Something in me has died. Not an actual thing. I know what that feels like. I have had a dead foetus inside me and been told to go home and wait to miscarry “naturally”. This is different. Another kind of ending. The bits that made me a woman of some description . . . they are still there, but they have no useful function. No more ovulation. No more bleeding. No more babies. No more contraception. No more wondering. No more tampon tax. The curse is lifted.
I want a medal, a paper hat, a prize; some kind of public recognition or a rite of passage at least, involving fire-eating, chanting and mescalin. Instead I find that no one wants me even to talk about it. “It” being the menopause. “My womb is a tomb” doesn’t seem to work well as a conversation starter.
“Can I have some sort of certificate?” I ask my poor GP.
“It doesn’t really work like that.”
“When can I say it’s over, that I’m done?”
She sighs. I like her and I feel if she could she would give me more than a wry smile.
No one really asks me how I am getting on with the old “change of life”. Especially not men. They probably think that would be rude and I would bite their heads off and they would probably be right. I don’t really have the mood swings that some talk about. I have just the one mood. Rage. I am enraged as soon as I wake up, enraged by the news, enraged by how the world is, enraged when I can’t sleep, and I can never sleep.
Some women cry. A lot. My friend cried because she saw a baby: “A baby at the bus stop. I cried at the bus stop.” She repeats the story several times until the bus stop is more significant to me than the baby. This is the hormonal horror that awaits. Weeping on buses. She is fully gone, I think to myself. A few years older than me, and constantly fanning herself. An evening with her is a trial, as the heating has to be switched on and off several times. Her thermostat has packed up. Her actual thermostat, the one in her house. It’s all the fiddling.
It is somehow reassuring to know most of my women friends are even more deranged than me. They talk of herbs and potions from hippie shops, black cohosh and sage tea, which is revolting. But some of the sisterhood around this time of life is what my kids would call “judgy”. There are right ways and wrong ways to do it. The natural and the unnatural. That is what being a woman is, I decide. Doing it the wrong way. I am further incensed.
“Are you having hot flushes?” my doctor asked at one point.
“I don’t know.”
“Then you are not,” she says. “You would know if you were. You are in the perimenopause.” She doesn’t have time to explain the perimenopause. I suspect it’s because she can’t. It can go on for ten years, apparently. Ten years?!
It’s just as well I am handling everything so well. I end my relationship because it’s bad and I end it badly because there is no other way. A process of shedding starts. Some hoard and hold on. This is not for me. Some intuition tells me that freedom will demand letting go.
At the time, I didn’t see these feelings as menopausal. But now I do. This deep sense of time passing, through one’s flesh, of not wanting more of the same, a sense of coming into the present and only the present, understanding that time is valuable and time has passed: these come through knowing that parts of my life are over. I can no longer create life – and I have created three – so now I must create my own. This self-creation is either selfish or absolutely necessary to survive. Yes, I can jump out of a plane, get a new “hobby”, rush around in a flurry of activities involving Zumba and watercolours . . . but why would I? The manic overachievement of the menopausal feels a lot like denial.
Read the medical books. Look at the fashion spreads. Women dry up. Youth is moist, wet, dewy. Old women are husks with coarsened skin and thinning vaginal walls and the cause of this curse is hormonal: oestrogen. We no longer produce enough of it. The ovaries stop their egg production. The average age for the menopause is 51 but it can come much earlier. Chemotherapy will bring it on. IVF treatment induces it; this is the fresh hell.
Some sail through it. I asked a brilliant 80-year-old I met smoking at a party about it. “Honey,” she said, “I was too damn busy to notice.” That generation was tougher than
mine in every way. Some of our angst is cultural. To put it into perspective, historically a lot of women just died before they got to this age. We are the lucky ones.
Having lost enough friends along the way, I know this but I can’t avoid the questions: what does it mean to be a woman who, having served her purpose – reproduction – may have another kind of life? We may not define ourselves by our reproductive organs, whether we have children or not, but we are defined by them. Whatever your opinion about your role, your sex, your gender, your identity, your biology, your destiny, something is physically happening. If one enters “womanhood” with menstruation, now you are exiting it. A predator whose bones are thinning is a woman to be feared. A woman whose ovaries no longer do what they should do is somehow ungendered and possibly disgusting.
