The Big M: Menopause Myths and Facts

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For women, life is never easy. Even if we had to keep the patriarchy and misogyny aside, we will still struggle with our physical selves. After puberty, menstruation, childbirth, motherhood, etc., there is another passage that we are destined to pass through in our lives; menopause. And just like the others, no one promises that this will be a bed of roses either. Menopause comes with its own set of issues. And as if this wasn’t enough, there is the perimenopause which occurs before menopause. Before I could get further let me define these terms for you.

Menopause- This is a biological process that marks the end of your menstrual cycles after 12 months have passed without a menstrual period. Menopause can happen in 40s or 50s. This is accompanied by physical symptoms, such as hot flashes, and emotional symptoms of menopause may disrupt sleep, lower energy or affect emotional health because of the decline in reproductive hormones. But it can also result from ovarian removal surgery, chemotherapy and radiation, or premature ovarian insufficiency (POI).

Perimenopause- This is the transition, begins several years before menopause when the ovaries gradually begin to make less estrogen. It lasts up until menopause and in the last 1 to 2 years of perimenopause, this drop in estrogen speeds up and women have menopause symptoms.

At these times, women need to be understood and supported more than ever because the symptoms can be depleting, overwhelming and confusing. Low mood, sweats, low energy, fatigue, irritability, stress, weight gain and many more symptoms can be felt all at the same time and many women may not be aware or understand what they are going through. Hence awareness and educating about this condition helps in managing this phase so that one may go through it smoothly and gracefully.

Here are some common myths and facts associated with menopause.

Myth: Hot flashes means you are nearing menopause

Fact: Hot flashes or excessive sweating and a flushed face are a common symptom but do not mean that it happens to everyone or signifies menopause. While some women never experience this, others may experience it for a period of a few years. This can be accompanied by night sweats, rapid heartbeats, and chills. Avoiding triggers like caffeine, tight clothes, spicy food, cigarettes, and alcohol can help.

Myth: Menopause is natural and there is no need to see a doctor

Fact: Yes as much as menopause is a natural occurrence in a woman’s life, meeting a doctor can help in keeping health parameters in check and also help in managing the symptoms better with the help of medical guidance and proper nutrition. Menopause is not a one size fits all condition. Being informed and aware helps in understanding the body. Also, due to the depleting hormones, the chances of poor bone health, hair loss, increase. Adding the right supplements to a good diet can help combat this.

Myth: You cannot have a normal sex life or enjoy orgasms after menopause

Fact: On the contrary, many women enjoy great sex because they now do not have the ability to conceive and this though can be liberating. For some libido is affected. Due to the decrease in estrogen levels, the vaginal lining can become thinner, dryer, and inflexible and this can be prevented with lubricants and vaginal creams. But using contraceptives should be encouraged because they also prevent STDs/STIs and other diseases like HIV.

Myth: Hormone therapy can help ease menopause symptoms

Fact: Hormone replacement (give them estrogen) is to help manage extreme hot flashes and night sweats but symptoms are different for everyone and should be a personal decision between the patient and her doctor. Women with a history of blood clots, breast cancer, etc. may not be a candidate for hormones. For some women who attain menopause earlier due to premature ovarian insufficiency, hormone therapy is considered by the doctor after taking other factors and health parameters into account.

Myth: weight gain and depression is inevitable

Fact: Middle-aged weight gain is more because of aging than menopause. People gain fat as they age due to decreased muscle mass, less physical activity, and poor sleep. A watchful diet with more protein, fruits, vegetables, and an active life with walking and proper exercises help keep weight gain in check.

Perimenopausal and Menopausal Depression in women without any past depression in earlier life is not common. However, if depressive feelings persist, medical intervention is needed. Depression can also be because of post-retirement for working women or empty nest syndrome and may not be entirely linked to menopause itself.

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Dr. Kamna Kakkar, an Anaesthesiologist recently shot to limelight when she shared her experience of bleeding in her PPE suit on her first day of period while attending to Covid affected patients. Taking to twitter, the doctor went on to say how her first Covid-19 ICU duty on 17 May in Rohtak will be unforgettable.

“I bled freely that day…,” she writes, “… though not out of compulsion but by choice. I belong to the privileged strata of society where I never had to think about safely managing my periods. But that day, I felt what it was like to be in the shoes of women who do not have access to sanitary napkins or tampons or clean alternatives.” She shared this post on May 21, world menstrual day and was quickly picked up by social media. She was a junior resident doctor then.

“It takes 45 minutes for us to wear the PPE in sequential steps — a process called ‘donning’. Then we follow a designated route to the Covid ICU where we work with the sickest of patients. When our shift ends, six hours later, we leave the ICU via another designated route to reach the ‘doffing’ area. ‘Doffing’, or getting out of the PPE, is another step-by-step process that also takes 45 minutes.

“In the rush and excitement to serve in the Covid ICU for the first time, I had completely forgotten that I was nearing the end of my menstrual cycle and it was time for my periods. All I could focus on was being in the midst of a pandemic and also needing to stay safe. I had completely forgotten that I had a woman’s body inside a frontline worker.

“I couldn’t risk leaving my sick patients unattended in the ICU for 45 minutes to doff plus 45 minutes to don the PPE again — a total of 1 hour 30 minutes — to just wear a sanitary napkin. Also, that would mean I would need another set of PPE, and in a pandemic, PPEs are precious and being rationed. I didn’t want to waste even one.”

So she decided to bleed freely in her PPE till the end of her shift. But while narrating her ordeal to a friend when she called her a warrior, Kamna wondered if she really was one or just another regular woman doing my job.

“Regular women menstruate while working — nothing heroic about it. However, unlike me, who bled freely by choice, if one has to menstruate without a pad or a tampon out of compulsion, it makes her a victim of social apathy.”

Just like the many women who do not have access to clean toilets or better hygiene practices and sanitary products during menstruation, the real difference between Kamna (and most of us) and these other women is the privilege of having the choice to bleed freely.

Source @drkamnakakkar on twitter