Joyce - Interview 21

Age at interview: 48

Brief Outline: Loss of memory, inability to concentrate and anxiety had a detrimental impact on Joyce's quality of life and ability to function at work. HRT has made a significant difference. She is determined to set up support networks to help women in the workplace.

Background: Joyce is a police officer. She is divorced with two teenage sons. She started the menopause at age 45. Ethnic background/nationality' White British.

More about me...

Coinciding with the breakdown of a relationship, Joyce found her periods becoming irregular at age 45. Following a blood test, her GP confirmed that she was perimenopausal. A year later she began to have hot flushes during the day.  but these did not inconvenience her. She believes that taking the herbal remedy soy isoflavones helped manage the physical symptoms. It was not until eighteen months ago, however, that emotional and mental symptoms of the menopause ‘really kicked in’.

In a demanding job requiring the ability to absorb and process complex information, Joyce became increasingly concerned at her inability to concentrate and remember details. Describing her poor memory as being like ’somebody’s taken a chip out of my brain’, Joyce feared she was experiencing the early stages of dementia. Feeling increasingly anxious, she found it difficult to function effectively in her job (despite positive appraisals) and to sleep at night.  A panic attack during a presentation at work was the trigger Joyce needed to take action.

After seeing an occupational health professional and a counsellor, Joyce consulted her GP six months ago and asked to go on HRT. Before prescribing, however, her GP discussed the benefits as well as the risks involved. Although Joyce felt her decision to go on HRT (Nuvelle) was a bit like playing ‘Russian roulette’ with her body, she balanced this against the negative impact her symptoms were having on her health and well-being. After three months she felt ‘like a new woman’, describing HRT as the ‘best thing going’.

As well as relieving her hot flushes and tiredness, the resumption of regular ‘periods’ on HRT made her psychologically feel less cheated at being deprived of her fertility at a relatively early age. While regaining her memory and concentration has taken longer, she now feels that her ‘brain has gone back into place’. Her GP has agreed to continue to prescribe HRT for one year and then to reassess. Joyce is apprehensive about the possibility of emotional and mental symptoms returning if she stops taking HRT in the future, but equally feels prepared to put up with some difficulties to reduce her risk of cancer.

Joyce believes that the menopause has a huge impact on women’s working lives. In a leadership role in a predominantly male workforce, she is determined to provide a support network through which women can not only share their experiences but get information and advice about the menopause.

Joyce was interviewed for Healthtalkonline in March 2009.

Joyce was very frightened by her poor memory and concentration at work. She wondered if she had...

I think I’m a reasonably intellectual person, I’m educated to degree level, I hold a responsible and a senior position whereby I need to deal with complexity, just about daily in my job, I need to be able to deal with ambiguity, and I need to read a lot, take in information and be able to store it and then use it. I had no problems doing that up till the age of 45, 46. But in those 18 months that I’ve just described from being sort of 46 and a half, I’ve found that incredibly difficult, it got more and more difficult, and it really started to trouble me. And what would happen, for example, would be I would have lots of things to read, or I would be reading about something, an issue that was maybe new or unfamiliar to me. And I would be given a briefing paper or some information about it and I would be reading the words but they wouldn’t be computing in my brain. So the words would go in and it’s almost as though they went into a vacuum.

And I found this really unnerving, really unsettling. And I actually began to question whether, I thought I actually had the early onset of Alzheimer’s. That’s how bad it was. It really really troubled me; I thought I was going mad. I also found that my memory both short term and long term was absolutely appalling on occasions. And this is where it got a bit scary, because sometimes I would have no problem with my memory whatsoever. On other occasions the most simplest of things would simply desert me. So, an example of that was, I was in a meeting with my top team, my executive team one day, and I was asked for some details on a project that I’d been working on for about fourteen months, now I should have known these details back to front, inside out, I’d lived this project for such a long time. And I couldn’t remember the order of something. And I found it very difficult not to cry, and in fact I was saved by the bell literally, because my phone went at that point, and I was able to exit out of the room. And I remember going to my office thinking, “Why can’t I remember this? I’m being asked something very simple, what’s the order of something, and I simply cannot remember it.”

And I actually then started to get quite worried, and I suppose this coincided also, I suppose what concerned me was, this coincided with a time of quite high demand on me professionally, and so what I wasn’t certain about was, is this hormonal and down to the menopause? Or is this because I’m under huge pressure at work? Or is it the combination of things?

