The Change is Changing

Photo by Allec Gomes on Unsplash

Peach Box Dialogues 

- a series of interviews with real women on real womens’ health issues, because we really need to talk about this!

Disclaimer: These interviews are not for medical advice and only represent an individual experience. If you have any health concerns we recommend consulting a medical professional for diagnosis and advice before taking any new medication, supplements or making life changes.

When I was around 16 years old a nurse casually informed me that I probably couldn’t have children. My periods had randomly stopped. No one could explain why, nor how to encourage them to start again, and I began to plan my life based around adopting children, should the right moment ever arise. Somewhat miraculously, however, after a year my periods started up again, and for the following 25 years, my monthly cycle was perhaps the only thing in life that was truly reliable. I also now have two children - another miracle for which I am thoroughly grateful. And yet, even after all this ‘experience’, I still haven't a clue how female hormones work. And I don’t think I’m alone in this.

In the 1980s and 90s when my friends and I went through puberty, the only sexual health education we received was the uncomfortably practical science teacher showing us how to put a condom on a banana, and sending us all home with a couple of tampons each, few of which made it past the lower branches of the tree at the school gate. Inappropriate to talk about these things at all at the time, our silent rebellion involving the tree felt like some kind of women's liberation. But we were children, and evidently still had a lot to learn, not just about the world around us, but about our inner worlds as well.

Female health is like an orchestra - when all our hormones, diet, fitness, mental stimulus and relaxation time are finely tuned and playing in order, we dance through life to the beat of a beautiful symphony. But when one instrument starts playing out of time, the whole show can go down in flames, or perhaps hot flushes, as I am discovering now that the perimenopause has thrown its inevitable spanner into my inner workings…

How much do you know about female hormone changes throughout life? 

• Do you know what jobs progesterone, oestrogen and testosterone do in the female body? 

• How do those three magic hormones come and go throughout the monthly cycle, and throughout our lives, from birth, to puberty, childbirth and menopause, and what effect they have on our physical and mental health?

• Did you know that the majority of post-menopausal women experience incontinence?

• Did you know that for 100s of years menopause was considered an illness often referred to as ‘hysteria’ and many women were sectioned, imprisoned, experimented on, were given involuntary hysterectomies, or worse? NB. the word hysteria is derived from the Greek word hystera which means uterus.

• Did you know that women’s bodies were only recognised as responding differently to medication in the 1980s? Before then new drugs were mainly tested on men based on the assumption that men’s and women’s bodies would respond the same.

Now that women’s health issues are finally coming out of the Victorian closet, we really do need to start talking about them more. Every woman's hormones are unique, and so her experience of those hormones changing through puberty, pregnancy and menopause are unique and very hard to predict or identify in some cases as changes can happen gradually, or affect areas of our health that appear totally unrelated. Female hormone changes are still widely under researched, and can catch us, and our partners, families and GP’s, completely off guard, so it’s really useful to hear other peoples’ stories and look for ways in which they resonate within us or with the women in our lives.

Over the next few months I will be conducting a series of candid and anonymous interviews with real women, each time focusing on different areas of women’s health. From periods and pelvic floor exercises, to female ADHD and ovarian cancer. We will be covering some sensitive topics which may be at times triggering, but which will hopefully be invaluable to recognise and understand in order to honour our bodies, our health, and all the women that we hold, and who hold us throughout this ever changing, bitter sweet symphony of female life.

Photo by Sanni Sahil on Unsplash

The many mysteries of the perimenopause…

The Change is Changing.

Trigger warning: this interview talks about panic attacks, cancer and suicidal thoughts.

October 2023 is Menopause Awareness Month, so I’m starting this series of interviews with one about just that.

I think this story highlights the experience of many women with misdiagnosis of hormone changes in their 30s, 40s and 50s, and the unpredictable and so far relatively undocumented effects of perimenopausal hormone changes on mental health.
(Interviewee: Female, 51 years old, white, British)

1. When did you first realise that you might be perimenopausal?

“I thought that I might be having symptoms when I was 48, but I had quite a stressful job at the time as well, and really difficult things were happening in the workplace. I went to my GP and I suggested that my anxiety, heightened stress and feelings of overwhelm might be menopausal, because there were periods of time when I would just burst into tears… And they said “are your periods regular?” And I said “yes they are” and they replied “well it won’t be the perimenopause then”. And they switched my antidepressant - I was on one type of antidepressant and they switched me to a different antidepressant - and that’s really what the result of that GP visit was.

