Rose - Interview 33

Age at interview: 50

Brief Outline: Rose's menopausal symptoms included hot flushes, headaches, and tiredness. Tried a number of types of HRT but problems with breakthrough bleeding, headaches and heart palpitations led her to manage her symptoms naturally with the help of herbal remedies.

Background: Rose is a personnel manager. She is married with two adult children. She started the menopause at age 43 and had her last period at 45. Ethnic background/nationality' White British.

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Having experienced no problems with periods or childbirth, Rose expected to ‘fly through the menopause’. To be ‘suddenly hit with all these hormonal issues’ with the onset of menopause at age 43, took her by surprise. Erratic periods, accompanied by headaches, difficulty sleeping, lack of concentration, and hot flushes which ‘became quite unbearable very quickly’, left Rose struggling to cope with a busy job and the demands of teenage children. While natural remedies such as evening primrose and isoflavins contained the symptoms in the early stages, by her mid-forties, Rose’s symptoms were so severe that she felt she had ‘no other option’ than to consult her GP.

After carefully weighing up the risks (she had previously had a benign lump removed from her breast), Rose decided to take HRT. Her GP described it as a ‘safety plaster’ to get her through the menopause. Finding the right type of HRT, however, proved difficult. Despite trying a number of different types of HRT including Elleste Duet, Evorel and Premique over a five year period which helped ease her hot flushes, she continued to experience side effects such as headaches, heart palpitations, breakthrough bleeding and weight gain.

In consultation with a specialist at a menopausal clinic, Rose made the decision to come off HRT and manage her menopause naturally. She feels that at age 50, she is ‘coming out the other side’ of the menopause and although she still experiences hot flushes and problems with memory and concentration occasionally, she is able to cope with the help of natural remedies, including evening primrose (for hair, nails and skin), isoflavones and sage (for hot flushes), and ginseng biloba (for memory and concentration). She believes that natural remedies can help women going through the menopause as long as symptoms are not too severe. She stresses, however, that like HRT, these remedies have potential side effects and do not suit everyone.

Rose’s experience of the menopause took place against a backdrop of her father’s death and ‘a really difficult time’ for her family, including her husband’s diagnosis with M.E. and problems with her teenage children. She feels that this, in conjunction with menopausal symptoms, increased her anxiety and made her less empathetic with colleagues at work. A short course of the antidepressant fluoxetine, together with HRT, helped restore balance. 

The menopause has brought Rose face to face with her own mortality and the realization that she is no longer young. She describes her inability to have children now in terms of ‘losing her femininity’. Moreover, since giving up HRT, she has noticed an increase in vaginal dryness. She finds ‘sex impossible’ without the use of the lubricant KY Jelly. She describes her lack of libido as if ‘that part of my body’s been removed’, and although she is in a loving relationship and still enjoys sex when her husband instigates it, she no longer ‘feels like making love’. She stresses the importance of making a conscious effort to show affection towards her husband even if it does not end in love-making.

Rose was interviewed for Healthtalkonline in April 2009.

Rose felt she had no option but to take HRT even though she had concerns

The first time I went I saw a female GP and I think that was quite useful, she put it into perspective for me. I was very afraid that if I went onto HRT I’d be on it for the rest of my life or I’d be on it for 15, 20 years and it’s still to a certain extent an unknown quality and quantity. She said, “You have to deal with the here and now, you have to deal with the 50 mile journey, the busy job, the two children going through their own problems, the husband with M.E.” she said, “Look upon it as a safety plaster to get you through the next two to three years”. She said, “Don’t think upon it that you’ve got to be on it the rest of your life, think upon it as a short term solution to get you through this period in your life”. And I think putting it into perspective like that I was more able then to consider it and give it a go and that’s what I did. And again, after five years, I just thought “Right let’s come off it, let’s see if I can manage” and I have and I am.

Did you have any concerns about the HRT, about going on it in terms of risk?

