‘With this book, Christa has branded the over-40s as the cool kids. Who else could make a book on the menopause a rip-roaring, witty but intelligent read? I laughed and laughed and learnt.’
Anya Hindmarch
‘Been there… survived that… but how I wish I’d had this menopause tour guide to get me through. Brilliant and beautifully written.’
Christiane Amanpour, CNN chief international correspondent
‘Menopause is something none of us want to talk about, it’s a club that no one yearns to belong to. So I am on my knees, weeping with gratitude to Christa D’Souza for writing about it in a way that doesn’t make me want to run screaming for the hills. Finally, a cool look at hot flushes… Men, if you want anything more than the most shallow relationship with a woman over 40, man up and read this book.’
Kate Reardon
To Nick, Flynn and Django.
And my mother for having me.
CONTENTS
Title Page
Dedication
Introduction
1. How It Was for Me
2. What Is Actually Happening to You
3. The Extra Tog Factor
4. Silicon Valley, Nuns and Hot Flashes
5. Whales and Hunter-Gatherers. And Jane Fonda
6. The Case For and Against Hormones
7. Sex, Silver Linings and Ambition
8. Menopause and Marriage
9. Some Thinking about Drinking
10. A Little Bit of New Science
Acceptance, Andy Warhol and a Poem
Plates
Author Biography
Copyright
INTRODUCTION
What do human beings, killer whales and gallforming aphids* have in common? The menopause. In other words, unlike almost every other recorded species (with the possible exception of pilot whales), we all go on living well after we stop being able to have babies. From an evolutionary perspective, this has always been a conundrum. What is the point of living if not to reproduce one’s genes? And yet here we have it: us, killer whales and gall-forming aphids* doing precisely that.
Female killer whales, who stop reproducing at about 35 yet live till around 90, are far from redundant, not just teaching the grandkids how to hunt salmon but being total stick-around Italian mamas to their sons throughout their adult lives (apparently there is a 14-fold increase in the death rate of male killer whales if their mothers die).
Let’s look too at the vital role the menopausal gall aphid plays within the colony. As a female loses its ability to reproduce, it starts transforming itself into a kind of suicidal glue-bomb. Once the transformation is complete it goes and sits outside the gall, or hive, and protects the rest of the colony by glomming itself onto potential predators.
Funny this. I have a mischievous writer friend called A.A. Gill, who quipped, when he heard I was embarking on a book about menopause, ‘So the first two-thirds will be brilliant, the last not so much?’
Yes, well. Go look at the aphids. Which may (bar the suicidal bit) be the underlying message of this book. Because one of the best things about writing it was discovering the cold, hard scientific evidence that, from a brutally reductive evolutionary perspective, there is a reason for us being around. God, if you believe in him, did have a purpose for us other than looking pretty and reproducing; all those self-help gurus banging on about finding one’s inner goddess and reigniting the fire within did have a point, while Japanese and Mediterranean societies that revere older women could teach us more than a trick or two.
Another thing. Did you know that the word ‘climacteric’ (what the Victorians called it), aside from meaning ‘critical stage’ also refers to the process of fruit ripening after it has fallen off a tree? A no-brainer, really. Wouldn’t anyone prefer the juicy just-about-to-turn fig on the ground to the hard green one you have to yank off with both hands?
And yet. Those of you who are as old as me (55½) will remember the patronising Virginia Slims ad campaign slogan in the 70s, ‘You’ve come a long way, baby’. Well, we have… in a way. There’s so much which used to be taboo and just isn’t any more.
Sex, How Much One Makes, Religion, Who You Vote For, Hair Removal, even – these are all perfectly acceptable topics to discuss alongside the chaps at the dinner table. But The Menopause? I want to say it is the conversational equivalent of passing wind but do I really mean that? Perhaps what I mean is that the subject is not so much taboo as plain dull, a much worse sin, in so many ways. A little like the drab, Patrick Hamilton-esque pocket of London off the M4 where I have lived for the past 18 years, the menopause is never, I fear, going to be fashionable or to ‘come up’. (Come to think of it, if the menopause were a borough, it would make a very good Baron’s Court.)
