The women who’ll help you through the menopause

No sooner than we are beyond the demands of young children and the ambitious climb up the career ladder, we women have a new life stage to look forward to. Hot flushes, insomnia, low mood, brain fog and weight gain are just some of the some of the delights on the menu for women in mid-life.

The reason for the sudden onslaught of ailments? A change in hormones, particularly oestrogen. During perimenopause, levels of oestrogen and progesterone produced by the ovaries start to fall, leading the supply of eggs to diminish and ovulation – and therefore our periods – to become irregular. Then periods stop altogether.

But the menopause doesn’t have to invoke a sense of dread. It can be a time to reevaluate and restart, focusing more on our health and wellbeing – and there are so many Jewish women at the forefront of a movement helping us do just that.

What exactly is not to celebrate when we no longer have to head out the house every month with a bag full of sanitary products and painkillers, and spare undies in case of leakage? And if our forebears were already resigned to below-the-knee skirts and twin sets by their 40s, it is at least now acceptable on a Saturday night to choose the sofa, Netflix and a bottle of wine – OK, mug of rooibos tea – instead of gallivanting about town.

While menopause was once a topic barely broached by professionals, increasing numbers of doctors are specialising in women’s health and offering newer, safer versions of HRT (the synthetic hormone replacement therapy that minimises the symptoms and effects of the menopause). Holistic therapists and nutritionists are also working to revolutionise women’s health, and they alongside online platforms such as The Latte Lounge, founded by Jewish mother-of-four Katie Taylor, are empowering us to face the change with confidence.

“When I set up The Latte Lounge in 2016, I was pretty much a lone voice,” says Taylor, who is releasing her debut book Midlife Matters in March. “After almost a decade of working in this space, I’m delighted to bear witness to the huge progress that has been made by so many of us grass roots campaigners, menopause specialists and high-profile people.”

She adds that thanks to the Make Menopause Matter campaign, set up in 2018 by her friend and colleague Diane Danzebrink, menopause is now on the school curriculum in England, all medical students will now receive menopause training (from 2024) and workplaces are putting support systems in place for their employees.

“Menopause used to be such a taboo subject and the word ‘peri-menopause’ didn't even exist. Women were leaving the workforce, leaving their marriages and in some extreme cases leaving this world, due to struggling with their symptoms and being too afraid to mention them. Thankfully we are now encouraged to talk much more openly. The menopause landscape today is far more optimistic today.”

Bronya Gorney, a GP with an interest in women’s health and menopause, agrees. “There's a paradigm shift in the level and quality of discussion that I'm seeing amongst women in practice,” she says, praising presenter Davina McCall for sharing her menopause story, setting in motion the topic being in the public domain. “We’re conditioned from a very young age to crack on in silence and grin and bear it, and so much of women's health has been about that. Many women were like, ‘well, this is just part of life. I'm a failure if I can't cope with this.’ I've heard that many times. There's a subtext in our society – this is the message women are given.”

Gorney is now seeing many more women come in with symptoms and wondering whether this might be menopause, and being more open to considering treatment, and says that the fact that they are articulating how they feel is “huge”.

She has also observed a wide spectrum of how women approach menopause. While it can be straightforward for some women who come in saying, “I'm not sleeping, I've got anxiety, I'm feeling full of rage, I’m aching, I think I’m menopausal,” there are others for whom the symptoms are vaguer and trickier to diagnose, such as those who already have mental health problems which may have worsened. What’s more, she says, the menopause itself undermines people's ability to cope or even work out what is going on.

“The brain fog is real, people's ability to think clearly and quickly and make decisions are all undermined,” says Gorney. “It's quite insidious in the way that it can also undermine a woman's self-confidence, in terms of how she shows up in the world and what she's capable of doing. And because people go through the menopause at what is already a complex time in life – they often have ageing parents, children or teenage children, complex relationships, a job, worries – and it can be very easy to dismiss these symptoms, especially the ones of anxiety and feeling overwhelmed, as ‘well, my life has just got so much on.’ Because for most women in their 40s and 50s, there is so much going on.”

What’s more, because it's cyclical there will be some months when everything feels very normal, and then you might go without hormones for a few months, when everything feels awful. So it can be hard to keep track of and to understand why the symptoms are getting worse, then getting better. “It can be very hard to see the wood for the trees.”