Yes I did because obviously it was big in the press at the time, the long term effects of it. I was quite concerned particularly six years ago, the year before I started going through the menopause, I had a lump on my breast removed which turned out to be benign. But having had that removed I was very conscious going onto HRT was I encouraging more lumps to come, would the next one be malignant. It was a big big decision for me to make and I was very anti the HRT for that reason. I think I was really concerned that I might get breast cancer from it. I think that was my biggest concern having had this lump removed. But I just got to the point well it was, I couldn’t have functioned without it and it was, well do I risk breast cancer or do I risk losing my job, my home, my family and everything else. So I felt at the end of the day I didn’t really have a choice to be perfectly honest.

Rose's sleep improved when she went to bed early and drank less red wine

And again the tiredness I’ve learnt that I have to go to bed by 10 o’clock at night. I used to stay up till eleven, eleven thirty, twelve o’clock. I used to be back up at six in the morning. Now I have to make sure I’m in bed by ten at night and I don’t get up until about quarter to seven in the morning. I have to make sure, even if I’m not getting eight hours sleep, because I don’t even now, I probably function on about six hours sleep, but I’m getting the rest. It’s listening to what my body needs and responding in the right way.

So your sleep has improved on what it was at its worst?

Yes, the fact that I get far fewer hot flushes now I’ll perhaps just get one or two a night and they’re less severe. Sometimes I can even sleep through them. I now get about five to six hours sleep a night which is fine for me I can function on that. It was when it went down to about two, three, four hours a night that I couldn’t function.

And I actually, the reality is the more red wine I drink the more hot flushes I get, the worse my sleep pattern is. I try now and have at least three if not four nights a week where I have no alcohol and it pains me to say it but I sleep better and the hot flushes are reduced.

Rose was brought up to accept her doctor's advice without question. She is more confident now and...

And I know when I started to have the symptoms of the menopause I went to see my GP, when I could no longer manage it myself, and I took their advice and I think that goes back to my working class background in that I’ve been brought up to accept what other people tell me and to deal with it. But actually in hindsight, I shouldn’t have done that, I should have taken more responsibility for my own wellbeing and done that research earlier and asked for that second opinion earlier, asked for that expert advice earlier. But I think going back to my working class roots GPs were Gods and you didn’t think to ever challenge or question their advice to you. And we need to be doing that more because as I get older and I get more educated and I learn more, I realise they’re not Gods, they’re like everybody else they’re doing the best job that they can with the limited amount of information and limited amount of time that they’ve got.

Rose believes that information in newspapers may be biased. She recommends ‘digging behind those...

What sources of information did you use to find out about the menopause? Did you use the internet or books?

Books, magazines. I did look at the internet but I found that the information on there was quite fragmented. I’m the sort of person, I’m very lazy, I like to be able to go to one place and find out everything I need to know. And it didn’t happen on the internet, not when I was looking, I don’t know it might be better now. When I was looking six or seven years ago when it first started, there wasn’t that much information available and I kept having to go from site to site to try and find out information. And it wasn’t that good and to be honest I wasn’t so much an internet user those many years ago anyway. I was tending to rely on books and magazine articles. And the newspaper which in hindsight was probably not a good thing to do but it’s there, it’s in your face.

Why not a good thing to do?

Because I’ve learnt through listening to other people and doing other research that actually they only tell you the information that is exciting, that is sexy, that is going to sell them a newspaper. They don’t necessarily represent all of the facts in the right order and in the right way, and that certainly, when I became aware of that through more research, is quite worrying because I did rely totally on what they were telling me. I did think it was harmful to take HRT, that I’d probably end up with breast cancer within a few months and that affected the whole way that I looked upon taking HRT. But actually when you dig behind those facts, you realise they’re just telling you what they want you to know and not necessarily what is true.

Rose uses herbal remedies to help her hot flushes, memory, dry skin and brittle nails

But what I now do is control the symptoms using evening primrose and isoflavones. I’ve actually been on isoflavones for about five years because interestingly I’ve read that the Japanese women have little or no problems with the menopause, allegedly because of the high fish diet but again read that you have to have a lifetime of that sort of diet really for that to be effective. So I have been on the isoflavones about five years and whether they help or not I don’t know, but they certainly, the hot flushes at the moment which are my biggest problem are much reduced to what they were and they’re bearable. The evening primrose I find just keeps my hair and nails and skin reasonably nice. I suffer, my nails went extremely brittle, my hair started going very thin, my skin was going very dry, taking evening primrose, quite a high dosage, I find has helped with that. I take sage, which again is for the hot flushes and ginseng biloba which is to help with memory and concentration.