The seeds of this little book were planted when the editor of the Saturday Times magazine, Nicola Jeal, approached me to write a piece about my own experience with it. I baulked at first. Never mind if men would read it. Would women read it? Moreover, do you think the average Syrian refugee mourns her reproductive years? Get over it already, and all.
But I wrote it anyway, and I’m so glad I did. The feedback, after it came out (and not just from women either) was huge and heartfelt.
Quite clearly, there were plenty of super-intelligent, super-switched-on, super-strong women out there in their late forties and early fifties who felt similarly bereft; women who, though they knew, intellectually, that just because they hit the menopause it didn’t mean they were going to be circling the drain or on their way to becoming ‘roadkill’ (as one New York City hormone doctor I spoke to for the piece helpfully put it), but nonetheless found themselves suddenly wondering who the hell they were now and what was the bloody point? Women who, like me, couldn’t remember the last time they’d been whistled at by a builder or been made a proper pass at, and found the physical, somatic reality of whatever that ‘thing’ we once had not being available again, never being available again, surprisingly devastating. I can say this only in hindsight: it is all too easy not to link societal value with one’s sexuality… until it is irrevocably snatched away.
There was one criticism. My friend Rosa, a West Country-based film-maker gently enquired why I hadn’t said anything about male menopause. And she was right – maybe I should have mentioned it for we are not the only ones who go through a hormonal crisis at this age. Imagine the hellish ignominy of moobs? But here’s the thing. Men can still technically reproduce. If you are looking for a section on andropause, therefore, it won’t be in here. (Although I will broach the subject of infertility and menopause. If you can’t have, or indeed never wanted, babies anyway, does menopause matter less? Maybe it matters more.)
Somehow the point when you stop getting your period is as symbolically huge as when you first get blood in your knickers. It is very much not, as I thought it might be, a mere existential crise. The hot flushes, the racking insomnia, the torturous restless leg syndrome (all of which, for me, hit like a brick, within the space of barely a month) are the irreversible concrete manifestations of a chapter finishing where it had once begun. And, however much you think it won’t matter, believe me, it will.
But it is not all bad. For one thing, we are not what you’d call a minority. Menopause affects half the population and, as I write this, more than a third of Western women are going through it. After the year 2030, they estimate that there will be a whopping 1.2 billion of us who have gone, or are going, through it (which is 10 per cent of the global population); and that 25 million women will go through it the year after that.
At the beginning of the last century, the average life expectancy for a woman in the UK was 48.5 years. According to the latest figures published by the National Office of Statistics, the average life expectancy for w
omen by 2030 will be 90. If you are reasonably well off and in good health, the number, obviously, will rise. That means, if I live to 100, and there is no reason, statistically, why I should not (according to Professor Rudi Westendorp of the University of Copenhagen, the first 135-year-old has already been born), I’ll have spent nearly half of it being post-menopausal.† If that is not a reason to think of it as the next rather than the final stage, what is?
Meanwhile, as women live longer, the relative time we spend being reproductive gets shorter and shorter. Might it be possible to see that febrile, fertile era between the ages of around 12 and 50 as a kind of blip? Might the time when we are at our most authentic (or as Simone de Beauvoir put it, the time when we most coincide with ourselves) be when we are either girls or old women – that is, are we at our true peaks when our fertility isn’t messing with our heads?
For a second thing, why suffer if you don’t need to? Just like you can have a nice sedative for a colonoscopy or an epidural before having a baby or a tooth frozen before it is drilled, so too are there ways, hormonal or otherwise, to take the edge off. You’re not going to get a medal after all, however stoically you approach it.
