The Hidden Symptoms of Menopause

The Hidden Symptoms of Menopause

When I was younger my impression of the menopause was much the same as many, I think.  I assumed it was all about hot flushes and mood swings.

My mum died when I was 22 (at the age of 54) and at that age, asking about her menopause was definitely not top of my list, so I had no experience of her menopause that I could call upon and no idea what to expect.

I was pretty clueless if I’m honest so it came as a massive surprise when my own menopause symptoms began to set in – not least because I had no idea that the physical and emotional symptoms I was dealing with were even related to menopause.

I must have been about 44 when I first started to realise something wasn’t quite right.  I’d started to have bouts of feeling very low.  I’m not sure I’d call it depression but I definitely wasn’t my usual self.  And these low moods no longer coincided with my menstrual cycle.

I had incredibly sore boobs for a couple of weeks each month and I’d started to have the most horrendous periods!  I think I assumed that as a woman got older her periods would simply get lighter and less frequent until they disappeared completely.  I was definitely not prepared for the flooding that arrived with a vengeance most months.  Not only that, my periods weren’t even sticking to our long-standing time table, but instead would strike out of nowhere.

On one occasion I was travelling to Newcastle with my husband and we had to pull into the service station at Scotch Corner because I’d suddenly found myself in full flood.  I was wearing white linen trousers and had to strategically wrap a jumper around my waist so that I could make it from the car to the ladies’ toilets without everyone seeing my predicament.  Thankfully we were heading away for the weekend so I had spare clothes in a suitcase in the boot of the car otherwise I have no idea how I’d have coped.

I finally went to see my GP when I was about 45 and tentatively asked if it could be the start of the menopause.  She smiled a mildly condescending smile and told me that I was far too young for it to be the menopause.  I asked if she was sure and was there a test that she could do to check.  Again, she dismissed my concerns, telling me that there was no accurate way to test for menopause and suggested I try some Prozac.

I declined.

I started to take Oil of Evening Primrose Oil as I was told it would help with the breast soreness, and I have to say it did but I was still struggling with low mood.  At no point was Hormone Replacement Therapy suggested to me.

Episodes of anxiety were starting to creep in too.

I’d never been a particularly anxious person so waking up with a knot in the pit of my stomach and my heart racing weren’t feelings I was used to.  I would say the anxiety began when I was around 48.  The episodes were infrequent and not particularly severe, but they worried me nonetheless.

I now know looking back that these symptoms are all common in peri-menopause.  That’s the time leading up to menopause when a woman’s sex hormones begin to decline and signals the start of the end of her fertile years.

I also now know that peri-menopause can start up to 10 years before a woman hits menopause (the average age in the UK for a woman to menopause is 51).   

Hormones and Depression

It has been known for more than a century that depression is more common in women that man. Suicide attempts and prescriptions for antidepressants are more common in women. The question is whether this is due to environmental, social or hormonal factors. An endocrine cause is suggested by the observation that this excess of depression occurs at times of hormonal change such as in the days before a period as premenstrual depression (PMS or PMDD) or in the weeks after pregnancy as postnatal depression (PND) and the years approaching the menopause as climacteric depression (CD). This latter problem is at its worst in the few years before the cessation of periods – the transition phase. This subgroup of depressive disorders is called Reproductive Depression (RD) and are important because the causation is endocrine rather than psychiatric and the most effective and logical treatment is by hormones rather than antidepressants.

Reference: The British Menopause Society 11 June 2019

I hear all too often of doctors misdiagnosing menopausal anxiety as depression and according to The British Menopause Society anti-depressants are not an effective treatment in this circumstance.

As I entered my fifties I started to experience even more symptoms that I didn’t immediately relate to menopause.

On one occasion whilst at work, I placed an order online for nearly five thousand pounds worth of equipment and yet when it was delivered I had absolutely no recollection of having ordered it.  The only proof I could find that it was, indeed, me that placed the order was by looking through my Google history and there, plain as day, was the order I’d placed just after 7am on a Monday morning a couple of weeks earlier.  To this day I cannot recall placing the order.

Having started a new job just before my 50th birthday I was finding myself struggling with a lack of confidence.  I was questioning my decision making and second guessing everything I did.  I’m not sure those who knew me would have noticed any change, but inside I was losing the plot.

On more than one occasion I found myself in tears as I tried to explain to my 28 year old, male boss that I thought he’d hired the wrong person for the job.  Thankfully I was lucky to have an amazingly empathetic and understanding boss, whose mum happened to be going through some of the same issues I was, and who assured me he was more than happy with his decision and I was doing fine.

But the thing is, I wasn’t doing fine.  I was feeling incompetent and under confident.  I felt in a constant state of stress. I was like a duck on water – trying to remain calm and composed on the surface while underneath I was frantically trying to tread water.

I had no idea that low confidence, cognitive dysfunction, memory problems and poor concentration were related to menopause.   The incident with the forgotten order left me wondering if I was developing early onset dementia.  I had no idea if dementia was a problem in my family, since both my mum and dad had been taken from me during my twenties while still relatively young themselves.

