But had my body built up a tolerance? Or had rules simply got laxer, the 8pm threshold turning to 7pm and so on? The fact was that, by the time I hit my fifth decade, the hangovers were actually getting worse. They definitely exacerbated the hot flushes – it was almost psychosomatic; I could feel my body temperature rising with that first sip, especially with red wine – and my REM sleep, frankly, was fragmented as hell.
In retrospect, I think what I was doing was ploughing through. Alcohol was my link, sort of, to the hurly-burly of my thirties and forties, a reminder that I could still be, as it were, fun and gay; it gave a sense of occasion to an otherwise humdrum day. And being a feast or famine sort of person, the idea of cutting down to one small glass a day seemed almost more depressing than actually giving up. So I continued apace, desperately trying to recreate the effect drink used to have on me when I drank moderately, feeling more and more bloated and oyster-eyed and menopausal than ever.
This almost allergic reaction is not simply psychosomatic. From as young as 30 our bodies start changing composition. Generally what happens, whether we are male or female, is that we lose muscle mass and our fat content increases. Our body water levels drop, too, which not only makes for drier skin and wrinkles, but also means a lot of us, by the time we hit 50, are walking around dehydrated. When we drink alcohol, we become as sere as deserts inside. As we age, our livers get bigger but less efficient and the enzymes in our stomachs that help metabolise alcohol dwindle too, meaning alcohol hangs around in the body for longer, allowing more pure ethanol to go directly to our organs including the brain. (Alcohol has also been proved to exacerbate the natural cognitive decline we experience in our fifties and sixties when our neurons lose speed.)
Another thing to remember: alcohol is not stored in fat. When there is more fat in the body and less muscle mass, the alcohol is forced into the bloodstream, wreaking more damage. This is the reason why, generally speaking, women who have a higher fat to muscle ratio tend to handle alcohol less well than men.
For most menopausal women, then, alcohol seems to be a lose-lose situation, ironic when this is precisely the time when drink, in the face of all those other things we lose, can be such a comfort.
Red wine, with all its sulphites and tannins, can be particularly bothersome, which is why you see a lot of women my age hitting the tequila, the supposedly ‘organic’ spirit which doesn’t give you a hangover.
My own mitigation involved drinking a lot more water (two litres a day minimum, because you can do crack cocaine as long as you hydrate adequately, as a New York fashion editor once told me in the 80s) and experimenting a bit on the wine front. For a while I decided to drink only biodynamic. A brand called Skinny Champagne – I was hooked on that for a time, too, until the ludicrous expense of it hit home. There was a phase of drinking anything I wanted as long as it was 11.5 per cent or under (and what a joyless, pointless phase that was). Then there was my long love affair with rosé. Preferably pale French rosé the colour of straw, chilled within an inch of its life, and enjoyed all year round, partly because it seemed more festive and sporty and outdoorsy than white and less heavy than red, but mostly because it slipped down so easily. (Rosé, it turns out, has a higher sugar content than either white or red and is the reason why so many of us come home from a lovely Mediterranean holiday feeling shit. Whispering Angel. Hah. Whispering Satan, more like, the amount I could put back.)
While all this strenuous mitigating was going on, I’d be on the constant look-out for studies linking moderate alcohol consumption to a reduced risk of cardiovascular problems, better bone density, etc. There’s always one around somewhere if you look hard enough, just like there’s always a report of sunshine somewhere, if you look hard enough, like on page 10 of Google, when every other weather channel is showing thunder and lightning.
Well? If oestrogen is supposed to have beneficial effects on your heart and bones, and if alcohol consumption is supposed to increase the oestrogen in your blood, then this moderate drinking would make wonderful sense.
Except the word ‘moderate’, the one that means one measly glass a day… In my case, there was no getting round that. Nor the evidence of alcohol’s increasing, almost incontrovertible link with breast cancer. There was one study published by the Journal of Women’s Health in 2012, suggesting that, in fact, red wine might help actually reduce breast cancer. Everyone jumped on that one, but it turned out to be teeny tiny – involving only 36 pre-menopausal women and lasting only a month.
