Help! I'm suffering from 'menoconfusion'

This article by Kate Spicer first appeared in the Daily Telegraph on 14th October 2019

To mark World Menopause Day on Friday, Kate Spicer reveals how the NHS made her experience worse

Back in August when news that a clinic in Brimingham, ProFam, was reversing the menopause using frozen ovarian tissue (for £7000-£11000), I couldn’t even get my hands on a supply of HRT. It wasn’t just that there was, and still is, a chronic shortage of the stuff despite nearly half the population qualifying for it at some point in midlife.

The problem for me was that despite several visits to the GP, no one would write me a prescription. HRT is considered largely safe now, and I have no history of oestrogen related cancers in my family anyway. I presented with symptoms of the perimenopause, none of the fabled hot flushes, but a definite woolly-headedness and memory loss -  I’m doing the battiest things: leaving my phone in the fridge and forgetting my keys. Then there’s the bloated stomach, the laborious painful periods and the stinging promise of tears at absurdly inappropriate things - not least the newspapers.

GPs at my practice have given me three blood tests so far and conclusions have ranged from, “Go away, stop over thinking it, you aren’t ready yet”; “I’m leaving the NHS to start work as a private menopause specialist on Harley Street, why don’t you come and see me there,” “Let’s do an ultrasound,” and, “How about a low dose antidepressant?” One medical person suggested the woolly headedness around the time of my period was probably just age related cognitive degeneration. What? At this rate I’d have full blown Alzheimer’s by Christmas.

All I wanted was some HRT. The multiplicity of conclusions left me utterly baffled and crestfallen. I wasn’t just 49, permimenopausal and a drain on NHS time, now I was also suffering from terrible menoconfusion. A little known phenomenon that seems to affect an awful lot of women.

Forget my hormones falling off a cliff, I felt like jumping off one [menopause is a recognised cause of suicide]. I felt rubbish about the future. In her book, The Change, the normally ferociously confident Germaine Greer describes sitting with a friend at 50 and them both seeing “telescoping of the next thirty years into a single grim tomorrow.” And that pretty much sums up how I felt.

You don’t need to be suffering from oestrogen withdrawal to be confused by this. Turns out I am not alone. Women are going into the menopause without any knowledge: one survey had nearly half feeling confused about their options for managing symptoms.

As so often happens in these situations when medicine abandons women, they turn to each other for support. One science writer acquaintance was horrified I’d been denied HRT and offered antidepressants, “that’s totally against NICE guidelines yet horribly common.” Alison Cross is on anti-depressants, and says they work for some of her symptoms, but that more worrying is quite how far she has to go to the nearest menopause clinic, two hours away. Another, the chef and food blogger, Kerstin Rodgers, “Took antidepressants for the hot flushes and it worked, but only for three months.” 

For Dr Louise Newson it is hormone replacement that is an essential protection from the serious health issues associated with oestrogen deficiency. “Even the contraindications of the worst type of HRT are offset by the improved [protections] against osteoporosis, heart disease, arthritis and diabetes.” She also makes a key point that I have certainly observed in older menopausal friends who have chosen to tough out the symptoms, “They’re drinking wine to cope.”

A rock stars daughter told me she’s getting through it with microdosing magic mushrooms and doing a lot of yoga. Rodgers admits self medication is essential, “I definitely drink more and only way I can sleep is if I have a joint.”

Newson is the author of the extremely pragmatic and practical manual, Menopause (Haynes). When I ask her about menoconfusion she agrees it is a patient and practitioner problem, “[One study] of 4700 women found the [majority] had been to several doctors before they got any help. It drives me mad that professionals are doing unnecessary blood tests for hormone levels, they’re known to be useless, any woman over 45 presenting with symptoms should be considered for HRT.”

Women are going into the menopause without any knowledge: one survey had nearly half feeling confused about their options for managing symptoms. CREDIT: NICOLASMCCOMBER

A few years ago, when Tania Smith started bleeding heavily in her late forties, “My GP sent me for constant blood tests and checks for cancer. No one, at any point, said, this probably or even might be the menopause and I had been taught nothing at school so I literally knew nothing.”

