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WHAT IS ACTUALLY HAPPENING TO YOU
Ignorance is bliss but knowledge is power. If you know what is happening to you, or what is going to happen to you (and being crap at biology I never really did), it might make the process less of an affront. So here goes.
Menopause – from the Greek men (month) and pausis (cessation) – was a term coined by French physician Charles Pierre Louis De Gardanne in 1821 (la menespausie) to mean the definitive cessation of menstruation. It is caused by a decrease in oestrogen, the female sex hormone that makes our ovaries produce eggs, although it is worth noting here that our adrenal glands, our muscles and our adipose tissue, i.e. fat, continue producing oestrogen throughout our lives. (This may be the reason why women who are overweight or super muscly often suffer less from hot flushes and osteoporosis.)
How long does the menopause last? Well, if you go by the book, just one day. Technically speaking, it occurs exactly 12 months after your last period, and can therefore only be charted retroactively, which makes it an irritating Chinese riddle from the start. In reality, the symptoms, such as hot flushes and anxiety, can last up to 30 years. (An interesting aside: in the West our most common menopausal symptom is hot flushes. In Japan it is shoulder pain. In India it is declining vision.)
Most of us start experiencing these symptoms between the ages of 45 and 55 (though Aristotle wrote of it starting at 40), with 51.4 years being the mean age of occurrence. Peri-menopause refers to the time when those symptoms start to the 12 months after your last period; post-menopause to anytime after that, but this is misleading as some women experience symptoms as many as 10 years, if not more, after they stop bleeding for good. Of course, since life expectancy was lower in previous centuries, many women didn’t even make it to menopause, but it would be quite wrong to think of it as the ‘luxurious’ by-product of modern medicine and improved living conditions. If you survived the rigours of childbirth in the 18th century, or indeed if you remained childless, chances were you’d make it to menopause and beyond. In fact, as a condition, the Victorians were all over it like a rash, often chucking women in asylums who exhibited symptoms.
As well as causing our ovaries to produce an egg each month, oestrogen protects against a whole myriad of ailments, including heart disease, osteoporosis, memory loss and even Alzheimer’s. (When we have too much of it, conversely, or rather when it is not balanced with the correct amount of progesterone, the hormone that helps line the uterus and maintain pregnancy, we may be more susceptible to breast cancer, but more, much more on this later.)
Oestrogen is also responsible for regulating the hypothalamus, a corn-kernel-like section of the brain that controls, among other things, thirst, hunger, sleep, desire and body temperature. When oestrogen levels fall, a false message is sent to the hypothalamus, indicating that the body has overheated, and in response the hypothalamus tries to cool it down by rushing blood to the surface and inducing us to perspire. Hence the hot flushes and night sweats. (Sweat itself, which is secreted by the apocrine and eccrine glands, is odourless. Only when it is acted upon by bacteria and other volatile acids does it becomes whiffy and it is the substance that the apocrine glands produce that bacteria love to convert into something particularly noisome. Interestingly, East Asians have fewer apocrine glands than we do – the reason, perhaps, that they mostly think we Westerners stink.)
Another benefit of oestrogen is that it produces collagen which not only keeps our skin relatively wrinkle-free but stops us peeing our pants. It does this by bolstering the walls of our vaginas and urethral tracts (Yup. Doing star jumps on the trampoline just got even worse). It also keeps them slightly acidic to ward off bacterial infection. As oestrogen levels fall, the vaginal walls become thin, dry and more alkaline, not just making sex hurt and peeing a full-time career, but making us more prone to urinary tract infections… and, ipso facto, not being quite as, um, fresh as we used to be down there. Well? Correct me if I am wrong, but wouldn’t an unhappy vagina and increased propensity to sweat automatically have an impact on the way you smell?
Okay. Can we just stop here a second? Because I have to declare an interest. One of the characteristics of ageing is that we are supposed to lose our olfactory acuity, males more so than us, which is why once our menfolk hit a certain age we need to tell them to cool it on the cologne front. But has that happened to you yet? It certainly hasn’t happened to me. You could almost call it a pathology, the ability I have to smell smells seemingly unsmellable to the average human nose. Not out-and-out phantosmia (the medical condition which can keep sufferers housebound) but if I were a dog I’d almost certainly have a little coat on my back and be employed in an airport.
