The Insiders' Guide to the Menopause

On my 11th birthday, I went with some other girls to see a film.

This was...you'd go to the pictures on your birthday,

you were very grown-up. We went to see She,

the Hammer film based on the H Rider Haggard book and I had read the

H Rider Haggard books,

and this is She, Aisha, looking for the elixir of life,

finding it, going back into the fire a second time to take the man she

loves with her.

And she starts to age and she starts to crumble and she starts to turn to

dust and it's absolutely terrifying, and it was probably my first real

connection with old age.

Bizarrely, in my head, ever since then, I thought,

this is what the menopause is all about,

this is getting really, really, old, this is turning to dust.

It's nonsense, of course, and I have always associated it with this film.

Every woman goes through the menopause and yet there is something about

the word itself that has these negative connotations

of ageing and atrophy which, in our youth obsessed culture,

can be debilitating for women and even

embarrassing, and yet we are all living longer and working longer and

menopause is a feature of midlife.

It's the start of a new chapter.

So why the persistent taboo?

It really is time for a change.

I'm setting out to discover what the menopause actually is.

I've never talked about vaginas so much in all my life

since taking this on.

I spoke to Joan Collins once and she said menopause is a myth.

Find out the reality for some women.

Then I would get hot spells and they would disappear and I would wonder

what is happening to me?

I was 14 and it was diagnosed at 16.

I'd be making sandwiches with a knife in my hand and I would have to

put the knife down and just walk away.

Look at what we can do to help ourselves deal with the effects.

I noticed the difference in my symptoms within a week.

Then the hot flushes started and that was horrific.

It was a bit more like adolescent sex, a lot of fun, really.

Yeah.

I meet scientists at the cutting edge of controversial research which

could potentially reverse the menopause.

I will look for any evidence of follicles and eggs being formed.

And I'm curious to find out how older women have been portrayed over the

centuries and the way that has shaped our modern attitudes to age and the menopause.

In her award-winning book Hot Flushes, Cold Science

historian Louise Foxcroft examined how society has treated older women through the millennia.

Take us back to the Greeks, what was the menopause judged as then?

First of all, I would say it was not really judged at all because women

post menopause were just not interesting and, in fact,

what happened to them, they became much more masculine.

The female, she is pathological, she is deformed,

she's a sort of mutilated male, in fact,

and that is where the interest lies in her

and her pathology and her reproductive system.

Did the Greeks demonise then, women, post-menopause?

No, they did not demonise them, but they didn't do anything with them.

It's just not interesting.

It's the gateway to death. That's the end of them.

-They're finished.

-The Victorians have the idea that there is a link

between the womb and the brain.

That is an ancient idea.

That goes back to the early modern period and before that where the womb

is sort of a disreputable and wild organ that runs around the body and

distributes blood. Of course blood is a bad idea.

They thought at one point that the blood stayed in the body after

menopause and then causes cancers and other degenerative illnesses.

We had hoped that negative attitudes towards older women and the menopause

might have changed over the last century,

however, even if we don't talk about it much, we do laugh at it

and the menopause has always provided fertile fodder for comedy.

It's like a big tide of jam coming towards us

but jam made out of old women.

I've got a bad feeling about this.

-I think we'd better get back in the house.

-Go away. I don't want to catch the menopause.

'And sometimes it even requires a man to take on woman's trouble.'

I wouldn't tell another living soul this, of course.

I'm approaching the change.

Approaching the change?

From which direction?

The menopause like most things in life has its funny side.

But sometimes, it just doesn't feel like a laughing matter.

Despite the majority of women experiencing this transition between the ages of 45 and 55,

we are still shockingly uninformed about what the menopause actually is

and, more importantly, how to deal with it.

We are headed towards Dumfries.

Actually, funnily enough, I was born in Dumfries,

which was instant, unlike the menopause, which we are going to talk about,

which is anything but instant.

It goes on for a very long time sometimes.

It happens to all women so therefore why do we know so little about it

and why are women so reluctant to do anything to alleviate the symptoms?

These symptoms can be alleviated now, myself included.

I haven't done enough to alleviate the symptoms so I am on a quest to

find out more.

I am here to see one woman who knows more about the menopause than most.

Doctor Heather Currie chairs the British Menopause Society,

which provides healthcare professionals with information and guidance.

So it's normal process that our bodies go through.

Sadly, our ovaries are only designed to last a certain number of years.

We produce egg cells on average up until the late 40s, early 50s

and by the age of 51, on average,

women are stopping having periods and the reason they stop periods is

because we run out of egg cells,

but the complicated thing is we now live for many years beyond that.

So when our ovaries are not working,

the key hormone that we stop producing is oestrogen.

Rather than it being just about periods stopping and flushing,

it is around the consequences of the lack of oestrogen.

There are lots of taboos about gynaecology in general

and the menopause affects every single woman.

So we really, really need to talk about it more.

There are many aspects of the menopause

that women can be embarrassed to talk about in public.

I thought it would be interesting to see if I could encourage them to open up on radio.

You're listing to Kaye Adams on BBC Radio Scotland

here with you until 12.

Coming up, we will be talking the menopause with Kirsty Wark,

and we would love to hear from you. How was it for you?