But the upshot of this difficulty in concentrating and being able to take information, and this loss of memory, I would describe as somebody’s taken the chip out of my brain. The information’s going in, either through my eyes because I’m hearing it, or whatever, but it’s going into this empty space, and it’s not slotting down into the bits of my brain where I should then be able to understand and comprehend it. And I found that very very frightening.

Things I found really difficult were composing a letter, trying to write a letter to somebody and convey the sentiments and thoughts I found difficult and trying to verbally convey to people, say in a meeting or just on a one-to-one basis, how I was feeling about something I’d find really difficult because I wouldn’t be able to pull up the right words I wouldn’t be able to pull them out of the hat. On more than one occasion I sat in my office wanting to cry, getting the dictionary out, because my dictionary’s got a thesaurus bit, thinking I know the word I want why can’t I remember the word? Why won’t the words come back? It was awful, absolutely awful.

Joyce tried breathing and relaxation techniques

The other thing I found was I couldn’t sleep. I’d be really tired and I’d get to sleep, but I’d then wake up again in the middle of the night, with my mind churning, and then fretting about what I couldn’t remember. Because things I hadn’t been able to remember during the day would then come back, so, it wasn’t that the memory chip was completely dead, but they’d come back at the most inopportune moments. And I find that once I’m awake, I’m awake. And I practise relaxation techniques so that when I woke up in the night and the world was either churning or I was remembering something which I’d struggled to remember earlier on, I’d unpack it, I’d practise the relaxation and the breathing techniques which I’d practised at yoga because by now I was starting to take up some classes at the gym to try and improve my well-being. But none of that worked and it was interesting because I’ve always needed eight hours sleep, but gradually I was finding that in fact I wasn’t needing eight hours sleep. And if I only got five, yes I’d feel tired during the day, but I was actually able to function. So a noticeable change was this inability to stay asleep for long periods of time, what I would consider a reasonable time for me, but in fact it wasn’t having a majorly detrimental effect on me. No more than I suppose I take tiredness as a fact of life.

Joyce had a very positive experience when she saw her GP about HRT

But when I went back to see the GP about getting HRT she was absolutely lovely and I would say very responsive. I mean while we haven’t talked about the different forms of HRT and that’s probably got something to do with the fact that the appointments are only five, ten minutes long and during that time she did a cervical examination, a breast examination, talked through the history, so, I guess we ran out of time maybe to talk about the different forms of HRT. I found her supportive on both occasions I was very happy with the service I got from my GP

And so my experience of doctors and healthcare professionals around the whole issue of menopause, HRT, how that then fits with a future contraceptive need, has been nothing but positive, and on each of those occasions I have had those meetings with female doctors, none of whom I think would be of an age to be going through the menopause themselves. So I’ve been really heartened by that.

What was it that made you satisfied with the service they provided?

Sympathy. I think trying to understand my position and wanting to know about me and my life. What was the impact on my life of this change, huge emotional and physical change. And just a genuine I think understanding of the practical and physical effects that it was having on me.

Joyce highlights the need for a specialised service for menopausal women

I suppose what seems strange to me is that we have clinics for diabetes, we have clinics for family planning and contraception, we have clinics for pre-natal and post-natal, we ought to be having some clinics really shouldn’t we for, because every woman’s going to go through it, fifty one per cent of the population’s going to face this challenge.

Do you mean clinics within the GP structure within primary care?

I suppose so, or somewhere where you can go, where people specialise in this and you can get the very best advice. I mean when I had a slipped disc I went to an orthopaedic surgeon who specialises in keyhole surgery who could see this is pretty critical to you as a human being so we’ll get you the best possible care. When I had a problem with my face, with my skin, I went to a dermatologist. I’ve got a problem with coping with life through the menopause but I see the GP who does everything. I’ve now seen three different doctors all of whom are general practitioners for advice and I’ve got nothing negative to say about the service I’ve got. But I haven’t gone somewhere where they’ve said, “Okay, well let’s sit down and talk about the various options, natural remedies might be right for somebody in the early stages, but she didn’t even know what the natural remedy I was taking, which is in a healthcare magazine, is even or what would the impact do. I’m not critical of the support I’ve had because it’s been brilliant in terms of a purely medical perspective. But I just wonder whether there’s the opportunity to give something that’s a little bit more holistic if you had healthcare professionals and it doesn’t just need to be doctors does it? But if you had healthcare professionals who were able to signpost you to a whole range of options and remedies for the whole range of symptoms and issues, I guess it would help you to make a more informed choice about how to deal with the issue.

Joyce's doctor had 'never heard of' soy isoflavones and felt that herbal remedies were unlikely...