Listen. Maybe you want to be butch about it and handle that edge and hopefully come out the other end stronger and wiser, which is perfectly fine too. Look, I laud women who, for whatever reason, get through the Change without hormones. I thought about coming off them myself for a month in a human-guinea-pig sort of a way because it seemed unfair, while writing this book, if I didn’t. See chapter 6 for why that just wouldn’t have worked for me.
Maybe we need to reclaim menopause, rebrand it in a more positive light and look forward to feeling the feeling as opposed to praying we’ll just ‘sleep’ our way through it, as quite a few women proudly told me they did. Indeed, there is a school of thought, which I’ll explore later, that claims having hot flushes is actually good for the brain, furthermore that they may have a positive ‘halo’ effect on the people around us.
As Germaine Greer pointed out in her fabulous if long-winded 1991 treatise The Change, ‘The goal of life is not to feel nothing. The climacteric is a time of stock-taking, of spiritual as well as physical change and it would be a pity to be unconscious of it.’
I suppose what I am throwing out here, is the idea of choice. Choice with maybe a sense of anticipation rather than dread, though it be a very different type of anticipation from the kind you felt during the Last Change, i.e. adolescence.
So here it is. The book. What it was like for me, what it will be like for you, and other things besides. I’ll meet a bunch of menopausal nuns in San Francisco; I’ll go hunter-gathering with the Hadza tribe in western Tanzania and I’ll sit around kitchen tables with a bottle or two of Whispering Angel and a bunch of fabulous, glamorous, overachieving women, who have just gone through the menopause and see how they have dealt.
Lots of books have been written about the menopause (5741 on Amazon at last count), but if you are like me you still have quite a few niggling questions. How long does it really last? Are hormones safe if you have had breast cancer? If they are, can we take them for ever? Will they make us fat? The list goes on. Is the only thing for a menopot a tummy lift? Back fat, lipo? Should I take up a hobby? Is there a cut-off point for plaits?
Oh, Lord, and then there is the old sex thing. What do we do about that? Is it our God-given right to feel horny until we die? Or is it time to finally admit that there are those of us out there who have barely done it with our other halves for literally years? And that we are fine?
* Scientific name: Pemphigus spyrothecae. Small soft-bodied insects that produce abnormal growths similar to benign tumours or warts on the plants on which they live and feed.
† The goalposts for menopause have not changed. If you were born in the 17th century and survived childbirth, you could expect to stop ovulating in your late forties, too.
1
HOW IT WAS FOR ME
I say all the symptoms hit me like a ton of bricks. In retrospect – goodness, is hindsight important when understanding the menopause – I started having symptoms five, six, maybe even seven years earlier. The night sweats, for example. Now, if you are, like me, the sweaty type (my children are hugely sweaty, while my other half barely sweats at all), it’s not something to panic about, waking up with prune-y finger pads and a sopping nightie. So I didn’t pay much attention. Neither to having to pee up to six times a night. Because that’s a psychological thing, right? You think about it and you have to go – it’s the Investment Wee syndrome to the power of, well, six.
Plus my body had begun to feel different. Not bigger, exactly, more like I had added some extra duvet ‘togs’ to it. For the first time ever, I noticed, I had back fat, with pouches of flesh sprouting around the sides of my bra strap. Meanwhile, when I looked down at myself in the shower all trace of hip bone had disappeared.
But then, perhaps, in my old age, I just was eating more food and drinking more alcohol. And, back in the olden days, where the latter had always been helpful in cancelling out the former, now it did to me what it did to everybody else: it made me pig-out.
Regular blood tests, which I’d been having ever since getting clear of breast cancer in 2008, confirmed the inevitable. My levels of oestrogen, progesterone and follicle-stimulating hormone (FSH), the troika of female hormones that regulate our reproductive cycles, had been steadily descending. On the other hand, it’s remarkable how dim one can play to oneself if one desires. It was obviously just my body pushing the ‘fuck it’ button after years of being such a career dieter/drunkorexic. Maybe my gut had started to revolt against all the red wine that had been sluiced into it before it got any solids. Maybe my zaftig genes had finally decided to show my brain who was boss. That’s all it was.
