We are witnessing a tipping point: the rise of Menopause Power: a growing activist movement which will change the Change in the same way that Period Power fought period poverty and stigma. On social media, on podcasts and in newspapers, there’s a huge menopause conversation, as confrontational as it is celebratory. I’ve just produced a Channel 4 documentary, Davina McCall: Sex, Myths and the Menopause, and there’s nowhere we don’t go: losing jobs to hot flushes, vaginal dryness, memory loss, orgasms after menopause, and the shocking misinformation we’ve been fed on hormone replacement therapy.
But above all, we give the menopausal taboo the kicking it has long deserved. As Davina McCall, who’s presented everything from Big Brother to Long Lost Family and had her first hot flush at 44, says: “I was advised not to talk about it, that it was ageing and a bit unsavoury, but clearly that didn’t work out very well, because I’m sitting here talking to you… I’m not going to be ashamed about a transition that half the population goes through.”
There are 13 million menopausal women in the UK and 4.5 million of us make up the fastest-growing demographic in the workplace, while nine out of 10 say the menopause has adversely affected their work. Indeed, if you clapped for a key worker in lockdown, she was probably menopausal: 50% of nurses are over 50 years old. Some women find their periods stop early in their teens, 20s and 30s, and menopause affects some trans men, intersex and non-binary people on different hormonal journeys.
Tackling symptoms and stigma is a feminist issue, and equal access to safer hormones is key. This is not about luxury and vanity. This is about long-term health and sanity.
Until I met the menopause and its dastardly little sister, the perimenopause, I thought I’d be fine: “Periods stop. Full stop. And whatever you do, don’t take HRT.” I was so wrong that I made the documentary and am writing a book, too. Those were fuelled by my own journey, which was more a Thelma and Louise car crash as my hormones went off a cliff. My passage through midlife’s magnificent shitshow has been an education that put me in my place, and helped me understand how tough that place is for others.
I thought perimenopause was just the run-up to the menopause and not a treacherous passage in itself. I had no idea it would make me so furious – or give me surprise periods like tsunamis. In the kitchen at various times during my deranged perimenopausal mood swings I threw: 1) a butternut squash, 2) Nigella Christmas, 3) broccoli, 4) a full butter dish, and 5) blue poster paint at the wall. No one was injured. Indeed, the missiles actually released family tension – and at least the dog began to treat me with more respect. I had no idea that progesterone and oestrogen drained erratically but inexorably away over the course of years in perimenopause, and that symptoms could be mental as well as physical.
In my late 40s I started getting erratic heartbeats in the night – sudden, fast, panicky pounding in my chest, for no reason at all. I still had my periods, but I also had a few hot flushes. My GP said: “Oh you’re too young to be menopausal. They can’t be hot flushes.” She sent me off for an electrocardiogram. My dog and I run most days. My heart was fine. The diagnosis was “too much coffee”. Now that I’ve been researching the menopause for two years, I know that those harmless palpitations were a classic sign of falling oestrogen, something that is reported by 11% of women. My doctor, however, did not. That’s because menopause – and perimenopause – is not a separate compulsory module in a GPs’ training.
There are oestrogen receptors in every part of your body and if fluctuating hormones are sending erratic electrical signals to your heart and internal thermostat, what messages might they send to your mind? Not long after my mother died after a long haul with Alzheimer’s disease, and I’d juggled going up to Glasgow to help care for her, a full-time job as the Times film critic in London, and raising three children, I suddenly needed to escape all responsibility. I got divorced and I changed career. I just couldn’t cope, waking up at 3am sweating and anxious. It wasn’t just the menopause but midlife unravelling, too, or as psychotherapist Susie Orbach puts it: “The menopause arrives, seeking out our vulnerabilities like a guided missile, just as we need all our strength to cope with daily life.”
London fashion designer and campaigner Karen Arthur, who set up the @menopausewhilstblack Instagram and podcast during the growth of the Black Lives Matter movement, was offered antidepressants by her doctor when she suffered hot flushes and low mood. She now prefers to see her menopausal breakdown as a breakthrough, having navigated the transition with therapy, mindful meditation, exercise and healthier eating. “The menopause gave me my voice,” she said. She launched a survey of the experiences of black Caribbean/African women based in the UK. “When I Googled menopause, I scrolled down, and all I saw was images of sad-faced, white-haired, white women. You’d think that black women didn’t get the menopause.”
There’s a lot of disappearance around the menopause. As film director Jane Campion once said, “we become invisible and unfuckable”, and there is also the shame and omertà among women themselves, particularly those in powerful positions. Dorothy Byrne, the former head of Channel 4 news and current affairs, broke that silence in 2019 in her MacTaggart television lecture about her executive-level hot flushes. “The problem barely discussed is the menopause,” she said. “Even getting your boss to understand there is such a thing as the menopause can be a problem.”
