Menopause Doula
Many, have asked why we don’t talk about menopause when what we really should be asking is ‘How can we learn to talk about menopause?’
The word menopause appears twice on the Relationships and Sex Education and Health Education guidance published by the Department of Education in 2019.
You will find it on page 29 under the section titled –
By the end of secondary school – Schools should continue to develop knowledge on topics specified for primary as required and in addition, cover the following content by the end of secondary: Intimate and sexual relationships, including sexual health
To have the word menopause mentioned in the curriculum was certainly a huge leap forward and a long overdue addition to the other relationship and sex education topics. However, in specific content, I have not been able to speak with anyone who knows exactly what is being delivered across the country.
What about Menstrual Health?
As with all topics in education they need to be introduced at various points, in relevant and meaningful terms for the age group and cohorts.
The word menstrual gets 7 mentions in various forms as either products, cycle, or wellbeing, and menstruation gets 6 mentions. Go the Period Campaigners!
However, there is still no mention of menstrual health in the curriculum, currently.
The term Menstrual Health was developed through a multi-stage process, led by the Terminology Action Group of the Global Menstrual Collective in 2021 – only 200 years after the word menopause was formally adopted thanks to French Physician Charles-Pierre-Louis de Gardanne to describe the permanent cessation of menstruation.
Since 2021 the World Health Organisation has placed menstrual health firmly on the global agenda.
What about the missed generations who have not learned about menstrual health?
Trying to learn about menopause without first learning about the prequel event called menstrual health, has proven time and time again to be the one thing that is holding back the conversation.
Let’s take a closer look at the missing menopause memo.
Menstrual health, like mental health, can be positive or negative. Most narratives place anything to do with menstruation in the negative column and refer to ‘period problems’.
Menstrual health is every single day of a menstruators life, not only the days of bleed.
For those who follow the typical timeline, they will experience around 450 menstrual cycles over 40-years. The menstrual health timeline is forecast the moment two sets of chromosomes unite. Menstruation will start a couple of years after the ovaries have ‘switched on’.
The regular infradian rhythm called the menstrual cycle has an unpredictable sequence to start with and then within a few years becomes mostly predictable, creating ovarian/uterine patterns that are relative to each person. On average menstrual cycles range from 21-35 days in length.
The first 30 years of circulating menstrual cycle hormones influence everything from muscles, bones, digestion, energy, metabolism, immunity, respiration, and the brain. In total, there are around 400 roles in the body that are collectively driven by sex hormones, in all humans not only those who menstruate.
It subsequently makes sense that the fluctuating cyclical version of events, driven by the ovaries in a menstruator will have a cyclical impact on physiology, second by second. The last 10 years of pre-planned ovarian activity is one that becomes less predictable, known as perimenopause. The tipping point of perimenopause, also known as accelerated ovarian aging, is estimated to be on average age thirty-seven and a half years.
Aging conundrum: A perspective for ovarian aging. Research has shown that the decline in follicle numbers is a bi-exponential function of age, and this change occurs at the critical value of 25,000 follicles at the age of 37.5 years. Frontiers in Endocrinology
From this point forward ovarian aging speeds up, slows down, does a loop the loop and then closer to the typical menopause day (51) the menstrual cycle stops for several months at a time, until it finally stops, permanently.
In my opinion, to truly understand menopause and create confident conversations, you have to know about the menstrual health timeline and the sequence of events that start 40 years prior.
Menopause Doula
Perimenopause is the word used to describe the time before a typical Menopause Day. Which makes it easy to know when perimenopause finishes, but not when it starts.
The typical Menopause Day is the one moment in time when you have traveled along the menstrual health timeline to the point when the ovarian cycle has stopped permanently. When there has been no menstruation for 12 months, the next day is postmenopause, the time before that is perimenopause.
- Menopause Day may occur because of medication used to treat another health condition such as endometriosis or cancer, regardless of the distance traveled along the timeline.
- Menopause Day may occur before the age of 45, which is below the age of a typical menopause day which most often happens between the age of 45-55. This kind of Menopause Day is called Early Menopause.
- Menopause Day may occur below the age of 40, and this is termed Premature Ovarian Insufficiency (POI).