Maybe you're still going through it. Did you consult your GP,

your family, your friends, your work colleagues? Do give us a call.

We are also joined by Doctor Fiona Kennan,

but we would love to hear from you this morning.

Kirsty, can I ask how was it for you?

Not great, really. Absolutely.

Not great medically induced,

hysterectomy at 47, everything whipped out,

HRT for three years and then came the big boom scare.

And suddenly HRT was taboo

and I came off HRT and actually my symptoms have not really gone away in the last ten years.

-What about you?

-I don't seem to have been affected.

-I know that I annoy people.

-You're not annoying me at all.

Virtually 100% will experience some symptoms, Kaye.

You're wonderful, you and my mother.

I do stick my leg out of the bed at night.

Hot, hot flushes.

I think that is a symptom, Kaye.

Even if it is only one leg.

-Only one leg.

-The menopause would affect your urogenital system,

so you might get dryness down below, problems passing urine,

discomfort during intercourse, loss of libido.

People don't want to talk about that stuff with their doctors.

I want to hear from women about how detrimental that is to their lives.

What you want to hear from people,

you get what you want because we've got lots of them.

Let's speak to Nan. Good morning, Nan.

-'Good morning.'

-How are you this morning?

'I'm OK.

'I've had a horrible, horrible night with hot flushes.'

-Oh.

-'Yes.'

-Does it affect you every night, Nan?

'Every single night.

'What I would like to ask is, I am 78, am I too old to go back on HRT?'

You may also want to consider other options,

non-hormonal options which can be helpful in some cases to control hot

flushes and which we sometimes use for ladies who are not so suitable for HRT.

Just a wee second, we talk about going through the menopause

as if it is a discrete period of time.

You have been experiencing menopausal symptoms for more than 30 years.

'Yes, I have.'

The average figures are that ladies will go through the menopause symptoms

in about four years, but the range,

we would normally quote a range of up to about 12 years.

Actually, we have Margaret on the line who I think is in a similar boat.

Margaret, just for people who are not at this stage of your life,

when you say sweats, it doesn't always sound that dramatic.

'It is terrible, I'd throw the covers back, get out of bed,

'cool myself down, onto the tiles in the bathroom,

'walk about there and cool down and then back to bed, and then up again.'

Aside from all the other symptoms,

the sleep disruption associated with that is huge.

'Sleep disruption's a big problem.'

Coming up to five to 12.

Time is against us.

We are talking about the menopause, let's speak to Angus.

Good morning.

'Good morning, Kaye. I saw my mother when she was going through all of this.

'I did not understand it, I was about 11. She was so depressed, etc,

'and at one stage they were thinking of committing her

'into an asylum or something like that. The doctor

'said "Right, we will give your wife pills, if it doesn't work,

'we will have her committed,"

-'and Father said, "Over my dead body."

-'

That was really, an overwhelming response,

I have to say, and it was very immediate

which is interesting.

As soon as you were on,

somebody is saying to me, really busy on this, really busy on this,

and actually we quickly took a decision to dump what we had planned

for the last half-hour of the show.

You kind of know that you have touched a nerve when that happens.

Sharing experiences honestly and bravely

is a very powerful thing to do.

And it can help others to know that they are not alone.

Especially if they feel they are having to battle to be heard,

even by their GP.

I was 46 when I started to see my periods have got less.

And I feel that I am going through the early stages of the menopause

and his words were, "You're far too young."

The menopause does not happen until you're 52.

Just like that. 52, on maybe the 3rd of January.

-Great.

-A few months down the line I noticed other things like low mood,

feeling very depressed at times.

Tearful, emotional for no reason at all.

So I went back to him again and I sat with him and I said to him,

"Look, I know I'm going through something. Something is happening to me."

"Maybe it's just a bit of depression, you're having."

I said, "No, I know fine it's not a bit of depression I'm having.

"That's not causing hot sweats," and I said, "If you do a blood test

"and if it comes back, we'll take it from there."

He said, "I'll do the blood test but I still think that...

"..you're not going to be, it's not going to show anything."

What happened?

So I went back and he said, "There it is written down in black and white,

"likely to be perimenopausal," and I breathed a sigh of relief.

I think lots of people identify with Caroline's story.

I think lots of women will feel I have just got to manage it,

because their GPs have been unsympathetic.

I think there are lots of GPs that are sympathetic, but I think for many

women, they don't get the answer they want first time and don't feel

confident about getting an answer the second time.

So it is a kind of suffer in silence.

We are all aware of the many pressures GPs and the wider NHS face these days.

In 2015, the National Institute for Health and Care Excellence, or NICE,

published its guidelines designed to clarify the confusion

about both diagnosis and management of the menopause.

Professor Mary Ann Lumsden is an internationally renowned expert on

the menopause. She chaired the specialist group which developed the guideline

by re-evaluating all the existing evidence.

What we wanted to get across is that menopause can cause problems for a

lot of women. That help is readily available for them,

should they want it and that every woman needs to be treated as an

individual, because everybody's circumstances are different.

There are lesser known and surprising symptoms.

It is not just hot flushes and mood swings.

