Why we are still afraid to talk about menopause

When we started looking for women who we could interview for this feature, we thought it will be a walk in the park. I mean, at the snap of a finger, I could count more than 20 women in my contact list who are past the age of 50, and for this particular story, I only needed four of them.

Also, the 2019 census report shows women in Kenya are more than 24 million, and therefore, women who are above 51 (average age for menopause), would be in plenty. 

I was wrong. The first respondent let out nervous laughter when I asked if she was willing to contribute to the story and she continued laughing at two other subsequent questions. She was out. 

My second and third subjects requested to "pass" the subject and by the time, I was calling the 10th, I was partly drained but mostly shocked at the fear, shame, and secrecy around the matter.

Like menstruation, menopause is a natural part of female life, I reasoned. I was perturbed that even though it will happen to all of us, there is still a stigma attached to it, with many women reluctant to reveal they are going through it.

To broaden my search, I asked around, mostly from my peers, and they would say, "Ah, let me call my aunt, or I'll ask my mum in the evening." Phew. "Mum doesn't want to talk about it", "my aunt wants to do it anonymously," my peers reported. 

"It's a very intimate issue," one woman confessed. Another said that she didn't want to be seen as old by her friends and colleagues as that may lead to teasing and demeaning. Then there's one who said that she didn't want to scare her daughter because she was yet to talk to her about the changes that she was experiencing. One wrote to me and said, "Some friends of mine are going through this. You know at this age; the husbands are also dealing with midlife crisis issues. A lady opening up on such a subject might become the last stroke on her marriage as he (husband) might be looking for any small excuses to leave."

A quick search across platforms like Facebook gave me a rough idea as to why some women would rather avoid the talk altogether.

On one occasion, a woman made a post complaining about a dressmaker that didn't do a good job. "He ruined my 50th birthday dress." A few of her friends sympathised but some said that she was simply menopausal. 

We have all heard about the snide remarks. "She is very difficult, she is menopausal," a colleague would remark on why an older woman behaved in a certain manner. What follows is some giggles and some suppressed laughter, before everyone dismisses the older woman. 

Or perhaps, it has to do with our ageist society. In our selfie-laden era, youth is gold, and any sign of greying or wrinkles a source of embarrassment, especially among women. Could it be that women believe that by admitting that they are going through menopause, they will be inviting isolation and ridicule? A confirmation that they are out-of-fashion, frigid, and outdated? 

According to a 2018 survey on menopause, 42 percent of the more than 400 women between the ages of 50 and 59 who participated in the survey say they've never discussed menopause with a health care provider. 

The survey, published by the American Association of Retired People reported that 84 percent of women say their symptoms interfere with their lives and 12 percent say they interfere "a great deal" or are debilitating.

An overlooked phase of life 

Kariuki Wanjohi, a gynaecologist in Nairobi says that women should not fear to talk about menopause as it is a biological phase of life just like menstruation. In the six years of practice as a gynaecologist and a doctor, Kariuki shares that many women have come to him having no idea that they were going through the stage. "There's little knowledge around the subject. Many women will after menopause think that they are falling ill and will seek the services of specialists such as neurologists and physicians. Some come to our clinics complaining about their work environment or children. Others fear that they are pregnant," he says. 

It's time we not only started talking about menopause but changed the conversation. Like most subjects that are taboo or stigmatised, the more we talk about it, the more we normalise it – and the more we learn how to embrace and get the most out of this new phase in our lives.

"A woman is born with a limited number of eggs. As she continues to ovulate, the supply and quality of oocytes, which is an immature egg, continue to decrease. When she has her last period, we say that she has reached the hallmark of menopause. Many women start to experience it in their 50s but we are having few cases where even those in their late 30s are experiencing symptoms that point to premenopausal."

A few brave women share their menopause journey

I had very scanty details

Beatrice Wangui, 62, Retired Curriculum Support Officer (CSO)

"Is this how it starts?" I was about 52 when I started having unpredictable menstruation cycles. For someone who has had a regular flow, this was a definite sign that something was happening inside of my body. However, this is not exactly what made me think that I was getting into menopause. I had become somewhat emotional. One minute I would be very sad and the next one very happy. 

When I was in my 20s, I joined our church's Christian movement- Mother's Union. 

This is a group mostly made up of women who've advanced in age and mostly married. As a young woman, I joined to help them in undertaking various activities. Being a member meant that I could attend their meetings and seminars. This is how I got to know about menopause and the changes that come with it.

But, I'll be honest. Then, it was more about finding it hilarious than it was about learning so I had forgotten much about it. When I would have, say the hot flushes, I'd be like, "I remember this from a seminar……what did they say about it?"

I am single, never married, and without children. When it occurred to me that I was past the childbearing age, psychologically, I was worried. "What will happen now that I don't have a partner?" Having children without being married was out of the question because I am a believer who holds on to the teachings of intimacy in the confines of marriage. Further, I am a role model to many and a lay leader in my church. What example would I be setting?

I did not tell people what I was going through partly because I did not want questions like, "What happens now because you have no children and are yet to marry?" 

However, those who are close to me witnessed the changes and I am sure they made their conclusions.

I think that society doesn't give menopause the attention it deserves. It takes bravery to talk about it when it should be an easy and open conversation that is taught to young women so that they are fully prepared for the stage. When I got into my forties, I didn't give much thought to menopause but in hindsight, I should have. Having ample information on it would have helped me to psychologically prepare.