Rose evaluates the usefulness of herbal remedies for her symptoms

That’s very difficult to be perfectly honest because I think if your symptoms are fairly minor they do help. And I will assess that in that I ran out of sage about two weeks ago and within a week I noticed that the hot flushes had increased. And I’m just waiting for the next lot to come through. So there’s no doubt that sage does help. In the same way when I ran out of evening primrose, it’s only about a week that I notice that suddenly my nails start to go brittle again and my skin starts to dry. So I know that those two help me personally. The ginseng biloba I take for focusing and concentration I don’t know. I can’t honestly say that I’ve noticed any difference when I run out of that so I don’t know whether that helps at all. I continue to take it in the hope that it does. But certainly the sage has helped and again the isoflavones I don’t know if it’s five years worth of those that has enabled me to give up on the HRT because they are having some longer term impact now or whether I would have just got to this stage because five years on I’m coming through the other side. And maybe I would have got to this stage anyway. And because it’s only a long term benefit I’ve never stopped taking those, I make sure I’ve always got a healthy supply.

 

I think in my own mind I’ve come to the conclusion that if your symptoms aren’t too severe I preferred to use the natural supplements and I’m quite convinced that they’ve helped me. When my symptoms got much worse and more severe they didn’t. So I think I’ve come to the conclusion in my mind they may help women who are going through a menopause that isn’t too severe and I think they helped me to begin with and I think they help me maintain a healthy system now. I don’t think they’re the answer if you get such severe symptoms that I got for a period of three to four years.

Rose follows a good skincare routine but knows that nothing will get rid of her lines and wrinkles

At that particular time in my life it was all around the fact that I was no longer going to be able to have children, now it’s more along the lines of “Gosh the wrinkles and things are coming along much faster now than they ever did”. I’ve always been a little bit vain I suppose in that I’ve always been told that I don’t necessarily look my age and I don’t think that I did whereas I think in the last couple of years going through the menopause suddenly I’m starting to find a) I look my age but b) I actually feel my age now too, which I didn’t use to. And that’s all quite difficult to come to terms with.

Oh yes, I’ve spent many many pounds over the years. I have to say I think they’re brilliant for keeping your skin nice and soft brilliant for that feel good factor. The reality is once the lines and wrinkles start to come in, I’ve tried all sorts of creams at all sorts of prices and none of them have banished any lines or wrinkles that I’ve accumulated. What they do do is they soften them and they make me feel better, I’ve learnt to buy the ones that I particularly like that smell nice, that make me feel good when I put them on. But none of them are going to get rid of the lines and wrinkles. I have to look at those as, “That’s what I’ve acquired through my life, each one tells its own story, quite a few stories have been told in the last five years” and I put it down to life experience. But yes I still follow a good skincare routine. I do think it’s important. I do cleanse, tone and moisturise twice a day. I don’t go to bed with my makeup on. And I think that’s had again a benefit for my skin over the years.

Rose suggests that women start their research before they reach the menopause

I think the message to people is “Do your research, have a look on the internet, find out everything you can and don’t be afraid to experiment and find what suits you.

Don’t do what I did which in retrospect was just walk, I read some women’s magazines, saw what they were recommending, went and bought things without looking into the impact that they might have on my body. If you’re going to take natural supplements read up more if you can and I’m sure now with the internet being so much more widely available, there’s a lot more information out there. If you’re going to take something, read up on the pros and the cons. Understand the implications that it might have for you and the same with HRT, if you’re going to go onto a prescription, find out as much as you can about the implications it will have for you as an individual.

