Menopause and the hormones that hijack your happily ever after

This is the last of our four part series on menopause (Links for part one to three attached)

Mwenda Ntwiga, a 54-year-old man from Meru, Kenya, found himself in uncharted territory when his wife, Nkatha, began experiencing dramatic mood swings three years ago.

"At first, I didn't understand what was happening. She became irritable, and we argued a lot. I felt like I was walking on eggshells around her," Mwenda recalls.

"In our culture, men are not taught to talk about these things. I thought she was being difficult or something was wrong with our relationship. I even started spending more time away from home and, regrettably, even considered ending our relationship."

Mwenda's experience is not unique. Across Kenya and around the world, couples are grappling with the profound changes that menopause brings to their relationships. This natural transition, often viewed solely as a woman's journey, can have far-reaching effects on partnerships, sometimes even leading to divorce.

The journey through menopause is often viewed as a uniquely female experience, but its effects can ripple far beyond the individual woman. This transitional phase brings about a myriad of emotional and physical changes that can significantly impact not only the woman herself but also her intimate relationships.

Part 1:  Furaha Bishota: My battle with menopause, the silent storm

Recent studies have shed light on a concerning trend: a correlation between menopause and increased divorce rates. This connection underscores the profound influence that hormonal shifts and their associated challenges can have on a couple's dynamic. As women navigate this transformative period, their partners may find themselves grappling with unfamiliar terrain, highlighting the need for a broader understanding of menopause that encompasses both the female experience and the male perspective.

Understanding these changes is crucial for fostering a supportive and lasting relationship. According to relationship experts, empathy and communication from a partner's perspective remain key to navigating this stage as a team.

Still, this transition can be particularly challenging. Although studies haven't pinpointed a definitive percentage increase in divorce rates solely due to menopause, there is evidence that it can be a time fraught with challenges for couples.

A recent survey by WebMD found that 38 per cent of men reported being negatively affected by their partner's night sweats and insomnia related to menopause. This lack of sleep can create a domino effect, leading to irritability and frustration in both partners, ultimately impacting communication and intimacy.

Hormonal shifts

Adding another layer of complexity is the fact that men also experience hormonal changes as they age, a gradual decline in testosterone levels- this is called andropause. This can lead to symptoms like low libido, fatigue, and irritability in men as well. While not exactly the same as menopause, it highlights that hormonal shifts can impact both men and women as they age.

Simply put, menopause marks the end of a woman's menstrual cycle. It's triggered by a natural decline in oestrogen and progesterone production by the ovaries. The transition to menopause, known as perimenopause, can begin several years before a woman's final period and last for up to a decade.

Every woman experiences menopause differently, but common symptoms include hot flashes, night sweats, vaginal dryness, sleep disturbances, mood swings, and changes in libido. The severity and duration of these symptoms can vary greatly, affecting women differently.

On average, perimenopause starts in a woman's 40s, and menopause itself typically occurs between the ages of 45 and 55.

"Women are not lucky because the number of eggs they have is determined by the time a woman is born. They cannot have more than what they have at birth. When the eggs are finished, they go into menopause," explains Prof Joachim Osur, a reproductive and sexual health expert and a reproductive rights advocate.

"The serious problem that comes with this is a serious drop in oestrogen. That hormone does many things in the body, so the moment it drops, the body changes completely."

Dr Angela Muliro Chekoko, an obstetrician and gynaecologist interested in menopause medicine, adds, "Menopause usually occurs between 45 and 55 for most people. The main challenge is the drastic drop in oestrogen levels, which can cause various psychological issues like anger, irritability, loss of confidence, sadness, mood swings, and stress."

Unfortunately, many men enter this phase with limited knowledge about menopause.

A survey conducted by Benenden Health found a surprising statistic: 15 per cent of male respondents had never even heard of menopause. This lack of basic understanding can lead to confusion and frustration.

Imagine experiencing a series of physical and emotional changes with no clear explanation and then having your partner seem completely oblivious. It's a recipe for miscommunication and potential conflict.

Among Kenyan men, as is with men elsewhere in the world, understanding and coping with their wives' menopausal changes can be a significant challenge, deeply intertwined with cultural expectations and norms. Even finding men willing to discuss these issues proved difficult, highlighting the lack of awareness and open conversation about menopause.

The Voice heard the diverse experiences of three men from different parts of Kenya, sharing their winding journeys through this transitional phase in their wives' lives, interwoven with insights from Prof Joachim and Dr Angela.

Fifty four-year-old Mwenda Ntwiga from Meru says his wife, Nkatha, started having mood swings, insomnia, and frequent hot flashes about three years ago. "At first, I didn't understand what was happening. She became irritable, and we argued a lot. I felt like I was walking on eggshells around her. In our culture, men are not taught to talk about these things. I thought she was being difficult or something was wrong with our relationship. I even started spending more time away from home and, regrettably, even considered ending our relationship."

Mwenda explains that Nkatha would snap at their children over the smallest things. She also got into unnecessary arguments with neighbours, causing him embarrassment.

"Our youngest daughter started avoiding her and would come to me instead. It was a tense atmosphere. I was distracted and couldn't focus on my work," he recalls.

"At first, I thought maybe there was some evil spirit involved. We approached our pastor, who prayed for us and even suggested counselling. It wasn't until the pastor's wife, who had gone through menopause herself, pulled me aside and explained what Nkatha might be experiencing. Understanding what was happening to her body made a huge difference. We are still healing, but our relationship is much stronger now."

Part 2: Menopause in the workplace: One in four women consider quitting due to symptoms

On such mood swings, Joachim elaborates, "The moment oestrogen goes down, women tend to be very moody and irritable. They become difficult to live with. Most men come to the clinic with their wives because they are in trouble. They are having a crisis in marriage because the woman is now very harsh and very emotional, increasing fights. Now, you can't get intimate with people you're fighting with, so couples struggle to be in each other's space at this stage."