The sanctioned discussions around the menopause are fairly limited, mostly to “ageing”. The physicality is rarely mentioned. Instead we ask: “Can we have more older women on TV?” “Can a grandmother be a president? “Can mutton be a lamb shish?” Well, yes, obviously, if these are the parameters of the debate.
Inevitably, then we see pictures of women who look good for their age. Helen Mirren, Carine Roitfeld and the other one. You know, some other one who is still desirable. I want to scream. It is their job to look good. This is not the job of most women, although we are increasingly groomed to think it is, to define ourselves purely physically. The advice comes thick and heavy as we try to stop being thick and heavy. It is relentless and relentlessly boring. Exercise and everything in moderation. Another part of me dies.
The menopause is not sexy. We get it. We don’t get it. It might be ultra-sexy, actually. Hormones are druggy and – rather like in pregnancy – some women find their libido shoots up; for others, it declines and they express relief. We are all different but the truism remains that our bodies, battle-scarred as they may be, are now somewhere we ought to feel at home. To not feel at home is the source of terror. To feel the fear of where this all might be heading.
Simone de Beauvoir could barely look at herself in the mirror, her own ageing was so horrific to her. For some, the cloak of invisibility of middle age is worn with aplomb; for others, it is a shroud. The worrying about libido, too much, too little, is real. If you want to depress yourself, google “clitoral atrophy”. Although I am not a doctor, the solution seems to be: use it or lose it.
The lack of information around the menopause is one of the things that has shocked me most. It is a mystery to many well-informed women. The perimenopause, for instance, is an all-purpose diagnosis for all kinds of ills. Many women are told they are “peri” with no idea what this means. Erratic bleeding, insomnia, itching, vaginal dryness, memory lapse and vasomotor disturbance are just a few of the symptoms that could make you “peri”. You are post-menopausal when you haven’t had a period for over a year.
The lack of definition bothered me. The female body can be a mess, so I simply decided to have it – the menopause – one cold November weekend a few years ago. I took to my bed, decided that my time was over and nested in a cloud of self-pity. By the Monday I was bored and went out and saw a great gig. These are a good menopausal activity, as they occur in dark spaces and no one cares if you perspire.
But I am not surprised so many women end up utterly depressed. If the menopause is seen as basically a disease, as lack, then women’s bodily chemistry must be rebalanced with hormone replacement therapy or antidepressants. Lately I am seeing that a lot. Middle-aged women are now on selective serotonin reuptake inhibitors (SSRIs) for what are basically the symptoms of menopause. The encroaching darkness must be kept at bay. Having seen women go from crawling around on all fours to functioning well on HRT, I know it can help. But why is there so little discussion about long-term medicating of the female body?
Despite my melodrama, in truth, I hardly suffered at all. Why would I? I never had terrible periods: indeed, I used to see PMT in others as a form of attention-seeking. But when menopausal insomnia hit me I felt unable to function.
“Can you not fall asleep, or do you keep waking?” the doctor asked.
More blood tests. Too much cortisol. “It’s the stress hormone. Your body is somehow trying to kick-start your ovaries. It will try anything.”
“I hate my ovaries,” I wailed. The doctor prescribed me tricyclics, the old-fashioned kind of antidepressants, just to use at night. Immediately I trebled the dose. When Michael Jackson died, my first thought was to wonder what sleeping medication he was on. Can I get that? That is what insomnia does.
As the drugs didn’t work, I was offered the sleep clinic. Off I trotted weekly to cognitive behavioural therapy, the NHS’s new bargain-basement cure-all. The first thing I was told by a shrink was that I must stop referring to our therapy as “The Insomniac Club” or, indeed, referring to myself as an insomniac. My thinking needed reframing.
