The Mirror of the Menopause

Production Directed By Harold Pinter Theatre Royal Haymarket, London

At the beginning of the twentieth century the average age of death for women was around 47, a huge improvement from 1841 when the average new-born girl was not expected to see her 43rd birthday. Little was known about the menopause, which was believed to be in tandem with mortality. But it’s 2021 and the world is a different place. Almost! Shockingly today, when many women live into their eighties, the tabooed ‘menopause’ can still raise a shudder and leave some vulnerable women feeling like untouchables.

There’s still a lack of knowledge and understanding about the menopause which is often an issue in relationships with the opposite sex. Unusually, I have more male ‘patients’ (1) than females in my practice. I not only hear about challenges of the menopause from women, but also the confusion and anxiety provoked in their partners. Many of which need reassurance that the reported symptoms of loss of libido, insomnia and mild to moderate depression are temporary consequences of hormonal changes. One individual – otherwise a relatively worldly man –looked bewildered when I suggested the menopause might be responsible for the disconcerting changes in his wife’s emotions. He blushed and asked what the word meant. I sent him home with an affectionate flea in his ear and some homework on Google.

It is equally critical that, through therapy or research, women become more knowledgeable and understand that as much as HRT, expensive bioidentical hormones or a course of antidepressants offer help during hormonal changes, the most important thing is accepting this archway into the unknown with knowledge, curiosity and confidence. A wonderful boost for self-confidence is to try to set up a woman’s menopause group. In my own case we met for so long we had to rename ourselves as the hip replacement group. It was such a relief that we all shared similar fears and small physical embarrassments.

The context, in any therapeutic dialogue, is critical and women’s experiences of menopause will be as varied as the phases of the moon. When it comes to hormonal cycles, whether talking about monthly blues, post-natal depression, or the menopause, the question is always the same: what is the degree of the symptoms: challenging but normal or so incapacitating that a medical intervention beyond therapy is required?

In my own case while I suffered a clinical post-natal depression, I managed to negotiate the menopause without casualty. My main grouch was not knowing when it would end and wishing that I would receive a letter from, ‘On High’ informing me of that date. I remember, after an absence of menstruation for several months, a deposit of three ruby-like drops of blood, which I chose to symbolize as life-going-forwards.

While menopause is a normal physiological stage, it is also a time of vulnerability both physically and emotionally. I recommend ‘patients’ turn themselves into light-houses which scan their bodies for lumps and bumps as menopausal symptoms sometimes mask pathology happening at the same time.

In my own case I was not plagued by visible sweats and flushes, but my body has changed temperature forever. I cannot enter a restaurant without thinking about whether I will end up too hot. The bedroom temperature has turned into a Goldilocks argument about never getting it quite right. Even the temperature fails to resolve problems of insomnia which, topping the list, seems to be a female issue throughout life. In terms of rare but serious pathology mistaken for menopause, I am reminded of Thomas Mann’s The Black Swan – an elderly and romantically disillusioned woman believes she’s having an extraordinary erotic experience with her menopausal body, but the tragic truth is she has Ovarian cancer.

Hitherto, my gaze into the menopausal mirror has been physiological, but the invisible self plays as large – if not a larger part – in the ways a woman comes to terms with this milestone. I like the metaphor of an archway clad in the vines of emotional and intellectual fertility through which ‘everywoman’ must pass and even celebrate. Yet, there are inevitable hurdles to be faced.

A woman’s response to menopause will be mediated by whether or not she has children. Where infertility, rather than choice, has played a part the menopausal journey may be different to the one from motherhood. A mother’s emotions may be mediated by what I refer to as the ‘Sleeping Beauty syndrome’. With the birth of a healthy child, it is inevitable that ecstatic parents have an idealized vision of a ‘perfect’ future and forget, at their peril, perfection is an illusion. Given time, every life becomes vulnerable to the disappointments of ideals and ambitions with the arrival of the ‘Bad Fairy’. By the time a woman reaches the menopause she is already facing the empty nest syndrome when another challenging moment of recognition might be dawning. Her dreams of a perfect family are dented by the bruises of life which may include divorce, illness, special needs, addictions and the reckoning that beloved children can grow into adults who disappoint. We may long for infants to grow up to be our best friends, but families – ever since those Greek tragedies – also become the matrix of emotional toxins and recriminations.

Menopause can coincide with this painful time of existential disappointment additional to inevitable fears of becoming less desirable and the disillusion that family has not turned into a fairy tale idealization, but the ‘Bad Fairy’ has had sway.  It’s one thing children exiting the nest and launching into independence but there are also examples when young adults fail to launch creatively into adulthood. Then, the menopausal mother feels guilt and disappointment exacerbated by her hormone related feelings of failure and diminished self-image.

Oh! For a draft of that healing elixir of self-esteem. Even if the mirror no longer declares us as most beautiful of all, we can use the freedom from maternal duties to mother if not smother ourselves with self-love. Love, not narcissism, being the relevant word. Menopause is a transition when we need to feed our passion for living and fall in love. It doesn’t have to be with a human being, but it needs to be a something novel that hitherto we have not had the time to nurture. In my own case I stopped being a ‘reader’ and became a ‘writer’. I literally fell in love with the word.

I have been fascinated to find, on more than one occasion, patients have shared a long-term and secret desire to have a breast reduction and assume a more androgynous shape. Others have chosen to use savings on dental veneers and start to enjoy smiling. It really doesn’t matter what it is as long as it is exclusively personal. The more subversive the better. I made a promise to myself as I approached sixty that I wouldn’t let the fear of rejection deter me from breaking through convention and asking for something, everything, anything ethical, I would stop being afraid of ‘No’!

Menopause challenges us to reflect on our views about ageing and our vanity. Historically it was the time when women disappeared from the drawing room. Today, it may be the moment when a woman decides to let her hair go grey or budget for more highlights. Menopause is the time to cherish the body and seize the day.

(1) I use the word patient reluctantly, but I do not like the word ‘client’. I prefer ‘people’ which becomes confusing on the written page. Besides, with COVID rampaging its Corona-crown-chariot across the universe, now we are all potential patients.

Photo Credit: Sweet Bird of Youth 1994 Tenessee Williams Lauren Bacall copyright John Haynes.