Zarina has been dealing with joint pain for more than a year.

I didn't think it was anything to do with menopause.

I thought it was because I was hitting 50,

and I'm just getting old, so I'm getting these aches and pains in my joints.

I need to get more fitter.

There were other things that were going on as well.

I was having really bad dizzy spells.

I was getting really bad headaches, very bad severe headaches.

What do the pains actually feel like?

It was like shooting pains, in my ankle or my knees,

either get a pain that would shoot down my leg

and then you would have an ache that would last for days.

So, you've had all these different things,

you've had joint pains, and night sweats.

-Yes.

-And you go up to the loo in the night?

Yes. And then you get thirsty because you're sweating in the night and you

drink water and then you drink water and you need to get up to go to the

toilet, but most of the time now, after every two hours, I get up.

You've got two options, you put up with the night sweats, the dizziness,

the joint pain,

going to the loo in the middle of the night or you maybe seek some help

for it, and it might alleviate some of your symptoms.

-What are you likely to do?

-What I would want to do,

is make my life better and have a better quality of life.

But, the way I am, I would probably just ignore it and just think,

it's going to get better and I think part of me thinks,

it is a passing phase that the menopause is something that will be here

for a little while and then you go back to normal.

I know that's not the case, but in my head,

I'm probably still in denial.

The most common treatment for menopausal symptoms

is hormone replacement therapy, HRT,

which helps replace the oestrogen lost

when our ovaries stop producing eggs.

It can be taken via patches or as a gel or tablets.

But it's been hard to work out if it's wise to take HRT.

This is due to the confusion ignited by the publication of the

women's health initiative study in America back in 2002.

The study cast serious doubts on the safety of HRT.

So, 2002, HRT study cancelled over cancer and stroke fears, The Guardian,

HRT risk to breast cancer in the Mail,

HRT does more harm than good, 2002.

2008, new cancer fear for women taking HRT and then HRT is safe for

millions of women.

Again the Express, two Express stories.

New menopause guide says one million women can benefit from HRT.

This is why it is all so confusing.

I was using HRT tablets for three years after my hysterectomy

but stopped suddenly, like so many women, because of this scare.

In 2002 the result of the women's health initiative study came out and

those suggested that being on HRT hugely increased your risk of breast

cancer and at the time it seemed like being on HRT even for a short period.

So at that time people just stopped taking their HRT because of this

risk. Lots of them without any discussion with a medical professional,

they literally stopped, cold turkey and after that people stopped coming

to ask for HRT from the doctors

and GPs became less and less familiar with

prescribing it and also got caught up in the safety issues around it so

were probably less likely to suggest it to their patients.

-So it's a kind of vicious circle.

-Yes.

Subsequent research suggested that the analysis of the data was

flawed and that the findings were overstated.

But these more positive reappraisals received nothing like the same

publicity as the original scare.

More up-to-date research has attempted to offer clarification of the risks involved.

The current understanding is that if women take oestrogen only,

which is taken if a woman has had the womb removed,

had a hysterectomy,

there seems to be very little increased risk of being diagnosed

with breast cancer.

If women take HRT which is oestrogen and progestogen,

the other hormone, progestogen, is added in to protect the lining of the womb for more

than five years after the age of 50,

there is a possibility that there is an increased risk of being diagnosed

with breast cancer. The other thing we have to clearly remember,

which is a really important fact,

is that there is no evidence that HRT causes breast cells to turn into

cancer. It may be that it is promoting something that is already there and

the other really important fact is that being overweight or drinking two

or more units of alcohol a day are actually really important risk factors

for breast cancer,

and particularly being overweight is a far greater risk factor than taking HRT.

The feeling now is that for women who are having menopausal symptoms,

for most women the benefits of HRT outweigh the risks.

And it is the most effective treatment that we have for controlling symptoms.

Janice has been taking HRT for almost ten years.

She began to experience menopausal symptoms when she was just 39.

I had this flush and I could feel it and my sister turned round and said

to me, "Are you OK? You've gone awfully red."

And I thought, thank God!

It is actually noticeable.

I didn't just imagine this.

So, I went back to my GP just after,

well, it was actually my nurse and I said to her,

"Could you do the test for me, just to put my mind at rest?"

And she put it through and she said she'd get back to me in a couple of

weeks' time. She phoned me two days later and said,

"You were absolutely right."

She says, "Your hormone balances are all over the place."

So, after that I started dealing with a female GP.

She offered me the chance to go on HRT but then, you know,

talked about the risks that were involved,

like the breast cancer risks and suchlike.

But also about the risk at my age of osteoporosis.

And we didn't really have much of a history in our house,

in our family for breast cancer.

So for me the osteoporosis thing was more of a sort of...

because my mum has arthritis and I have known people with osteoporosis

and thought, "Oh, that's horrible."

So, talking about that made me more inclined to go with the HRT option

and they put me on patches.

And so I started on them and it was great.

How quickly did things change once you got a patch on?

I noticed a difference in my symptoms almost within a week.

The sweat, the night hot flushes weren't nearly as bad.

They still came,

but they were so much more bearable, sometimes you barely even noticed them.

Janice's concerns about osteoporosis are certainly well founded.