Another study carried out by Brigham and Women’s Hospital in Boston, Massachusetts, in which the drinking habits of around 105,986 women were analysed between 1980 and 2008 came to the conclusion that around three to six glasses of wine a week raised a woman’s risk of breast cancer by 15 per cent. (However, as critics pointed out when the study was published in 2011 in the Journal of the American Medical Association, if an average 50-year-old woman had a five-year breast cancer risk of around 3 per cent, a 15 per cent increase would raise that risk only to 3.45 per cent).
In a report published alongside the Brigham study, Dr Steven Narod of the Women’s College Research Institute in Toronto concluded that women who consumed one drink a day would see their 10-year risk of breast cancer rise from 2.8 per cent to 3.5 per cent.* For women who had two drinks a day it would rise from 2.8 per cent to 4.1 per cent. That meant women who had, um, four drinks a day (and that is less than half a bottle) could be looking at 8.2 per cent. It made me think anew about the grape-seed-sized tumour I had found in my right breast that summer of 2007. Could it have been caused by my drinking? And now that I was on HRT, could I be putting myself in danger of getting it again? (The smart thing to do, according to Dr Martin Galy, a fashionable hormone doctor I went to see in London, would be to reduce the drink and carry on with the HRT. He told me that, although he recommends only using bio-identical hormones, you are probably safer, both for protection of well-being and against cancer, taking even the most generic, sledge-hammering form of HRT than not taking HRT and continuing to drink in quantities greater than the recommended amount. And if that’s not enough, the most recent NICE guidelines also reflect this advice.).
Although it was somewhat heartening to learn that once you’ve got your breast cancer, alcohol did not help the tumour to grow, it was really really hard to find a study that did not, in some way, link alcohol to getting breast cancer in the first place.
Which didn’t curb my habit. At all. See, the more I drank, the more I could drink. To grossly misquote Aristotle: We are what we repeatedly do. Drinking, then, is not an act, but a habit.
An alcoholic? Moi? Well, something wasn’t right. Something wasn’t right if the idea of going out and not having a drink had become so appalling that I’d end up not going out. And then, er, opening a bottle anyway.
I suddenly realised the kids rarely saw me past 7.30pm without a glass of wine in my hand. I also realised how there would never be a situation, unless I was in bed with a fever, where I drank less than my other half. What had happened to that basic rule of thumb? That a woman in her twenties slurring her words and swaying a bit can be quite sweet? That a woman in her thirties can just about get away with it too? That a woman in her forties needs to watch out and that in her fifties it becomes, frankly, grotesque? How come I saw it in others, but not myself?
And then there came a point, in January 2016, to be precise, when I just stopped. I realised I’d done enough drinking in my life thanks very much, and I didn’t want any more. I didn’t want to be in that permanent low-level state of hungoverness, I didn’t want my partner to feel that he had to constantly monitor me from the other end of the table, I didn’t want to be obsessed with how slowly everybody drank compared to me, I didn’t want to be more interested in the wine list than the menu. What I did want was to wake up feeling the same way I had done the night before, a feeling I hadn’t experienced for what seemed an awfully long time, and the only way to do that was… to give it up.
You may no
t need to, and I envy you. The idea of a summer in Mykonos without rosé, of going to my favourite Italian restaurant without drinking red wine, of getting through a family Christmas without any medication at all is pretty unspeakable. Drinking is good for you in moderation. The experts (on page 10 of Google) say it is. But at the same time, if I’m going to make anything of this third third of my life, I’m probably going to have to do it sober. Wish me luck.
* Study started in 1976 and involved 105,000 women aged between 30 and 55
10
A LITTLE BIT OF NEW SCIENCE
In terms of medical innovation, I’m afraid we’re not that sexy or urgent a demographic. We ought to be – by 2020 there will be 60 million peri- and post-menopausal women living in the US alone – but we are not. Not yet anyway. Companies like Calico, Human Longevity Inc et al are obsessed with making death optional, ploughing billions into cures for cancer, diabetes and heart disease, but when it comes to hot flushes and menopots and dry vaginas, meh, we need to get over ourselves. Or so it feels.
