My two children were born when I was in my early 40s, and I was so busy being a mother that when things started to go wrong at 49, I had no idea what was happening.
With so much talk about the menopause, and so many taboos on the subject being broken, I am appalled to confess that I went through two years of low-level anxiety and high-level insomnia, oblivious to the idea that my complete change of character and alarming inability to cope could have anything to do with midlife hormones.
The irrational anxiety totally threw me. There was no respite, and no filter. I’d be as agitated about whether I’d remembered to put carrots on the online grocery list as I was about getting home in time to relieve the babysitter.
My temper was horrific as I teetered on the edge of confusion and despair, wondering who the harpy in the house was and why, if my heart rate was any indication, even I was scared of her. My radio presenting job relies on quick responses and short-term recall of salient facts. When you’re counting on mental agility and recall, it is frankly terrifying to find yourself lapsing into blank spaces.
Permanent exhaustion, irritability and brain fog seemed to affect every part of my life, sapping the joy, destroying self-confidence and removing the ability to perform as well as I wanted. For someone accustomed to seeing the larger picture, and generally able to rise above irritability or ill humour in order to get things done, this was frustrating and upsetting.
Mariella Frostrup says her mood swings were horrific and she teetered on the edge of confusion and despair when she started going through menopause
Finding reason was no longer in my skill set.
As my stress levels escalated, my nights were elongated by my inability to sleep, and my days passed in a haze of exhaustion.
We might joke about ‘senior moments’, but it is not even slightly funny. For previously swift and reliable recollection to diminish is utterly discombobulating.
Dementia is a very real and personal fear for me. My grandmother suffered from it, my mother now has it so badly she is in a care home, and her brother (my uncle) is also deep in its grip. As it is believed to travel down the maternal line, it is a concern for me and my children.
Rather than wondering whether there might be a medical cause, I simply resorted to the conclusion that I wasn’t coping with the demands of parenting two children and working as well.
It is shocking that it took me two years to seek help — and I am certainly no stoic.
I was one of millions who suffered from bewilderment and self-castigation, rather than swift recognition and diagnosis, which in itself can give relief. Many of my contemporaries are now enduring this — and far, far worse — in ashamed or puzzled silence.
Finally, in 2014, I was prescribed the first version of the non-alcoholic cocktail on which I now thrive.
There’s transdermal (absorbed through the skin) oestrogen (initially in the form of patches, which I didn’t like, as they failed to break through the barrier of my body lotion); micronised progesterone, in the form of a tablet; and, initially, testosterone gel.
Many women struggling with the menopause find that proven practices such as yoga, mindfulness and meditation can come in very handy
Perhaps not overnight, but over a matter of weeks, the agonies of insomnia and the misery of being perpetually worried had faded to the back corridors of my memory. I was, to all intents and purposes, my old self.
HRT RESTORED MY LIFE
It is no exaggeration to say that HRT restored my quality of life, at the age of 51, and has contributed to maintaining my state of health, hope and happiness ever since.
Barring true disaster (such as global shortage), I will take HRT until I turn up my toes. My tube of oestrogen gel will have to be prised from my cold hands as my soul departs my body.
But whether or not to take HRT is as hotly debated and even more passionately argued than Brexit, communism, immigration, the right way to poach an egg and if boot-cut jeans really are back in fashion.
Around HRT there remains a hotchpotch of conflicting advice.
My days of partying with George Clooney are behind me
There’s no denying I love a glass of wine. I once spent four days holed up at the Hotel du Cap during the Cannes Film Festival with a selection of debauched movie moguls and George Clooney.
But now, those decades when any problem could be diminished by a vat of fermented grape juice are well and truly behind me.
When I hit 50, I hit a wall. A hangover would snake painfully around my head for 24 hours or longer. I wasn’t drinking more, but the recovery period had doubled.
Research shows these worsening hangovers are linked to age and hormones, as well as levels of hydration, stress and sleep quality.
The thought of an arid, alcohol-free future is enough to make any woman reach for the Chardonnay, but the menopause is a good time to learn to love your liver.
In perimenopause, oestrogen levels can go up as well as down. Your body tries to recalibrate by getting rid of the excess, processing it through the liver (already busy processing caffeine, chemicals and pollutants). Throwing in alcohol adds extra duress.
As the years go by, alcohol has an increasingly toxic effect on us. An older body contains less water to dilute it, and more fat (sometimes far more), which retains alcohol.
