Vichy Laboratories has over 19 years of dedicated scientific research and development into menopause diagnosis and education to help people feel better equipped and speak openly about their experiences (it also has a dedicated skincare range specifically formulated for the three stages of the menopause, the Neovadiol collection). The range was created in response to the changes the skin goes through during the various stages of the menopause to ensure people are given the products needed to help them to look and feel their best. Here, five AllBright women share their experience with the three different stages of menopause and expert Dr Ginni Mansberg helps explain.
We all know that periods have long been taboo. Only last year, the Modibodi ad campaign was blocked from Facebook for daring to show red blood on screen (apparently bloody crime scenes are fine; period blood, not so much). But what about when they stop? We asked our community about their experience of menopause, and we were inundated with stories from women telling us the same thing: the only thing more taboo than a period, is menopause...
We usually speak about menopause as a singular transition in a woman’s life - the ‘Change’. But in fact, menopause happens in stages. While Dr Ginni explains that there are actually seven stages to menopause, we can break them into three main transitions: perimenopause, menopause proper, and postmenopause.
In the first stages of perimenopause, Dr Ginni says, “you lose a little bit of your body's ability to make progesterone. But in fact, because that system's going awry, your brain is trying to stimulate your ovaries more. In fact, you often overproduce estrogen. I think of estrogen as your New York city hormone, it's a go, go, go hormone. It builds more blood in the uterus, tells the brain to just go and fire and be on top of everything, think clearly. Whereas your progesterone is more relaxed: ‘Hey, chill out, don't worry about it, it's so cool, let's go to sleep.’
And so as a result of having too much estrogen and not enough progesterone, certainly the early part of perimenopause, a lot of women feel like they're going crazy, because you don't sleep that well anymore, because progesterone's an amazing sleeping pill. You are a little bit too in overdrive with your brain. So you can overthink things and your brain's a little bit too intense, and you don't get the calming effect. And one in four women get absolutely crazy periods, they're really, really heavy because you don't have enough progesterone. But slowly the lack of progesterone starts to be matched by a lack of estrogen, because your ovaries are tired. So that all slowly tapers down.”
For Dr Shahzadi Harper, the owner and founder of The Harper Clinic in London which specialized in menopause, experiencing perimenopausal symptoms coincided with losing her father so she found it hard to unpick what was grief and what was perimenopause symptoms. “I had joint pains, neck and knee pain to the point that I even felt like I had a necklace around my neck which was too heavy, and I’d want to take it off in the evenings. Brain fog which was quite frightening for me as I always prided myself on my memory. No hot flushes, itchy skin. Unusual symptoms and even I didn’t put two and two together at the beginning,” she says.
Dr Shahzadi Harper
It’s an all too-familiar story for Kate, 49. “I’ve been in perimenopause for a few years now”, she tells us. “I am up and down like a yo-yo. Very irritable with most people, only I don’t show it most of the time, apart from at home with the kids and hubby. Symptoms are on for a month, then maybe six months off.”
Stylist Jo is 50 and felt the same way: “I started having irregular periods and my mood swings had gone haywire. I found it extremely difficult to focus with work.” On top of this she noticed her body temperature “starting to feel hotter, especially at night, and finding it hard to sleep.”
The temperature change may be a clue. In the second half of perimenopause, says Dr Ginni, “you'll get a lot of the features of menopause. You'll start to get the hot flushes, you'll get some night sweats, you can get aches and pains. You can get all of those things as well as the other stuff with the lack of progesterone, so you're still not sleeping great. You can still feel a little bit anxious because progesterone's a great anti-anxiety medication, and a sleep pill. But meanwhile, your adrenal glands that some may call your male hormones, your testosterone type hormones, they don't go into menopause. For at least 10 years afterwards, you can get chin hairs and your hair can thin, you can get perimenopausal breakouts. And then eventually the whole thing winds to a close and by the time you get to menopause, you tend to get your ovaries, if they are making a bit of estrogen, it's a tiny dribble, but mostly the ovaries are flat lining and you're not getting those cycles at all.”
Jasmine is 45 and has reached this stage of menopause. “I am on the other side”, she says. “We have a family history of early onset. It was so hard at 40 to start to go through it, without anyone of like age speaking about it, and older women staying quiet.”
But how do you know where you are in your menopause journey? It’s a surprisingly tricky question to answer, and, as Dr Ginni explains, requires patience. “When I went through medical school, I did speak about menopause once, maybe, but we don't learn a lot about it. And I think women's health is just really neglected by the medical profession altogether, so that is a really big problem. In terms of getting a diagnosis, a lot of my patients come in and want a blood test. And for most women, a blood test is completely useless when you're in the perimenopause - it doesn't matter what it is one day, because it could be completely different the next day. So a blood test is a hormone level at point in time, and it can even show you've gone into complete menopause, but then the next day you have a period, so it's not helpful. By the time you've gone into menopause proper, it's been 12 months since your last period. Well, we don't really need a blood test for that, because you know it's menopause.”
