Menopause: Why do we talk about it so little?

In 2021, British menopausal specialist Dr Louise Newson interviewed 3,800 women across Britain to survey the effects of menopause. Faced with the sometimes intolerable symptoms of perimenopause or menopause, 1 in 5 women questioned had missed an opportunity for a promotion at work.

In addition, 99% of respondents said that perimenopause and menopause had a negative impact on their work. More than half (59%) said they had to take time off and 18% had to be absent for more than 8 weeks.

According to the survey, menopause and its accompanying symptoms left 12% of the 3,800 people questioned. Inefficiency, lack of focus and the resulting poor quality of work are cited as reasons for work interruption.

“The menopause corresponds to the cessation of the ovaries,” defines Dr. Nasrin Kalit, MD, a gynecologist at the Curie Institute. Concretely, it is a period in a woman’s life in which the cycle gradually stops, and then permanently. The ovaries stop producing the hormones estrogen and progesterone and stop producing an egg every month.

It is preceded by perimenopause, which very few women still easily recognize and spot, according to Sarah Davis, co-founder and director of Talking Menopause in the UK. Approximately 70% of women do not yet recognize the symptoms of menopause. Many women develop symptoms during their forties, but do not know if the anxiety, fatigue and memory loss are related to their lifestyle, work, adolescents dealing with it, or whether it is menopause.” According to the expert, this is due to the lack of knowledge and information he conveys. Health professionals.

This period before menopause is characterized by low estrogen levels. “Permenopausal is when the ovaries start to get tired. They still work, but not right. We have our periods, sometimes the ovaries don’t work at all, sometimes they don’t work well.” […] It depends on each woman’s ovarian reserve,” explains Nasrin Kalit.

The average age of onset of menopause varies for women. It generally occurs between 45 and 55 years of age, but the difference in average lifespan between women can be up to 14 years. Some early menopause occurs between the ages of 40 and 45. “Before the age of 40, we talk about primary ovarian insufficiency that causes infertility, which should be screened for,” adds Professor Micheline Masrahi-Abadow, National Reference for Genetic Infertility in Women and Men at Pistri Hospital. APHP from the Paris-Saclay Medical School. On average, menopause is really “fixed” in the body when you haven’t had your period for a year, except for menopause associated with one or more pregnancies.

“We know that there is a very important genetic influence of menopause. There is an 85% concordance between a mother’s menopausal age and her daughter’s age. So by asking your mother, you can tell if you are going to be part of late or young menopause. Micheline Misrahi Abaddo identifies that On average, a woman is no longer able to conceive before about 10 years of menopause.It is important to specify that in the premenopausal period, pregnancy is still possible, even if the chances are lower, because the quality of the eggs diminishes.

From birth, a woman loses eggs. “We are talking about a million eggs at birth and 400,000 at puberty. It is believed that precisely during the process of maturation of these eggs, all those that were of poor quality will be eliminated. At menopause, there will be less than 1,000, which is not enough. For pregnancy The quality of the eggs declines in an accelerating fashion after 35 years. […] But that doesn’t mean you can’t have more children,” explains Micheline Masrahi Abadow.

Symptoms and support

To reduce these side effects, hormone replacement therapy based on natural hormones may be prescribed. “It’s the only treatment effective against all symptoms,” Nasrine Callet supports, specifying that not everyone can use it. For people who have had early menopause, or chemotherapy, sometimes other treatments can relieve symptoms, even if they are less effective, according to a gynecologist. “Based on phytotherapy, amino acids … acupuncture can also be a good alternative. Against dryness [vaginales et dessèchement de la peau]Topical treatments can be prescribed with creams and ovules.”

“When estrogen levels go down, it’s serpentine. At some point, everything is fine, and after a minute we want to cry, or we get nervous, or sensitive, or our skin sometimes gets dry, or our hair falls out, it’s really a combination of symptoms. In a perfect world Women in their late thirties should be alerted and informed about perimenopause. It’s not just about looking at hormonal therapies, but also revising one’s lifestyle. Get more exercise, review your diet, and be with you,” adds Sarah Davis.

Symptoms vary from person to person. In general, hot flashes are very frequent. “It corresponds to the thermoregulation of the body associated with our brains. This is one of the first effects, and then gradually, we can notice the drying of the skin and mucous membranes, because the body is no longer receiving hormones.” Vaginal dryness, hair loss, dizziness, chills, tremors, sudden memory loss, profuse sweating, extreme tiredness: the list of side effects of this phase of hormonal imbalances is long.

Nasrine Callet recommends that an x-ray be taken during perimenopause to see if the patient needs to undergo orthopedic treatment. In fact, “one of the later symptoms that can also occur in the face of estrogen deficiency is the risk of calcium not fixing well to the bones and long-term osteoporosis.”

The UK is currently short on hormonal treatments, ‘estrogen’, which is widely prescribed in the country to postmenopausal women. Company acquisition, shortage of adhesive used to apply the patch: Since 2018, pharmacies have been warning of a shortage in the face of surging demand. Lots of women here in the UK use it, and unfortunately few doctors are aware of alternative treatments. For women, Sarah Davis says finding doctors who offer alternatives is complicated. Discussion and access to information about current treatments have increased in recent years in Britain, thanks in particular to the study by Dr. Louise Newson and centers such as The Menopause Talking by Sarah Davis.

In some women, the symptoms are unbearable, and the testimonies speak specifically of suicidal thoughts, “Some women buy prescriptions on the black market or borrow prescriptions from friends to get treatment for symptoms,” confirms Sarah Davis.

Some studies are being conducted by scientists and experts regarding the effect of menopause on the brain and psyche. “The key is, of course, research, but it is also the education of the medical community,” says British expert Sarah Davies. The various experts interviewed are unanimous and encourage women to welcome menopause as a positive thing, through follow-up, listening, and accompaniment. “We live in a patriarchal society, menopause is considered a disease, when it is not at all. This can have certain advantages,” notes Nisreen Kalit. “We are freer, we no longer have periods, we no longer need contraceptives.”

“Over the course of an evolutionary period, the fact that there was no additional risk of pregnancy from a certain age allowed, on the one hand, the preservation of women’s lives, and on the other hand, it allowed grandmothers to look after young children and thus mothers played an important social role. They were fighters, hunters, and farmers. In the end, It was something beneficial for the human race,” concludes Micheline Misrahi Abadow.

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