Again, no one wanted me to use the word “menopause” but they pushed me to learn something called “sleep hygiene”. When I described physical feelings of insomnia that were decidedly menopausal, that I could actually feel descending on me, they talked about turning off my laptop. This did not help. Mostly I didn’t understand why I was having group therapy with a perfectly nice but unemployed man who couldn’t sleep at night because he slept all day; a wired and scratchy young woman who was always shivering; a very angry man who claimed not to have slept for ten years; and a shy emo who did sleep, but was troubled by the idea of seasonal affective disorder.
But the reason I was there summed up for me what is wrong with our attitudes to the menopause. A psychiatrist had assessed me over the phone.
One of the questions he asked was: “Do you have dark thoughts?”
“What kind of thing?”
“I just think about how I will die and everyone I know will die and how dying is when everything you hold dear is taken away from you bit by bit.”
“Do you have those thoughts often?”
“Yes, often. I always have had. But now a lot.”
To me, this is normal. The NHS clearly does not have a tick box labelled “existentialism”. Somehow over the phone I had been assessed as mildly suicidal. Nothing happened. I just got a letter telling me as much, which is . . . cheerful, first thing in the morning. The thing is, I’m not in the least suicidal – but menopause is something to do with death and yet no one wants you to say this out loud. No one at all.
To deny the connection to death is a lie. Your body is not returning to a previous state. The death may be metaphorical, as you are not dying, unless your body was only ever there for childbearing. Are women who have not had children lesser women? Are we only defined by motherhood and fuckability? No, of course not. We are more than that. That’s what we tell ourselves. But what is this more? How do we reproduce ourselves for ourselves? If you have a moment. If you are not looking after children and parents. If you can be bothered.
Maybe that’s why so much cheery advice on looking younger (it’s not happening) or getting a pet or internet dating can be grating. And inane. A further denial of loss. I’ve never met a woman who misses having periods, but I know many who felt a form of mourning in middle age. The mourning is unvoiced and unsure because one of the things women learn very young is that putting yourself at the centre of things is unbecoming. The flood of feelings about life, death, ageing, sex and the whole damn shebang is easier to push away, to belittle, than to confront.
This may also explain the constant uplift of some of the blogs on the subject. At least women do exchange information online, and because most of us are so clueless this is useful. I knew far more as a teenager about what menstruation was than I knew about the menopause as a fiftysomething. While information is scant, the drive to be happy is so manic that it is near hysteria.
My favourite advice was on the value for menopausal symptoms of a nice, hot bath with Taoist oils (no idea). There was a picture of an antique bathtub and an inspirational quote – “There must be quite a few things that a hot bath won’t cure, but I don’t know many of them”, from Sylvia Plath. The Sylvia Plath. That well-known life coach.
Is a jaunty sense of humour a response to fear? Germaine Greer may have been right when she said that what women “are afraid of losing is not femininity, which can always be faked and probably is always fake, but femaleness”. If by femaleness she means the ability to reproduce – certainly not a defining part of every woman’s life – then the return to the individual that existed before menstruation raises interesting questions. Her view may be seen as unfashionable essentialism, or rather we may begin to see the menopause as a form of transitioning. For it is a time of transition. Undoubtedly. Is a woman who is free of her “sexual and reproductive destiny” less of a woman? If so, someone needs to explain what a woman is exactly and why she may not now become more of herself.
In the early 1990s the menopause and what it meant were explored by feminists such as Greer and Gail Sheehy, who stood at opposite ends of the spectrum. For Sheehy, the menopause was something that women as health consumers would lobby around, breaking the last great taboo. HRT would stop osteoporosis and heart attacks, and women could embrace a second adulthood in ways men couldn’t. Some medics described women low in oestrogen as “the walking dead” and Sheey’s 1991 book The Silent Passage is a call to arms to demand intervention.
Since then, debates about HRT and breast cancer have raged and the standard dosage of HRT has come down.
The theory is that sexless cronehood can thus be swerved. The practice turns out to be different. The sexed-up older woman, the “cougar”, honed and toned, botoxed and HRTed up to the nines, is still a figure of fun, for men and for other women. We do not like the bodies of older women even when they are our own. And every pleasure-giving thing from sunlight to gin is said to age us faster. The menopausal woman must decide whether she will go with thinning bones or a higher risk of breast cancer – and for many it is no choice at all, as they feel so terrible. We still have to function.