It's a condition that weakens bones,

making them fragile and more likely to break.

Reaching menopause at a younger age means your body is losing the oestrogen

vital for bone health even sooner than usual.

Many of us are a generation who've watched our mothers experience the

effects of osteoporosis with multiple fractures often,

and decreased mobility, loss of confidence.

It's an awful disease and it is extremely common,

particularly in women.

And so some people would like to prevent osteoporosis.

It doesn't totally prevent fractures,

but it certainly can go some way in doing so.

HRT decreases the likelihood of a fracture.

It's a beautiful sunny morning and I'm on my way to have a bone density scan. A Dexa scan.

And the reason I'm having it is that it's definitely the case

that bone density is a pretty critical issue for a lot of women

going through the menopause,

and osteoporosis is a pretty horrible disease.

I am not expecting to find problems with my bone density

because it's not in the family. I'm reasonably fit and healthy, but you never know!

Dr Adamson, nice to see you.

We're going to use this calculation tool just to calculate your

probability of a fracture and then that will help us to guide us as to

whether you need a Dexa scan or not.

You can see the first thing that we need to just pop in is your age.

-61.

-OK.

And then you're female.

No previous fractures.

-Parent fractured a hip?

-No.

-You don't smoke?

-No.

And alcohol.

So the question here is three or more units a day?

So that would be 21 units a week.

Pretty sure most times I'm under that,

but there could be the odd party time where I'm over that.

Of course. So we calculate it both ways because I think it's quite

interesting to see the difference that that makes.

So if we do it without and then we calculate,

you can see that your fracture risk there is 6.7% over ten years.

And just to see that visually, you can see there.

So, I'm in green, just.

Just in the green.

And then if we change that and say, yes on the alcohol,

that takes us up to a risk of 8.3% over ten years,

and you can see that that's

just enough to push you into the category where

we would measure your bone mineral density.

-So, actually, lifestyle is really important.

-Really, really important.

Yes. Alcohol intake is very important.

-And if you were a smoker then that would have pushed you even further into that category.

-OK.

OK, so we'll just get you to come over and lie up on your back on the table.

Just shuffle down the bed an inch there. That's lovely. And just rest back.

So, we're going to start off by taking a picture of your left hip.

We use this as an average across the population.

So we do the left hip on every one and the lumber spine.

OK, so that's just ready for the first scan.

I'll just pop this hand just on to your tummy.

Just nice and still there.

It has recently been estimated that by the age of 70,

half of all women will have had a fracture related to osteoporosis.

So, what we're going to do now is position your knees on top of this pad.

Just there. How is that for you?

-Fine.

-OK.

No instructions for you, just to lie nice and still.

Not even pressing my back into the table?

No. Just relaxing normally.

Osteoporosis can be treated and bone strength increased in a variety of

ways. But because it can lead to such devastating consequences,

it should always be addressed.

Fantastic! That's us all finished.

-Hi.

-Hi, Kirsty.

-How was that?

-Straightforward.

Good! Good! Are you a bit anxious to see the results?

I'm keen. I really am keen.

OK, so we'll start with the spine.

-Yes.

-OK.

Bottom line here, total T-score is minus 0.7.

That's normal. A T-score down to minus 1 is normal.

A little bit of a different story at the hip though.

-OK.

-Nothing to worry about desperately,

but just below minus one.

So minus 1.1.

So, classification of that would be osteopenia.

Right, so it's pre-osteoporosis.

-Wow!

-Just a little bit thin at the hip.

Minus one down to 2.5 is osteopenia.

And below minus 2.5 is osteoporosis.

So, what does that mean in terms of what I have to do about it?

So, we would just recommend lifestyle management.

Lifestyle changes.

So the kind of things we talked about earlier,

keeping your alcohol intake down.

You don't smoke.

Sensible, healthy diet.

Making sure you get a decent amount of calcium in your diet.

-Yeah.

-Yeah.

-And in terms of alcohol, it should be south of 14 units.

South of 14 units, where possible.

Yeah.

Good. Well, I better get a grip on that.

OK.

Well, that was a bit of a surprise.

I was quite shocked, actually.

But, you know, it could be a lot worse

and I can do something about it.

I'm now beginning to wonder if coming off HRT so suddenly all these years ago was a mistake.

If I had kept taking it would my bone density have been better?

So is it too late for me to start taking it again?

It's not ideal to have that gap, but we can't turn the clock back,

so what we have to do is look at the safest way of taking HRT and

certainly start with a low dose and you'd give consideration as to the

root, whether it was tablet or a patch.

But, yes, I feel sorry for a lot of women who,

you know, this has been often described as ten years wasted,

but HRT is definitely still an option.

There's obviously been an impact on my bone health and I'm going to have

to be extra vigilant for the rest of my life.

It certainly wasn't something I was thinking about in my 30s.

So, let's look at this.

Back when she was in her 30s,

Jennifer Saunders was writing about the funny side of the menopause.

-Did you go to the hospital?

-Yes.

And to the gynaecologist.

I hate gynaecologists,

a man who can look you in the vagina but never in the eye!

Used that line about four times!

Patsy's got osteoporosis.

