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Dossier: Sexuality

10 myths about the menopause

The menopause affects every woman at some point in their life. Nevertheless, it is fraught with taboos and myths – we clear up 10 of them for you.

Text: Katharina Rilling; photo: Edward Cisneros / Unsplash

What’s happening to me? Women face huge challenges during the menopause when their fertility comes to an end and the body changes. As part of a couple, perhaps they’ve not been able to have children or their children have flown the nest and they have to find their way now in a new scenario.

Cause of menopausal symptoms

Physical menopausal symptoms are caused by oestrogen deficiency. The ovaries, which are particularly active between the age of 25 and 35, gradually reduce their function even before the menopause itself, with the egg supply decreasing and ovulation occurring less and less frequently. The ovaries produce less oestrogen and progesterone, the two main female sex hormones.

When does menopause start?

A woman’s last menstrual bleeding is known as the menopause. It usually occurs between the age of 45 and 55, and on average women have their last period at 51.

Totally normal? Menopause as a turning point

One thing is certain: the menopause is a turning point in the life of every woman – and is far too often a taboo topic. Doubts, fears and symptoms are hidden and many women suffer alone: “An incredible number of women just grin and bear it. Many try to cover up symptoms such as anxiety, irritability, forgetfulness or even poor sleep,” says Petra Stute, head physician at the Maternité Women’s Clinic at Bern University Hospital. The Maternité is the leading centre of competence for the clarification of symptoms during the menopause.

“I often wonder why women do this to themselves. Some patients don’t sleep properly for months. It doesn’t have to be that way; you can do something about almost any symptom.” The first and perhaps most difficult step is admitting or recognising that menopause is the cause of the changes.

We take a look at the most common prejudices surrounding the menopause with explanations by Professor Stute:

Myth 1: Sweating is part of menopause

“Yes and no. Some women are more susceptible to cold during the change of life. So this can also be listed as a symptom. But it is true that two-thirds of women suffer from hot flushes and sweats, with one-third suffering so severely that they have to go to the doctor, where they are often prescribed hormone therapy.

Patients with milder symptoms can try alternative therapies. Herbal remedies containing black cohosh, rhubarb, sage, soy or red clover, for example, can reduce hot flushes and sweating by around 30%. Acupuncture is also said to help relieve symptoms by 30 to 40%.

In a few cases, antidepressants or antiepileptics are prescribed when hormones cannot be used and herbal remedies do not go far enough. Factors that encourage hot flushes, such as being overweight, obesity and smoking, should be avoided. Plus genetics also play a role here, so it’s worth asking your mother how she felt during this period.”

The herbal remedy St. John’s wort can help with depressive moods.

Myth 2: All menopausal women suffer from mood swings

“Thankfully not! However, the likelihood of developing depression is higher during the menopause, i.e. during the transitional phase from the late 30s or early 40s until menopause at around 51 years of age. More precisely, women in this stage are two and a half times more likely to suffer depression than younger women.

Generally speaking, women are particularly vulnerable during any periods of hormonal imbalance – not just during menopause, but also after childbirth, which sometimes leads to postpartum depression, or simply during their period as a symptom of premenstrual syndrome. The good news for women going through the change of life: Once they get through these phases, the risk of depression falls again.

The herbal remedy St. John’s wort can help. Antidepressants and psychotherapy are also popular in Switzerland. But HRT is prescribed in some cases.” 

Myth 3: All women gain weight after the menopause

“Unfortunately, that’s often the case. On average women gain half a kilo a year. But it’s not a gradual weight gain, so we could “get used” to it. Most women experience sudden weight gain of five to six kilograms within a few months. The reason for this is that the metabolism and hormone balance change, while women don’t really adjust their eating habits and exercise routines.

It’s also a good idea to take a look at hidden fatteners like alcohol. But to suddenly eat fewer calories, change long-held habits and to exercise more is, of course, incredibly difficult. All the more so when symptoms such as joint pain or depressive moods start happening at the same time.

Women often worry that this will go on indefinitely and their weight will get completely out of hand. But that is not the case! Eventually, things settle down. Nevertheless, it is important to adjust your lifestyle: Excessive weight is a risk factor for diabetes, cardiovascular disease, and dementia – especially when oestrogen levels fall.”

