Susan - Interview 41

Age at interview: 55

Brief Outline: Alongside hot flushes and joint pain, Susan experienced anxiety, anger, inability to make decisions and loss of self-confidence. Support from her partner and colleagues helped her emerge from the menopause with a sense of hope, renewal and refreshment.

Background: Susan is the manager of a women's health centre. She lives with her partner and has no children. She started the menopause at age 45 and had her last period at 50. Ethnic background/nationality' White British.

More about me...

Susan describes the menopause as ‘a hormonally induced change’ that affects women not only physically but emotionally and spiritually. From the age of 45 to 50, she experienced a gradual ‘fizzling out’ of her periods, painful ankles and knees and ‘the soles of my feet burning like hell’, as well as hot flushes. Unable to take HRT because of a family history of breast cancer, Susan found temporary relief from her ‘desperately annoying, embarrassing and debilitating’ hot flushes by adding the sage infusion Menosan to water.

Yet despite these physical symptoms, it was the emotional aspects of the menopause which had the most significant impact on Susan’s life. She describes her anger, emotional outbursts, inability to make decisions, and loss of control as ‘a shadow side of me; a darkness; a cloud coming over me’. As a gay woman proud of her ‘boyish, thin figure’, menopausal weight gain eroded her self-confidence and contributed to a cycle of ‘eating too much, maybe drinking too much and not exercising as much as I should have’. She speaks of her feelings of invisibility and the sense that menopausal women are no longer seen or heard. For her, the menopause represents a ‘bereavement of one’s self; a going into purdah behind the veil’.

For Susan, this sense of loss was compounded by the death of a close friend and by the realization that, despite a life choice of childlessness, the menopause marked the end of her fertility. She emphasizes the importance of a strong support network to help women face the physical and emotional challenges of the menopause. Her ‘very sympathetic’ partner and the ‘great community of women’ at work who understood the physical and emotional challenges of the menopause and offered support when needed, played a significant role in helping Susan successfully negotiate the menopause transition.

Since her last period on her fiftieth birthday, Susan has been diagnosed and treated for breast cancer. She believes that this and the experience of the menopause have shaken everything up, forcing her not only to become more conscious of her health and the needs of her body, but to become aware of her spiritual core. As a postmenopausal woman, she now finds herself ‘on the shore recovered’, having emerged into a place of peace and contentment.

Susan was interviewed for Healthtalkonline in June 2009.

Susan was surprised at the impact loss of fertility had on her life choice of no children

The menopause is just a process that you go through hormonally but your fertility and the loss of all of that and I suppose what I didn’t talk about because I am gay is the fact that I haven’t had children. And just a funny story. It was when Sainsbury’s were running a kind of a promotion at Christmas and they did these huge big white teddy bears and I went through a phase of about six months of just wanting teddy bears. And there was one of these darn teddies, these big white lovely teddy bears left you see. And I ended up fighting with some poor woman in Sainsbury’s to get this last teddy bear and that’s when I thought, “Susan, what is going on here?” So there was a real fact that it was over. I couldn’t have children. That hit me. That actually did hit me and that was part of the loss and part of the loss of the possibility that I could ever have children, even though I was gay and there was a life choice there for me that I wasn’t going to have children it still impacted on me and manifested itself in this stupid way of looking for teddy bears everywhere I went. And thankfully I’ve ditched the teddy bears.

Susan was worried about taking HRT so tried a sage infusion to relieve her hot flushes

And I didn’t want to take, I couldn’t and didn’t want to take HRT with my mum’s breast, it was breast cancer in the family. I was concerned about HRT and I was never going to take it. So I was always interested in looking for other remedies so one thing that worked for me was the sage infusion. I forget the name of the product and it doesn’t matter but it’s a little sage infusion, so many drops in water and that alleviated it just for a short period of time for about three months. And then it came back but that actually helped. Menosan I think is the name of it but it’s a little sage infusion and I found that useful. I know that people who have taken the black cohosh it’s not such a good idea because it actually creates high blood pressure and things like that but so the Menosan, a wee bit of evening primrose oil, that type of thing. But at the end of the day, you just feel, I felt it was very much a natural, it is a natural process but it does get you down and there’s something about it that you know you have to embrace it and go with it. I think if you fight against it you probably, if you’re resisting it or thinking, “Gosh, this is.” It’s just going with it and accepting it as a natural part of your womanhood and your stage in life.

Susan describes how her partner dealt with her mood swings

So [partner] is fine and I think she’s beginning to notice little changes in her cycle now but so no, we’re on the advent of [partner’s] [menopause], we’re on the brink of it while I’m coming out of it. But she was very good, extremely understanding, extremely patient. Her mother had had a particularly bad menopause so that [partner] was really very sympathetic and knew what I was going through. She wasn’t always patient with it and she did have to take the brunt of some of it and was happier with my moodiness and could cope with me being emotional and tearful better than obviously when I would go into a fit of stupid rage about something. But she was always there and always supportive and always kind of pro-active in helping. Would have found out is there anything that could help. Encouraging me out on walks, that sort of thing, always so it was good to have a supportive partner. And a woman who understood probably from her own perspective, of course from her own perspective even though she hasn’t experienced the menopause but certainly who knew her mother’s situation and was able to kind of support me because she understood it. As indeed her mother did. It was great. So it’s great to be part of a community of women who support each other through the menopause, it is I think very, very important.