Dr Nighat Arif, the BBC Breakfast GP and menopause specialist, tries to reach out to her underserved community by doing TikToks in Urdu. The #MakeMenopauseMatter campaign is aiming for 150,000 signatures on a petition to parliament demanding mandatory menopause training for all GPs, and menopause policies in every workplace.
The conversation is getting louder, but while some lucky women joyously “sail through” the menopause with little more than red clover tea, the reality is that 80% have symptoms – from brain fog to anxiety, depression, sleeplessness, exhaustion, vaginal dryness and stiff joints – and most (like me) don’t tell their employers, partners or each other. Yet the period of menopausal change is also a peak time for suicide, and one survey of 3,000 women who went to their doctor during menopause revealed that 66% were offered antidepressants rather than HRT.
I was terrified to demand HRT from my reluctant GP although my memory was short-circuiting and my body was screaming for oestrogen. The breast cancer-risk headlines from the older oral HRT pills – made from synthetic progestins and conjugated oestrogen from horse urine – were seared on to my retinas. So I asked around my 50-something friends, and one by one they revealed they were on natural compounded hormones from fancy private clinics, at £300 for an initial consultation. I paid up.
The compounded oestrogen, progesterone and testosterone worked brilliantly at first – within four days my hot flushes and palpitations disappeared forever, my memory returned and – unexpectedly – my mood lifted and my joints became supple. Oestrogen was the oil I needed in my engine, but a year later, I got a bad batch of the compounded hormone lozenges, which turned out to be from an unregulated pharmacy, and ended up having bleeding and then cervical and uterine biopsies.
Those tests were clear, thankfully, but I dumped the compounded HRT and went cold turkey until a friend recommended Dr Louise Newson, a campaigning menopause specialist with a clinic in Stratford-upon-Avon employing 40 doctors and there’s still a three-month waiting list – most of the patients are women who have been refused HRT by their GPs. Dr Newson solved my problems in an instant and prescribed plant-based body-identical hormones, made from yams. These are also available on the NHS – micronised progesterone and transdermal oestrogen gel or patches – which the British Menopause Society says have “no or lower risk of breast cancer” compared to the old oral combined pills. I just wish my GP had told me about body-identical HRT in the first place.
But as I left Dr Newson’s clinic, I thought that if I, as a white, cis, rather privileged, well-informed journalist had made such an omnishambles of my own health, what was happening to those who couldn’t afford a private consultation? As Dr Kate Pickering, a GP on the frontline in Glasgow, tole me: “If you’re 10 floors up in council flat in Easterhouse and you’re a grandmother getting up to look after a baby because the mother is looking after the other kids and you’ve got night sweats – well HRT should be bog standard to help. Menopause is a big issue, and there’s not enough information available. No one ever talks about working-class women and it’s a real inequality.”
The more I found out, the more I got incensed by the ignorance, discrimination and disregard for older women’s quality of life. I’m now helping Dr Newson launch The Menopause Charity, and it turns out the safer body-identical HRT isn’t available in all parts of Britain. Micronised progesterone isn’t licensed on the NHS formulary in Scotland, Darlington, Doncaster and most regions in the north, while it’s much more easily available in London. It’s yet another injustice tossed on the pile.
Inequality is coupled with medical sexism, which fails to take account of the latest science, and leaves women to keep calm and carry on. While researching my book, I discovered the grim toll of oestrogen deficiency in the second half of every woman’s life, and the latest research on HRT’s extraordinary long-term health benefits for osteoporosis, diabetes and dementia, which women are twice as likely to get as men.
The documentary was made by menopausal women, for menopausal women – and their partners and families. Four of the production team at Finestripe in Glasgow were on HRT, and the director, Linda Sands, has three young children. How we managed all the filming in lockdown, I don’t quite know, apart from the fact it seemed imperative that the message got out there, with Davina McCall acting as our menopausal masked avenger.
Working on the script gave me a new purpose, and I’ve been lucky enough to find a new partner, a new home, some new and old friends, and even a new dog, all of which emerged from the painful chaos of the last few years. I want to tell my story, and that of the tribe of menopausal women, so that others don’t need to drive off the cliff before picking themselves up. Menopause Power is going to require a massive cultural and medical shift. The silence around the menopause needs to become a cacophony and, one day, a symphony.
Davina McCall: Sex, Myths and the Menopause is on Channel 4 this Wednesday at 9pm. Everything You Need to Know About the Menopause (but were too afraid to ask) by Kate Muir will be published by Simon & Schuster later this year (@menoscandal)