March 2023 – By Richard Hull (First published by RTE Brainstorm, August, 2021).

Opinion: the condition has a significant impact on quality of life for almost all women at some stage of their lives.

Imagine that we discovered a new condition which was certain to affect roughly half the population. It would involve some of the following problems in varying degrees and combinations: cardiovascular disease, osteoporosis, neurological transition symptoms (such as hot flushes, disturbed sleep, mood changes and forgetfulness), Alzheimer’s disease (given a particular genotype), low self-esteem, breathing difficulties, anxiety, tiredness, irregular and/or heavy periods, joint pain, vaginal dryness and decreased sex drive.

Imagine too, that recent research continues to discover more problems associated with this condition and, moreover, they can last for ten years or more. This is not long Covid. If it were, we’d be throwing the kitchen sink at trying to sort it out. On the contrary, this is a condition that affects almost all women, and trans and non-binary people, at some stage of their lives and it is a travesty that more attention is not paid to their experience.

Menopause touches on many important issues including gender equality, public health, economic impact, ageism and, crucially, the health and well-being of women. There can be no doubt that symptoms at the time of the menopause can have a significant impact on women’s lives and their capacities for flourishing. As such, it is hard to see why this issue is not much higher up on political, social and medical agendas.

The health implications of the menopause are obvious from the list above. Yet many of us know very little about it, let alone how to improve quality of life for women experiencing symptoms. There is an increasing consensus that hormone replacement therapy (HRT) improves many menopausal symptoms on a long-term basis, as well as protecting against cardiovascular disease and osteoporosis, but this is not yet widely appreciated. While the debate about HRT persists, many are working very hard to raise awareness of the benefits of it (as well as other treatments) for women from the early stages of the perimenopause.

Studies overwhelmingly suggest that menopausal symptoms can have a significant impact on quality of life if left untreated or improperly treated. For example, severe tiredness accompanied by a lack of concentration and confidence, anxiety, joint pain and headaches can heavily compromise work life as well as marriages and family relationships.

This is especially the case if one is unaware of what is actually going on. We can look much further for reasons for mood swings, lack of self-esteem and loss of libido, both in ourselves and in our partners, if we are unaware that they are symptoms of menopause transition. We can hunt for causes that simply aren’t there, which can lead to mistaken assumptions in the absence of a more nuanced understanding of mid-life.

strong theme coming through from research on this issue is that perimenopausal symptoms ‘can be quite disruptive and distressing, particularly when women do not know why these things are happening to them in the first place’. If their partners do not know either, we have the seeds for an inauthentic challenge to even the most healthy of relationships.

Clearly, the impact on women’s quality of life can be severe. The impact can be economic too. A constellation of menopausal symptoms can have direct costs via lost wages due to leaving employment or reducing hours; and indirect costs due to missing out on promotion opportunities. These costs are borne by women themselves, their partners and families, their employers and wider society.

Given all of this, we can see the pressing need for both greater awareness of symptoms and experiences at the time of menopause transition and for greater employer support. Recommendations include training for professionals so they are more aware of and sympathetic to the effects of menopause transition; awareness raising campaigns for mid-life women; tailored absence policies; flexible working patterns for mid-life women; and fairly low cost environmental changes. Together, these recommendations might help to erode a culture of gendered ageism and encourage that menopausal symptoms cease to be such ‘a humanistic and economic burden on women in middle age’.

In the 19th century, menopause was said to be associated with ‘moral insanity demonstrated by peevishness and fits of temper or self-absorption and exacerbated by reading novels, dancing, or going to the theater’. Two centuries on, not nearly enough has changed. Thankfully, we now take mental health and gender identity and equality seriously, in addition to physical health. By extension, we really should take the experience of menopause transition more seriously. Given the historical certainty of the experience along with the significant impact that it can have on quality of life for a prolonged period of time, continued failure to adequately address this issue for women in mid-life displays a notable lack of humanity.

You can read the full article here

Richard Hull is a Lecturer in Philosophy at the University of Galway. He is the author of Deprivation and Freedom (Routledge, 2007) and has published on topics including disability, genetic technologies, parental responsibility and agent intention. He served two terms on the Irish Council for Bioethics and is a member of the Irish Government’s National Advisory Committee on Bioethics. He teaches in the areas of ethics, political theory and applied philosophy.

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