Susan lost her vitality along with her thin, boyish figure

Well, just that loss of the youthfulness and I suppose being gay I like my kind of almost gamine type and this is very personal to me. I like my almost androgynous look. When I put on weight there was no denying my womanness, that was me. This is me. This is a gay woman talking and a woman who enjoyed looking kind of boyish, thin, young all of that. So that to lose, to kind of put on weight that was the first thing and just feeling not as physically fit because I would be quite a physical type person and I would have enjoyed sports and all the rest. So I kind of let myself go a little bit. There was a wee bit of that I should of kept up that sort of thing. Whereas instead I think I began to adopt behaviours that were just not good for me. As I say, eating too much, maybe drinking too much, not exercising as much as I should have, doing things that were because I was more preoccupied with the way I felt. I let and then as a result my physical and one impacted on the other. The heavier I got the more down I got about that, the more down I got the more I ate and drank, the more I ate and drank, so that there was a bit of a cycle there. There was a bit of a cycle of that kind of destructive behaviour type stuff. That our lifestyle stuff that I can see then was no good for me and I’ve come out of that and can look back and see that I’m in a place where I want to change and improve all of that.

Susan describes a clinic which offered 45 minute appointments with a menopause nurse who...

Yeah. Well, first of all it’s non-directive. The first thing that it offers is time. Every appointment’s 45 minutes. And a review appointment’s half an hour so the first thing it gave when it started, first of all it was the first menopause clinic in the city. There was no other menopause clinic so it was the first. It was offered by health visitors and what they did was really give women time to talk, just what I’m doing here now, to talk at length about how it’s affecting her. There would have been advice around complementary therapies and there would have been referrals to places that did complementary therapies and we at that time, would have done quite a bit on Bach Flowers, that type of thing as well as referring them to other centres for complementary therapies. There would have been advice around HRT. It was non-prescriptive so therefore it was offering women choice. It was also I mean there were maybe other issues that are going on for women as I say, there usually are so it was signposting them to other routes either within [women’s health centre] or within the city where they could get support with other issues that were going on for them.

It was very much offering advice on how to manage stress, how to relax, how to manage hot flushes, how to, well not to manage them, but to accept them I guess and to go with them and to treat them as with complementary therapies. They would have been informed fully about HRT and I suppose about accepting the natural process of it and just the power of being able to talk. And frequently [name] who was the menopause nurse, said that really the menopause might have just been the outer layer of what was presented.

What people wanted was to go in with the onion skin effect that just was layer upon layer to it was so many other things that are going on in a woman’s life. And that really it’s maybe the ability to cope is lessened and the ability to deal with kind of what can be tectonic change type events in your life to the ability to actually manage those at a time when you are just physically in such a state of hormonal upheaval really. So it was by putting in support. It was about offering choices. It was about acknowledging that there are complementary therapies there that can support you and help you to relax and to ease the symptoms of the menopause.

Susan describes her anger and emotional outbursts as ‘the shadow side of me'. She felt an ...

But my menopause actually began when I was about 45 and physical symptoms began with hot flushes but the thing that I noticed mostly was the emotional, almost loss of control at times. Anger, emotional outbursts just tapping into things that I felt were a shadow side of me that I hadn’t really felt before and certainly a darkness, a cloud coming over me. But normally, I suppose I would have been prone to mild depressions prior to that I think. I wouldn’t say I was very depressed. I had been prone to mild depression and I always knew there was a light at the end of the tunnel. In this experience I felt as though there was no light at the end of the tunnel. I thought I was in just a very dark place and that I was peculiar. I wasn’t being heard, paranoia, all of these sorts of things. It was that kind of thing that took me aback, a lack of confidence. The invisibility. I mean I suppose I’m somebody, I pride myself on my physical appearance and I would be very confident about my physical appearance and all of that left me as well. So it was that kind of stunning kind of crushing of my sense of myself and the overpowering sense of loss.