I tell young women, "Whether you want or not, once you get to a particular age, this is something that you'll have to deal with. Menopause is inescapable so be prepared for it. Research and talk about it."

I wasn't sure, I had to ask my physician 

Scola Muthoni, 50, a stay-at-home mum

"When I turned 47, the changes began. I would have hot flushes that manifested as profuse sweating and an uncomfortable feeling of intense warmth around my face and neck.

Two years before this, I had been diagnosed with cervical cancer so I couldn't really determine whether to attribute the symptoms to the disease or menopause. When I started to experience abnormal and erratic periods, I would ask myself, "Am I getting into menopause or…." I was confused but luckily, through a physician, I got the answers. I was menopausal.

Another change that happened was vaginal dryness and loss of sexual appetite. 

One time, my husband asked me, "Are you the same girl I married?" we both laughed because we have had better times. In my younger days, I would pester him to come home, but now, I infrequently think about intimacy. Thankfully, we are open to each other and he knows what is happening to me. Notably, I no longer experience the hot flashes and regarding cancer, I am in complete remission.

I grew up with very little information about menopause. Before I started attending training for women, all I knew was that "When you get to menopause, you stop having children." After seven children, this was not something to worry or be concerned about. However, I didn't have much information about other changes and the same was not extensively covered during the training.

Whenever I engage women in my neighbourhood and I introduce the topic, I have discovered that many lack basic information. They don't know what to expect and some assume that something is wrong.

To ensure that my children are well versed, I openly talk about it with the two elder children. I tell them of my experiences, let them ask me questions and I remind them that they won't be young forever. Looking back at my life, I am glad that I had a rewarding sex life and I had my children in my youth." 

I was too busy to notice

Martha Mumbi, 74, Retired reverend 

"Menopause. I don't know if it's weird that I have never given it much thought. By the time I was getting to my forties, I had a vague idea of what this was all about. "You get to a certain age and you can no longer have children." I had heard this line many times- in school, church, and from my peers.

When I got to 50 and I started having erratic periods that later ceased altogether, I remember thinking to myself, "I am getting old." I did not lament over the fact that I was not married or had no children. 

At that particular time, I was busy with the process of establishing a primary school in Kajiado County having retired from my position as a reverend cum counselor. Sometimes I wonder if I was too occupied to notice the changes in my body because, besides the cessation of the periods, there were no other symptoms.

It helped that I am surrounded by many people with whom we get to fellowship and share a lot. These are friends from different age demographics. When you associate with people, you don't have time to wallow in self–pity. I think it also comes with acceptance. For me, getting old was not an issue because it is an inevitable stage of life. The fact that I didn't have children of my own wasn't something of a big concern. When I see the hundreds of children who attend my school and I get to interact with them, I am fulfilled.

To women nearing this stage, I would say, "Practise simple exercises like walking and start a hobby if you don't have one. I like gardening and visiting the elderly and the sick. Such activities give me strength to carry on and keep me occupied."

Why women don't talk about menopause

A gynaecologist's take: Dr Wanjohi Victor, a gynaecologist consultant in Nairobi.

Why is menopause an overlooked subject?

There is a culture of silence surrounding menopause. When women hear the word menopause, they think old, plus there is a lot of prejudice against older women. Throughout history, the natural physical transition of menopause has been viewed as something to deny, fear, and eradicate.

Are there health risks associated with menopause?

During menopause, the female reproductive hormones decline significantly. These reproductive hormones protect the woman from certain diseases such as osteoporosis, heart diseases, high blood pressure, and high cholesterol. In the brain, they protect women from cognitive decline such as memory loss. Therefore, brain diseases and cardiometabolic diseases increase significantly during the postmenopausal period. Fortunately, these can be prevented if not controlled.

Does menopause affect sexual appetite?

Paradoxically both yes and no. Yes, because some women at this time do not fear the risk of getting pregnant therefore are more motivated to engage in sex. No, because hormonal changes in the woman cause other symptoms such as vaginal atrophy –thinning, drying, and inflammation of the vaginal walls.

Signs and symptoms of menopause

We define menopause as one year without menstruation. Symptoms will include the absence of menses, hot flushes, mood swings, urogenital atrophic changes – vaginal dryness, and pelvic organ prolapse. 

How can one with these changes?

Women should consult their gynaecologists during the premenopausal period (the period of a woman's life shortly before the occurrence of menopause). Starting preventive strategies will prevent diseases such as osteoporosis which is associated with hip fractures in the elderly. Apart from behavioural therapy, there are various medications such as hormonal replacement therapy to tackle severe symptoms of, say hot flushes.

Research: 

A healthy diet rich in fruits and vegetables lessen menopause symptoms

Research published in 2020 by the North American Menopause Society (NAMS) shows that a healthy diet rich in fruits and vegetables plays a role in lessening various menopause symptoms. The study suggests that dietary factors may play a critical role in oestrogen production, metabolism, and consequently, menopause symptoms. In particular, the consumption of fruits such as citrus fruits or a Mediterranean-style diet, characterised by a high content of green leafy vegetables, fruits, cereals, and nuts, was linked to fewer menopause symptoms and complaints.

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