To some Perimenopause is a fairly new word, and others say it has been made up. The earliest known use is in the 1960s. The word was first used in an official clinical capacity in 2001 when the first Sexual Reproductive Agin Workshop (STRAW) was held and then modified to include Earl and Late Perimenopause when they met again in 2011 and the new revised edition became known as STRAW+10.
Peri means ‘a time leading up to’, however, it does not help us figure out when it starts. Medically they consider the key indicator to be a change in the menstrual cycle, or ‘fertility becomes unpredictable’ (don’t like that phrase either as it takes back to reproduction).
Menopause Doula
The Menstrual Health Timeline is a sequence of events linked to DNA and time. Menstrual Health orchestrated by the ovaries and the brain.
When someone is born with ovaries and a uterus they will take their first step on the menstrual health timeline when their ovaries switch on, which we know to be around the age of 8. From this point, the estimated time frame of ovarian activity is 40 years, before the ovaries switch off again.
The Menstrual Health Timeline v Reproductive aging
From the point of ovaries switching on, to switching off, is medically defined as reproductive aging. I don’t like that term because it places the role of the ovaries and uterus exclusively in the reproductive system category. What if you don’t want to reproduce or find yourself unable to, does that mean they have no importance? I have chosen to use the term the menstrual health timeline to reflect a journey that links, menstrual health and ovarian aging, to overall health and well-being.
What happens next?
- There are 100s of hormones. We know a lot about the actions of many but you will hear mostly about the top 20. There are 3 main hormones at the top of the list, particularly when we are talking about menstrual and menopause health.
- These 3 very important hormones, referred to as sex hormones, are made in all humans.
- They have a vital role in all 11 systems of the body.
- There are 11 different functional networks in all humans. They work together to keep us alive. One of the key parts keeping them operating well is the method of communication between them – hormones.
- Hormones have no gender. No hormone is exclusive to one gender over another. It’s a huge misconception, and even today our children are taught the wrong kind of language about hormone health.
Do Sex hormones need a re-brand?
Calling the top 3 (oestrogen, testosterone & progesterone) sex hormones is a very old nomenclature based on the fact that they are part of the development of secondary sexual characteristics in humans. Technically, progesterone doesn’t really qualify but gets grouped into it by default because of menstruation and pregnancy.
There are only 2 pages in a school textbook about these hormones and they are placed on gender pegs, which creates a smoke screen around hormone health moving forward. Scientists have known for decades that sex hormones play a role in all 11 systems of the body. Since I discovered this I have never understood why it is not in textbooks at school or university education. Speaking as someone who taught the A Level Biology curriculum, who now knows about this massive hole in our education system, I just don’t understand why there has been no upgrade in what we teach.
I will explain more about The Menstrual Health Timeline in future blogs, but for now, here is an illustration of what it looks like.
Menopause Doula
A Menopause Tool Kit is a collection of actions and items that will enable you to manage symptoms and optimize your physical and mental health as you travel the menstrual health timeline.
It could equally be called a Menstrual Health Tool Kit.
What you choose today, may not be what you choose tomorrow. It’s all about balance.
Choosing what to add to the robust selection of items can only happen when you have a clear understanding of where you are and what the options are.
1. Learn about the menstrual health timeline
You can read a copy of Menopausology (no email required). This short read will explain the process of menopausing and give you an insight into why menopause transition may lead to some physical and emotional challenges.
2. Keep a Journal to collect the data on you
Use a symptom tracker, pen and paper will do, to identify the signs and indicators that you are noticing now. You could also recall any other symptoms that may have come and gone in the last few months or years. Write down as much as you can about your historic menstrual health.
3. Tune in to you
As you start to notice more things about yourself, start to record the information in terms of food, mood, movement, and stress. Also, note any significant differences in relation to your menstrual cycle. It may take 30 days or so to collect enough information but gradually you will start to get a much clearer picture of when symptoms occur, what makes them better, and when they are worse.
Key ‘supplements’ that could be in any menstrual or peri/menopause tool kit, are*:
Breathing (Vit O) – get plenty of Oxygen. Controlled breathing, on purpose with a purpose, will instantly reduce stress which triggers a reduction in cortisol, which then helps all hormones work better. What kind of symptoms may be helped? Feelings of sadness, anxiety, physical strains, vasomotor symptoms (hot & cold flushes, and sweats)
Move (Vit E) – exercise that helps to maintain muscle strength and joint flexibility will keep you mobile for longer in your lifespan. Moving requires the heart to pump and the lungs to inflate. Both help with circulation and cardiovascular strength. What kind of symptoms may be helped? Mindset, emotions, aches and pains, flexibility, brain fog.