A couple of years later I started to get some other symptoms. I was self medicating with CBD oil as another friend of mine had said that that was really good for anxiety. So I’d taken some CBD gummy sweets and I was having a lot of low energy which I guess I put down to depression, even though I didn’t have other depressive symptoms at that point. But just no energy. I would get up and do some bits and then have to sit down again. I was just exhausted all the time. I read a bit about long covid. Was it long covid? And that was when I went back to the GP again and they said I have a post-viral thing, it’ll resolve in due course. 

That's when I started looking into cold water therapy and meditation. And that's brought a lot of good things into my life. I started having cold showers and cold water swimming and that definitely brought me into the now. Because when you’re experiencing a lot of anxiety, which as it turns out is physiological - waking up with this feeling of dread - but it’s a physiological feeling, it’s somatic. I get it at the top of my legs and from my belly downwards in that area. It's like a tingling and I feel really anxious and that's how it manifests in my body. So I was doing a lot of somatic work and recognising that, you know, your thoughts don't have to follow through on the physiological feelings that you’re getting. And that was really helpful as well. This was the sort of alternative therapies that I was seeking out for myself.

The other thing I started to notice was that I was vomiting. I would wake up in the middle of the night with an urgent need to vomit and I would rush to the toilet, and this took place anywhere between 1 and 4 o’clock in the morning. And I’d just throw everything up, and I knew this wasn’t right. I was particularly worried about this because it was persistent. It wasn’t happening every day, but it was happening with reasonable frequency. And my sister had died of stomach cancer at a very young age. She was only 39 when she died of stomach cancer. So naturally I was really worried about stomach cancer. 

So, I went back to my GP and they prescribed me some acid reduction drugs. They ascertained that I wasn't pregnant, even though these symptoms were very like morning sickness, and I said at that point “could it be menopausal?” and they said “absolutely not, you don’t get these symptoms with the menopause”. So they referred me to the specialists, but there was such a long waiting list because of covid and they decided I was ‘non-urgent.’

Anyway, after a period of about 3 months waiting I didn’t want to wait anymore. I was feeling very anxious, I was still vomiting and it had been going on now for about 8-9 months. I was tracking all my food and changing all my diet and seeing if I was having some sort of reaction to food, but there didn’t seem to be any correlation with that. So I paid to go private and have an endoscope look inside my stomach and make sure it wasn’t cancer. What they said was “it is very red and sore in there but it’s not cancer and sometimes women have developed this in middle age. There isn’t a cause and there isn't anything you can do, but live with it and take acid reflux medication.” So I was relieved that it wasn’t cancer, but at that point then there was not much more I could do.

The next thing that happened in this story is that I got ill with covid - just the standard fever for 3-4 days - and I got better and went back to work. But then I had a kind of relapse. It wasn’t a relapse of covid, it was an almighty psychosis. When I spoke to my GP afterwards, they thought I'd had a panic attack, but this wasn’t like any other panic attack I’d ever had. I would say it was more psychotic than that. I had to go into a room, I had to close all the windows and doors, and go into as dark a place as possible. I felt like I was collapsing into a dark dark pit of despair, and the feeling of anxiety was so overwhelming, it was like the excruciating pain of childbirth, but in an emotional pain sort of way. I would say that I couldn't move out of the bed because I was in too much distress. And I couldn’t speak, and I couldn’t eat. And I wasn’t able to eat anything for 36 hours. And I had this vision where I felt I needed to keep pumping out squares of anxiety like a factory, just keep pumping them out into the world, as a way of ridding myself of them. I was completely paralysed. I couldn't go to sleep and I couldn't think, I couldn't have a conversation and I couldn’t eat… 

(Eventually) I rang the GP and I absolutely begged and I said “can we please just try HRT, and prescribe me some diazepam because I honestly think that if my life continues like this I’m going to finish myself off. I can’t live like this. This is not functioning for me”. So he started me on HRT, an oral pill. And he also prescribed to me yet another antidepressant which was more for anxiety which you can take with HRT…

So that was about 18 months ago now. I’d started to take this HRT, only 1mg, for two weeks, and I just started taking the progesterone part of the HRT, and I woke up one morning and I thought “shit! I feel normal!” and it was quite a revelation because it was the first time in years because this had been getting progressively worse. And I didn’t throw up again.