Susan ‘drank quite a bit' to relax when she felt angry and frustrated

I remember getting desperately angry and I raged at things. Just feeling that I thought, “God help me if I had kids or was with a family.” I’d give them grief because I know I gave [partner] grief. I know I gave, because you just get angry at and frustrated with things. So I didn’t lash out. I wasn’t physical in that sense but just I certainly would have raised my voice and all the rest. And I can see how you’d get into things like maybe drinking too much or finding that you want to drink, you want to relax. You want to get rid of, so that. I suppose it was a period when I look back when I drank quite a bit. I’m not saying I was anywhere close to alcohol, liquor or anything like that but I certainly would have enjoyed having a few bevies and enjoyed a few drinks partly to relax and I could see you could get into a pattern of that. To such I suppose an extent where I now I don’t drink very much at all. I mean I enjoy wine with meals and things like that but I just began to become conscious of it. And maybe I suppose I enjoyed a little bit of, you need to be careful of self-destructive type behaviours as well. I mean I don’t know if that but just because your mind gets messed up, there’s no doubt about that. And the focus on your life and its meaning, you begin to get into a negative place and a negative way of thinking.

Susan's breast cancer diagnosis coincided with other changes in her life

It’s at a stage in your life when so many other things are going on. And that’s what makes it, that is where the sense of change and the notion that it is change is really compounded because I mean for me I was to lose my best friend. Co-incidentally I changed job although I’d been part of here for twenty years I didn’t actually come to work here until 1997. So that was a time of change. I’d been here working just full-time for twelve years so it was a period of change. You just felt that there were things going on that had a greater impact, you had a sense of things just changing and the loss of people. I know from women it’s the loss of children leaving home or the loss of a partner or there can be other changes at that time in your life that just seem so much more exaggerated because you’re going through this change.

It has changed but it's not over. I suppose for me it was compounded because I had other diagnoses then. I did have breast cancer then two years ago and so that I often think with the two running parallel in some ways because you do have an overwhelming sense of your own mortality. You do have existential feelings. You have feelings about your well-being and your health and where you might be. So I never I suppose that’s the bit that for me is a bit confused as well, is that what the menopause is, or was that something much more deeper that was going on that I was tuned into.

Well, jeepers it all seems to have been part and parcel of it. It seems to have been part and parcel of the whole thing. I just see them all as a bit connected. I personally can’t separate them out. I see them all being crammed into that 10 year period of my life or whatever from when I was 45 to 54. I just see that as being a kind of a ten year chunk that I entered quite early compared to others, and I just wish for myself good health from here on in, and good mental health, but the greatest confidence it gives you is if you can survive all that, you can survive a lot of things.

Susan describes the menopause as a ‘bereavement of one's self' from which she's emerged ‘renewed...

It is a bereavement of one’s self. It is dying to oneself. That’s what the menopause is in many ways. It’s a kind of and someone I always remember compared it to when I think of an Indian culture where a woman loses her husband she was into purdah almost. She was into a darkness and I know there’s a lovely Greek mythology which talks about the mother and daughter going underground during winter and emerging in the spring. There’s something about the menopause that is a going underground, a dying to one’s former self, a going into purdah behind the veil.

It’s all of that but all I can say is from where I am here now is that you emerge again and that it is a place of hope and renewal and refreshment and that you can look back on it. I mean certainly while you’re there nobody could tell you. Before I’d done it nobody could have told me how bad I was going to be and now that I’ve come out of it to look back on it I think, “God, that was awful. I can’t believe I am where I am now.” And I suppose that’s the one thing I can say is that it’s a wonderful place to be, to have it behind you and that you are renewed.

Susan counsels women to make sure they keep going for screening

Absolutely exercise and walk, talk and listen. So then, go walking, talk to people and listen to people who want to support you. Yeah, and the diet and all the rest. I don’t know. Enjoy because it’s such a painful kind of time in some ways it’s important to enjoy and treat yourself as well. If you want to enjoy food, enjoy food. But, like me I enjoyed it a lot. I ate too much. And if it’s screenings, avail [yourself] of your screenings, your mammographies, your cervical screening, any screening, absolutely attend all your screening sessions because it is a time when other things are going to go to the wall. Go and get cholesterol tested, blood sugar tested all of that sort of thing. Be absolutely vigilant about screening. And just accept each phase of it.

Susan felt paranoid that she was no longer doing her job well. She feared she would be ‘caught out'

My biggest thing was the loss of confidence, the loss of self-esteem, the loss of putting myself out there. Up until then I would have been a confident, out and about kind of person doing talks, going to meetings, all of that. I completely lost my confidence with the result that I very much retreated in back to the centre here, much happier to work on books, planning systems, working within the centre. I certainly stopped being out there. Going to meetings I felt awkward, lacked confidence and I felt that as a representative of the organisation I was letting it down in some ways. That paranoia, stupid jealousies sometimes, every kind of emotion you can think of was exaggerated. The impact on work then was probably I didn’t feel I was doing the job. I felt, “I’m going to be caught out. I’m not doing this job as well.” A lack of belief in my own ability, so looking for reassurance all the time and wanting to be reassured that I was doing, that I was okay, that I’m doing the job all right. That kind of, paranoia is the word for it, that not saying that people are talking about you, it’s not that sort of thing but that you’re going to be found out that you’re not doing your job properly or you’re going to be found out that you’re not the great person you thought they think you are.