In addition, women produce less of the enzyme alcohol dehydrogenase than men. This breaks down alcohol and contributes to higher concentrations of alcohol in the blood.
There’s no question that a drink may exacerbate menopausal symptoms such as hot flushes, night sweats and lack of sleep. If you are feeling anxious and depressed, alcohol is unlikely to lighten the mood.
And we all know the general dangers of drinking to excess: too much alcohol is linked to heart and liver disease, stroke, dementia and cancers, including breast cancer — and these risks increase as we get older. Oh yes, and alcohol is really bad for your brain, both in the long and short term.
Thankfully, this doesn’t mean you have to become teetotal. I like the ‘no drinking at home’ rule, which guarantees your liver at least half the week off.
But sometimes I even break that. When I get home to Somerset from a few days working in London, the house is usually a tip. The children’s clothes are strewn across the floor, along with a heap of wet towels; the dishwasher is full and dirty; and chances of supper will be 50/50.
This is clearly a highly frustrating state of affairs — but one lovely glass of red wine, or a long, cool skinny bitch cocktail (vodka, lime juice and soda water), and I see my family in a far more benign light: charmingly bohemian rather than slovenly and irritating.
While I respect anyone who doesn’t wish to take it, there is still an ingrained fear that HRT might be the cause of your early death when the evidence suggests that you are less likely to die prematurely if you are taking it.
Nothing gives a substance a bad name like a cancer association — though, on reflection, it’s odd that we continue to smoke and drink in the face of very clear evidence that both have proven links.
Unless you’re a raw-food- munching vegan living in the wilderness and have zero contact with 21st century pollutants, chemicals, drugs, tobacco, saturated fats or alcohol, HRT isn’t making it into any top 100 ‘steer clear’ lists.
Google HRT and thousands of websites still issue dire warnings which are now years out of date.
Thankfully, scientific opinion has shifted and we are able to put those fears into context. For most of us, the benefits of HRT far outweigh the risks, but it has taken 20 years to start undoing the propaganda. Women have been, and still are, misled about HRT in a way that is criminally impacting on our ability to manage midlife.
There are women who swear by HRT, women who vow never to take it and many others who simply don’t know what to do.
To add to the confusion, GPs are similarly divided, though I have to say that every single menopause expert to whom we spoke (bearing in mind they have specific and specialised training in women’s health) was absolutely committed to its positive effects. Every single one.
We need to start demanding change in the treatment (or should that be mistreatment) of so many women after centuries of misinformation and malpractice.
For women approaching or in the throes of menopause, knowledge is essential. Yet, until recently, there’s been no sense that women need any sort of literature or a chat about the end of our fertility, even though it’s just as significant a process as the beginning.
You’d think that an automatic perimenopause GP meeting in your mid-30s or early 40s would be an obvious and positive step. Every GP surgery in the land needs at least one Dr Menopause.
We are fortunate enough to have all manner of automatic health checks and screenings: cervical smears, bowel and breast cancer checks and the over-40s health checks. But why is menopause not on that agenda?
I never want to hear another anecdote about a GP appointment that ends with the doctor saying he or she doesn’t agree with HRT, or fobbing the patient off with a prescription for antidepressants.
Middle age is surely no time to turn down substances that genuinely improve your quality of life.
When my gynaecologist suggested that I try HRT — predominantly to preserve bone density, as I edged towards osteoporosis, but also to help with my poor sleep and anxiety — I was only too happy to slap on a patch and to hell with the consequences.
At that point, like most women, I thought I knew about the risk HRT might pose when it came to breast cancer, but it seemed worth taking it for the sake of a good night’s sleep, a boost to my bone and heart health, as well as possibly lowering of the chance of type 2 diabetes and, potentially, Alzheimer’s disease. Having suffered from lumps in my breasts (benign and transitory) in the past, I was wary but I now have a regular breast check.
My current reliance on a daily squirt of gel and nightly popping of a pill seems a small price to pay for so many health benefits.
It took a few months to find the right cocktail, but it really works for me. There are more than 50 variations available: patches, pills, gels and even implants. As every woman’s menopause is different, you are entitled to a personalised prescription.
‘Brain fog’ affects many of us at this point in our lives, and HRT can help, but it is also thought that oestrogen is a protective factor against developing Alzheimer’s.
… AND BREATHE
Many women struggling with the menopause find that proven practices such as yoga, mindfulness and meditation can come in very handy. For me, though, the idea that you can breathe your way through menopause is one I initially approached with cynicism because it plays to every stereotype of the hysterical woman.