She has the lowest bone density on record.

Cheers! Well done, darling!

She is just gristle clinging on to bone powder.

This is what happens when you have the menopause.

-No!

-No!

-You will learn about this and you will take control because

frankly, if you don't...

See you learn about this and take control.

Certainly was a precedent.

Oh! This is bad!

BONES CRACK

Oh!

-Is that my leg?

-It's my leg.

Split!

Oh, God!

When you look at that now!

I know!

Oh, my God! Little did I know it was all going to happen.

When you were writing this episode,

this was specifically about the menopause.

Yes. I wonder why I did that?

I think I did it because I thought it would be funny if Patsy had osteoporosis.

We liked it when she had a breast check,

so I thought anything gynaecological with Patsy is really funny.

And we don't know how old she is,

so I thought she won't have any bones in it, so it's a funny thing.

Yours was a particular kind of menopause.

-What happened?

-I was, I got breast cancer and so I wasn't menopausal,

I was still having periods,

but the second year of chemotherapy all your periods stop

and so you're sort of plunged into it, but because you're so full of

chemicals, you really have no idea.

It's like the tiniest thing.

Compared to everything else that's happening.

By the time you've got over the chemicals and you're on Tamoxifen,

which gets rid of all your oestrogen, you can't tell the difference.

You don't know what's coming out of chemo and what's menopause and it

wasn't until, I think about a year after,

that I started to feel like, oh, this doesn't feel right.

This feels different and it changes everything.

It changes your metabolism, your energy levels, your skin, your hair.

Everything. I mean it was quite astonishing.

-So, how did you deal with it?

-I don't know.

I drank. No!

I had a large glass of champagne!

And got on with it. I think you just get on with it.

What are your symptoms now?

I mean I still have, my main symptoms are night sweats and bad sleep pattern.

I've always had a very good sleep, I'm very good at sleeping.

-Lucky you!

-Yes, I'm very good at sleeping, but the

first time I had a hot sweat it did take me by surprise.

I kept going, "What's that?

"What am I sitting on? What am I sitting on?"

I kept thinking... It felt like I was sitting on a radiator.

Sitting on a radiator.

I was looking around the room going, "Is everyone else?

"No, they are not hot like me."

Do you actually feel different post menopausal as to who you were before?

Is that tied up in the breast cancer as well?

No, I don't really think about the breast cancer.

But I think, yeah,

I think it happens and all the things I used to make jokes about are so true.

You know, just your place in the world and how you feel about yourself.

Your general feeling of sexiness and libido and, and,

it's an indefinable something that you don't have any more.

But for me, I feel completely able to do what I want to do.

Some of the physical changes of the menopause can massively affect a

woman's self-esteem. Like Jennifer,

Isabel experienced what is termed medical menopause,

'that is when a woman is catapulted putted into menopause unnaturally

'because of surgery, like a hysterectomy,

'or as a result of cancer treatment.

'Isabel experienced symptoms almost overnight after she had her ovaries removed.'

Because I didn't feel like me.

I didn't really feel like me.

When I was looking in the mirror I had changed so, so much.

My face had changed, it blew up, everything.

My skin was really...

My mum always had amazing skin,

she always looked younger than what she was and I prided myself in that.

I then developed a beard as well

and my husband... That became a joke as well because my husband has got a

goatee and these hairs stop growing on your legs but they just travel up

to your chin, so tweezers became my best friend.

Do you think there is a problem talking about the menopause?

Yes, I think so.

I think in one way it's you're facing the fact that you are no longer

a young woman. As we say. So you've got that to get over as well, that this is now...

You're not going back the way,

there's no change, as much as I didn't want to have any more children,

it's gone. All that's gone, you're into a new phase of your life but...

-And I think...

-But the point is you're not old.

You're young, middle-aged.

But it made me feel old.

For some women like Isabel,

the menopause can really shake their confidence but it doesn't need to

feel like the beginning of the end.

No matter what we look like on the outside,

inside our bodies are inevitably ageing

but there are many ways to deal with that.

We know that being low on oestrogen also affects our bone health and our

heart health and for these reasons, so HRT is part of the option,

one of the options, if we need to take treatment for

menopausal effects but

also diet and lifestyle changes are really important as well.

So not only are the symptoms important,

but that should also lead to a discussion

around what can I do to improve my health later on?

Now, some people turn their noses up at herbal remedies or

different kind of, almost talismanic things.

But I'm going to meet Karen.

The thing about Karen is that she swears by her lady magnet and

what we're going to do is we're going to see how that works for her,

what difference it's made to her life.

For Karen, and women like her who have a family history of ovarian or

breast cancer, taking HRT does have slightly increased risks of

breast cancer, so Karen felt it was not a safe option

and she had to consider alternatives.

So I looked at my diet,

I looked at my exercise regime,

which was kind of non-existent at that time,

and I thought I've been a runner before, I can do this again.

That's been a big part of your, as it were, rejuvenation.

It has been an absolute huge part of my rejuvenation.

And then I thought, right OK, the exercise thing is there,

now I need to adjust my eating.

My eating habits were just a bit appalling, really.

Then the hot flushes started.

I thought, what's this? I was like, what?

