On paper, midlife should be the time when women’s careers are really taking off, thanks to greater self-esteem driven by professional experience and strong networks to build on. But as inspiration and opportunity come knocking, so does another phenomenon: the perimenopause or menopause, and falling hormone levels that can cause anything from hot flushes and sleep problems to low self-confidence. So how can ambitious women successfully juggle these changes, professional and physically, and make the most of this powerful third stage of life?
The average age of the menopause (the cessation of periods) is 51, with symptoms of the perimenopause (when a woman experiences menopausal symptoms due to hormone changes, but still has her period) often start at around 45 years of age. Which means that challenging, and sometimes debilitating, symptoms often occur just as a woman reaches this crucial point in her professional career.
Perimenopause and menopause see levels of oestrogen and progesterone in the body fall, which in turn can lead to myriad symptoms from low-self-esteem and energy to sleep problems, mood swings and hot flushes — and at a point where women who’ve been building their careers need to be on their A-game as they take on increasing responsibilities at work.
Yet many female women, busy powering themselves toward their goals, don’t recognise their symptoms as being related to the menopause. Instead, they put them down to the demands of work and the often long hours and stresses that are involved…often with diminishing returns to physical and mental health.
GP and menopause specialist Dr Louise Newson is on a mission to empower women to recognise the signs of perimenopause and menopause early, so they can get the right help and continue to flourish, in business as well as life. She developed My Menopause Doctor and the ‘balance’ menopause app during the onset of her own perimenopause at the age of 45 — with the goal to provide evidence-based, non-biased information for women about the treatments available. ‘Menopause care is a massive unmet need — and the more that I see patients with symptoms, the more I realise how many women are being neglected,’ she says.
Negotiating perimenopause while juggling a demand career is a personal challenge she knows well. ‘When I was setting up the menopausedoctor website, I was feeling incredibly tired and irritable with low mood and reduced energy. I felt like I had been drugged; I wasn't sleeping, and I felt awful. I put all these symptoms down to taking on a new project when I was still working full-time, with three children and managing everything else in my busy life,’ she notes. ‘Even as a menopause specialist I didn’t recognise my own symptoms — it was only after five months that I realised that it was actually my perimenopause that was affecting me.’
Three in four women experience some menopausal symptoms, NHS guidance suggests these will be severe for one in four. However, part of the problem of supporting women through this transition is that everyone's experience is very different; symptoms can vary and even change with time. ‘The majority of women will experience hot flashes or night sweats at some stage, but some women don't. And so many women suffer with psychological symptoms alone or have other physical symptoms. That's why it can be so difficult to diagnose,’ says Newson.
The other barrier is the lack of a blood test to diagnose the onset of perimenopause or menopause. Tracking symptoms is vital to gain personal awareness of factors that may be impacting you other than external pressures. ‘It’s about recognising changes in anything around your physical or psychological health — and then thinking, could it be my hormones? If these have happened since your periods have started changing or stopped, or you’ve had your ovaries removed or a hysterectomy, then it's often an alert.’
To this end, she also recommends using the free balance app as an effective way to pattern spot. ‘Women can put their symptoms in the questionnaire on the app and repeat every three months. If they find that they're experiencing symptoms, and they’re tracking periods as well through the app they can quite readily see that there's a difference, and potentially a problem. And the earlier they pick this up, the earlier they can receive treatment.’
For Newson, there are things that you can do to mitigate the effects of hormonal changes, including being aware that other things may be at play alongside simple start-up business stress, and practicing self-care around symptoms. In the end, though, she insists that the right hormone replacement therapy, whether patches, gels or tablet form, is the most effective way to positive change in this transition period — and beyond.
‘You need to look at the whole person, and you need to address everything. But if I recommend a menopausal woman to lose weight, see a psychologist, sleep better and relax they might feel 5% better — however, balance their hormones first, then talk about everything else and they'll often be at least 80% better,’ she says.
‘For years, women have been given wrong information about HRT. Most types of HRT have no associated risk of breast cancer. So, it doesn't make sense to avoid hormones, when the symptoms are due to a hormone deficiency. Ultimately, you need to treat the underlying cause.’
Five ways to make the menopause work for you
Physical symptoms such as hot flushes and night sweats are perhaps the easiest menopausal symptoms to spot, but other tell-tale signs you might miss include migraines, changes to hair and skin and joint pain.
Think about…Caffeine and spicy foods can trigger hot flushes, so avoid them before big meetings to minimise the risk, and if you do feel a flush coming on, spray your face with cool water or use a cold gel pack to reduce the heat. And don’t sweat the small stuff, or you may end up sweating full stop; stress triggers the release of epinephrine from the adrenal glands, raising your temperature and prompting a hot flush as the body’s attempt to cool it down.
‘These can really decline and sometimes it's because of poor sleep, or because someone has put on weight or it can be due to muscle and joint pains and reduced stamina. It can be a combination of factors,’ notes Newson.
Think about… Support yourself holistically; get rid of energy breakers such as alcohol and junk food and follow a healthy low GI diet to keep blood sugar levels stable. Gentle exercise can be beneficial as well as help stave off increased fat distribution around your waist, a result of falling oestrogen levels. And avoid the temptation to push yourself too hard — now is the time to learn how to strategically delegate, and eschew seven-day work weeks, which will quickly deplete you. Things may take a little longer, but what you lose in speed you’ll make up for in stamina and longevity.
‘Many women in perimenopause find that changes to sleep start to happen quite early. They might start waking in the night, even if they're not getting night sweats, have difficulty getting to sleep initially or find that the duration of their sleep is different,’ says Newson.
Think about…flexible working patterns can help you to manage your work and your energy amid the tiredness caused by disrupted sleep. Don’t try and burn the candle at both ends. Keep your bedroom cool, avoid caffeine, keep to a regular sleep routine to anchor bedtimes cues in your subconscious — and resist the urge to work in bed. To function, you need proper time to rest and recharge in the day away from your desk.
The challenge…Memory problems, poor concentration and general brain fog are common. ‘Hormones such as oestrogen and testosterone help your neural pathways so when levels drop a lot of women find that they can't concentrate. This will obviously affect how sharp somebody feels about progressing in life,’ says Newson.
Think about…Use technology to augment your memory and keep you focused — put reminders on your phone, keep a note of important dates and make meeting and conversational notes as prompts for when you next need them. Regular meditation practice with an app such as Headspace can help increase clarity, while getting as much quality rest as you can is crucial to maintaining mental acuity.
The challenge…Mood changes can make the challenge of managing a team or a busy workload even more challenging, while low self-esteem and self-doubt are also common menopausal symptoms but are often mistaken for depression by healthcare professionals.
Think about…A lack of confidence around your position may be a hormonal red herring rather than a red flag during peri- and full menopause. ‘There are a lot of women out there who would reach so much more of their potential if they had their symptoms recognised and managed appropriately,’ says Newson. Try deep breathing practices and meditation to lower cortisol, the stress hormone, and produce more happy hormones such as serotonin and dopamine. And think about finding a mentor to bounce things off — they may be able to provide valuable perspective at crucial times when self-esteem lags behind your ambition.
Dr Louise Newson is a leading menopause specialist. She is the founder of www.balance-app.com offering free menopausal support for women.