Dr Angela underscores the impact of these changes, saying, "Fatigue is one of the greatest complaints of women not having a desire to have sexual intimacy. The lack of oestrogen also causes dryness, which can make intercourse painful. Couples must seek medical advice and use lubricants or moisturizers to alleviate discomfort."

In addition to biological factors like hypoestrogenemia during menopause, psychosocial factors can also cause sexual problems. With menopause, women may think that their sexual attractiveness decreases. This situation can lead to deterioration in body image, self-esteem, and sexual reluctance. It is known that emotional problems such as anxiety, depression, and anxiety disorders are more common in postmenopausal women.

For 58-year-old Wanyonyi Masinde from Kakamega, his wife, Nekesa, was no longer the wife he had been married to.

"She began experiencing severe menopausal symptoms, including depression and anxiety. Nekesa became distant, and we barely communicated. I didn't know how to handle her mood swings and lack of interest in intimacy. I thought she didn't love me anymore. I was tempted to start spending more time at work and with friends, avoiding home because it was too stressful."

Diet and exercise

When Nekesa's night sweats refused to go away, Wanyonyi suggested that she sees a doctor. That was the first time someone had linked her behaviour to menopause. The doctor she saw mentioned most of the symptoms she had dismissed before, recommending that she pay attention to her diet and exercise. After seeing her doctor on several occasions, Wanyonyi says his wife finally told him about her menopause onset.

"We started working on making things better. I now understand her change in character and know that she's not giving up on our family," he mentions.

Joachim further explains: "The physical symptoms of hot flashes and feeling generally tired, along with weakened bones, make them more vulnerable to diabetes, hypertension, and arthritis. Their general health declines. Add all these things together, and the relationship suffers. People are not loving themselves; they are having all these other sicknesses that come with menopause. They no longer want sex. Most women just leave and stop having sex."

Dr Angela adds: "It's important for women to have regular check-ups to rule out other conditions like bacterial vaginosis or cervical issues, which can cause discomfort during intercourse. Educating both partners about these changes can significantly improve their relationship and overall well-being."

Mombasa's Musa Chokwe first noticed his wife Mwatela's moods. The 66-year-old retired civil servant says his wife would suddenly start confrontations. She would get angry at the slightest provocation, and sometimes, she went for days without speaking to him. She started staying up longer at night, even when she had to work in the morning.

"When she would sleep, it was at irregular patterns, and I was afraid she was going through work problems," Musa recounts.

Luckily, Musa had interacted with men in his circle, some of whose wives were over the harsh symptoms.

"I also found some articles online and videos explaining menopause. While I wasn't prepared, I immediately recognised Mwatela's changes and knew them as part of a natural process. I started helping around the house and encouraged her to exercise and maintain a healthy diet. We also joined a support group where we could learn more about menopause. Musa says their four kids, all in their 20s, were initially confused by Mwatela's sudden mood changes, but they became more understanding and supportive once they understood. 

Part 3: Oestrogen wars: When menopause and puberty live under one roof

Dr Angela concurs: "Menopause is a natural phase in life, and understanding it can make a significant difference. Couples should be encouraged to seek information and support from healthcare providers, support groups, or reliable online resources."

For Kilonzo Nduku, the end of his marriage was anything but rosy.

"I am not sure if menopause led to my separation from my wife because I did not understand what this phase does to a woman's body and emotions. What I do know is that my wife of 32 years changed around 2017. She was 49 then and suddenly became a completely different person — unapproachable and irritable," he confides.

Unable to bear the hostility at home, Kilonzo sought solace in alcohol and a younger woman who seemed to understand him and offered comfort. "Unfortunately, my wife found out about this, which escalated the situation between us. She was so angry and eventually left our home. My efforts to win her back have been futile, and there has been no communication between us for as long as I can remember," he shares with palpable regret.

"This still hurts me, and I have never gotten closure on what exactly happened. But after learning from you what menopause does to women, I believe this might explain the changes in my once calm and accommodating wife. It's crucial for men to be educated about the impact of menopause, as I believe this knowledge could save many marriages and relationships."

Joachim emphasises education's importance: "Education just by knowing what to expect can help a lot. Educating both the man and the woman about menopause is vital. Our people are not used to annual sexual health checks, relationship therapy, and education about their sexuality and reproduction. They experience it without knowing what it is. If they can get education about menopause (both the man and the woman), that will be good."

Joachim adds: "Most men are not educated on menopause, and they are blaming their wives for all manner of things. Infidelity is very common, and most of these men will go for younger women. Now all these things just cause more crises in the marriage. Most of these things can be managed. Relationship therapy is crucial because all those things cause relationship problems."

Dr Angela stresses the importance of open communication and seeking help, "Menopause can lead to misunderstandings and conflicts in relationships, but with the right support and information, couples can navigate this phase together. It's crucial to address these issues openly and seek professional help when needed."

Both experts emphasise that education, compassion, and open communication are essential for navigating menopause.

Prof Joachim advises, "Understanding what your partner is going through can significantly ease the tension. Educate yourselves and seek professional help if needed."

Dr Angela adds: "Menopause is a natural phase that requires support and empathy. With the right knowledge and approach, couples can strengthen their bond and improve their overall well-being during this time."

These insights highlight the need for society to break the silence around menopause and provide the necessary support for those affected.

As a call to action, clinicians and health practitioners should ask women about peri-menopausal/menopausal symptoms, loss of libido, and the marital relationship during annual visits. Education related to this period of life may provide a better understanding to women.

Their partners may be included in menopause education, as many men do not understand the changes associated with perimenopause and menopause.

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