And if you can’t get enough information from your GP go on the internet and try and do some more research yourself because I didn’t and the problem is when you are feeling unwell and you’re having headaches and you’re feeling low you just want to go to somebody that’s going to give you all the answers. So my advice is even before you get to the menopause and you start to feel like that, start doing your research earlier. When you are feeling fit and well and when you’re in the right frame of mind to make some informed decisions. Because by the time you hit the menopause it may be too late. You may already be going through depression and the headaches and the feelings of anger, you may not be in the right state of mind to make those informed decisions. You may like me expect to go to a GP and be given all the answers and be put right. And that’s not necessarily going to happen. So do your research, do it early, before you go through the menopause. Write it all down, keep it somewhere safe so that you’ve got it to go back to at the relevant time.

Rose talks about what made her seek help for her irritability and feelings of anger. The...

I was getting very irritable, very irrational, the hormones were obviously kicking in, and the slightest thing at home, at times I would just blow it all up out of proportion. So I think it was them realising how I was and encouraging me to go back and seek help for that rather than my own realisation that that’s how I was. Because I think that the depression, the feelings of anxiety, the not coping, the feelings of anger that you can go through, because they creep up on you, you don’t necessarily realise how much they’re impacting on yourself and the way that you deal with other people.

It’s very difficult when you’re feeling anxious and you’re feeling angry about things to admit it and go and seek help, it’s much easier to deny it, and say it’s not me it’s you. But

Was there a particular trigger you remember, ‘the straw that broke the camel’s back’, and you thought I’ve just got to go and see about this?

Yes, I can’t remember, we’d had a discussion about something, I can’t even remember what it was, it was something quite innocuous, but I can remember going up into the bedroom and just sitting down on the chair in the bedroom and crying my eyes out. Just sobbing my heart out because I felt very alone. I felt that I’d tried all the HRT things that I could and was still feeling so many of the symptoms, the tiredness, the lack of concentration and everything else and I can just remember sobbing my heart out one day thinking “I don’t know what else do to”. And again, I went back to the doctor and that’s when we tried the natural things. And I think actually they did put me on fluoxetine* for about three months.

[* Note that antidepressants such as fluoxetine and citalopram are sometimes prescribed in the treatment of severe premenstrual syndrome, although they are not licensed for this purpose.]

Rose wonders whether her father's illness and death triggered the start of her menopause

One of the things that I hadn’t thought to discuss with my GP is, obviously when I started to go through my menopause quite early, I spoke to my mother because I wanted to know what her experiences were, maybe she could give me a clue as to what I was likely to expect, if it was genetic hereditary and I didn’t realise but when we started discussing it, she didn’t really have a menopause I lost a brother when he was 17, my mother was 44. Overnight her periods ceased, she never had another one, but she never had any side effects either. She never had any hot flushes, difficult to know with things like mood swings because clearly she was going through a grieving process and a bereavement process. But for her, she would say “I never had a menopause. One day I was having regular periods”. She’d always had regular periods like me, they’d never been a problem to her and suddenly they ceased and that made me wonder, my own menopause started as I said when I was 43, 44 I was perimenopausal, that coincided with my father being diagnosed terminally ill and I was a main carer for his last three months along with my mother. And again, the irregular periods and things seemed to start when he died. And so I wondered if significant life changes like that can actually affect when women go through ‘the change’.

Rose asked her partner to look on the internet so he could talk through with her how she was feeling

What advice would you give to partners of women going through menopause?

To try and be patient, to talk about it with your wife. The most important thing is with any life changing event, to talk to each other. That was difficult for me, I don’t find it that easy to talk to people in general, I think I’ve got much better at that and I think the experiences I’ve gone through in the last six years have taught me that it’s much healthier to talk through issues, but that wasn’t how I was six, seven years ago. My advice to partners is to listen to your partner, to talk through how they’re feeling, to go and do your own research. My husband actually went off onto the internet and did his own research so that a) he was able to help inform me when I was at my lowest and didn’t feel that I was actually capable of doing my own research, but also it helped him to understand how I was feeling. And also some of the physical effects, the fact that I did lose my libido and it’s still not back now a hundred per cent. At least he could understand why that it wasn’t suddenly that I’d gone off him, that actually it is a very genuine side effect of the menopause.