I've dithered around writing about this but as the year comes to an end it's been such a big feature, especially of the last few months, that I think I probably ought to if for no other reason that one day I'll hopefully be able to look back and think about how glad I am it's over.
There are a lot more books available on menopause and women's health than - well, ever, I suppose. It gets talked about more on television, and advertised more on social media - at least if you're a woman of a certain age, and most of my female contemporaries will make comments about their hot flushes and brain fog. There's a lot of talk about HRT - who it's working for, who's still struggling to get the right balance with it. But really I don't think much has changed.
My mother, along with a lot of her contemporaries/sisters/the mothers of my teenage friends had a hysterectomy in her early 40s. It seemed to be the go-to option in the 1990s around here (they would all have been seeing the same handful of GPs, and referred to the same hospital) so there's a lack of family experience to call on. Even if that wasn't the case I'd have been away at university. Then home concentrating on jobs, a relationship that seemed serious at the time, and a busy social life when mum hit that age - I wouldn't have been paying any attention. When my grandmother hit that age my mother was living at the other end of the country raising a young family. Generations aren't gatekeeping this stuff, but we're not necessarily listening to each other either.
Regardless of vaguely progressive policies from employers (we have an App, how great are we!) the reality is still that a lot of women fear for their jobs - juggling teenage children, a suddenly unpredictable body and mind, a potential range of serious health issues that are embarrassing enough that nobody wants to talk about them, and added anxiety about sick leave, making mistakes, and being forced out of the workplace - it's not fun. My work is fairly good - mostly because there are a few middle-aged women around who are sympathetic and supportive. My previous job would have been impossible.
I don't think the majority of my peri-menopause symptoms have been too bad - the weirdest ones are indigestion, splitting nails, an increased risk of static electric shocks, a need to write a lot more lists to remember what I'm doing, and so far manageable hot and cold flushes. Which is good because my GP hasn't been amazing about it so far. After several appointments with the practice gynecologist who insisted I was too young at 48, and then said any tests would be inconclusive at my age I did end up on an expedited endometriosis pathway. Expedited it still took more than a year to get a hospital appointment. It was not a good year due to extremely heavy periods that closer and longer.
Eventually there was an appointment with an examination and 4 attempts to take a biopsy sample. They failed and I had to go for another appointment for a hysteroscopy which is a perfectly foul procedure involving cameras, a lot of water, and entirely ineffective pain relief (they suggest you take paracetamol beforehand). It's painful, invasive, and undignified - nobody is much inclined to listen - medical opinion has been that a coil would fix everything but nobody (and my god have they tried) has managed to fit me with one. Despite making it very clear that I would not consent to another attempt the consultant was still offering to try until he had to admit that the position of the lemon-sized fibroid they found would make it impossible.
He did get a useable biopsy sample, it instigated 7 weeks of heavy bleeding that landed me in A&E, I didn't get a blood transfusion but it was a very close thing. My iron and hemoglobin levels have not yet properly recovered. During all this I got a handful of contradictory letters. An appointment to have the fibroid sliced out - they will only do this under a local anesthetic here, then a letter to say it couldn't be done in one go so it was;t an appropriate treatment (relief). I can't have a hysterectomy because of previous scar tissue and other issues that haven't really been explained, there's a thing where they put miniature nails into the fibroid and hit it with an ultrasound but this often doesn't work depending on how firmly or otherwise the fibroid is attached - they have no idea how it'll go until they actually do the procedure.
A chemically induced full menopause was an option but apparently, that's brutal until the right mix of HRT can be worked out. In the end, I was prescribed a newish drug that should mimic menopause but also has, I guess, an HRT element to it. I have started taking it today - side effects include initial heavy bleeding which I'm honestly terrified of. To me, that means floods of blood and clots every 10 - 15 minutes that make doing anything almost impossible for the 2 or 3 hours a day it often lasts and leaves me desperately tired and emotional as well as anemic. The interim pills I was prescribed have not been agreeing with me though, I have a follow up appointment in March to see how the first 3 months have been and a work week which should provide reasonable toilet access (this is the major consideration at the moment, and very hard to explain to anyone who hasn't experienced this sort of bleeding). It has to be now.
All of it makes me angry about the lack of research, lack of options, and lack of understanding for women in my position. The only place where there's much discussion of the new medication is Mumsnet - it's inconclusive but on balance encouraging - it might work, or at least if it doesn't do everything it promises it might do enough. we're half the worlds population, and a significant proportion of us will not sail through menopause. We deserve better treatment and we deserve it now.