Once I knew that I was perimenopausal and I’d got some hot flushes, I take quite a lot of supplements and so it’s something that I would kind of naturally do if I thought there was going to be some benefit. What I don’t know is how effective they actually were because I didn’t have any most of the time. I would take them most days, I’d have a packet in my drawer at work, in my desk, and I’d have some at home so most days I’d remember to take them. It was interesting when I said, “Oh I’ve been taking a natural remedy called soy isoflavones,” that the GP said, “I’ve never heard of that.” Which I found quite interesting actually. And I don’t know whether that sort of says something about the medical profession or maybe her as an individual but her view was that over-the-counter natural sort of plant or herbal remedies are unlikely to have a major impact. And certainly on the anxiety and the mental side she was absolutely right, they didn’t.

Joyce eats well and sees exercise as a chance for some 'me' time

I need exercise for several reasons. One is that it’s my own down time. It might not be for very long but it’s the time that nobody can get hold of me, and I do something purely and simply for me. So that would normally take the form of either going to the gym and spending an hour in the gym. I like swimming because I don’t run anymore I love walking and I have a couple of circuits near where I live, that are four and five miles long, and I’ll quite happily on a Sunday morning put my training shoes on, and go out for a power walk and run. In the summer I like horse riding and in the winter skiing is my passion. And I only learnt to ski about three years ago and I’ve already been once this year and I’m going again in a fortnight which will be fantastic.

I suppose it really made me think about my diet and my lifestyle, how could I ensure that my body was as healthy and resilient as possible to being able not to be susceptible to cancer? And I know that sometimes that’s really difficult but I’m very conscious about my diet. I eat a lot of fruit and vegetables, and I like to think I know all of the antioxidants that exist, do you know what I mean? I do a lot and I’m interested and I read about keeping yourself fit and healthy.

Joyce feels a strong sense of responsibility to support other menopausal women who work in her...

And I just think back to my experience that there was no way I would have wanted to have shared it with anybody and I suppose I see part of my responsibility to be able to set a climate where people can confidentially be able to go and seek some support. I think the more difficult thing is getting the wider managerial levels to understand that sometimes people need to be cut a bit of slack and need a bit of empathetic support. Because we don’t go into work do we, with a badge saying, “Oh by the way, I’m just starting my menopause”, because this is something that creeps up on you. It’s not something that you just, it’s not like being pregnant is it, that you can say well from here to here this is what this is, how it’s going to be. These are symptoms and features of a woman’s life, which are very difficult to define. I couldn’t say yes it started there and it ended there, it’s not like that, is it? But I think it’s just being able to strike an empathetic working environment where, when people need a bit of support. When I was talking to you wasn’t I about opening that working group for women, I said something which I saw everybody smile and nod their heads at. I said, “Sometimes you just need a hug. Sometimes you just need a hug when you’re feeling tearful and you just think, ‘Oh I’m just, I’m having a shit time’. You just need a hug”. I can’t go round and hug them all. But I can start to engender a working environment where metaphorically that hug is there if they need it, because they can go to somebody to talk it through. And that’s what I’d want to do.

Joyce's memory and concentration began to improve after a few months of taking HRT

And my GP agreed to give me HRT for three months to see how it worked. And I remember literally snatching almost the prescription out of her hand, racing to Boots and saying, “You have got this haven’t you?” Sitting in the car, outside Boots the Chemist, reading the booklet that came with the tablets and going through these are the symptoms that HRT will alleviate, and these are the symptoms that it won’t and I remember it saying this will not alleviate memory loss. And I remember thinking “Oh shit, that’s not going to work then is it? Oh bother, that’s not going to work. And so I just thought “Oh well, we’ll give it a go.”

Certainly the hot flushes and tiredness was definitely alleviated. The memory issue wasn’t immediately and I think over the four months, five months now that I’ve been taking it that’s gradually improved. I wouldn’t say it’s perfect and even now I’m struggling to remind myself of the name of somebody that I wanted to tell you about. But I don’t think it’s as bad as it was. And the most startling thing has been the ability to concentrate and I feel like my brain just went back into place.

Joyce's uncharacteristic anxiety and loss of confidence led to a panic attack in a meeting while...