The production (and politics) of oestrogen is incredibly complicated both within our bodies and without. Too much of it is bad for us. Too little of it is bad for us. This was brought home to me when I was in a hospital with yet another friend with a tumour in her breast. “It’s because I smoked, isn’t it?” she said to the consultant.
“No. We see every type of breast cancer here and the only things that all the women have in common is that they have breasts and produce oestrogen.”
Not all cancers are related to oestrogen but some are. It is produced in the female body, mainly through the ovaries, but also the liver and the adrenal glands. A few of the things that make us produce too much of it and are therefore dangerous are excess fat, too many carbohydrates, alcohol, meat and perfume – basically what I would call the finer things in life. Then there’s all the excess oestrogen in the environment from plastics, pesticides and from women who are leaking it out all over the shop because they are on the Pill.
At this point, if you are sensible, you may make an informed choice about a healthy diet and exercise to get through menopausal symptoms. Cortisol – the likely cause of my insomnia – is related to insulin production, so I can vouch that if you cut out all sugar and alcohol your mood will level out, your cravings will stop and your night sweats will ease. After three weeks of this, however, I felt such a life wasn’t really worth living.
Upping your calcium is a good idea. Women swap hard-won tips such as “tahini is a great source of calcium” but it’s all a bit reminiscent of that time when you’ve just had a baby and you go out and people assume that all you want to talk about is babies, when it’s the last thing you want to do. Except this time it’s even worse, because you’re talking about seeds. Still, you are now in the zone of bone scans and mammograms, with bowel cancer tests to look forward to.
I was called in for a smear. While the cold metal was still inside, the nurse said casually: “Well, you won’t be needing these so often. Cervical cancer is a young woman’s disease.” As I was putting my knickers back on she pulled back the curtain to hand me a leaflet on pelvic floor exercises.
This was one of the better days.
As always, for the rich, there is something better and more “natural”. The common or garden kind of HRT is made from hormones extracted from the urine of pregnant horses. Private doctors prescribe BHRT instead: bio-identical hormone replacement therapy. Bio-identicals are said to be natural. They are made not from horse piss but from Mexican yams, which, let’s face it, sounds a lot nicer. And somehow more feminine.
Bio-identicals are prescribed in carpeted offices and individual doses after a series of tests. Those who take them swear by them. As so often, though, a lot of sense goes out of the window when people start talking about drugs versus naturally occurring chemicals, Big Pharma versus . . . private “BHRT” medication.
It’s a minefield of wishful thinking. This is an argument about giving women synthetic hormones rather than the naturally occurring versions that some of their advocates insist are not drugs. This is patently rubbish: if something is stopping your hot flushes and depression and keeping your skin smooth and all the things that BHRT claims, then it’s a drug. Perhaps BHRT is a better drug and the way it is prescribed is better than the random handing-out of normal HRT by stressed-out GPs. Perhaps it is a better way, but to argue for access to these better drugs, or more information, we would have to think politically about the menopause and it is hard to be political about things that embarrass us.
Indeed, we may begin to question why this stage of life must be dealt with by chemicals at all. Are women to spend most of their lives ingesting hormones to stop them getting pregnant, and then the rest of it ingesting others to mimic the effects of oestrogen? For this is what we are doing.
Is the answer to every woman struggling with aches, pains and questions about her very being simply HRT or SSRIs? It can certainly feel like that. At one stage I dabbled with HRT. I can’t remember why. It was a locum and I think he wanted to get me and my dark thoughts out of his surgery. For nine days I took the pills, waiting to feel something. But there was nothing. On the tenth day I woke in the night with what I can only describe as labour pains and with puddles of blood everywhere. My “femaleness” had returned with a vengeance and it was so horrible, I had to stop myself dialling 999 and telling them I was Carrie.
