Diane Danzebrink (dianedanzebrink.com) is a wellbeing consultant and menopause counsellor with professional nurse training in Menopause; she is the founder of Menopause Support (menopausesupport.co.uk) and the #MakeMenopauseMatter campaign.
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Recently, on my way to a television interview the taxi driver asked me what I was going to be talking about, when I said menopause, he laughed and said, “well we think you’re all going mad.”
It turned out that his wife was experiencing menopause symptoms, as were the wives and partners of many of his friends. The consensus: down at the pub on Friday night, where he and friends met once a week, was that we (women) are indeed all going mad at this time in our lives.
As we talked and I explained what happens during menopause it became clear from our conversation that his wife was in fact experiencing quite distressing symptoms which were affecting all aspects of both of their lives. Suddenly it had stopped being funny. This man I had never met before told me how his wife had changed and how they had become increasingly distant both emotionally and physically. He explained how he felt that he was always walking on eggshells and no longer looked forward to going home.
In that short taxi journey, I learnt that they had been married almost thirty years, had a wonderful family and had been happy, “well you know, apart from the normal ups and downs” but recently things had changed. He told me how his wife was always tired, never wanted to go out or see anybody, unless she had to, and had become snappy and cried a lot. When I asked him if she was having hot flushes or struggling with sleep he laughed and told me how she was always too hot these days and that he couldn’t remember the last time he had slept through the night with the quilt constantly being flung on and off.
When I asked him if he had spoken to his wife, he told me how he had tried to ask her what was wrong on a few occasions, but it had just turned in to a row so now he just kept quiet. It turned out that he was really worried about their relationship as they had stopped talking like they used to, and physical contact had gradually diminished and had now reduced to the occasional peck on the cheek when he was leaving the house to go to work.
I counsel women every day of every week who don’t understand what’s happening to them at menopause, so if women don’t understand what chance do their partners have? Sadly, we still don’t talk about menopause until it comes along and, for some, slaps them in the face. I believe that menopause should be included in the curriculum in all secondary schools and discussed openly at home and in the workplace so that we all understand that this is a natural stage of life that we all need to be prepared for. Until that happens, here is The Menopause Support guide to Understanding Menopause for Partners.
Menopause-So what is it?
Menopause simply means the end of monthly periods, once the ovaries stop producing eggs the hormone levels start to fluctuate and eventually fall and the cycle that used to produce a monthly period eventually stops. Medically menopause is defined as one day, the day twelve months after the last menstrual bleed, on average this happens between the age of 51 and 52.
Leading up to menopause is the perimenopause and this is when the hormone levels start to fluctuate. Approximately twenty-five per cent of women will experience very few symptoms and sometimes none. The other seventy-five per cent will experience symptoms and for some they can be debilitating, affecting all aspects of their lives and those around them. Many women start to experience peri menopausal symptoms in their late thirties and early forties although they may not recognise them, more on that later.
Post menopause is everything after twelve months and one day without a period. Many women believe that post menopause means no symptoms but for some this is not the case and for some symptoms can continue for years.
Some women will experience menopause as the result of surgery to remove both ovaries, this is called surgical menopause. Medical or induced menopause can happen as a result of treatments like chemotherapy or radiotherapy or if treatment is given to suppress ovarian function for conditions like Endometriosis or premenstrual dysphoric disorder (PMDD). Natural menopause can be difficult for some without the right help and support, but surgical or medical menopause can be very challenging if women are not well advised.
A small but significant percentage of women will experience an early or what is known as a premature menopause, premature menopause can affect women in their thirties, twenties and even their teens. In many cases the reason is unknown but the physical and emotional impact cannot be underestimated and expert medical support is vital.
So, what is actually happening to a woman’s body when the hormone levels start to change, sometimes on a daily basis?
Oestrogen, Progesterone and Testosterone are the three main hormones responsible for menopause related symptoms, it’s important to remember that women have oestrogen receptors all over their bodies which might help to explain why the symptoms can be so varied.
Progesterone levels are usually the first to fall and as well as helping to regulate monthly periods and maintain pregnancy progesterone can act as a calmer and aid sleep for some. When this hormone starts to deplete, sometimes quite rapidly, some women start to experience broken sleep or feel tense, nervous, anxious.
Whilst the progesterone levels continue to fall the oestrogen levels start to fluctuate, sometimes wildly. This can lead to a host of symptoms which unless they are recognised as related to menopause can seem quite unconnected. Some of the most common are anxiety, low mood, broken sleep, brain fog, fatigue, muscle and joint pain, hot flushes, night sweats, loss of libido, vaginal dryness and soreness and increased urinary symptoms.
Oestrogen levels can rise and fall on a daily and sometimes hourly basis so if you have noticed that your partner can move from happy to sad or anger to tears at the flick of a switch it’s likely that her hormones have well and truly taken control. If you are finding this difficult to adjust to just imagine what it’s like to experience firsthand. Many women tell me that they have lost their joy and just don’t know themselves anymore. Honestly, it’s not you, but those feelings are very real, and it can be very scary to feel so out of control.
Testosterone is a hormone that is always associated with men and sex drive, but it has an important role to play for everyone and it’s not all about libido. Testosterone can help to support bone strength, muscle strength, energy levels and even self-confidence. Women, like men, experience a reduction in testosterone production as they age and like men some women will be more affected than others. Those in surgical menopause will experience a rapid reduction in testosterone when their ovaries are removed. Many of the women I counsel tell me how sad they are that their libido has disappeared, but help is available if that is the individual’s choice, and your support is key.
It’s important to remember that your wife or partner may not experience any of what I have described above but when three out of four women will experience symptoms it’s likely that you may notice some changes, sometimes before she does. If your partner has had a hysterectomy including removal of her ovaries or is undergoing treatment that will affect ovarian function the onset of symptoms can be rapid. It is vital that she gets expert advice and support to help manage symptoms and long-term health.
