Hard Work – the serious impact of hormones out of whack
Have you heard the story about the middle aged man who went to the doctor? “Doctor, there’s something wrong. I’m constantly tired, I’m not interested in sex, I can’t concentrate and I‘m having problems at work.” The GP says “Well, there doesn’t seem to be anything wrong. You sound anxious or depressed. Try some meditation techniques, do some exercise, eat well and maybe consider reducing your hours at work.” The patient returns a few weeks later, even more fed up. The doctor does the usual “tired all the time” blood tests, and finding that the patient doesn’t have signs of anaemia, diabetes or thyroid issues, prescribes antidepressants. Over the months, the patient’s relationship breaks down. He has to leave his job to take one with less responsibility and lower pay. He becomes socially isolated as he can’t face the crowd and the noise of a football match and he doesn’t have the energy to go mountain biking.
Sorry – trick question. Now replace “man” with “woman” and “he” with “she” and you have a scenario that is being played out every day.
I first encountered a GP’s lack of interest in my hormones when I was 18. As I approached my A levels, I realised that my PMS could ruin my chances of doing well in the exams. My GP asked me if I had water retention and gave me water tablets. When my mum asked what the doctor had said, I cried. She went to my GP herself and got a prescription of the contraceptive pill (without the usual blood pressure check etc).
The worst years of PMS were in my 20s. Symptoms included insomnia, tearfulness, low confidence, dark moods, clumsiness, heartburn, brain fog, lethargy and irritability. There were days when I was unable to do my job due to being clumsy. I stopped going out when I was pre-menstrual as I always ended up in tears. After a while, my boyfriend also stopped going out then, as he would come home to find me in tears after I’d convinced myself he was lying dead or dying in a gutter somewhere. I tried various different contraceptive pills and was repeatedly told that I couldn’t be experiencing PMS when I was on the pill. I saw a gynaecologist who suggested I try Danazol, a testosterone or “having a baby might help”. I asked about remedies such as Evening Primrose Oil or special diets and was told that they had a good diet for vegetarians who were pregnant. When I spoke to my GP about the visit, he told me that Danazol is a progesterone with no side effects, which is completely untrue. Meanwhile my boss was understanding and told me I could make up any work that I missed on bad days when I felt better. My boyfriend wanted me to make up for being antisocial on my bad days on the good days. On the good days I needed to catch up with housework and shopping. I ended up feeling like I was trying to fit 4 weeks of life into about 2 weeks. The contraceptive pill killed my libido, but my boyfriend didn’t want me to risk coming off the pill in case I was even worse.
The PMS never went away but was less severe as I got a bit older. During my 30s and early 40s, I didn’t need to take days off due to PMS but still avoided certain tasks and struggled to do anything but the bare minimum. Between the PMS and period I seemed to spend a third of my life on about 60% power and productivity. I was still trying to live a whole life in a reduced time and I never had a blood test to check hormone levels, nor received any effective treatment.
In my mid 40s I started to experience a lot of anxiety. I’d suffered from stress and depression in the past, but I didn’t feel depressed and I had no particular reason to feel stressed. I was also increasingly tired and felt that it was an effort to do anything. My sleep quality deteriorated, I started clenching my teeth at night and developed tinnitus. My skin, eyes and mouth were dry. I was sure that there was a physical reason for my symptoms. Blood tests came back normal and eventually my GP convinced me that all my symptoms were due to anxiety. I started practising mindfulness and taking yoga and pilates lessons, which did make me feel better. However, my balance and strength were poor and didn’t improve even after many months of practice several times a week. I had taken a promotion at work but found that I didn’t have the mental or physical strength to cope with it. I resigned and returned to my previous role.
The first time that menopause was mentioned as a possible cause of my symptoms was when I saw my GP about a sore mouth, caused by the dry skin rubbing on my teeth. I didn’t want to believe that I was entering the age of menopause and it wasn’t followed up. However, over time, a suspicion that I did have symptoms of menopause grew. Symptoms were similar to my PMS and there was still the cyclical element. However, the anxiety, irritability, lethargy, brain fog, poor memory and tearfulness were present, to an extent, all the time.
I requested HRT, which was a limited success. A friend added me to a Facebook page, The Private Menopause Room, and suddenly there were hundreds of women talking about the same symptoms. I also joined the My Menopause Doctor page (as it was named at the time) and learned about the NICE guidelines and research findings. I read a lot about symptoms and treatments and had a Skype consultation with Diane Danzebrink. Armed with information, I was able to request a change to body identical HRT which has helped me a lot, although I still get PMS type symptoms.
I changed my job 7 months ago to reduce the daily commute and aimed to get a better work-life balance. My manager was aware about menopause symptoms from the start. I was feeling very hormonal on my first day, and so I mentioned it straight away, in case I burst into tears. I also let the whole team know about my symptoms, as I had to explain why I spent some days in tears for no apparent reason. I was also irritable at times, but I tried not to let this affect my work. All seemed to go well for about 5½ months and I got lots of positive feedback. Then, suddenly, my manager started finding fault with everything I did, checking up on me and making unreasonable requests. On two occasions, once in a team meeting and once in a surprise one to one meeting (which felt like an ambush), my manager criticised me in such a way that I became upset and frustrated. This is exactly the type of situation in which I become most distressed and tearful. I feel unable to defend myself and the frustration builds to tears and then to a feeling that is so uncomfortable that I need to escape. Leaving the room in tears in on both of these occasions was deemed “unacceptable behaviour” by my manager. Another example of unacceptable behaviour that was cited by my manager occurred right at the start of my employment and had never been mentioned until the end. A colleague had stated that the Gender Pay Gap is purely due to Maternity Leave, and that this is more than compensated for in current legislation. I disagreed. The same colleague apparently said that he was intimidated by me and that we all have bad days, but that he doesn’t have menopause “as an excuse”. This, among other accusations that still haven’t been fully explained to me, resulted in my suspension from work. The stress of not understanding what was going on and worry about how it might affect my future career prospects caused my heart to race. I was so afraid for my health and of being dismissed on a gross misconduct charge that I resigned. The HR Manager simply said “I don’t blame you”. I feel that I was treated very unfairly and have raised a grievance against my manager. Due to my length of service, and the fact that I resigned, my only legal option is for discrimination. If the company does not react to my grievance in a manner that I feel is fair, I shall try to take the company to an employment tribunal on that basis, as I believe that I lost my job due to my symptoms of menopause.
Another Facebook page gave me information about Vaginal Atrophy and I recently requested local oestrogen treatment for that. I have an appointment at a Menopause Clinic in 3 months and I will be asking how far I can safely reduce my progesterone dose, and whether I can try testosterone gel to increase my energy and strength.
Awareness of menopause issues is increasing and I hope that the wide ranging symptoms won’t come as such a shock to ladies starting this phase of life in the future. However, before we can hope to have any safety from discrimination at work, the medical profession needs to understand the signs of perimenopause and the most suitable treatments.