People had told me about this and you just have to whip all your

clothes off and then it doesn't matter where you are,

Marks & Spencer's or anywhere, you'd be like...

And people will be looking and you going, "Oh, dear."

Well, I was having up to about 85 hot flushes a day and night

in a 24-hour period. I've ignored this a wee bit.

No, I'll do it, it's my job.

And so I heard about this magnet and I thought, right, OK.

People wear magnets for arthritis and rheumatism,

and it works on the same principle as that.

I think it's a balancing thing.

So how long did it take to stop the hot flushes?

It took me about eight weeks.

-But you persevered?

-For me to notice a difference and the difference

that it's made to my life, I probably have maybe four,

five hot flushes a day now.

I'd still say four or five is quite a lot actually, but obviously compared to 80.

Compared to 80 it's not.

And you think it's definitely the magnet and not a progression of your

-menopause?

-It could be a progression of my menopause.

-It doesn't matter because it works for you.

-It doesn't matter because it works for me.

So it could all be psychosomatic but it works for me.

-Can I just see the magnet?

-Yes, of course.

That's the magnet now. How does it...?

It's two bits. Two pieces to it.

-Right.

-And that it goes inside, up against...

-Yes.

-Your pubic bone there.

-And the other bit goes on the front of your knickers and keeps it firm.

-And that's 24 hours a day?

-24 hours a day.

Magnet therapy is just one option for dealing with the menopause.

Although there is no comprehensive medical research to back up the

effectiveness of alternative therapies,

the idea of a placebo which works on the mind rather than the body has been proven.

Placebo work brilliantly for everything.

And you need quite an effective treatment to be better than

placebos, so I never say to a woman something won't work.

-Never say that because you know that in a certain proportion of cases it will.

-Why?

I suspect it's because of neuronal pathways.

The control of hot flushing is in the brain

and it's an alteration in the perception of temperature,

heat and cold.

So you react very quickly to changes in temperature postmenopausally in a

way you don't premenopausally, due to the absence of oestrogen,

and I wonder if somehow the placebo, if you like,

relaxes somebody.

They feel differently and this impacts on the way the brain is working.

It's quite possible.

This connection between mind and body can have a massive impact on our lives.

One of the effects of the menopause is the mood swing or indeed low

mood, as I've heard it described.

And that can be incredibly upsetting and debilitating for women

experiencing that, but just as upsetting and debilitating for

relationships, be it with your partner or indeed with your family when,

all of a sudden, out of nowhere

a rage comes on.

Women are, historically and traditionally,

have been thought of as unstable, volatile, uncontrollable.

What happens is that they are supposed to, post-menopause, do good deeds,

do charity, to become serene, to get by on just the love of their families

and the love of society.

Generally keep quiet, not rock the boat,

vanish. Just disappear and if you don't do that

then you're troublesome and

then you can be diagnosed with a immoral insanity or hysteria.

Hysteria was a very big thing, only dying out in the early 20th century.

The cliche of the older woman as mad, bad and dangerous to know

is the comedy gift that just keeps on giving.

-Dougal!

-Hello.

But uncontrollable rage is no joke.

For Jackie, it's been horrendous.

She was prescribed antidepressants for six months

to try to help her cope

but she didn't feel that was the best way for her.

She's been trying to manage the effects of her menopause without

medication for more than a year.

It's like having an out of body experience where I'm watching and

listening to myself ranting like a lunatic.

Completely nuts and what I'm saying is irrational

and the logical side of my brain is saying, "Shut up, you are being stupid," and I can't.

So did you direct the attack at anybody in particular?

My husband got it every time.

And sometimes he'll poke fun at me a wee bit just to make me laugh

and he actually said to me, he says, "It's not the menopause,

"I've got another phrase for it," and I said, "What is it?"

Me - No - Pause. He says, because see when you start,

you don't know when to shut up.

Full-on. You know,

all those years ago women were locked up in lunatic asylums for it

and I'm thinking, "Yep, that would probably be me."

If that was a century ago, that would have probably been me.

What, losing the temper, losing the rag, going into a rage?

Absolute rage.

And I've been making sandwiches with a knife in my hand and I've had to

put the knife down and just walk away.

How do you calm yourself down?

Well, I was taught some breathing techniques.

So I close my eyes, imagine this light round me,

slow down my breathing and imagine either running water...

I'm either at the side of a river or on the shore

and then as my breathing slows down,

I then lie down on the bed and carry that through for the next 10-15 minutes.

Just concentrating on breathing slowly,

deeply, in and out.

Finding practical ways to cope with the symptoms of the menopause can be

an uphill struggle.

'Three teas? I invited some of the women I met in the course of making this film for afternoon tea.

'And the chance to get a bit more information and support from Ruth Devlin,

'who runs workshops for small groups of women.

'She's also the Scottish ambassador for the British Menopause Society.'

So do you take us through,

do you now take us through different treatments for what happens?

Yes, I will go through different treatments.

-Great.

-You'll have heard of vaginal atrophy being bandied around.

Well, that just means that basically everything is thinning and wasting

away down below. I've never talked about vaginas so much in all my life

since taking this on.

Very easily treatable.