Unfortunately, particularly for women in the younger age brackets, a diagnosis can take years. Melissa was just 40 when she began to experience symptoms of menopause. “Irregular periods, huge pimples, exhaustion and going from tears to anger to shame all in the space of two hours were some of the early symptoms”, she says. “I had three year old twins and two older children so being 'menopausal' was not on my radar and was ruled out by doctors and practitioners. Time went on and symptoms continued to stack up. I experienced weight gain, hair loss and debilitating chronic sinus issues and infections."
Melissa's "normal" was to push through to Friday and limp across the finish line. "I fell in a heap most weekends either in tears, or just wanting to escape and be on my own. I was guilty about the impact on my kids and husband. By this stage sex was painful, and my libido went missing. I recall my last period because I was running a senior leadership meeting at a hotel and as I was setting up at the front of the room I felt 'the flood gates open' unexpectedly. I was the only female and I had to make an excuse to go back to my hotel room so I could figure out how to clean my light orange pants! I had normalised high levels of stress," she says.
It was two years after the symptoms that Melissa started to experience her first hot flush. "I thought I was sick so went back to the doctor. A few weeks later she met with me to review my results, confirming it was not a virus or infection she said ‘I am sorry to tell you, Melissa, that you are in menopause’. She then went on to discuss HRT and I could not process anything as I heard ‘you are old and on the shelf’ and I had to figure out how I was going to run a leadership offsite the next day and digest this news."
Unfortunately that was not the end of her symptoms. "I experienced dizziness and fainted in an H&M store in NYC, and on other occasions. I had continued sleep challenges. It continues to be a journey."
Melissa experienced the same challenges with locking in a diagnosis, until finally after “6 doctors, specialists and alternative therapists; it was the Integrative GP who told me to ‘slow the F down’ that helped me the most. I felt heard. She connected me to the emotional side of menopause, and the opportunity for transformation. She helped reduce the overwhelm about what to do.”
So why the confusion? Well, according to Dr Ginni, “I think what happens is if your symptoms are anxiety, insomnia, aches and pains, but not hot flushes, not everybody connects the dots. And the other thing that can happen is that you have hot flushes, but because you're still having periods, a lot of doctors don't connect the dots and they'll blame that on a thyroid problem, but it's got nothing to do the thyroid, it's everything to do with the menopause hot flush, and a lot of women get them in the second half of perimenopause, but a lot of doctors go, ‘Well, you're having periods, so it's not menopause.’”
But Dr Ginni’s advice is not to get caught up in the diagnosis and rather to address the issue. “We’ve got to treat the woman, rather than getting stuck on the nomenclature and just getting stuck on, are you in late perimenopause or late menopause transition? Or are you in menopause?” she says. “That can be really unhelpful nomenclature because if the problem is, at the end of the day, a hormone related problem that we can fix with hormones, then we're going to do it.”
Speaking of treatment, it can be rather contentious. A common path is Hormone Replacement Therapy (HRT), which many women are nervous about given its association with breast cancer. But, explains Dr Ginni, “the position of the international and the Australian menopause societies is that HRT, when used appropriately, might involve a slight increased risk of breast cancer, but a decreased risk of osteoporosis fractures and a decreased risk of colorectal cancer. And most importantly, it treats the symptoms.” Plus, she says, in the study that found the minimal increase in breast cancer risk, “they used a form of HRT that we don't use anymore.”
It’s a decision that Fiona had to grapple with after starting menopause at just 37 years old old, as a result of cancer treatment. “My youngest child had not long turned 1”, she says. “I went straight to HRT, knowing the risks, but weighing the known symptoms against needing to bring up two small boys with some level of normality.”
Kate agrees. “ I have decided to take the plunge and commence HRT next week. I am scared about breast cancer, but my endocrinologist said I am low risk, and I’m looking forward to getting ‘me’ back.”
And as Kate puts it, “there’s so much that is never discussed with menopause (almost like periods used to be a ‘just deal with it’ topic). I see my friends bewilderment now, as they start approaching menopause, so I think that this is the generation who need to change the stigma.”
It's this stigma – or the menopause taboo – that Dr Harper is passionate about breaking. “It’s about believing in yourself and understanding that this stage of life is normal. You’re not going crazy, it’s your hormones and we can get back into control. It’s understanding that you can get your confidence and sexy back but it is a journey and you need support throughout it.” And thank goodness for women like Dr Harper who are passionate about women’s health.
“I felt that women’s health doesn’t get the priority it deserves. I am very much an egalitarian, growing up with five younger sisters and having a daughter myself, seeing the inequality in men’s health and women’s health really drives me to address the balance. When I see midlife women fading when they shouldn’t have to infuriates me which is why I’m so passionate about women looking and feeling their best and taking charge. It’s about putting women’s health on the map.” Now that’s a woman – and a message - AllBright can get behind.
In partnership with Vichy Laboratories