And anyway, didn’t two litres of water a day and a mild obsession with hot yoga mean something? Might I belong to a new generation of women who were too fit to get the menopause? The ideation that I was a rare medical anomaly had particular traction, I found, at this point of my life.
Besides, I was still getting my period. Way beyond other people my age. Oh, boy, was I still getting it. Getting technical here, after I hit 50, they became not only regular and closer together but almost Roman candle-like in their heaviness, a gynaecological indicator, as it turns out, that everything is gearing up for that one last chance to sprog before it is too late. Sometimes my other half would catch me stripping the bed yet again and roll his eyes. Which made me feel guilty on the one hand and cross on the other. It reminded me of a famous article Gloria Steinem wrote in the October 1978 issue of Ms magazine called ‘If men could menstruate’. In it she imagined how it would become an important ritual for the beginning of manhood accompanied by lavish celebratory dinners and presents; that there would be a National Insitute of Dysmenorrhoea; medical funds for heart disease would be diverted into research into cramps; and lesbians would be told all they needed was ‘a good menstruating man’. Brilliant. If only you guys knew what it was like.
And then, whooomph, they stopped. Just like that. The summer before last was the last summer I got my period. From that day on, I never got another (not a natural one, anyway). No more sitting down for a wee, looking at the gusset of my knickers and being able to go: aha, that’s why I’ve been such a cow for the past few days. My ‘woman’, as some phenomenally successful Hollywood stylist I once interviewed insisted on calling it, had gone for ever. And, though I should have been grateful that I had made it this far, relieved I didn’t have to play the old wad-of-toilet-paper-in-an-emergency trick any more, all I could do was mourn its passing. Its absence every subsequent month and the cartons of unopened Tampax sitting there balefully on my bathroom shelf gathering dust were such concrete irrefutable proof I had passed into the ‘final stage’.
It got worse. Because then came all those symptoms I ludicrously assumed I’d be spared. Hot flushes. Palpitations. Hardcore insomnia, alleviated not one tiny bit by zopliclone. The c
omplete absence of desire, as if it had been snatched, like a rug from beneath my feet. You’d think, in mitigation, the hurty bosoms and the crankiness would go after you stopped menstruating. But in my case they hung around like students who never graduate or unwanted stragglers at the end of a party. Compound that with the fact that my eldest son had suddenly gone from being 5ft nothing to over 6ft and had developed this habit of picking me up every time he wanted me to stop talking… And oh, Christ, was I beginning to fully intuit the meaning of ‘old’ and ‘helpless’.
The biggest ‘surprise’? Probably hot flushes, though thankfully they mostly happened in bed, just after turning out my light. There was, however, one notable exception. A birthday party in a very swanky members’ club in Mayfair, London. Italian waiters in white coats shaving truffles onto the risotto; young women in head-to-toe Chanel, that kind of thing. And suddenly, this heat, out of nowhere, rising, rising from my solar plexus to the roots of my hair, my face pulsating like a sore thumb in a Tom & Jerry cartoon. In a funny perverse sort of way, it was fascinating that my body was able to do this, without me being able to intervene in any way. But the mortification of having to keep dabbing at my upper lip and eventually having to get up, dripping, in my sleeveless summery dress and go outside, cancelled the wonder of it big time.
Remember David Reuben, MD? The forward-thinking guy who wrote the 1972 No. 1 bestseller Everything You Always Wanted to Know About Sex…But Were Afraid to Ask? Well, this was his description of a menopausal woman: ‘Not really a man, but no longer a functional woman.’ But he was wrong, just like he was wrong about douching with Coca Cola being an effective contraceptive. A hot flush doesn’t make you feel more like a man, or at least it didn’t right then. It merely made me feel the way I had done as a new girl at school, forever in fear of getting called up in class in case I blushed: powerless and increasingly fearful of group situations…
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