You can have the moisturising lubricants or you can have vaginal

oestrogen. That is the safest way to take HRT.

It is a tiny, tiny, tiny amount of oestrogen.

It's extremely safe and it's also not systemic because it's localised,

so it's not being processed through your liver,

so it's the safest way that you can have it.

You get something like this tiny little tablet in the end there which you

insert. You can start off, if you've got bad symptoms,

you can start off having it daily and then reduce it down

to twice a week and then you might find

that you just need it once a week.

If you take oestrogen like that,

that is a general good or is it too small a dose?

The vaginal oestrogen is only treating your vaginal atrophy.

-That isn't treating any of the other symptoms.

-OK.

-If you want to go...

-This poor woman's having a hot flush.

It always happens at the most inopportune times. Sorry.

-Would you like some water?

-I've got some here, it's OK.

That one came from your head down. Explain to me what's happening.

Right, it starts here.

And as much as you try and put it off,

you can't and I was getting hotter and hotter and hotter and I thought,

typical. This always happens to me at the most inopportune times.

-Can happen anywhere, can't it?

-Yes.

-It doesn't matter, you just proved it.

CBT, cognitive behavioural therapy has definitely been proven

to help with all your psychological symptoms,

but also now you can train yourself to help manage your hot flushes

and your night sweats as well.

I don't get many hot flushes but sometimes they come on if I'm stressed

with something or a train journey being late or about to miss a flight

or something. That tends to bring them on.

Sometimes they'll come on in the middle of a meeting at work

and it's usually a meeting where you're predominantly surrounded by men.

You should just be able to take a little fan.

A rather lovely fan and fan yourself.

That would be wonderful.

It's one thing for women to talk to each other but symptoms that can

affect a couple's physical relationship are often really tricky to tackle.

Artists Minty and Nick have been together for almost 30 years.

We don't have children and that's through choice.

So for me, in a way,

going through menopause isn't tied up with reproduction.

When you were going through the menopause, what symptoms did you have?

The big one was vaginal dryness and soreness

and how that affected having vaginal sex,

and that was a bit of a shock.

Yeah, and was that gradual or did you, when you went through menopause,

-was that quite quick?

-It was quite quick actually.

It was really quite quick.

It seemed to go from being completely fine

and everything in the garden was rosy, then, ooh, what's going on?

This is actually sore, this is not...

This is not comfortable.

So what did you do about that?

-Initially...

-Initially, I suppose you kind of, you know,

take a little bit of advice and suss out things that might help.

-But that wasn't really...

-It didn't really seem to make enough difference

and the kind of faffing around with tubes of lube and stuff like that.

Yeah, it was odd to find it not straightforward.

-Yes.

-But, I mean,

it wasn't that difficult to start going, OK,

how do we enjoy having sex but in a different way, or whatever?

So without penetration, that's the key thing?

-Yeah, without that.

-Wasn't going to work.

I mean, we often sort of talk about it as a bit more like adolescent sex,

really, which a lot of fun, really.

-Yeah.

-Yep.

And it's kind of, you know, it's a funny thing.

Then you go, actually,

but we think about sex as being just about vaginal penetrative sex and

actually it's lots of things.

But clearly,

I mean it's wonderful because you have a relationship where you can

talk about this stuff and you can deal with it together.

Yeah, I think... There was a bit where I felt like...

I was letting you down, I think.

We don't always talk about everything immediately, it maybe took a week,

a month or so, before...

Or you said, I'm not sure which of us said, actually, you know,

if this is just painful, let's just stop trying to do this and it's OK.

I mean, there's other options.

Nick and Minty were just so honest and giving and reassuring about the

impact it's had on their relationship and how they've dealt with it.

And it must be like that for lots of people.

We tend to think of the menopause as something that usually happens to

women in their 50s,

but going through a natural menopause before the age of 45 is not uncommon

and a tiny proportion of women will experience it at a very young age.

It's a devastating diagnosis to be told.

We've had lots of young women who'd been told, it can't be menopause,

you're too young, but actually we are encouraging

that investigations are carried out. So there is the fertility aspect,

which is hugely important and, as I said, absolutely devastating,

but there are also then these extra number of years of potentially being

low on hormones.

'Dealing with the health implications of the menopause

'when you're extremely young is a lot to bear.

'When it happened to Heather, she was still at school.'

I was very young when I went through menopause.

It was termed as premature ovarian failure.

I was 14 and it was diagnosed at 16.

And in those two years do you remember what life was like?

When I was 13 I started to miss periods, so we went to the GP who had said,

"You're still young, they're just settling down."

So we just kind of forgot about it and, actually,

I was quite pleased that they weren't there

because they'd been so heavy and painful.

But actually at school that must have been quite interesting

because your friends were having periods and you weren't,

so you are able to say, well, actually, I don't feel so bad.

I don't feel so bad, exactly.

I was doing my GCSEs,

quite glad not to have periods but it was at the end of that,

when I was 16, that we went back to the GP and said, "Look,

"I think this needs to be looked into the bit further."

And that's when I was referred to and an endocrinologist, who said,

actually, you're no longer ovulating,

you've had premature ovarian failure.

But your mum was perimenopausal at that moment, no?

