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Blog / / Living and Coping with Menopause
BLOG
Living and Coping with Menopause
It is best to start my blog on menopause with answers and descriptions by several women that I talked to about how they experience menopause and the accompanying changes they face.

“I feel a kind of smouldering, smouldering restlessness and flickering all the time”.

“First I feel an unprovoked unrest, then a wave of heat and sweating hits, and when it subsides, I feel the need to cry, and this repeats several times a day”.

“I wake up at night (if I manage to fell asleep at all and I sleep for couple of hours which is success) bewildered and wet with sweat and I don't know what came over me”.

“I suddenly feel tired, I ache all over, every move I make hurts, I sometimes barely move… I think maybe I'm sick”.

“Libido is a thing of the past. My partner will leave me for sure…”; "I have the feeling that everything is drying up in my body - hair, skin, nails...everything”.

“Irritability, tearfulness, lethargy in addition to several physical symptoms (hot flashes, heart palpitations) really make life difficult for me.”

“I don't have any noticeable symptoms for now, but based on the experience of my friends, I'm quite scared and I'm waiting to see what will happen to me.”

“It’s really disturbing that I don't have any clear guidelines regarding the use of hormones in menopause. Everything is a matter of personal decision, choice, but also risk. Some doctors say it's safe, these so-called bioidentical hormones have been innovated, the recommendation is to use them, and others say you should not take them because this has not been tested yet, it is not 100% safe and without risk. So all these contrary pieces of information confuse me”.

Both the beginning of the reproductive period in the turbulent teenage period when you get your first period and the end of the reproductive phase in a woman's life - menopause represent natural biological processes. They are seen in psychology and medicine, as expected, common developmental stages that mark the beginning and end of an important cycle in a woman's life. Menopause usually occurs between 45 and 55 years of age (the average age for the onset of menopause is around 51 years), although it can occur earlier, especially in cases of various female diseases (for example, in the case of oestrogen-dependent tumours of the breast and uterus) when therapeutic protocol and treatment necessitate introducing a woman into premature menopause in relation to the biological clock, which represents a particularly complex life crisis for women who have not had the experience of giving birth (the so-called oncofertility).

There are usually three phases in menopause:

Perimenopause phase - a transitional period that begins a few years before menopause and the complete termination of a period. At this stage, women usually notice changes in the menstrual cycle related to irregularity or changes in the intensity of the period. Menopause symptoms and some of the vasomotor symptoms such as hot flashes, night sweats, dizziness, palpitations, fatigue, insomnia, etc. they can start and gradually vary already during perimenopause. Ovarian reserves (number of follicles in the ovaries) and levels of oestradiol and inhibin decrease significantly, and levels of FSH (follicle-stimulating hormone) and luteinizing hormone increase already during perimenopause.

Menopause phase - cessation of the menstrual cycle for at least 12 consecutive months.

Post-menopause starts after menopause and in this phase a series of various symptoms of menopause can be registered with special emphasis that there are significant individual differences between women which means that not all women experience all the symptoms of menopause and that symptoms may vary in terms of their intensity, frequency, and duration in specified phases.

Expected, typical symptoms of perimenopause and (post)menopause:

Physical symptoms:
- Hot flashes
- Night sweats (intense sweating during the night that can disturb sleep and affect the quality of sleep and rest)
- Sleeping problems (insomnia, waking up at night)
- Dryness of skin and hair
- Vaginal dryness
- Decreased libido (sexual drive)
- Painful intercourse due to vaginal dryness
- Decreased quality of sexual life (satisfaction)
- Pain in joints and muscles
- Headache
- Fatigue
- Loss of bone density (osteoporosis)
- Changes in body weight (especially the accumulation of fat in the central part of the body)

Emotional and mental symptoms:
- Mood swings (depression, anxiety, irritability)
- Problems with concentration and memory
- Feeling of sadness, emptiness
- Restlessness (decrease in the sense of well-being)

Research on the relationship between the severity of the premenstrual period (PMS) and cycles in the reproductive period and the severity of symptoms in menopause (frequency, number, and intensity of symptoms) due to the influence of the subjective self-assessment of women did not provide unified results that would indicate the existence of a potential connection.

Prevailing social pressures and aggressive advocating of aesthetic ideals of "perfect look" and the terror of imposed standards of eternal youth, beauty, slimness, freshness, complexion without wrinkles, etc. (the list is long) through the media, all kinds of advertisements in the service of the beauty industry and through the terror of photoshopped presentations on social media, they directly contribute to the creation of stigma towards women in the menopause period, but they also indirectly influence the formation of self-stigma.

Negative attitudes, stereotypes, the devaluing social perception of menopausal women also significantly influenced that throughout history and different cultures, menopause is viewed with fear, shame, and discomfort. Menopause is often associated with the aging of women, and the so-called ageist attitudes (stereotypes, prejudices and discrimination based on age) also lead to negative perceptions of menopausal women as less valuable, attractive and appealing.

Misinformation or lack of education and understanding of this natural biological process can lead to numerous misunderstandings and additionally strengthen negative stereotypes. Prejudices are often encountered that menopause marks the complete end of a woman's sexual attractiveness, activity, and fertility, which reinforces feelings of inadequacy, failure, and loss of "socially validating" characteristics in women at this stage of life. Negative, aggressively discriminatory language in our environment ("women 50+ are old/ruined/useless"; "everything is over for women 50+";" women 50+ are unattractive, undesirable"; "women 45+ are condensed") and the already mentioned stereotypes influence the maintenance of stigma and the deepening of prejudices and the formation of self-stigma.

Menopause self-stigma refers to the negative attitudes, self-deprecating and self-criticism that women may feel about their own menopause and the changes that this period brings. Self-stigma is actually an internal process in which women internalize negative social prejudices and stereotypes about menopause, leading them to feel shame, embarrassment, inadequacy, self-criticism, reduced self-confidence, self-esteem in relation to their own appearance and their changing and naturally aging bodies, visible symptoms of menopause and the identity of a woman in menopause in general. Both stigma and self-stigma often lead women into (self)isolation, withdrawal, silent suffering, and loneliness, making it difficult to deal with the numerous changes and symptoms that menopause entails.

Overcoming the stigma and self-stigma associated with menopause requires, on the one hand, efforts to raise awareness of society, communities through possible legal regulations, education of experts (doctors of various specialties) but also of the general public, open conversations, initiation of open and accessible counselling centres for women, then normalization of menopause period as a natural part of every woman's life and promoting acceptance, understanding, encouragement in overcoming symptoms. It is especially important to find ways to support women in a fertility crisis. And on the other hand, in overcoming self-stigma, it is important to move from the prevailing attitude and behaviour in our environment of "be quiet and suffer" to not being silent and not suffer, i.e. self-acceptance, self-empowerment, adequate and professional information about the symptoms while finding adequate and medically proven ways to overcome them.

It is important to understand that menopause is not a sign of weakness or inadequacy, but a natural phase in a life cycle that can bring also new challenges, possibilities, life joys. Connecting with supporting communities, access to adequate, reliable medical information and resources on overcoming the symptoms of menopause and working to change intrinsic unhelpful beliefs can help women overcome self-stigma and embrace menopause as part of their exciting life journey.

Recommendations about several reliable and informative webpages that render detailed information about menopause: Mayo Clinic – Menopause; The North American Menopause Society (NAMS) is the leading organization dedicated to menopause and connected health issues; MedlinePlus – Menopause; Women's Health – Menopause; Tell_me_about_it (Instagram page on menopause).
AUTHOR
Prof. Dr. Tamara Klikovac
psychologist and psychotherapist