As a demographic we are still deemed too dull for any significant studies to have been conducted around this delicate subject. And scent, let’s face it, is a tricky one to be objective about. But if fertility has a smell – and there is good evidence to suggest that it does, men being more attracted to us when we are ovulating and so forth – would not the sudden lack of it act as a repellent?
Might that dreaded cloak of invisibility everyone talks about have an actual odour, and might my sniffer-dog-like abilities have enabled me to detect it? I remember thinking they probably had when I used to visit someone in Wandsworth Prison back in the 90s while working on a story. It wasn’t that the guy (convicted of rape, public school educated, in his early twenties, but that’s another story) smelt of sweat, not at all, he was actually scrupulously clean; it was more as if he smelt inanimate, like an uncared-for piece of furniture, almost, rather than a human being.
The author Helen Simpson writes about this beautifully in her story about the menopause, ‘Arizona’:* ‘Nothing awful,’ one of the characters muses after attending a concert where the audience was mostly older women, ‘just the subdued but unmistakeable smell of underwashed jumpers and hair that had been left to go an extra day. They weren’t expecting anything.’
According to Tim Jacob, Professor Emeritus of Cell Physiology at the School of Bioscience at Cardiff University, the power of smell, or the lack of it, is a ‘huge unexplored, unexploited area’.
‘The psychophysiological links between age and smell are as yet largely untapped,’ he says via email, ‘but it is a specialist area which is just waiting to be looked into and jumped on by commerce and industry.’
To that end he has created Kodobio Sensory Therapy, a newly launched, state-of-the-art treatment that uses smell and light to help improve mood, reduce blood pressure and lower anxiety. ‘It is designed to use natural sensory stimuli to alter your psychophysiological state, resulting in a healthy, happier you, better able to cope with the pressures of life.’
Bring it on, and, while he is at it, since he works with Procter & Gamble, could he spare a thought for us lot, and come up with a scent that makes us smell the way we did in our twenties and thirties? How to nail Eau de Youth exactly? What is it that we had then and that we apparently do not have now?
‘The smell of sex, that’s what,’ says Jacob. ‘Young secretory tissue, including the skin and the vagina, has a pH (acidic) and this supports a particular bacterial population. As pH changes during menopause (less acidic) this bacterial population changes and it is these little microbes that cause the odour of both the nether regions and the rest of the body.
‘Much research in the 70s was dedicated to identify “copulins” – specific molecules present in vaginal secretions that triggered mating behaviour in male primates,’ he goes on. ‘This search was naturally extended to humans in the mistaken assumption that, as we are related to apes and chimps, we must exhibit the same biochemistry and behaviour. This turned out not to be the case. Then Karl Grammer [Professor of Anthropology at the University of Vienna, and a pioneer in human attraction and courtship research] carried out trials looking at the effects of these “copulins” on male behaviour. His lab found that of two groups of men looking at pictures of women, those smelling ovulatory vaginal secretions rated the wo
men more attractive than those who were given a control aroma to sniff. One up to women, then. There was a sexual molecule in vaginal secretions.
‘Perfumers have spent much time over the centuries adding compounds to perfume which resemble sex hormones or have odours similar to sex secretions or are from animal glands that have an influential role in sexual behaviour – why is this? There has been no consensus among them about what they are doing or whether they have succeeded and therein lies the hope and the clue – it is a mystery, well, for now at least.’
In answer to my question then, no, they have not come up with the scent of youth, nor have they come up with the scent of motherhood, which is maybe more to the point.
I know I worshipped that heady maternal mixture of Calèche and cigarettes my own mum emanated – and continued to do so, a little pathetically, right up until my late teens when I left home for the States.
