I was prompted to write this post following a twitter discussion around treatment for menopause, a subject of hot debate. Several interesting points were made that I wanted to respond to more fully rather than I could do in a Twitter word count.
The discussion centred around where to turn for advice and fears of being sold a particular lifestyle and products at a time of vulnerability. One woman recounted spending a small fortune on magnesium only to conclude later that it hadn’t been right for her. Here is a summary of some of the comments:
· There is no one size fits all solution, and this is troublesome because it may require effort and persistence to discover what works for us as individuals. Sometimes women give up trying before they find suitable help.
· Some women follow advice even when it transpires not to be helpful or make an appreciable difference.
· Information about treatment seems split into two paths – medical i.e. HRT or alternative e.g. herbs, acupuncture, diet etc.
What is becoming clear is that we need to be our own researchers and bring an openness as well as an ability to be critical. But the reality is that this process can feel overwhelming. Often decisions are made on the basis of who we trust and who we choose to listen to. I made a conscious decision to research the information available and frankly, at times, there is so much out there it has almost made me want to give up.
One of the difficulties is that opposing advice is given with such conviction. I have heard it said that a woman is risking her health if she does not take HRT, this raises a level of anxiety and is unhelpful for those who cannot take HRT for medical reasons. Others advocate a purely natural route, which works well for many, but the conviction that this is the ‘right way’ can leave those taking HRT feeling marginalised. In some ways it reminds me of the polarised bottle or breast debate that was raging when I had my newborns which failed to take into account individual circumstances. We have to be careful we don’t end up in the same territory.
Naturally, some of us will be more comfortable easing symptoms using conventional medicine, some will prefer an alternative route and some will choose a combination of both. The important factor is that we choose a path that fits our needs, values and make choices on the basis of good information.
How do we become self-experts?
To make good decisions we must know ourselves, become experts on ourselves. We are the ones who have the full, technicolour experience of what it is to be us. Let’s use that.
In Gestalt psychotherapy the goal is to become more aware of our unique needs and desires. We then use this awareness to find creative ways to meet our needs and live authentically.
Thoughts, feelings and body experiences all provide valuable information about ourselves. Whilst many of us are aware of our thoughts and emotions – albeit in our busy lives our thoughts tend to dominate – we are often less aware of our bodies.
The idea of a mind body connection is becoming more widely understood and accepted; it is reflected in many familiar expressions:
She had a broken heart (grief)
She had butterflies in her tummy (nerves)
Her legs turned to jelly (fear)
Take stress - when we are under stress we may clench our jaw, tighten our shoulder muscles, our heart rate goes up and our breathing becomes shallow. The body gives us the first clues about how we really are but all too often we override these signals. This is how we reach burnout or poor health, by ignoring the warning signs.
During menopause transition our bodies undergo considerable transformation. Our symptoms may scream out for attention, they may be an inconvenience, or show up in more subtle ways. It is up to us, with the help of information, to find out what helps. We must be the primary experts on how we are.
This involves regularly checking in with our bodies. We stop what we are doing and taking a moment to notice how we feel:
How is our breath – shallow or light?
How are our muscles – tense or relaxed, where are we holding tension?
What emotions are you in touch with?
What would help you right now - rest, activity, alone-time, expressing your needs/feelings to someone, a hug etc.
It sounds simple but it is best if it becomes a practice, and developed into a habit. To establish a habit a good start is to link it with another habit, say after we brush our teeth, at the start and end of each day, or when we stop for a hot drink.
This practice is invaluable when we make changes – in medication, lifestyle, try a new therapy – to see what effect they are (or are not) having. This can also be combined with keeping a diary, noting times of day when you feel better or worse and finding connections with particular habits, foods, stressors etc.
I have been using this practice for years, it allows me to be flexible, to recognise when I’ve been overdoing things and need rest, or when my body needs extra support. It tells me which foods energise me and which foods leave me feeling depleted.
So, how can we use advice?
In the past few years my family and I have had several misdiagnoses; when I injured my knee a consultant failed to identity I had a torn meniscus (the shock absorber under the kneecap) and told me I could run on it as per usual. Everything inside of me told me I couldn’t. Many relapses later I requested a second opinion, this revealed I needed surgery to repair it. Another doctor failed to pick up my daughter’s appendicitis despite her showing all the signs. As a mother I knew something wasn’t right, but we were sent away with a prescription for anti-biotics. By the time I took her back for a second opinion her appendix had perforated and what followed was a distressing and complicated recovery. Thankfully she received excellent care, but it was a reminder that the advice we receive may not always be best for us and we need to listen ourselves.
Recently there have been numerous reports of women with menopausal symptoms being treated with anti-depressants, rather than HRT which the NICE guidelines suggest should be the first course of treatment. It seems that, for now, women are well advised to be familiar with these guidelines when they speak to their GP’s. And if we are unhappy with the care we receive from a particular professional we can ask to see another, it is worth remembering that there are plenty of women whose lives have been transformed for the better thanks to the care they received.
It is a powerful experience when a doctor or health professional tells us what we need, or we find a product that promises to make our suffering go away. We can put a lot of faith in them, especially when we desperately want answers and relief. But once we agree to a course of treatment we need to be honest with ourselves, and with them, about how helpful it is. And we should be willing to investigate the option for safety and effectiveness.
Doctors, and other practitioners, have an important role to play, they can be enormously beneficial and indeed life-saving at times, but if something isn’t working we need to recognise that it is time to review. The emphasis should be on a two-way dialogue with good listening on both sides, working together to establish what is most effective for you. If we are unsure we can ask for a second opinion and investigate different possibilities.
Becoming more connected with ourselves, more aware of how our thoughts, feelings and bodies respond, may seem like a longer route but it is an empowered route and one that will continue to serve us for many years to come.