However, a simple breathing technique to quieten the all-night-long chorus in my brain is one of the most helpful tools I’ve embraced. I’ve regularly lain awake in the small hours, breathing deep into my abdomen and counting each breath until my frenzied thoughts subside.
I’m not a natural candidate for meditation, although I would probably benefit hugely from mastering something that puts boundaries around my brain’s restless meanderings.
I know that meditation and mindfulness are potent therapies but my mind is far too good at wandering off to deadlines and life logistics, or what Netflix option I will go for that night.
The bonus of mindfulness is that it’s free, you can do a meditation in just one minute, although longer is preferable, and you can do it anywhere, although a peaceful location is more conducive to success. The more you practise, the better you become at being in the moment.
Mariella swears by yoga. The physical postures and breathing exercises improve muscle strength, flexibility, blood circulation and hormone function, and the relaxation is beneficial for the brain
My other weapon against post-menopause insomnia, stress and generally seizing up is yoga.
A handful of times, over the past five years, I’ve attended a residential yoga retreat in Devon. I always return revitalised and determined to carry on with the good work — until someone plonks a steak and a glass of red wine in front of me and I embrace retoxing with gusto.
Obviously, a few days at a luxury reboot camp like that is an enormous treat. However, there are countless positive clinical studies highlighting the benefits of yoga for midlife health — and it absolutely doesn’t have to take place in five-star surroundings.
The physical postures and breathing exercises improve muscle strength, flexibility, blood circulation and hormone function, and the relaxation is beneficial for the brain. Once I started reading about the subject, I discovered that there are specific menopause benefits: yoga helps you to manage stress, anxiety and insomnia — all boxes I’ve regularly ticked on the symptom chart.
At the age of 52, I took up regular running. Until then, I’d describe myself as having remained base-level fit hoping that regular dog walks and intermittent gym visits would compensate for a lifestyle that was otherwise stress-dominated, reliant on alcohol and punctuated by irregular meals based on convenient foodstuffs rather than nutritional value.
It worked for decades. But, at 50, I realised I was going to have to up my game. Passively accepting decline would, I suspected, swiftly become a self-fulfilling prophecy.
To my surprise, I’ve become a middle-aged cliché when it comes to exercise. I am dedicated to finding the time for two or three yoga classes a week via Zoom, as well as a few three-mile runs.
I am sure that all this maintains my physical and mental health. If I stop moving, then my mood drops and my body stiffens up.
It is only in midlife that I’ve discovered that exercise is about far more than just getting your heart rate up. Exercise releases endorphins — the happy chemicals that push the mind into a short-term euphoric state.
Not only does this alleviate low mood, it also has an impact on positive self-perception. What’s more, my running has become as much about spending time with friends (being sociable is definitely good for mental health) as it is about trying to firefight the flab and my unstable fat/muscle ratio.
What started as an effort has become a pleasure.
MY RESTLESS LEGS
Part of my insomnia problem is learning to live with a little-understood condition called ‘restless legs syndrome’ — I’ve discovered that joint and muscle aches and pains are common in menopause. It means my fitful sleep is disturbed by a fizzing in my calves that swiftly becomes a brain-addling desperation to stretch my ‘restless’ leg.
When I was younger, it only struck when I was overtired or in cramped conditions. Now, there’s no accounting for when the tell-tale signs will turn a night’s sleep into a marathon of irritated wakefulness. Rather than restful slumber, I’m leaping in and out of bed to try to stretch. Yet, the minute I snuggle beneath the duvet, the symptoms return, often with a side order of cramp.
A few years ago, a friend recommended magnesium tablets and, within a few days of taking them, the worst of my symptoms had eased off. But, still, there were nights when I was woken at 3am and sleep was an impossibility.
Now, I’ve added magnesium spray to my armoury and it’s become something of a miracle cure for me. While you need to be careful not to overdose — I found that too much exacerbated symptoms — a quick squirt of magnesium on the affected area before I go to sleep means the worst of my symptoms are vanquished.
Adapted by Louise Atkinson from Cracking The Menopause by Mariella Frostrup and Alice Smellie (£20, Bluebird), out on September 16. © Mariella Frostrup and Alice Smellie 2021. To order a copy for £18 (offer valid to 14/9/21; UK P&P free on orders over £20), visit mailshop.co.uk/books or call 020 3308 9193.