There is part of me that feels that, actually, we probably do need to get over ourselves. Why medicalise something that is so perfectly natural? Why not ride it out, as so many of our mothers did, and be emotionally stronger for it on the other side? Isn’t this just another First World problem? Do the Hadza women of Tanzania complain about hot flushes? And besides, how are we going to change the way the world views older women if, at 55, we expect to look and feel as though we were 40?
On the other hand, if average life expectancy for a woman is 85 and going up all the time, if – assuming the age we become menopausal pretty much stays put – we can expect to live more than a third of our lives in a post-reproductive state, is it intelligent or right that we should live it with crumbling bones and poor memory and a general ‘it’ll do’ approach to the way we look and feel? Biologically, wouldn’t that not add up?
It’s hard not to feel that if men got the menopause like we got the menopause, a cure for hot flushes and irritability without the risk of cancer would have been invented ages ago. Gloria Steinem was so right when she said back in the 60s that if guys could get pregnant ‘abortion would be a sacrament’.
It’s not all bad. Take a treatment, currently in development, that could administer oestrogen to our brains only, therefore bypassing the potentially dangerous side effects on our uteri and breasts and so forth. The chemical, discovered by Professor Laszlo Prokai, the Robert A. Welch Chair in Biochemistry at the University of North Texas Health Science Center, is called DHED (an acronym given from the chemical name of the molecule) and is nearly identical to natural human oestrogen, except that it has an extra oxygen atom. Prokai’s study found that a specialised protein found in rats’ brains recognises the chemical and chops off the oxygen, turning DHED into oestrogen – whereas the body’s other organs lack this protein so they can’t turn DHED into oestrogen. When rodents, bred for use as experimental animals with their ovaries removed to mimic menopause, were administered this ‘prodrug’, there was a measurable increase of oestrogen in the brain but not in the uterus or bloodstream. Furthermore, as Prokai and his colleagues found, unlike oestrogen, DHED did not appear to promote the growth of breast cancer cells in culture or when implanted into mice. The potential upshot? The disappearance of hot flushes and symptoms of depression or cognitive impairment without an increased risk of cancer. DHED has not been tested on humans and thus requires development costing over a billion dollars and lasting several years to gain approval as new medication.
In fact, though it may not seem like it, tremendous leaps and bounds have been made on our behalf in the last 10 to 15 years; it’s just that they weren’t necessarily made in the name of boring old menopause; they were made in the much more exciting and urgent name of reproduction and (in)fertility.
Controversial biomedical gerontologist and Cambridge professor, Aubrey de Grey, for one, has already stated that the menopause could be ‘cured’ by stem cell science and regenerative therapy within 20 years. ‘We could rejuvenate the ovary by stimulating or replenishing stem cells,’ de Grey told the Times in 2014. ‘We could create a whole new ovary through tissue-engineering like an artificial heart. There are all manner of possibilities.’
Sounds a bit Brave New World-y? All medical breakthroughs do at first. And de Grey (who, let’s remember, has also claimed that the first 1000-year-old has already been born) is not the only one predicting a world where we’ll be able to conceive well into our late fifties and beyond. Take Jonathan Tilly, a reproductive biologist from Harvard Medical School who came up with a remarkable discovery in 2004.
In the process of analysing the lifespan of cells, he isolated a population of rare ‘oogonial stem cells’ in rodents’ ovaries, which were capable of producing a constant supply of fresh eggs or oocytes – therefore totally upending the widely held dogma that women are born with a finite number of eggs and that by the time we reach the menopause they have all disappeared. (The time when we have the most, around seven million, is when we are five-month-old foetuses in our mothers’ bellies, from which point, tragically, it all goes downhill.)