People are still confused about the treatment options for menopause symptoms, mainly due to some scary headlines about HRT (hormone replacement therapy) back in 2002. The fact is that HRT is the most effective treatment for menopause symptoms and many of the myths that arose out of those headlines are simply not true. For women who choose not to take HRT or absolutely can’t (and there are very few) there are lots of alternatives which means that nobody should have to suffer in silence.
If you have read this far and are starting to panic, thinking: how the hell do I help her?
Never fear, here are my top ten tips for helping your partner. Following my own experience of surgical menopause and that of my husband a few years ago I have now spoken to thousands of women and quite a few men and it has become clear that there are some simple things that you can do to offer support.
- Educate yourself: the more you know about what she is experiencing the better, whilst you will never be able to understand how it feels if you are a man, women who have not yet experienced menopause can find it difficult to understand too. This shouldn’t stop us trying to understand and be mutually supportive of each other. Many women feel lost and lonely at this time in their lives, your love and support is more important than ever.
- Try not to put any undue pressure on your partner: whilst it can be a confusing time for you both this is not the time to be making big decisions. Try not to ask when does this end or how long will this last? Firstly, it’s not helpful and secondly, she has no more idea than you do. On average the menopause transition from perimenopause through to post menopause is thought to last four to eight years but everybody is different. Just being there to offer support, maybe a hug (unless she’s having a hot flush) or a cup of tea or running her a nice relaxing bath is enough. Simple things can make an enormous difference when you are feeling overwhelmed.
- Ask her what she needs: it can be tricky to know what your partner needs when she is struggling physically and emotionally, nobody can be expected to know what another person wants or needs, no matter how close you are. You can’t be expected to be a mind reader, so my advice is to ask, gently.
- Accept the silence: many women tell me how they just need a period of quiet for self reflection, this is not aimed at cutting you out, although my husband tells me that it sometimes felt like that, it’s our way of processing what is happening to us. Try to imagine what it must be like to have so many physical and emotional changes happening at the same time and wondering where the real you has gone.
- Resist the urge to snap back; easier said than done I know but it’s important to understand that fluctuating oestrogen levels can have an effect on anxiety levels and mood and that can result in a sharp tongue sometimes, as my husband will confirm. Just stop, breathe, and walk away if you have to, it will pass.
- Encourage your partner to seek help and consult her doctor about her symptoms and offer to go with her. For some women just making the appointment can be a major hurdle, anxiety during menopause can be crippling and self confidence can just melt away. It can be so helpful to have a supportive partner with you when you sit down in front of your doctor and everything you had planned to say evaporates.
- Be prepared to change your plans: many women struggle with self confidence during menopause and if this is coupled with crashing fatigue it’s likely that your partner may just want to curl up on the sofa at home rather than socialise. If you have ever experienced social anxiety, you will know how hard it can be but during menopause it can be paralysing. No amount of trying to tempt her out with the promise of weekends away, fancy restaurants or even tropical holidays will make her feel better. This takes time to work through and every woman is different, but she will be so appreciative of your patience and understanding. Remember you are probably the only person in the world that she feels able to be truly herself with. The pressure to keep up appearances, particularly at work, can be exhausting and curled up on the sofa with you is probably where she feels safest right now.
- However challenging life can be don’t forget to show her that you love her. One of the unexpected effects of menopause for many women is the physical changes to their body shape which can result in your partner experiencing a loss of confidence and becoming very body conscious. If she has started covering up at all times and will no longer allow you to see her naked try to understand that these changes can take some getting used to and even though she might be desperate to exercise and change her diet, it’s the last thing you feel like doing when your energy level is on the floor. Sometimes all women want is reassurance and a hug, which leads me to…………
- Sex, which, let’s face it, can be tricky at any time but once menopause arrives for some couples it can be a no-go area. Sex is complicated and there can be many reasons why both men and women no longer seem to be interested in sex, which, if it suits you both is fine. However, if one or both of you is feeling increasingly unhappy about intimacy, which can be shared in all sorts of ways, it needs to be tackled. It’s important to recognise that for some women falling oestrogen and testosterone levels will have a direct effect on their libido, you may also have experienced this as you have got older, but the physical effects of oestrogen depletion can be extremely upsetting both physically and emotionally. Many women tell me how they avoid any physical contact at all to avoid having to talk about what’s happening to them. The physical effects of falling oestrogen levels on the vulva (the bits you can see) and the vagina (the bit you can’t) can be that left untreated they can become extremely dry and sore and for some women excruciatingly painful. Oestrogen acts as one of the body’s main lubricants and it helps to keep the female genitalia both healthy and lubricated. Partners that I have spoken to tell me that they start to wonder if their partner just doesn’t love them anymore and many of the women I counsel tell me how sad they feel about their physical discomfort and lack of libido. Both speak about their longing for physical intimacy again but neither wants to start the conversation, for me this is heartbreaking as often it leads to an ever-widening gap both physically and emotionally which is why …….
- Communication is key (at any time) but particularly at this time in your lives. I see so many women who tell me that they wished they had known what was happening to them so that they could have discussed it with their partner and sought help and advice before it was too late to save their relationship. Menopause has often been referred to as the change of life and in so many ways it is. We all change, both physically and emotionally as we age but that doesn’t mean that we shouldn’t be able to look forward to long, happy, healthy, fulfilling lives with our husbands, wives and partners.
Menopause can be a challenging time for any couple, but it doesn’t have to be. The key is to be prepared so that you can approach this time in your lives with the knowledge to help you support each other through it and on towards a new chapter in your lives.
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