And then I returned to London 12 or so years later, around the time I hit my thirties and my mother hit her fifties (young mum, my mum), and suddenly, she didn’t smell like her any more. Same perfume. Different smell. Kind of sickly, like it wasn’t sitting right – it wasn’t bien on her peau. It really was the end of an era, that. Scroll forward another two decades and I suddenly found myself smelling that peculiar sickly smell again. On me. Different perfume. Same smell. It was one of the ways I knew I had entered peri-menopause, and the funny thing is I smelt it on another friend recently who has been taking tamoxifen for oestrogen-positive breast cancer. Tamoxifen blocks your oestrogen receptors by acting like a key broken off in a lock, prohibiting oestrogen from connecting to its receptor and therefore, hopefully, blocking cancer growth. Could there be a link? (I should say that, now that I am on the hormones, a cocktail of oestrogen, progesterone and testosterone, more, much more of which later, my favourite scent in the world – Tiempe Passate by Antonia’s Flowers with a dot of Rive Gauche, possibly supplemented by Noble Isle’s Rhubarb Rhubarb handwash – smells the same as it did before.)
‘When oestrogen levels drop in menopause, a false message is sent to the hypothalamus saying that the body is overheated,’ offers Professor Jacob. ‘In response, the hypothalamus causes an increase in sweat production in an attempt to cool the body and this changes body odour. Tamoxifen, by blocking oestrogen receptors and thereby preventing it from working, induces some of the symptoms of menopause, including hot flushes, and if you look at internet chat-sites, people on tamoxifen report changes in their body odour from no odour, to changed and unpleasant odour.’
Phew. So I’m not such a nutter. Those smells may not be so phantom. If your wee starts smelling like chicken soup, or your prohibitively expensive perfume suddenly smells like eau de cheesy feet, or worse, your otherwise anosmic partner tells you you don’t smell like you any more, it may not be your (or his) imagination. Oh, and another thing. Decreasing oestrogen has also been linked to a rise in histamine, which, according to at least one blog I read, smells a little like nuts. Histamine intolerance is not a recognised medical condition, apparently, but if you’ve been wondering what the stuffy nose, the itchy eyes and the peanut butter wee is all about… who can say that that is not what it is? Tests, schmests… sometimes actual testimonies count for more, as some doctor somewhere might have, should have, said.
* Published in her new collection Cockfosters (Vintage, 2015), recommended to me by a menopausal friend, and which I urge all of you out there to read…
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THE EXTRA TOG FACTOR
It was the summer of 2012, two years before I hit menopause proper, when it first became apparent. Friends had invited us to a significant birthday party on a boat in Capri—with a 70s theme. Christ, I hate fancy dress, but for once I felt okay about it because I had something appropriate to wear, a floaty halter-neck maxi which had always looked sort of ridiculous in London but would have been just perfect for this. It was while having a last look at myself from behind in the hotel’s wardrobe mirrors that I noticed it. Overnight, apparently, I’d grown back fat. Back fat, which draped in folds like a chubby baby’s from underneath the sides of my bikini top strap (and this is someone who, for all her bodily defects, has never had spare flesh there, even in her chunky teens and twenties).
That was a turning point, that weekend in Italy. From that moment on, it felt, everything subtly but surely started changing. My pants felt somehow ‘friendlier’ (as we used to call it at school when they crawled up your behind). So, weirdly, did all my shoes. Though I was basically the same size, my upper body felt – what’s the word, moosier? And I found myself having to unhook my bras a notch, tucking fewer things in, wearing baggier tops. Without realising it, I was beginning to dress like my mother. My waist, meanwhile, which had never been a strong point anyway, I could literally feel going by the day. Going through some old photos, I found some of me in a bathing suit five or so years before I had babies. Nora Ephron was right: with the hip-to-waist ratio I had then, I should have been walking around in a bikini the whole damn time. What had been the matter with me? I looked fucking great, and now, well now… it was like wearing an extra duvet tog, or as one friend described it, like those padded cooler jackets you put on a bottle of wine. It wasn’t just about being bigger, though. It was about not having any say over it. My body, after years of toeing the line when I told it to, obediently shrinking when I put myself on the Paleo Diet or 5:2 or whatever, suddenly had a mind of its own, almost like when I was pregnant. This powerlessness against the forces of nature made me angry as well as sad. Why was this happening to me? It just didn’t seem fair.