That paper of Tilly’s was heavily criticised by the medical science community when it came out, but it was supported by a study performed in China in 2009. Biologists led by Ji Wu at Shanghai Jiao Tong University claimed they had isolated a population of stem cells in adult female mouse ovaries, which they used to produce mature egg cells. These eggs, which had been injected with fluorescent green protein to identify them, successfully fertilised and resulted, yes, in glowing green offspring…
It was music to Tilly’s ears, though it took him a few years to take the research one step further. Thanks to his colleague, Yasushi Takai of Saitama Medical University in Japan, he was able, this time, to prove to the doubting Thomases that those precious ‘oogonial’ stem cells existed in humans as well as rats. How? Because Takai had in his lab, at Tilly’s disposal, ovary tissue donated by six healthy young Japanese women in the process of undergoing gender reassignment surgery. Using Ji Wu’s protocol, Tilly and his team managed to extract those oogonial stem cells from the donated tissue, and after treating them with the green fluorescent protein, implanted them in the sterilised mice. Between 10 and 14 days later, they saw that immature follicles had formed… with glowing green oocytes in the middle of them. As Tilly said at the time, ‘It made the hairs on my arm stand up.’
Tilly now holds a patent on human egg stem cells, and with the help of reproductive biologist Evelyn Telfer from the University of Edinburgh (who has pioneered a procedure to bring those egg cells to full maturity, which is exactly where Tilly’s work has come to a halt), he hopes to radically change the current approach to fertility treatment as well as to incurable diseases such as Parkinson’s.
He has also potentially rewritten the rules about how we women age. If Tilly’s trajectory continues in the way he hopes, our ovaries could eventually keep working until the end of our lives.
Ethical and legal implications aside, imagine what that would be like: to be able to delay or even reverse the menopause; to bypass hot flushes and night sweats and osteoporosis; to remain as healthy and glossy-haired and pliable-boned as we were in our twenties and thirties… and that’s without the sword of cancer hanging over our heads.
Imagine, for God’s sake, being able to sprog again? Because that’s the logical trajectory, isn’t it? Forget about the Sandwich Years, as they are called. This will be the age of the Triple Decker, what with the parents who won’t die, the school leavers who won’t leave and a new baby or two.
‘Of course, we are more likely to think that what is the norm is natural, because that is what has always happened, but if we are looking at a future where women are going to be living to 100, where for half our lives our ovaries don’t work, then people are going to want a new normal. So there are going to have to be social changes, but technology will also have an increasingly important place.’
So speaks geneticist and mol
ecular biologist Aarathi Prasad, 40, the glamorous author of Like A Virgin: How Science Is Redefining the Rules of Sex, and presenter of the recent Radio 4 feature, ‘Rewinding the Menopause’. In the programme, which aired in 2015, she looked into how all this new research into fertility can help stave off the menopause and how society is going to deal with that.
Should we be greedily availing ourselves of all this new technology, aimed, let’s face it, at young women in premature menopause, desperate to conceive? Or should we be going gently into this particular good night and gracefully accepting our lot? Just like our mothers did. And their mothers did. And their mothers before them. And look at them. They just about managed, didn’t they?
Interestingly, a lot of the menopausal women Prasad approached for the interview either refused to participate, or insisted on remaining anonymous. God forbid it should seem like we’re complaining, sort of thing. Older women complaining. So boring, after all. Although sometimes I wonder if we are our own worst enemies, the way we can gang up on each other for not being tougher, the way we can pull a ‘Gaslight’ on ourselves, colluding with the old patriarchal mindset that most women are mad anyway…
Prasad raised a few hackles at the Hay Festival in 2015 when she quoted scientists who say that the menopause has become ‘abnormal’ – that in the modern world, where resources are plentiful and we are living longer, healthier lives (and older women don’t need to stop breeding in order to forage for food), it is redundant to our needs and it may be that evolution does away with it.
‘Some scientists say that humans have already evolved as far as we are going to,’ she says over coffee near her office at University College London, ‘because, rather than us adapting to our environment, what we have become good at is adapting our environments to us. Evolution may or may not be a trajectory which has finished, but to live a third of your life when the rest of your body is functioning perfectly but your ovaries are not is referred to by some doctors as living with organ failure, and the consequences of this clock don’t fit with the way we live in the modern world.
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