Myth 4: Women lose the desire for sex during menopause

“Menopause is not automatically associated with a decline in sexual activity. There are many influencing factors, such as the quality of the partnership or stress levels. But also the question of how a woman feels about getting older.

One irritating physical symptom can be vaginal dryness. Fortunately, however, it can be treated very easily with creams or suppositories containing hormones. Some women feel liberated by the menopauseas it means no more periods and no risk of falling pregnant. It can have a positive effect on your love life.”

Myth 5: Women go through a process of “masculinization”

“As oestrogen levels fall, male hormones gain the upper hand. Although these also decrease with age, the level of female hormones decreases more sharply. That’s why the hair on our head usually becomes thinner and sparser. Many women also feel that they lose more hair and that it doesn’t grow as long as it used too. At the same time, more hair tends to grow on the face.

But women don’t start to grow hair all over their body like men. A woman’s voice also changes slightly, but the change is hardly noticeable in everyday life. Only professional singers are likely to notice the difference.

Myth 6: The ageing process is speeding up

“There’s a grain of truth to this myth. If a woman doesn’t take hormones, she does age a little faster. Oestrogen protects against many ageing effects when it comes to skin, hair, blood vessels and bones. Some women now see more wrinkles when they look in the mirror or suffer from joint pain, swelling or back pain as a result of ageing. Some feel like everything suddenly hurts.”

Myth 7: The risks of hormone replacement therapy (HRT) are greater than the benefits

“Patient anxiety is understandable, but it really pays to talk to your gynaecologist. The therapy is used for more severe symptoms of menopause such as hot flushes, psychological changes, sleep disturbances and to prevent osteoporosis. I estimate that in Switzerland about one in 15women are treated with hormones.

HRT has many benefits: It not only reduces the symptoms of menopause, but also lowers the risk of osteoporosis, dementia, heart attack, diabetes and colon cancer. There are also benefits for the skin, hair, figure and weight. If oestrogen is not taken orally but delivered through the skin, the risk of thrombosis and stroke is not increased.

What is true, however, is that the risk of breast cancer is increased after five and a half years of combination therapy with oestrogen and progesterone. Specifically, this means: Without hormone treatment, around14 out of 1,000 women between the age of 50 and 59 are diagnosed with breast cancer within five years. After five and a half years of combination therapy, this figure rises to around18 out of every 1,000 women in the same age group. Three to four women are thus additionally diagnosed with breast cancer within this period.

Herbal preparations have the disadvantage that they are symptom-oriented, which means you have to take one plant, such as St. John’s wort, for psychological well-being, valerian drops for sleep disorders, and black cohosh, soy or red clover to control hot flushes. But in this case you have no protection against the long-term effects of oestrogen deficiency on bones, heart and the brain. It is important to know that your choice is not set in stone. You can switch between therapies or combine them – and you can mix and match without having to justify yourself.”

Myth 8: You can just keep taking the pill

“Yes and no. Although the combined pill does contain artificial oestrogen which helps against symptoms of the menopause, the classic contraceptive pill is associated with a higher risk of stroke, thrombosis and heart attack than HRT. Therefore, only healthy women are recommended to continue taking their usual combined pill until the age of 50. Then, at the latest, it’s essential to change.”

Myth 9: Menopause lasts two years

“It depends on the individual. Unfortunately, there is no way to predict how long the symptoms will last, but hot flushes and hormone-related mood swings do stop for all women at some point. However, changes in the genital area such as vaginal dryness do not get better on their own. If you have irritating symptoms in this area, they have to be treated permanently.”

Myth 10: After menopause everything starts to go downhill

“That’s not true.The hormonal transition is a challenge for most women, but it can also be a good thing. Many women use this hormonally enforced period of reflection to focus on themselves for the first time in years and think about what they want, sort out their relationships, get rid of negative influences, stand up for themselves more and demand more from the people around them.

People around them may initially find this process irritating and exhausting, but it can be a positive experience for the women who are going through it. What’s more: ageing takes place on multiple levels, it’s not just a question of hormone-producing ovaries. Women at this age are often just getting to or at the peak of their emotional-social competence.”