She tells me the facts. The highest suicide rate in the UK is currently 45-49. Peak sadness strikes us at 47. ‘Menopause is known to aggravate manipulative disorder, and perimenopause may increase the risk of first-present psychosis: schizophrenia, for example, usually has its onset in young adulthood, but there is a second peak in women around. menopause. ‘
“Am I five years away from the peak sorrow?” Please. I can’t feel sadder. ‘I’ve already reached the top.’
I also have brain fog, insomnia, anxiety, depression, mood swings, fatigue, memory loss, distancing, migraines, emotions, mood, memory, anger, lack of motivation, as well as sadness or emptiness, all of which, I discover, are symptoms of perimenopause. I also have many of the physical symptoms she then lists: hot flashes; night sweats; vaginal dryness; headaches; palpitations; discomfort during sex; vaginal atrophy; dizziness; recurrent urinary tract infections; incontinence; irregular periods; bladder problems; osteoporosis; increased cholesterol; decreased libido; bleeding gums; hair loss; dry skin, hair, nails, vagina, eyes, mouth; joint pain; diminished vision; fatigue; muscle pain; chest tenderness; numb hands and feet.
“People focus on the known physical symptoms of perimenopause, the hot flashes, for example,” she says, “but the symptoms are mostly neurological, and can lead to a neurological decline, even a degenerative disease. Estrogen is a master regulator … ‘
Neurological decline? Degenerative disease? Top sadness? And are the physical symptoms well known?
My doctor – unlike, I’ll find out later, too many doctors – is well informed about perimenopause. But in many cases, in my case, even though I was a nurse for 20 years – I had no idea what these symptoms were. No clues.
I’m trying to describe what I experience to the doctor anyway. ‘Suddenly my mind and body feel completely apart, working independently, falling apart in different ways.’ She nods, knowing. ‘Then there are the social factors,’ she says. ‘Because clearly that list isn’t long enough for women.’ She laughs, and shakes her hair again. My hair is falling out. I think about when it first happened, and about the handful of relaxing hair whenever I wash it. My scalp becomes visible. My friends say they can’t notice, but I suspect they’re kind. I can’t brush my hair right now because even something like gentle brushing causes small piles to fall out. I no longer dress in black, so as to avoid so clearly seeing the hot threads constantly falling on my shoulders. I started looking at other women’s hair with great envy.
Of course, in the grand scheme of life, hair loss should be trivial. But it doesn’t feel trivial. The word trivial means very common and therefore inconsequential, but it comes from the word ‘crossing’.
“Aging parents,” she says, “teenage children, financial stress.” She smiles at me, looks up from the screen. ‘Think of it less as a loss of youth,’ she says, ‘but a gain of wisdom.’ I look at her without blinking. ‘What are my choices?’ I ask her. I don’t know at all if she can help me, and how, or even if medication is the way forward, but there’s one thing I certainly understand: I clearly need regulation. And she suddenly looks older than her years, and wiser.
‘HRT,’ she says.
Natural change versus medical intervention
In her 1994 book, The Menopause Industry, Sandra Coney says, “Menopause is a natural part of life, not a disease, and it doesn’t necessarily require medical intervention.” This was not a new idea. In 1936 Marie Stopes argued that the crises of a woman’s life were much rejected by male medical writers – and perhaps the most artificially created was her “change”.
I’m changing. And it doesn’t feel natural or evolutionary at all. I want my brightness back. I want to know the part of me that I lost, and how I can get it back. I want to win, not lose. I need the drugs.
‘You’ll probably need two or three weeks to feel any effect,’ the doctor tells me, tapping his heels on the floor. ‘Just change the patch twice a week and let me know if you have any problems.’
‘Here it is? You don’t need to take any more blood or anything? ‘
“I’m going to do routine blood tests because you’re younger than 45, but basically that’s it,” she says. As if she has a secret I don’t know yet. She tells me that the little transparent spots stick to my skin, but if I don’t get them I can use a gel instead.
We argue that HRT is not for everyone but it is suitable for most people. She tells me that there is little or no change in the risk of breast cancer if you take only estrogen HRT, and no increased risk of blood clots with the only estrogen HRT chips. ‘But there are a lot of different treatments available for women,’ she tells me.
‘If HRT isn’t right, there are non-hormonal medications we could talk about, and other treatments, but most women can have HRT, and the benefits outweigh the risks in the vast majority of cases, and actually reduce risks of issues. such as osteoporosis and heart disease. There is no increased risk of breast cancer in women under 51 using any type of HRT and it is a very low risk for other women. ‘