Menopause, let’s talk about the taboo

For one person the menopause is plain-sailing, for the other it’s a years long struggle with mood swings, hot flashes, and sleepless nights. It’s time to call it what it is. Because this might sound like a far cry to you, any smart girl is prepared for the perimenopause. We talked about this sensitive subject with Dorenda van Dijken, gynecologist, chair of the Dutch Menopause Society, and Cycle expert.

The perimenopause, we are not concerned with that at all. Why is it such a relevant topic for young people?

“The perimenopause is also called the 3rd life phase. For women who are born now, that’s the second half of their life, because they will most likely become a hundred years old. In that scenario it’s very relevant to know what’s going to happen, so you can get through that life-changing event well”

During the spring there is a week of the perimenopause each year and (fortunately) more awareness is spread. But why do we do that?

“Women in general know too little about the perimenopause. When it starts, what the symptoms are, which impact it can have on their life and work, which risks there are, how to deal with the symptoms, and which treatment options are available. As a result, women during perimenopause walk around for far too long with symptoms that interfere with their functioning and that can simply be treated. Women also have the right to know information about the risk for cardiovascular diseases and osteoporosis, which can occur after the perimenopause.”  

Okay, that’s clear. But what does the perimenopause and the menopause mean exactly?

“Menopause is actually nothing more than the day of your last period. We speak of menopause when you haven’t bled for a year. So, you won’t know until after it has happened. The perimenopause is the name for the entire party surrounding it that is caused by a (fast) descent of the estrogen production. Perimenopausal symptoms can occur when you are still menstruating. Every woman -so half of the population- will deal with it in her life. It begins on average around the age of 45, with the day of menopause on average at the age of 51. 20% doesn’t suffer much. 80% experiences symptoms and for a part of them the symptoms are very heavy. I’m talking about hot flashes, nightly transpiration, mood swings, memory and concentration problems, insomnia, heart palpitations, stress, muscle and joint pains, and a leaky bladder.”

That sounds really tough

“It can be. If you can’t sleep at night and are dead tired during the day, it’s really tough to concentrate. You become more sensitive to light and stimuli; you get a very short fuse. Some women can handle it when they are at work, but once they are home it’s over.”

Do you want to know more about emotional complaints during the perimenopause? Read here about the top five most occurring complaints.

So, work and perimenopausal symptoms don’t go together?

“Indeed, it’s an underestimated societal issue. Perimenopausal complaints occur mostly with people 40-60 years old. We're calling in the House of Representatives for a women's quota for top jobs in business and politics, so it's exactly about that group of women. But how will we do that if we can’t help those women with their perimenopausal complaints? You really don’t want to talk about your hot flashes as an attorney, minister, or CEO in a men’s world such as that. These women cannot function sometimes due to their complaints, whilst there are really simple solutions for them.”

Do you think that’s the reason the women’s quota isn’t met?

“That’s a good possibility. But perimenopausal-related problems play out in many more areas of work than just where there is a women's quota. Think about aviation, fire brigade, and the police. They are all man’s worlds where they wear synthetic uniforms. If you suffer from heavy sweating, you will absolutely drench the uniform, but if you say anything about that as a woman, you will be lynched, so to speak. And what do you think of the teacher getting a hot flash whilst standing in front of their class? They will be teased for it, that’s for sure. In the Netherlands there are currently many different investigations into absenteeism. This shows that 1 out of 3 women call in sick because of perimenopausal-related complaints. But those women do not dare to name it. Think of the enormous cost savings you could make by doing something about it and by making it a subject of discussion.”

Why does nobody speak about the perimenopause?

“The perimenopause is hugely trivialized in the Netherlands - as was pain management for childbirth in the past, for that matter. It’s also part of the mindset of women themselves, out of fear of being put in a box. Nobody wants to be old and written off and to not belong. Personally, I think it’s because we Dutch people are Calvinistic people, we always say: ‘don’t talk the talk, but walk the walk.’ Look at, for example, hormone therapy. That could help women so well. For some, they are symptom free after just two weeks. The Netherlands is miles behind others in this field and a lot of doctors don’t have the right knowledge about the perimenopause. And another thing: in every other country you can go and see a specialist if you want to, but in the Netherlands you need a referral from your GP and a high excess.”

But what about hormone therapy? You hear some weird stories about that

“Perimenopause occurs because your ovaries produce way less estrogen. Hormone therapy replenishes this deficiency and it works like a charm on menopause symptoms. In the 1990s, everyone was getting it, until a study of one of the drugs was done in the US in 2002 on older women (majority age group 65-85+). There appeared to be a higher number of breast cancer and cardiovascular disease in that group of women. For every 1,200 women, it was only one more case, but in the media this was inaccurately translated to 26% more chance. That news hit like a bomb, and we are still dealing with the negative perception of this -then already incorrect and outdated- information. It was about a product that has never been on the European market, and you can’t just compare hormone preparations. Still, that’s exactly what happened. Moreover, there are lots of risk factors for breast cancer and those were not included in the study at the time. For example, excess weight, smoking, and alcohol use. Unfortunately, we just can’t seem to get rid of the painted picture.”

Do you want to read a personal story about hormone therapy? Read the interview with Anita Witzier here.

We as women really hit the jackpot, didn’t we?

“Exactly. Recently it was written that hormone therapy increases the risk of breast cancer by 5%. So, we then we write another article, because it’s more nuanced than that and blatantly not true. People get scared and sometimes believe everything that is written. Even GP’s are reluctant because of these kinds of messages. After 2002 everything was on hold in the Netherlands for 15 years, nobody dared to prescribe hormone therapy. Now it’s fine, but we have a lot of catching up to do compared to the rest of the world.”

Is there any positive news as well?

“There are some amazing aspects to aging. These are not directly related to the perimenopause, but with the change in motivation and daring to be yourself. The menopause rings in a new era, where you can and must choose for yourself. Change course, get an education, start your own business, do what really suits you and what you love to do from your heart. Women always place themselves at the bottom. We take care of everything and everyone for years, and once that’s done, we need caretakers. There is something in us that upholds this role pattern, but we are allowed to -read should- step out of that mindset. I’m convinced that there are many more female role models than male role models, even in higher positions. We have to stop being so modest about that!”

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