Dr Kate Panter is a consultant gynaecologist at Guys Hospital menopause clinic and a member of the council at the British Menopause Society. “NHS commissioning groups are cutting services in a lot of areas of women’s health,” meaning the expertise women need at menopause is very hard to access, “Most GPs will have a women’s health expert but your average GP is both deskilled and doesn’t think menopause is important. Fact is about a quarter of women will have significant problems, half will have some trouble and only a quarter will sail through.”

To an extent, sailing though the menopause is a luxury few can afford. Newson doesn’t want to have a private practice. Her Newson Health Menopause & Wellbeing Centre of 15 hormone specialists exists, she says, only because the NHS didn’t want her.

With a raft of access to top medical advice and the attentions of expensive medical spas and grooming experts, women can stay in a glossy perma prime, if they have the time and the money. Another friend, a rich one, said I must go to the high profile celebrity hormone doctor, Marion Gluck, for her exciting array of tailored bioidential hormones, apparently “everyone” goes. While another poo poo’d this: “B******s! bioidentical and common-or-garden HRT are exactly the same these days. Your doctor can prescribe them.”

Classic menoconfusion. See what I mean?

With the first appointment at £300, and with a bank of tests and prescriptions stacking up annually into the thousands, Gluck is a luxury few can afford. Even less an attendant industry of cosmetic medical, spa and beauty treatments for women keen to the preserve the polish that comes so effortlessly in youth.

The owner of EF Medi-Spa Esther Fieldgrass recommends a phalanx of treatments for menopause including a £200 testosterone cream for flagging energy and sex drive,  a ‘Femilift’ for stress incontinence and vaginal laxity, £5000 - lasts just two years, and prophilo injections to hydrate the face, £500 a few times a year, and a peel to make sure your lady parts stay a pretty shade of pink. 

Ramsbottom, a retired banker, takes issue with, “Rich and famous women talking about their amazing menopause experiences doesn’t help as it’s financially out of the reach of most normal women.

As with too many things to do with women’s sexual health, it’s not just a feminist issue it’s a financial one. Gaining access to experts is hard unless you are paying. Even those with private health insurance can suffer from this. “Profoundly unfair insurers,” says Panter, “Have decided unilaterally not to cover menopause. Even mentioning the word can make a claim invalid.” 

Could there be some benefit to being a bit of a menopause denier, then?

I admit, talking about menopause can be enlightening, but it can also make you on paranoid high alert for symptoms. Was that a hot flush or is it just a bit hot in here?

Yes, to add a new political dimension to the menoconfusion there are some that believe menopause doesn’t even exist, that it is the invention of entirely male Western European early modern medicine. The ” acauthor of a new book, The Slow Moon Climbs by Susan Mattern, a history professor at the University of Georgia, writes: “Modern menopause is a cultural syndrome. We don’t even need to be consciously aware of the input and signals we are given, which amplifies the symptoms.”

Unlikely as this may sound to some, it makes sense to me. It was my general fear of the menopause that sent me to the doctor, not unbearable symptoms. But what about those symptoms that are more serious like osteoporosis? You can’t describe crumbling bones as a psychosomatic illness, surely. “They should be rethought. They are not entirely due to having less oestrogen.It is not a medical problem, it is a transition. I like the phrase Middle Age.”

Mattern’s book, subtitled, The Science, History and Meaning of Menopause dedicates four pretty dense chapters to this theory, makes a strong argument for embracing the menopause and treating its symptoms singly rather than bundling it into this female syndrome. Imagine if the male “andropause” were so hysterically catalogued and pored over. The idea of menopause as societal construct isn’t bonkers.

Tania Smith’s own experienced of menoconfusion saw her found regular retreats, Menoheaven, “A space for women to get information, tools [like lifestyle changes] and support to make the menopause a positive experience and important transition when women can come into their power. Most women arrive completely confused and leave feeling heard and transformed.” For her, ”HRT is a male invention to keep women in a juicy libidinous stay. I actually prefer life now.”

I asked a group of groomed women at a smart London charity dinner and the universal response was, “No way.” One, a late fortysomething consultant, a patient of Gluck’s, motions to her perfect body and bouncy hair saying, “If we can live another twenty years like this, why wouldn’t we?”

Personally, the menoconfusion endures, rather like this bizarre two week period I’m currently experiencing. What is the menopause? Thrilling rite of passage, life threatening chronic condition or some kind of foe to be fought at all costs? As Panter says, “If women had good information they would be better placed to decide.”