I remember one day, this was in July of last year, going to a meeting to give a presentation about something, which again I’d been working on for 12 months, this wasn’t new territory to me but I’d got an e-mail from another person who’s a friend and an associate, who said, “You could meet some resistance at this meeting on this particular issue that you’re going to describe. Suggest that you really are prepared for the difficult questions.” Which, he was giving me a heads up it, there was nothing more to it than that, but I really became very very anxious about this to the point where I actually had a panic attack in the meeting. The meeting was being [held] unfortunately in a very big room and as I started to speak people at the top end of the table said, “We can’t hear you, would you stand up?” And so that kind of added to being under a spotlight that not only can I not sit here and say this, I had a presentation and I needed to touch the keys on the laptop to bring it up. Not only could I not do that but now I had to stand up and the words came up, the words were in front of me and I could see the words but I couldn’t read them if that made sense. And I just said, “I’m really sorry, I’m feeling really unwell at the moment, you’re going to have to excuse me,” and I walked out the room. And fortunately a colleague came out and said, “Are you okay?” And I didn’t admit to having a panic attack but I just said, “Look, I just thought I was going to faint and pass out, I think I’ve eaten something, I think I’ve got a stomach upset.”

Fortunately a colleague was with me at that meeting and said, “Actually what [name] wants to tell you is X, Y & Z” and she conveyed the message. So it wasn’t a big problem but I just felt so embarrassed, I wanted the ground to open up and swallow me and I just thought I can’t go on like this.

Joyce wonders whether she will lose her sex appeal when she turns 50. To judge people by their...

I see your life as being like a book, and there’s lots of chapters in it and I wasn’t quite ready to finish that, be out of that last chapter and I’ve been forced into the next one. Which rightly or wrongly is entitled “Middle Age.” And I’m not ready for that.

What do you fear about it?

I fear losing my looks, I fear people making assumptions that I’m not at the top of my game, or the peak of my both professionally and personally. I think less now, I think I’m a bit more mature about this now, if you’d asked me that question ten years ago I think I might have said “Loss of sex appeal,” but actually I don’t think that’s the case anymore.

But I suppose yeah and it’s a silly thing to think because people in their forties, fifties and sixties now there’s some lovely posters out aren’t there, about how people age differently now and we do. There’s some gorgeous women who are in their early sixties who are just very sexual, very sensual, and I suppose that’s what I feel, will I lose that sexuality, will I lose my sensuality, will people if I were to say how old I was, I’m still in my forties but when that day comes and it’s only two, one year and eleven months away and I trip over the big five oh and people say how old are you? If I was single then would people still be interested in me when I was 50? And I suppose that’s what it’s synonymous with, that it’s that loss of youthfulness but that is a silly thing to think because we make our impressions of somebody on what we see, what we feel, what we say, what we hear from people isn’t it. It’s not, “Oh and by the way just tell me how old you are and then I’ll make a judgement about the person you are.” Your age is kind of academic isn’t it. So it’s kind of I sort of pull myself up sharp sometimes and say well that’s a bit of a shallow way of thinking. Because you wouldn’t make that judgement on a man would you? Men in their fifties are often still utterly, really really attractive and some in their thirties aren’t so it’s just kind of academic really isn’t it, it’s the person. So there’s quite a, I kind of I do pull myself up sharp because I just think that’s a pretty shallow thing to think.

Joyce decided to use HRT so that she could maintain her 'professional pride' in her work

So yes it did make me stop and think that, well hang on a minute, am I playing a bit of Russian roulette here with my body [by taking HRT], and what’s the impact of that but equally I suppose I thought what the impact of this is having on me mentally. I’m not in a position to give up work and even practically changing my job to something that’s less stressful would be very difficult. I’ve a mortgage to pay, bills to pay. If I were to step out of the job I’m in now because I’m going through the menopause we’re talking a significant change in my lifestyle and more importantly in my future lifestyle because it won’t be many years before I’ll be able to draw a pension so to have to go into a different job where I couldn’t be assured that in fact the stress would be any less, that wasn’t an option.

So I suppose to some extent rightly or wrongly I kind of felt well if I’m going to get through the next couple of years actually I need some help with this. If this is the impact that going through the menopause is going to have on me emotionally and mentally because I suppose I also have quite a high degree of professional pride as anybody would that if you’re known and you have a good reputation and somebody says, “Do you know what, she has lost the plot.” You wouldn’t want that to happen would you particularly if you’re in a senior position and you’re in a position of authority and a position where actually a lot of people not only look up to you but they actually analyse what you say, they take everything you say at face value and if you’re not firing on all cylinders one day and you decide to either make an off the cuff remark or whatever and it comes out wrongly actually that’s what they remember you for not the good things. And I just knew that in the job I’m in, but even if I worked in Starbucks making the coffee and you’re taking someone’s order you’ve got to be able to remember what you’ve just been told and you’ve got to understand instructions so it’s no different because I think I’m in a senior position in my organisation even if I wasn’t I knew that emotionally and mentally I was struggling with some day to day things.