What I’m about to say will irritate a number of readers. Specifically, it may not go down well with women of a certain age. But here goes. The menopause might be all in the mind.
Now, of course, there’s no doubt that there is a biological phenomenon whereby a woman’s reproductive cycle stops. But the associated symptoms that make up what we call ‘the menopause’ are not as clear-cut as you might imagine.
Before I’m inundated with angry letters from those of you plagued by hot flushes, let me reassure you: I’m in no doubt that your symptoms are real. It’s just that there’s no clear biological basis for them, making many doctors, scientists and anthropologists question whether there is something else going on.
The associated symptoms that make up what we call ‘the menopause’ are not as clear-cut as you might imagine. What causes such problems — and other associated physical complaints such as hot flushes, sleep disturbance and mood changes — is not understood (stock photo)
There’s no doubt that menopausal symptoms can be crippling. This week, Yasmin Le Bon made the news after speaking out about how the menopause affected her memory and weight, and how upsetting this was.
‘You ache all over, you’re tired and fractious and you develop a layer of padding all over,’ the supermodel told a magazine.
These are very common complaints. When I worked in a memory clinic, we’d often see menopausal women referred to us because they were convinced they had dementia, when in fact memory problems are common in this group and can be linked to ‘the change’.
Yet what causes such problems — and other associated physical complaints such as hot flushes, sleep disturbance and mood changes — is not understood. While there’s no clear biological mechanism that neatly explains them, one interesting theory is that the menopause is a result of the West’s obsession with youth.
Hear me out on this. There is a group of illnesses that in the UK few outside of medicine know about. Even within medicine, they are confined to a few footnotes in medical textbooks. And yet around the world, millions of people suffer from them.
The thing that sets them apart from other illnesses is that they only occur in specific cultures or societies and are known as ‘culture-bound syndromes’.
They are often regarded as types of mental illness and yet they are not like any mental illnesses we’d recognise. The bizarre symptoms can seem unbelievable to us, but to those affected, they’re very real. Dozens have been reported, but one example is Koro.
This occurs in Asia and is a condition in which men suddenly believe that their genitals are shrinking inside their body and they are going to die. It can occur in epidemics, with whole villages and towns succumbing, overwhelming A&E departments.
What is interesting is that while for years Western doctors viewed these conditions as exotic anomalies, we have our own versions. Hysteria, agoraphobia, Gulf War syndrome, ADHD, multiple personality disorder and the response to traumatic stress, such as PTSD, have all been considered Western culture-bound syndromes.
In fact, the flashbacks reported in PTSD are actually a relatively new phenomenon and first started being noticed shortly after filmmakers began using flashback sequences to represent past events in films. That’s not to say that these things aren’t real, but it does show the power the culture that surrounds us has on how we experience illness.
Certainly women stop having periods after a certain age, regardless of their culture. But academics have realised that many of the typical physical symptoms — the hot flushes, the mood changes, the night sweats — are not universally experienced (stock photo)
So what does this have to do with ‘the change’? Well, as amazing as it sounds to us, not all cultures have the menopause. At least, not in the way that women in the West experience it.
Certainly women stop having periods after a certain age, regardless of their culture. But academics have realised that many of the typical physical symptoms — the hot flushes, the mood changes, the night sweats — are not universally experienced.
In-depth research by medical anthropologist Margaret Lock has described how in Japan, where the elderly are held in high-esteem, women did not describe the same physical symptoms of the menopause. For Japanese women, entering old age is a positive experience because of the respect they will attract. The negative symptoms Western women experience are unheard of.
Some of the physical changes associated with decreased female sex hormones, such as dry skin, were still experienced, but were not felt to be as troublesome. In sharp contrast to our culture, the women rejoice in the fact that they are ageing.
It’s not a reason to dismiss women’s experiences of the menopause — and it doesn’t mean that what they experience isn’t real. It simply means that the underlying mechanism is far more complicated than being simply a biological process.
For me, this shows the power of the mind and how little we really understand the interaction between it and the body.
My crazy night ion A&E – thanks to a full moon
The supermoon this week made me think of my colleagues working in A&E, as staff there tend to be superstitious about full moons.
Early on in my training in A&E, I was put on the front line dealing with all the acutely mentally unwell patients who walked through the door.
‘Ready for tonight, then?’ smirked a nurse as I arrived one night.
‘What do you mean?’ I asked.
‘It’s a full moon tonight,’ she whispered conspiratorially.
This irrational fear of a full moon is thanks to the ancient Greeks, who thought that madness was caused by too much moisture in the brain. Just as the moon affects the tides, they believed it was linked with mental illness, too.
The Romans shared this theory. In fact, it was commonly accepted by the medical profession until very recently that the phases of the moon exacerbated madness.
By 3am that particular night, I’d seen eight patients and admitted four — and there were many more waiting. Just as dawn began to break, I came to my last patient. ‘Hello, Mrs Armstrong, sorry about the wait,’ I said. ‘It’s because of the full moon,’ I added.
‘Oh, don’t tell me you believe that?’ she scolded.
Walking home, I reminded myself that I was a man of science. Some nights are busy and others less so: I’d just had a bad shift, that’s all.
Even so, I was mindful not to let any black cats cross my path. Just in case.
Be wary of booze if you’re retired and bored
When we think of people who have a problem with alcohol, what tends to come to mind is the binge-drinking teenager or the dishevelled figure on a park bench.
In reality, it’s middle-class, retired people who are most likely to be problem drinkers.
Alarming figures this week show the full extent of the problem. For people in their 50s and 60s, alcohol is now the sixth most common cause of disability in later life, with alcohol-related dementia a particular concern.
Dr Tony Rao, a consultant old age psychiatrist at King’s College London, who highlighted the figures in the British Journal Of Psychiatry, blamed a culture of drinking wine at home.
For people in their 50s and 60s, alcohol is now the sixth most common cause of disability in later life, with alcohol-related dementia a particular concern
Of course, people can develop a problem with drink at any time, but retirement does seem to be a particularly critical point.
The fact is that, for some, retirement isn’t quite what they were planning. The sudden change of pace and the loss of structure and routine leaves people feeling directionless and afraid. The ready-made group of friends and daily contact is suddenly gone.
For many, it also represents a loss of identity. They feel they’ve lost their place in society and everything they deemed important is gone. For years, hobbies have been put on the back burner, so they aren’t even sure what they enjoy any more.
And retirement coincides with other big changes in people’s lives, such as children leaving home and physical health starting to falter and fail.
All of this can mean people reach for the bottle in an attempt to fill the void.
It usually starts slowly. Perhaps the odd glass as a treat with lunch. Then a few glasses turns into a bottle. Or perhaps that mid-morning G&T becomes more gin than tonic. And then you pour yourself another one.
Wealthy, retired and bored is a lethal combination when it comes to alcohol. Research has shown that the higher someone’s income, the more at risk they are of developing a problem with drink.
So before you next reach for your favourite tipple, remember: problems with alcohol can creep up on anyone.