for the population figure. But it’s the exact same figure for all women aged 18 -70 in the UK population estimates for 2018.

They extrapolated this figure from a survey of just 1000 women, with no evidence of representative sampling, asking vague questions and then extrapolating the findings to an inappropriate and incorrect population. But you know what? Bupa got phenomenal press coverage from this PR survey. And then they launched a £250 a year menopause plan in addition to their regular health insurance.

I used to work in PR, so I know all about doing a survey to generate press coverage. It’s a useful tool in the PR arsenal. Some journalists love them because they’re easy copy. And of course, dramatic headlines get lots of eyeballs, which means more advertising revenue. Follow the money.

It was staggering, really. It’s worth noting that 4% of 1000 is 40 women. So all of this misinformation off the vague responses of just 40 women. But how many times do we see that figure – since 2019? 900,000 women have left work and sometimes it’s a million. In March 2022, the CIPD, which is the Chartered Institute of Personnel Development, held an online event about menopause in the workplace in which a ‘menopause trainer’ told the audience that 900,000 women are leaving the workplace because of menopause every year.

Can you see why I get annoyed? Other examples? Carolyn Harris MP is a member of parliament and has been spearheading the HRT campaign. She went on Loose Women to talk about how terrible it was that women couldn’t get their HRT. And she said, what about all the midlife women in prison because of bad decisions they made due to menopause? So we’re now blaming menopause for women in midlife being in prison?

Menopause, suicide and staying curious

Let’s talk about menopause and suicide which is a really difficult subject. I know there are instances of women of menopause age having taken their own life. And that is terrible, any suicide is terrible. But we keep being told that the rate of female suicide is highest in the menopause years. And it’s left hanging because, therefore, menopause is to blame.

But if you look at the statistics, as I’ve done, the rate of increase for men, is also highest during that period, over midlife around the age of 50. But they don’t go through menopause or not female menopause anyway. And their rate is nearly three times higher than women.

There’s a lot going on in midlife: there’s empty nest syndrome, older parents to look after, gendered ageism kicks in. When women feel they need to dye their hair just to stay in work, let alone move jobs, there’s something wrong with our society.

There was another piece of research that talked about menopause making women feel invisible. It’s not menopause doing that, it’s ageism doing that and it’s internalized ageism, because we tend to buy into the fact that our value decreases as we get older, and we shrink, we don’t take up space, we don’t become the matriarch whale leading our pods, we shrink back into the background.

Back to suicide. The other thing is that there is never just one reason for suicide. But again, it makes for good headlines. But women and men, they want better information about menopause, not frightening headlines, and the shocking claims may get reactions and may be likely to increase web traffic. But misleading information can undermine the integrity of those associated with it and the discussion itself. And as the old adage goes, correlation does not equal causation.

I actually sent my research to the Samaritans. What they said in response to my post was, “We know that there has been increased interest in this area recently, but unfortunately, there are a lot of unknowns due to limited evidence based on these particular issues. However, we do know that suicide is complex, and is rarely the result of one thing. A combination of psychological, social and physical factors contribute to a person’s risk of suicide. And it’s important that we don’t oversimplify the reasons why somebody might take their life as it can impact vulnerable people.”

We get back to the concept of ideation there. If we tell women that menopause is a time when they may well feel suicidal, then they may well feel suicidal. And that’s what really worries me. That is why I get up on my soapbox, and I rant. Because women deserve better.  Some women may commit suicide, but there could be all sorts of other reasons. And guess what, and this is going to sound really awful. But it may help the people left behind to have menopause as the reason. Because then they don’t need to deal with all the other stuff that might have been going on.

We have to be so careful with data, we have to go back to the source. Dr. Nighat Arif, who’s done amazing work on raising awareness of menopause, throws out information that isn’t verifiable. Again on live TV, on breakfast television on ITV, she said that one in four women contemplate suicide because of their menopause symptoms. There’s no research on that! I don’t know where it comes from. Does it come from a recent survey that found that actually one in four women said they contemplated leaving work? Did she get it muddled – between leaving work and suicide? I called her out on Twitter, she didn’t respond.

But this is why I’m still stuck in menopause. Because I can’t bear this level of misinformation, this cavalier attitude towards data and giving women the information they need and sometimes people just making shit up, because it suits a certain narrative.

One woman’s negative experience of menopause, whether they’re a politician, a celebrity, someone who’s taken their own life, their negative experience of menopause does not have to become the blueprint for the rest of us. So I would urge you all to be suspicious about what you hear. Stay curious, and decide what narratives work for you.

If you want to go with my whale narrative, then you come along and go with my whale narrative. And let’s have this army of magnificent postmenopausal women, changing the world and let’s empower younger women to know what’s coming for them so they’re prepared, not scared about menopause, they know what they can do to make their menopause experience better, they can embrace this period of deep transformation as something positive that’s going to make them grow into the next iteration of who they were always meant to be.

The business of menopause

I also want to talk about the business of menopause. A July 2022 report found that the global menopause market size is expected to reach $24.4 billion by 2030. It’s expected to expand at a compound annual growth rate of 5.29% from 2022 to 2030. There are an awful lot of people who want to make an awful lot of money out of women going through menopause. The Female Founders Fund conducted research concluding that responding to the needs of women experiencing menopause is a $600 billion opportunity for companies.

We’re just another way for people to make money. Menopause and menopausal women – let’s just milk them for every penny they’re worth. Let’s tell them they’re broken, and that they need fixing. And if they need fixing, we can sell them products to fix them. Whereas actually, what most women need to do is fix their diet, fix their lifestyle, change their mindset, don’t succumb to ageist narratives, do lots more exercise, weight bearing exercise for their bones and muscles, aerobic exercise for their heart, yoga or Pilates to stretch out all of those muscles. They need to stay engaged with the world and believe they are magnificent.

We don’t need special new products. We don’t need menopause skincare. We have skincare for older skin. That’s fine. It’s enough. There are good products on the market already. I interviewed on my podcast the founders of Cucumber Clothing, with nice fabrics we can wear if we’re suffering from a hot flush. But we need to think about why we’re having a hot flush. It’s not just the hormones. Are we drinking too much caffeine? Are we having too much sugar? Are we drinking too much alcohol? Are we too stressed?

Are we just a $600 billion market opportunity for companies? And who is it that makes lots of money when they sell us lots of HRT? The drug companies and the private doctors. I’m having a hot flush, just thinking about all this. Do we have a $600 billion marketing opportunity for companies for puberty? Menopause is puberty in reverse.  Yes, it may be difficult, I am acknowledging that it can be difficult, but there are reasons as I hope I have expressed here as to why that may be the case.

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I’m delighted we’re talking more about menopause but we’re saying the wrong things. The wrong things are the ones that are being shouted loudest. The small voices have to come through too so we get a balanced picture. Thank you for reading. Go out there and be absolutely friggin’ magnificent.

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Last Updated on January 16, 2023 by Editorial Staff