So there I was, feeling moosier and moosier by the day, and oh, did it piss me off. I pity my family at all times anyway, but I really, really pitied them in those two years leading up to my menopause proper. In retrospect it felt like being in permanent PMS, with no let-up from the water retention and rattiness and monstrously hurty boobs, not to mention this infernal thickening waist.
Hormonally, of course, it was all happening inside. If the first part of peri-menopause is when testosterone dominates, then the second part is when oestrogen is the relative top dog, both testestosterone and progesterone levels now fast dwindling away. Oestrogen is the good guy, I know, but when it is unopposed it can do some bad things. Inhibiting the production of hormones from your thyroid gland, for example, which slows down your metabolism; making you feel like you are walking in treacle, like you have lost your memory and, yes, causing you to gain weight. Oestrogen is produced in your ovaries and your adrenal glands but also in your fat cells and because of this a vicious cycle is set up. More fat cells, more fat storage, more fat cells and so on. But if you thought a decline in oestrogen – which, joy of joys, happens next – balances everything out, you’d be wrong. Oestrogen, for all the havoc it plays, has a soothing serotonin effect on our mood – it’s what helps us feel calm and full after we’ve eaten. So when it goes, we don’t even have that anymore, and are therefore hungrier than ever before. Wait. There’s more. There’s evidence to suggest that a decline in oestrogen decreases our tolerance for carbohydrates and affects the way our digestive systems work.
According to Gale Malesky and Mary Kittel, authors of The Hormone Connection, where it used to take only two hours to digest our food, now it takes more like four, which ensures higher carbohydrate absorption and therefore more insulin production (the hormone that is so nice and helpful in allowing us to store more fat). Cutting out carbs is the obvious solution – isn’t it great the way, once you cut out the bread, potatoes and rice the pounds just melt away? – except that a very high-protein low-carbohydrate diet eats into the calcium our bones produce… and we need all the calcium we can get at this time of life to protect from osteoporosis.
Also to be taken into consideration is the extra cortisol your menopausal body is producing via your adrenal glands – that’s the stress hormone which, in excess, sets off binging and cravings and contributes to the fat around your middle, and essentially means you haven’t got a hope in hell
of maintaining your weight, let alone losing it.
So then. Hot flushes, night sweats, an increased appetite and a thickening waist. What fresh hell, to paraphrase Dorothy Parker, will be visiting next?
At this juncture I’m supposed to say don’t worry, it does drop off once your body gets used to its new hormonal state. But that is not what happened to me. Certainly the HRT worked wonders on the hot flushes and the sleeplessness and the feelings of doom. But it didn’t give me back the body I had lost. And why would it? The fact of the matter was that I had, in the past year or so, slightly pressed that fuck it button around food. After years and years of treating the bread basket as if it had an electric fence around it, it just didn’t seem worth it any more. Meanwhile, that cunning trick of drinking alcohol instead of eating food? Now I was doing what most people did, i.e. both. Was it because I had resigned myself to being a middle-aged mother, knowing I categorically, emphatically would never be on the pull again, and that I was never going to be my former self again so I might as well indulge? Not consciously. It’s only in retrospect, I realise, that in that last year of peri-menopause (when more than likely my testosterone levels had diminished to zilch) the fridge-pilfering after supper had become the norm rather than the exception; and that I had been averaging the good part of a bottle of wine every single night (we will come back to that one in chapter 9).
What felt extra demoralising was how all the exercising I was doing to mitigate, all the Tube escalators and hot yoga I was doing… wasn’t having any effect at all. But then, as studies continue to prove, you can do all the hot yoga and treadmilling and soul-cycling you like, but it’s not in itself going to make you lose weight. In fact, it may even increase it (the thought being that if you increase your activity, you increase your appetite and compensate by eating more food). Fit and fat. We all know that one.
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