HRT may be a godsend for some, but there is something very odd in tricking the female body into thinking it is still capable of reproduction when it is not, just in order to remain lubricated and shiny. Those with partners now have no excuse for twin beds or relief from “conjugal duties”. With Viagra and HRT and the ideology that sex is compulsory for health and happiness, we can all go on for ever and ever. The time when women could call it a day or no longer need to scratch that itch is gone. For some, there is joy in no longer fearing pregnancy; for others, sex is one less chore they have to perform. Or it may be that many older women renounce sex because men have renounced them for a younger model and it’s easier to pretend it’s a choice.
Lubrication is important in so many ways. Use lube for sure. But know that you no longer have to be it. All those years when femininity was enacted as social lubrication have gone. You don’t have enough time left to go round making everyone else feel comfortable. Let them sort themselves out. What does return – or never left but I can only now admit to – is what I can only describe as the delightful cockiness of adolescence.
Alongside this is the rage. The rage I felt so intensely is so obviously a rage against the dying of the light that I am suspicious of New Age stuff that seeks to pacify it. Holding on to this rage and not caring what people think of it is powerful.
What helps is paying attention to yourself – and I don’t mean exfoliation regimes, I mean attention to your interior self, because the outside is going to decline whatever you do. Listen to your psyche beginning to grasp what it does not want to let itself know: that it is not immortal. Listen and learn, for this is the place creative thought comes from. Creation is always to imagine something living beyond yourself out there in the world. This urge surely is not reducible to femaleness or reproduction. So this time of loss may be a time of gain if you allow it.
Pleasure is still possible because at this time, thankfully, most of us start needing glasses. We can no longer see all the flaws that young girls with luminous skins search for on themselves with eyes like microscopes. The light may indeed be dying but we all need a dimmer switch at hand.
As we start to exit “womanhood” we need again to redefine it. The curse. The change. These old words come up as some seek a power grab in the realm of the spiritual, too often the substitute for real power. Serenity can’t possibly be a bad goal, though I don’t see so many middle-aged men seeking it. Instead, I prefer Angela Davis’s take on the serenity prayer: “I’m no longer accepting the things I cannot change. I’m changing the things I cannot accept.”
Menopause makes us impatient. This is good. Women my age won’t just melt away and we won’t become invisible. It’s a fight for sure, but then it always is. Womanhood and femaleness, born or made, is nomadic. That place we call home shifts so much over the course of a lifetime. In this movement lies some knowledge that may scare us as much as it may set us free.
“The change” can be medicated, but what the menopause does is tell us explicitly that although parts of us are now “done”, there is more to do and it’s now or never. Accepting this can feel bloody awful sometimes and whatever gets you through the night may indeed be worth having. Unquestioningly dulling all these feelings associated with menopause exacts another price, too. Natural is not better than unnatural yet surely by 50 or so women should be able to make informed choices that can only happen when we discuss exactly what those choices are. Too few do. Doctors who are trained to prescribe HRT do not know quite how and when to take women off it. There is withdrawal, and there is no soft landing for so many. HRT is not a cure for menopause but a ploy to delay it and the devastating symptoms often return. Except now you are in your sixties, not your fifties. Many seem unclear about this.
For me, some clarity comes after and even during the heat daze. It just does. One day I am in an office and a guy says to me: “You’re on fire lately, Suzanne.”
“Wow!” I think. “What a sensitive sort of man is this man, knowing about my fluctuating hormones. How does he know that I’m currently what one of my friends describes as ‘sweaty and mental’?”
Normally when women are given a compliment we demur. But there’s no need any longer.
“You are right!” I say. “I am actually on fire!”
He looks slightly worried. He backs away. He clearly thinks I am mad, so I decide to leave the building and go to the revolving door.
It whirls round as I push the door harder, as I am now on the way to the next place. Everything changes. Inside and outside. All the time. How did I ever think life was anything but this?
I am “in the moment”, as they say.
The door jams. I have pushed it too hard. We are all stuck. Now a young woman trying to come into the building starts tutting that I am making her late. I burst out laughing to myself and I don’t care who sees me cackling.
Then the door starts moving again and through I go.