Meet your Crone - The Gift of Menopause

“So many women I’ve talked to see menopause as an ending. But I’ve discovered this is your moment to reinvent yourself after years of focusing on the needs of everyone else. It’s your opportunity to get clear about what matters to you and then to pursue that with all of your energy, time and talent.”

— Oprah Winfrey

In honour of International Women’s Day which fell on Tuesday the 8th of March this year, we would like to offer our thoughts on the menopause, as ever, from both a scientific and spiritual standpoint. This momentous time in a woman’s life is rarely discussed and can become an extremely negative experience. We want to celebrate the menopause and all it symbolises and hope that after reading this, be you woman or man, you will too.

Let’s start with the science…

The menopause is the biological state in females when ovarian follicular activity ceases and the menstrual cycle stops. It is official diagnosed when there have been no periods for 12 months. The average age of this in the world is 51.5 years (according to the International Menopause Society).

The time leading up to menopause is known as the perimenopause. This transition period can vary in length and is when the clinical signs and symptoms of menopause begin. Genitourinary Syndrome describes the vulvovaginal changes that occur with menopause.

What happens?

As we age the ovaries produce less and less oestrogen. This disrupts the cycle and produces the symptoms of menopause.

• Changes in our periods – they can become irregular, further apart or closer together and they can get lighter or heavier.

• Hot flushes and night sweats

• Sleep disturbance

• Fatigue

• Mood swings

• Anxiety

• Poor concentration (brain fog)

• Irritability

• Vaginal dryness

• Recurrent urinary tract infections

• Burning and itching

• Stinging feeling when peeing

• Loss of libido

• Joint pains

• Headaches

• Loss of confidence

It is important that healthcare professionals understand the impact that menopausal symptoms have on women and their families.

The diagnosis of menopause is clinical. Hormone tests are only useful if your periods have been affected by contraception and so you do not know if they have really stopped. In this scenario, a persistently raised FSH will confirm you are post-menopausal. There is no blood test that will tell us if we are perimenopausal. The symptoms we are experiencing do this.

What can be done?

There are lots of treatments for menopause and it is time that more women accessed these. No-one needs to suffer in silence, and we cannot urge you enough to speak to your GP if you are struggling with any aspect of menopause.

Lifestyle modifications that may help

Regular exercise, weight loss, loose clothing, reducing stress, relaxation exercises, avoiding spicy foods, stop smoking, reduce alcohol.

Non-Hormonal treatments

Selective Serotonin Reuptake Inhibitors (SSRI’s) which you may know are used to treat anxiety and depression have been shown to be useful for hot sweats. The effect should be very quick and so a 4 week trial is suggested for those who do not want to use hormones.

Hormone Replacement Therapy (HRT)

This involves replacing the oestrogen that the ovaries have stopped making. For those whose main symptom is vaginal dryness, this can be done using a topical cream direct to the area. For more pervasive whole body symptoms the oestrogen needs to get into the blood stream. The best route of delivery is via the skin either as a patch or gel. These replace the traditional tablets. This transdermal route reduces the risk of developing blood clots that has been associated with HRT.

In women who still have a womb, the oestrogen needs to be balanced by progesterone to protect the lining of the womb which can grow abnormally under the influence of the oestrogen. If you are under 55 or within 12 months of your last period the progesterone should be delivered cyclically (sequential HRT). This means there will be varying levels of hormones to create a withdrawal bleed that mirrors the menstrual cycle. The reason we do this is that early on your body may still be trying to create your cycle and the continuous HRT can result in lots of irregular bleeding.

If it is more than 12 months since your last period or you are over 55 you can start on continuous HRT which delivers steady levels of oestrogen and progesterone. These are called no bleed preparations as you do not get a withdrawal bleed. When you have been on the sequential HRT for 12 months you can switch to a no bleed continuous type.

If you have no womb you just need the transdermal HRT via patch or gel.

A note about libido. It can be useful to have your testosterone level checked if libido is a problem and there are treatments for this. In some areas this may be via specialist clinics.

The key thing in treating the menopause is that it is personal to you and is based on your symptom profile.

Risks of HRT

Blood clots – this risk is removed by using the transdermal routes.

Coronary Heart Disease (CHD) and stroke – transdermal HRT does not increase the risk of stroke. When started under the age of 60 it does not increase the risk of CHD and oestrogen alone HRT may reduce this risk

Dementia – affect currently unknown

Breast cancer – combined HRT does increase the risk of developing breast cancer and the risk is dependent on duration of treatment. HRT does however not appear to affect the risk of dying form breast cancer.

Benefits – reduced fragility fractures and improved muscle mass

In summary, for women under the age of 60, HRT is a safe effective way to manage symptoms of the menopause. Once started the current guidance states that HRT can be continued as long as the benefits and improvements to quality of life outweigh any risks and there is no limit to duration of treatment. Women with or at high risk of breast and ovarian cancer will need specialist advice about HRT.

Referenced from NICE current guidance.

That’s the science. Now what about the wider implications of menopause for us as women? This is a huge time of change.

Many of us view this change as negative, focusing on the loss of fertility and youth that menopause can symbolise to some. This is reinforced by the attitude to older women in our society. They are often viewed as powerless and unimportant. They can be forgotten about. If we let this societal travesty affect our own journey, then the menopause will only ever be a negative experience.

We choose to see it as a change to rejoice. It is an extremely powerful time. We are moving into a creative, new phase of our lives. We are moving away from a time when we are marshalled by our biological cycles and into freedom. We are experienced, we can let go of the need to be mother and embrace our Crone.

The Crone has been described in mythology and stories for centuries.

The word crone has difficult connotations. The dictionary definition ‘a cruel or ugly old woman’ is a terrible one. In fact, the Crone is an archetypal figure and is the wise woman part of ourselves.

She represents everything that the younger self has experienced and learned throughout the whole of life. She is knowledge and wisdom, intuition, and patience. She is the part of Self that remains indomitable at the end of life having survived everything we have endured; but she is always with us and has been from the very beginning.

The Crone is the part of Self that is associated with letting go. When we acknowledge the impermanence of all things and learn to let go, we are free. We can release the need for perfection and let go of thoughts feelings and behaviours that no longer serve us. We can enjoy what we have right now without the need to cling on to it. The Crone knows when to kill and when to cure.

The Crone is ever present in all situations representing intuition, wisdom, integrity, discernment, inner knowledge, and transformation. She is the one who knows. The menopause is a wonderful way for us to access this magical part of the psyche. From that viewpoint, it is something to be grateful for and as we have discussed before gratitude helps create positivity in our thoughts emotions and resulting behaviours.

The Crone is present throughout all phases of a woman’s life at every age. Get to know and love her as you love your innocent child Self, your playful and rebellious teenager Self, and your all-nurturing mother Self. Let her be the completion of that cycle that aligns with all the cycles of nature from birth to death to rebirth.

Embrace this time of change. Revel in it and let your inner Crone loose to take her place in the great, mysterious dance of life.