Not all women want to take medication; some prefer a holistic approach such as tweaking their lifestyle and nutrition. “But for many women, HRT is an absolute Godsend,” says Gorney. “I have seen so many women's lives dramatically transformed for the better. So many women have said to me, ‘I wish I'd done this sooner.’ The tide is changing. It's really gratifying, because women will come in feeling absolutely hideous, in despair and in tears. And you try some HRT, and they come back feeling so much better.”

When you know just how many places around the body oestrogen affects (and it’s almost every cell), then you really start to understand why we feel so rotten without it. Plummeting hormone levels are accompanied by potential health risks including bone loss (osteopenia then osteoporosis), heart disease, Type 2 diabetes, depression, cognitive decline and UTIs.

“People don't appreciate that,” says Gorney, pointing out that people on HRT have half the number of knee replacements than those who aren't. Although she adds that it is complicated to treat, because sometimes women start treatment and there's some change, but not “the complete miracle that they were hoping for. Sometimes they also need a better approach to nutrition and plenty of exercise.”

Still, only around 15 per cent of women take HRT, due mostly to fear around the medication’s safety, in particular increased risks of breast cancer. Gorney says that GP and menopause specialist Louise Newson has been “pivotal” in training GPs on the latest HRT research to understand the difference between the various formulas and which are safest.

“Not all HRT is the same. The risk profile between different forms, whether it's in a tablet or taken through the skin, varies. There are forms of HRT which are incredibly safe now.”

Prescribing pharmacist Lindsey Lester, who has specialised in menopause for five years and runs Avicenna Menopause Clinic (The Hormone Pharmacist UK on Instagram), says women should feel assured by the newer, safer versions of HRT available. Lester recommends “body identical” treatment which uses hormones that are identical to those the body naturally produces, and says that transdermal (gels, spray and patch) are the safest options, particularly if you are at increased risk of blood clots, stroke or have a family history of heart disease.

“Most of the tablets are more inflammatory and potentially could be less beneficial,” says Lester.

In the Jewish community, we are more prone to the BRCA gene, however, Lester cautions that unless you carry that gene or one that’s associated with breast cancer, to have had breast or ovarian cancer in the family does not necessarily increase your risk. There could be benefits not to overlook.

Around four in five women will notice some sort of symptom, but 25 percent of those will describe it as severe and impacting on their life. Ten percent leave work because they feel they can't cope anymore. While premature menopause is under 40 and early menopause is before 45, the average age is 51 and women are most impacted by the symptoms between 45 to 55 (although symptoms can be experienced in your late thirties).

Gorney recommends that any woman from the age of 40 experiencing symptoms however vague should talk to a GP. “Because there is so much that can be done. There are options out there which will make a huge difference. If you're feeling overwhelmed or achy, that is a good thing to bring to the GP.”

She also stresses the importance of knowing what age your mother went through the menopause, as it can help determine your likelihood. “If your mum had a premature or an early menopause, it does put you at higher risk,” she says. “

It's not coincidental that rates of divorce and suicide are highest for women around the age of 45.

“It impacts the whole family, not just the woman undergoing menopause,” says Lester. “It's a very stressful time; we're kind of in reverse puberty. Imagine your teenage children, and what a state they get into; we're reversing out of that. It's like we were sitting on a chair with four legs, and then all of a sudden someone's sawing away one of those legs, and the body's trying desperately to balance. Obviously, if you're treating the root cause, you're going to put the hormones back.”

However, she says that if you’re among the 25 per cent of women who really struggle, you can't rely on hormones alone and need to look at everything from nutrition to lifestyle. It’s why Lester started working in tandem with Stefanie Daniels, a naturopathic hormone specialist. 

Daniels underwent surgical menopause at the age of just 38 following a double mastectomy and having her ovaries removed after she was diagnosed with BRCA. When she left her surgery, she was handed a leaflet with a list of the symptoms she could expect and prescribed antidepressants.

“You feel too young to face all these horrible symptoms whatever age you are,” she says. “It's horrific, but once you see menopause for what it is, you realise that you just need to make a few tweaks and you can truly feel your best. Menopause is just a rejig of the hormones. You fluctuate in a downward spiral, your oestrogen, your progesterone, your testosterone, and it takes more than hormones to fix hormones.”

During lockdown, Daniels stumbled upon a TED talk on intermittent fasting and its benefits for menopause by Cynthia Fellow, who empowered her to take back control and tweak her diet and lifestyle, tackling one symptom at a time.