Food (Vit N) – a good quality of nutrients is essential. Without a great source of vitamins and minerals from a wide variety of real foods you are not going to experience the best kind of natural hormone cascades that your body should be experiencing to function well. What kind of symptoms may be helped? Crushing fatigue, brain fog, joint aches & pains, temperature regulation, insomnia.
Rest & Destress (Vit Sr) – Stress and Sleep are two vital components of life. Whilst we need positive stressors to function, too many for too long of the negative stressors will impair all hormone functions, slowly grinding us to a halt. Sleep, or rest, must be good quality to balance out the stress. Sleep can become impaired not only because of changes in ovarian hormone levels but also because we rush into it. Take more break points in the day to connect with the parasympathetic nervous system. For example, while the kettle is boiling stand still and breathe, prep your real food meals, and chop/mix in a mindful way, let your mind wander, and journal for 5 mins before bedtime. What kind of symptoms may be helped? Insomnia, overwhelm, lack of joy, anxiety, vasomotor symptoms, ear and eye ones (anything related to the vestibular system)
Social Connections (Vit L) – finding joy and laughter during times of confusion feels like a complex ask. ‘Shouldn’t you be focusing on the core elements?’. We are human beings and we benefit from being human with others. Oestrogen has a direct relationship with oxytocin the ‘cuddle and care’ hormone, which also happens to be a brain chemical. Without enough oxytocin, it directly affects our happiness dial. The bad news is oxytocin depletion can present as aching muscles, sleep disturbance, and a bigger appetite for sugary foods. The good news is laughter swaps the cortisol in the bloodstream with the happy hormones oxytocin, dopamine, and endorphins. Altogether they can improve immune functioning, stress relief, cardiovascular health, reduced anxiety, sense of safety, and improved mood. What kind of symptoms may be helped? All of the above.
*The Bottom Line – Obviously, there is a play on the word ‘supplement’ and those 5 vitamins are not real – but I honestly think they should be.
About Fiona Catchpowle
Here’s a quick version, because I can talk forever about how I became a Menopause Doula and created The Menopause School to teach others.
My background as a Biologist, Holistic Therapist, Lecturer, and Social Media Marketer provides an eclectic mix of skills, that were the backdrop to creating The Menopause School.
In 2017 I took perimenopause by the horns and made peace with it. I don’t think you can say you beat or won against perimenopause. I think it’s far more successful if you find a relationship in which you become one.
It turns out my previous life experiences had done little to prepare me for the curious journey from periods to postmenopause. I later discovered this was the case for almost everyone I met who sat still long to have a conversation with me about menopause.
Retrospectively, I now know that the beginning had started at least 6 years before. The classic sadness, insomnia, palpitations, crushing fatigue, and brain fog symptoms had been present on and off for many years. Mix in some driving in the dark, tinnitus, plantar fasciitis, and spontaneous vertigo you had a mysterious disease no one had heard of.
As a Holistic therapist with my own business, I had never learned anything about menopause and how it could have affected my clients. As a Biology teacher, I knew only 2 pages in a GCSE textbook about hormones existed.
For me, the worst part about menopause was the unknown. The anxiety that came with each new weird and wonderful health challenge was exhausting. By the time I got to 2017, the year I was going to be 50, I had used my skills and science-driven mind to devise a Food & Mood Diary, worked out a good movement routine, and identified lots of other triggers. I remember thinking how much easier it would have been if there had been someone to talk to. I simply wanted to reach out, have a conversation, and get some advice. Maybe someone like a Menopause Doula. I couldn’t find one so I decided to become one.
I started to explore how I could help others and it soon became apparent that there was no particular place or way of learning about menstrual health and menopause for Holistic Health & Wellness Therapists and other Complementary Alternative Practitioners. From this point forward The Menopause School started to take shape and officially opened its doors in September 2021. Driven by a passion to change the face of menstrual and menopause health education, I believe that this is possible by creating as many information touch points with menstruators as possible.
My aim is to create a global collective of Menopause Doulas. Saving lives, changing the world, one menopause at a time.
