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Why children are the forgotten victims of menopause
Dr Lucy Steed offers a personal and professional perspective on how menopause impacts children
As a parent we want to be exciting, inspiring, a role model for our future generation.
But when you throw symptoms of the perimenopause and menopause into the mix, things can get complicated.
It’s a scenario I see on a regular basis as a GP and menopause specialist at Newson Health: women are now having children later in life, and as a result, many are raising very young children when they reach their perimenopause and menopause.
The most common menopausal symptoms in women in my care are low mood, anxiety, irritability, sleep deprivation – symptoms that have an impact not only on work and relationships, but also on children.
Women will often tell me they feel guilty for snapping at their children when irritable or in pain. Others say they are often too exhausted to play or help with homework, or that their low mood means they don’t feel the same sense of enjoyment in family life.
It’s my belief that children are very much the forgotten victims of the perimenopause and menopause.
My childhood experience
I have a personal as well as a professional interest in how health – especially our hormones – can affect family relationships.
I was 11 when my mother began suffering severely with her mental health. She had always suffered with premenstrual syndrome (PMS), but in her early 40s, she experienced her first manic episode.
Mum became paranoid, suspicious, delusional, irritable, distracted, and was ultimately diagnosed with bipolar affective disorder.
It was hugely distressing for my family. Thankfully, Mum eventually responded well to antipsychotic medication and remained well for some years and even came off her medication.
But in her late 40s and early 50s she had several manic episodes, with each episode wiping out the following three to four months of her life.
I have a very clear memory of my dad telling me at the time how doctors had carried out blood tests looking for any underlying causes, and that they had ruled out anything like a thyroid issue or ‘the change’. So that was that then; hormones were ruled out.
My lightbulb moment
It was only after five years of medical school and into my eleventh year of practising as a doctor – and sixth as a fully qualified GP – that I began to learn more about the menopause and HRT. This speaks volumes of the quality of menopause teaching at medical schools and in GP training.
It changed the direction of my career and led me to my current role at Newson Health: I learned the menopause cannot be diagnosed nor ruled out on the basis of a single blood test; it is a clinical diagnosis, based on age and symptoms.
I also learned about the psychological impact of menopause on women, especially those who have previously experienced hormone fluctuations such as PMS and postnatal depression.
My mum is now on HRT; she’s well and we have a really good relationship. We’ll never know for sure whether her bipolar disorder was triggered by her changing hormones, but I have a very strong suspicion that they played a large part. I am quite angry that this opportunity was missed by all involved in her care at the time, but realise that this happened all the time, and still does.
Another personal reason for my interest in this subject is that two years ago, I was suddenly widowed.
As the mother of two young boys, I now face the prospect of navigating my own perimenopause and menopause as a lone parent. This is a huge responsibility, and I can get quite scared when I look at what happened to my Mum.
However, I get great comfort from the fact that, unlike her, I am armed in advance with all the information I could possibly have about the menopause and HRT.
I will enter my perimenopause ready to access support and to start HRT, because I know the protection it will offer me and the difficulties I could well experience if I did not have that as an option.
I often wonder what would have become of me had I not had my Dad to turn to for support when my mum had become ill. I wonder how others cope when they are going through their perimenopause and menopause as a single parent, or whilst raising much younger children. I speak to many women in these situations on a regular basis.
The sense of shame around menopause symptoms
I make a point of asking patients with young children (of which there are many), whether they feel their menopause symptoms are impacting their relationships.
Often women become very emotional when I ask this question: there is a real sense of guilt and shame around the issue, and many women feel they can’t discuss it with a healthcare professional until our conversation.
And this isn’t just an issue I hear about in clinic: I regularly have fellow mums at school and nursery asking me about their hormones because they have not been able to have any meaningful conversations about it with their own GPs.
Scratch the surface and it is everywhere.
So how can we talk to our children about menopause?
The general advice is to reassure your children that there’s a reason why you are not feeling yourself (hormones), and to use simple, straightforward and age-appropriate language when describing the menopause.
Then the advice for women themselves is to take time out to de-stress, eat well, exercise and prioritise sleep.
All very sensible strategies, of course, but what is missing is the single most effective thing that can help women, and by extension their children: HRT, the first line treatment for menopause symptoms.
Not only that, but HRT also helps to protect future health, meaning long term it is likely to be extremely cost effective for the NHS.
And while in recent years there has been a huge amount of work increasing awareness of HRT and menopause, we still have a long way to go.
We know at Newson Health speaking to women from around the UK that there is still a postcode lottery whether you will be get an in-depth conversation with a healthcare professional who is willing to prescribe HRT.
There is no standardisation and what we are left with is a minority of women who can afford to pay privately, informed woman who manage to get started on HRT via their GP surgery (but often care has been suboptimal), and then we have the majority; all the other women, informed or not, who are just not able to access HRT at all.
This really is a tragedy: it puts women most vulnerable to the physical and psychological impact of the menopause and perimenopause at a huge disadvantage. And not just them and all they might have to offer in terms of the workforce and the economy, but their children and their families.
What needs to change?
The NHS is supposed to be looking for the most cost-effective means to deliver healthcare and improve the health of the whole population. It is not supposed to discriminate. But in failing to run a proper standardised primary care menopause service, it is doing just that, and it is as well creating more problems for itself in the future. Running menopause clinics for all women in primary care- delivered by healthcare professionals confident and up to date in menopause care (GPs, nurse practitioners and nurses) would be preventative medicine at its finest. Taking more of this approach is surely one of the main ways the NHS can survive the next five years. There are many GPs ready and willing to deliver this care within the NHS; indeed it is often frustration at not being able to provide this kind of care that is genuinely contributing to many leaving the profession or switching the private sector.
More than that, information on perimenopause and menopause should be offered to teachers and caregivers in nurseries and both primary and secondary schools. Good menopause care should go hand in hand with campaigns for children’s wellbeing.
Catherine, Princess of Wales, recently launched a campaign focusing on the vital importance of early childhood.
The early years fundamentally shape our whole lives, she says, affecting everything from our ability to form relationships and thrive at work. Parents, she says, need the very best information and support – and I believe this support must extend to those who are going through the perimenopause and menopause while raising children.
There is a huge opportunity here to improve and transform the current and future health and wellbeing of women and their children, our future generation.