She was in her early 40s, hadn't gone through the menopause,

my grandmother had not long gone through the menopause,

so it wasn't something that I'd ever really thought about.

How did you and your mum talk about it?

I think after we left the hospital there was that initial...aah

..moment and I had a good cry.

Always knew that I wanted to be a mum,

and that was the only thing at first that was sort of sticking with me.

This is going to be quite difficult to be a mum now.

So when did you meet your husband?

When I was 22.

And he would have known from the beginning?

Yes. About six weeks in, I knew, very early on,

that he was the man for me, so I had to test at that point.

It was a big part, I wouldn't want him down the line saying this is a deal-breaker for me,

-so...

-And the implications for you in terms of having a family were,

obviously, huge. But you have taken steps.

We have tried egg donation and IVF treatment

and unfortunately it wasn't successful.

It was quite a painful time.

It was five years ago and we haven't tried since.

And there is a part of me that doesn't want to get hurt again.

At the moment, I'm over the weight limit to get treated,

so I think a little part of me is thinking, well,

I can't get the treatment, I can't get hurt again.

So, there's a little bit that I need to work on with myself to do that.

But it hasn't dulled my want to have children.

Entering menopause at such a young age is extremely rare,

but it can happen in your 20s or 30s and this has a massive effect on the

chances of having children.

But in the future, this may not always mean the end of a woman's fertility.

In Edinburgh, Professor Evelyn Telfer and Dr Marie McLaughlin are

collaborating with US scientists on ground-breaking research to determine

the potential of our ovaries.

The prevailing wisdom has been that woman are born with a finite supply

of eggs. However, a controversial scientific paper was published

in 2004 which challenged this thinking.

The view now is that ever since the work of an American scientist at

Harvard, he discovered a population of cells

within the ovary that had the potential to form new eggs later in life

and that was the work of John Tilly.

And this really met the scientific community with surprise and...

-Scepticism.

-Scepticism, and I was one of the sceptics.

I was really incredibly sceptical.

He came to our lab.

He brought the cells and we then saw what these cells were capable of,

and we then thought, well, you know, there is something in this.

The game changer was the cells that had the potential to form eggs.

Now, that's different from them forming eggs throughout life.

So, they may well be sitting there, dormant,

but if they're given the opportunity of the correct environment they may

well form new eggs.

So, we then decided we're going to look to see if we can isolate them.

These are cells that we have taken, we've taken a piece of human tissue,

cut into very, very tiny pieces.

We've dissociated using enzymes and filtered that,

so essentially we have a single cell suspension.

We've then used an anti-body to try and tease out the cells that have

-the important molecular markers.

-Potential?

-Yes, that's right.

The gem cells and then we've gotten these back and sorted them out and

then grown them to a point where we think we can see cells that look

as if they're developing into eggs.

And to them we would then inject them into small pieces of tissue and

watch and wait and see what happens.

At this stage, we see our researchers finding out more about the ovary.

We see it more in terms of say, alleviating infertility

for particularly young girls who lose their eggs

very early and that may well be through a genetic disorder,

or chemotherapy.

But I think we really need to get more,

a greater understanding of how the ovary actually works,

and then we can, you know, understand the process of menopause

and how we view the ovary as well.

The work that Professor Telfer and her team is doing is potentially

transformative for all women who are, for whatever reason, infertile.

But it's got something else going for it,

it also means that the way we view the menopause may well be different

because it may not be the end of a woman's child-bearing years

and if that is the case, what is the impact that will have

on the way we look at ageing?

In years past, women have often been written off after a certain age,

when work and child rearing are at an end.

But in the early 21st century,

when the average life expectancy for women is now 81,

how can we best approach this next stage?

I don't think many people have thought through that women will live

probably a third of their life post menopausally,

and so need to be absolutely at their best in terms of feeling well.

The key thing I think is let's talk.

Let's just talk menopause, so it is going to happen to all of us, so,

it's a normal event, but we need to tackle it and be proactive about it.

So, post menopause, women are still strong and vital,

creative and capable.

We are not in retreat.

Instead of fearing this stage of life,

the years after the menopause should be a positive, liberating time.

I don't feel any less intelligent

and, in fact, I think I'm probably more confident.

I think I set out more positively about things because I don't,

I don't know... I don't ever,

like if I go into a meeting or anything,

there's not that element of, oh, I wonder if I look all right? I don't have any of that any more.

I feel much more positive and confident about my own abilities for things.

In the making of this programme, I have met such lovely women,

willingly sharing our stories with us and some of these stories are very

different, all because they don't want other women to feel alone or to

suffer in silence. Of course,

some women will sail through the menopause and there'll always be women

who put up with whatever the menopause throws at them.

But we don't have to do that.

Things are changing.

I had no idea the extent and variety of symptoms, so, of course,

women should have individualised care.

And I certainly learned I need to take better care of myself,

to do even more exercise, watch my alcohol intake,

take vitamin D and now I may revisit taking HRT.

The menopause, the 21st century shouldn't be a curse.

It should be about stepping forward to embrace the next stage in our lives,

not letting it hold us back, and in order to do that,

we have to learn to be good to ourselves.