I’ve slowly increased my dose since then, but from that moment forward my hormones were being managed with the HRT. And it stopped all the autistic things going on - no meltdowns, no hitting myself in the head, no pacing or flapping or any of the stimming that’s associated with autism, that all went as well. To all intents and purposes, my emotional health has stabilised and I’m feeling just the normal ups and downs of living - something bad happens, you feel a bit bad, something good happens, you feel good. Rather than this crazy, erratic emotional health roller coaster.”

Photo by Todd Quackenbush on Unsplash

2. Do you think your GP was helpful?

“No, I don’t think they took my symptoms seriously as potential perimenopausal symptoms. I don’t think they were willing to entertain that. They seemed very reluctant to prescribe the HRT because I did ask for it on at least two occasions and was turned down before I got to desperate times, desperate measures, where I was absolutely pleading with the GP over the phone to give it a try.

I didn’t really find that my GP surgery was particularly compassionate. So I don't think that is necessarily everyone’s experience, but it’s certainly been mine.

All my symptoms were resolved with HRT, and my energy levels returned. I definitely have far more energy again, perhaps much higher than they ever were. And I can have a better work/life balance, because before I was putting all my energy into work, which didn’t leave much left when I was at home. I was just sitting in a chair most of the time and that’s not a good place to be. And I didn’t have time or energy to pursue hobbies. I like to do a lot of outdoor activities. I took up pottery because it was slightly more sedentary and I thought maybe I could do this because it’s not good for your mental health to do nothing.”

3. What’s your advice to women in their 30s, 40s and 50s who might be experiencing hormone changes?

I would say that you can’t rule anything out as potentially being perimenopausal and I think that there are some risks of taking HRT around breast cancer. However, I’ve done some research into this and there are huge benefits: it helps to prevent osteoporosis and Alzheimers. So for some people it might be bad. But for the vast majority of people it’s probably a good thing. And if you try it and it works then why not just try it. If it doesn’t work you can discontinue.

My personal experience of it was that after two weeks of HRT I was back to normal and that was on a really low dose, and that showed me how long I'd been struggling on my naturally occurring hormones. And my periods were, throughout this whole time, relatively consistently cyclical and on time. No additional breast tenderness, no heavier periods, no lighter periods, none of that. But the proof is in the pudding. Is that the placebo effect? I think that’s highly unlikely after 18 months. I’m a lot better with it and I’m very very pleased that I started down this path. So my advice is to give it a go. Especially if you’re suffering from crippling anxiety, or stomach related illness, or racing heart, or any of those sorts of things because you have oestrogen receptors all over your body, so an imbalance of oestrogen and progesterone can really affect you in a whole variety of ways. So it’s worth looking into.”

4. How did your partner respond?

“He’s a very practical guy. He’s not really good with emotional support. However he is really good with keeping the household together. So he was preparing all the meals and doing all the laundry and really keeping everything functioning. He was supportive in a way that he wasn’t criticising me and he wasn’t punishing me for what I was going through. He was just very accepting of it and left me be, to just work through my own shit in my own time. And, whilst I could say I think it might have been better if he could have found the reserves to be a bit more supportive, I don’t think that we should put all of these things onto our partners. It’s important that we have other support networks, other women to lean on. People who are going through similar things at the same time, that we can reach out to and have those conversations.

What I would say is, how could he empathise with this? He’s not going to go through this himself. But he didn’t make it worse. He didn’t put pressure on me. He didn’t say “why aren’t you doing this? Why aren’t you doing that? Get your lazy arse out of bed!” So I am truly appreciative that he held the family together at a very difficult time while I was basically suffering. And fortunately I did get hold of HRT and it was a successful outcome for us. (...) I think you do need to look after yourself and be kind to yourself to just get through this really rocky period of transforming into your ‘wise owl stage.’”

Photo by Andy Chilton on Unsplash

REFLECTIONS

This experience is just one example of how female hormone related symptoms are often very difficult to diagnose.

If you think you might be perimenopausal, do not hesitate to consult your GP for diagnosis, advice and treatment. If you don’t get effective support initially, try again or ask for a second opinion. There are natural therapies and supplements available that may be beneficial for balancing hormones as an alternative to HRT, such as wild yam, so you could consult a qualified herbalist.

There are also some fantastic resources available. I personally really like Dr Louise Newson’s Menopause library, podcast and free symptom tracking app: https://www.balance-menopause.com/

And Dr Anna Cabeca’s books on natural ways to balance hormones and nutrition, online resources and courses: https://drannacabeca.com/

You are not alone, there is so much information, support and treatment out there these days, and we all need to talk about this more.

Author: Alexandra Porter.