During my late forties I began to get what are known as ocular migraine or migraine aura during which I’d suffer visual disturbances.  The best way to describe this is like a metallic zig zagging that frames my peripheral vision.  Another way to describe it might be that the outer edges of my vision are pixelated.

They usually last for about half an hour and then go.  The first one was a bit scary but as they became more regular (about 2 a year) and as they weren’t associated with any headache or pain, I didn’t worry too much about them.

Then, about 2 years ago, I experienced one start as I was working at my computer at work.  I started to explain to my colleague what was happening and that it would pass in about thirty minutes.  It was just leading up to lunchtime and my vision was starting to return to normal as I headed up to the staff kitchen to grab some lunch.

As I tucked into to my salad a male colleague, sat at the same table, asked what I had in my lunchbox (I had been following a diet so my food choices were something of a novelty each day!).  As I looked down I tried to recall the words to describe the contents of my lunchbox.  I could ‘see’ the words in my head but for some reason I couldn’t quite connect them to my mouth and try as I might, I just couldn’t recall the words for rice, peppers or chicken.  The more I tried to say the words the further away from me they seemed to be. 

I started to feel panic rising and a sense of embarrassment and shame.  How could I not even remember the word for rice?

After an incoherent attempt at trying to explain why I couldn’t answer his question I could feel tears starting to fill my eyes and I made a hasty retreat from the kitchen into the ladies’ loos where I stood looking at myself in the mirror and wondering what the hell was happening to me.

As I stood there the tears started to flow.  I couldn’t explain what was happening and I was embarrassed and scared.

When I’d composed myself, I headed back to my office and tried to explain to my colleague what had happened.  She wanted me to call my GP and make an appointment but I didn’t want to make a fuss.  In the end she persuaded me to at least call my husband and get him to take me home.

When I called him he ordered me to call my doctor immediately.  I gave in and called and was told by my GP to make my way straight to the surgery and to get someone else to drive me.  Thankfully my husband worked at the same place and drove me straight there.

I was put through a number of non-invasive tests – checking my eye movement, my reflexes, asking me questions about my age and where I was born, what year it was and how many children I had.  Then the doctor disappeared out of the room for what felt like forever but in reality was about 15 minutes.  When he returned he looked serious.  He didn’t speak to me but went straight to the telephone and made a call.

I heard him ask to be put through to the specialist stroke clinic.

My heart was racing and panic began to rise.  My husband squeezed my hand and gave me a smile that tried to say ‘don’t worry, it’ll all be fine’.  But he didn’t look convincing.

I was given an appointment at the stroke clinic at our local hospital the following morning.  Again I was put through a range of cognitive tests, then given an ultrasound scan of my neck.  I was weighed, had my blood pressure taken and asked dozens of questions about my general health.  I was sent through for a CT scan.

All of the tests came back normal.  In fact, the doctor told me I was in ‘great shape’ for a woman of my age – I know a bit shallow but it made me feel better in amongst all the chaos!

However, they still weren’t willing to let it go and made an appointment for me to come back for an MRI scan.  In the meantime I was told I wasn’t allowed to drive.

After 6 weeks I finally got the all clear.  There was absolutely nothing wrong with my brain and the consultant’s opinion was that the memory loss I’d suffered was a result of peri-menopause induced migraine.

Who knew?

I’ve since had another episode just recently as I was driving to Birmingham, and I couldn’t recall the name of the place I was due to deliver training to despite having just typed it into Google maps. 

Another irritation I’m still coping with is an inability to find the words I want to say.  Not quite in the same way as the lunchbox episode, but oftentimes the word I’m looking for simply won’t come.  I can find myself standing, mouth agape, wracking my brain for the word I need.   I’ve learned to be very open and up front about this, especially when I’m delivering training.  It helps that I train menopause and therefore my loss of words is actually quite helpful in making my point!

Despite trying to make light of some of the more irritating symptoms, I really do wish I’d known ten years ago that menopause could have such a wide and diverse effect.  I wish I’d known that it was perfectly normal to experience some of these symptoms.  I also wish I’d had a GP who understood more about menopause who could have given me more accurate guidance and possibly the offer of HRT to help me.

Many of the symptoms we experience as we approach menopause are insidious.  Creeping up with stealth and before we realise, they’ve become a part of who we are.  So much so that we don’t even recognise that we’re no longer the person we’re used to being.

I believe that as humans we can cope with just about anything once we know what it is we’re coping with.

Encouraging women to share their experiences can help them to realise that they’re not going mad or heading towards dementia.  The old adage a problem shared is a problem halved has much truth to it.

Encouraging a culture of openness where menopause and its symptoms are talked about freely can reduce the taboo that still surrounds the subject and enable women to cope more effectively with the scary moments.  Having social networks (either online or offline) where women can be surrounded by others going through similar experiences can help to normalise their symptoms.

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