She gave up her career in media – which included a stint at the JC – and retrained, taking a three-year diploma in nutrition, before launching Life Begins at Menopause to help other women. What started as a challenging chapter ended up being the gateway to a more fulfilled life.

“It has become one of the best things that's ever happened to me,” says Daniels. “You should be excited because this is an opportunity to get educated and tweak a few things. You can't do things like you did in your twenties anymore. Once you realise that, you thrive.”

She points out that there's no one-size-fits-all manual out there in this “very noisy landscape”, but that we should tune into what's going on in our individual bodies.

“Is there bloating? Is there insomnia? All these are signs your body's trying to talk to you. And if you listen when your body whispers, it won't need to shout. Pay attention to the cues and you can start feeling better than you did before this even happened.”

She realised that she was eating the wrong foods, such as low-fat, and recommends that people up their protein intake as a first measure, followed by essential fatty acids and fibre.

“I always start with protein for my clients, because it balances blood sugar and we suffer from insulin resistance in menopause,” she explains. Blood sugar dysregulation impacts energy levels, metabolism, muscle mass, bone health and weight. Gentle intermittent fasting (which means no noshing into the evening) is also important for maintaining healthy glucose levels.

As for alcohol, gone are the days of being able to metabolise it quickly and bounce back to normality. These days it disrupts our sleep.

Sleep is a key area, so Daniels recommends blue-light-blocking glasses or switching your phone or laptop onto a black-and-white setting if using them late at night, as the blue light from your device disrupts the sleep hormone melatonin, sending a message to your body through your eyes that it's time to wake up and you will not sleep as restoratively. Meanwhile, early daylight exposure is beneficial, so I will be putting Daniels’ daily hack – of looking up at the sky out the window for a few minutes every morning – to the test. She also recommends taking baths infused with Epsom salts and essential oils.

Since our muscle mass deteriorates as we age and go into menopause, strength training puts healthy stress against your muscles, so that your body reacts by strengthening. The key is not overdoing it and stressing the body further, when it is already under a lot of stress.

“Weight-bearing exercise is really important,” says Gorney. “Walking, dancing, all of those things help our bones stay strong. And resistance training helps prevent dementia.”

It is important to avoid consuming stressful media late at night, which gets your heart rate pumping and increases the stress hormone cortisol.

“You can manage a lot of the symptoms if you look after yourself,” says Lester. “Today's world is so much more stressful than it ever was. That's possibly one of the reasons that we find women are suffering more with the symptoms.”

For Lisa Quait, whose husband first noticed her hair falling out, a combination of HRT and lifestyle changes was necessary. For three years she had no idea what was making her feel so ill and unlike herself. 

“I was feeling dreadful. My muscles were killing me. I was in a lot of pain, and my personality started changing. I've always been confident and energetic and I just retreated into myself. I didn't know what was happening to me. I had occasions where we'd be going out, and I’d look at my clothes thinking ‘I don't want to speak to anyone’. I'd lost myself. I was worried about what people were thinking about me, all these insecurities and anxieties.”

During Covid, she attended webinars, including an online nutrition class for menopause, and came across Lester. Luckily for Quait, HRT proved a Godsend. “HRT literally saved me. The fluctuation in hormones was, and still is, too intense for me. I could not live without it.”

While Quait had a “severe” response to the menopause, it’s not “one size fits all” – everyone is different. It took her time to find the right combination and type of HRT and she still needs to monitor her symptoms and tweak her intake. “It's not just a case of taking HRT and everything's going to be OK. You still have to work on yourself and be aware of your body, your personality – are these emotions because of hormones, or are they because I'm stressed out from daily life? It's about trial and error, and you really have to slow yourself down and work it out.”

All that work has been worth it. “I woke up one morning, and suddenly felt myself again. I realised I had this newfound confidence.”

It prompted her to become a life coach to help other women find their way in midlife, and to launch the podcast Real Women’s Stories. “I said to my Dad this year, everything has settled, it's the happiest I've ever been in my life, because I'm doing things that I would never have done when I was younger. I'm not afraid anymore. I've got this newfound energy and confidence. It's almost like a rebirth. You never stop learning, but going through the menopause and coming out the other end has taught me that life's too short, and I don't I do care about what people think. It's such an empowering feeling.”

Midlife Matters by Katie Taylor will be published by DK RED on March 6