Menopause ends menstruation-but before that, many women experience periods that can disrupt their lives and careers

Last modified on Monday, July 26, 2021 at 11.00 EDT

If Emma Pickett needs to travel a long distance, she will check the calendar very carefully. She often changes clothes urgently when she goes out. If she is going to work and lecture, she must ensure that it does not exceed half an hour. However, she rarely heard anyone talk about the causes of so many elderly women sneaking up on these troubles. Why do they start to insist on wearing black pants, give up their favorite sports, or carefully plan their holidays-especially with children.

"If you have a group of 12-year-old children in the car, you can't say:'I'm sorry, lads, I just shed a lot of blood today,'" said Pickett, a 48-year-old breastfeeding consultant and author of the book. The Breast Book, she is also one of five British women who have a long period before menopause (or perimenopause). "You can talk about hot flashes and make a joke. But because menstrual blood is disgusting in our society, no one talks about it. There must be women around the world just pretending that they need to run away for other reasons."

Michelle Obama frankly dealt with hot flashes at the White House, and the Countess of Wessex also recently admitted that she had menopausal brain fog. However, openly talking about wearing three pairs of underwear—just in case, or in response to what the Canadian gynecologist and author of the "Menopause Manifesto" Dr. Jen Gunter called the "super soaking event"—the bleeding situation requires varying degrees of courage. It penetrates into clothes, and even the combination of super-strong tampons and pregnant women's towels fails, causing women to need iron supplements, or in some cases to prevent them from leaving home. At a time when many people think their period will disappear politely. (Menopause is defined as the point at which no menstrual period has come in a year.) Considering that approximately 13 million British women are in perimenopausal or postmenopausal periods, there are still some transgender and non-binary people on similar journeys, and the silence seems strange. Deafening.

Today, thanks to activist movements, taboo-breaking books, and groundbreaking TV moments such as the period sex scenes in Michaela Coel's award-winning play "I May Destroy You", young women are becoming more and more frank about their menstrual cycles. But there are few middle-aged equivalents. The notable exception is Alison Pearson's 2017 novel How Hard Is It? There, her 49-year-old heroine was caught during a high-intensity work activity and was finally trapped in the toilet, bleeding on the beautiful towels of the hotel.

"I read that book and thought:'Gosh, this happened to someone else,'" Pickett recalled. But even Pearson, based on what happened to her at the awards dinner, later wrote that she was still ashamed of discussing it. The shame of losing control and feeling "my body, usually so reliable, openly betrayed against me" is deeply ingrained.

Helen Claire said: "You have been worried that there might be a stain on the back of the skirt that you didn't know about," said Helen Claire, a former biology teacher, of the teacher's coping strategies. "You have reached the point where you think you know how to manage women's bodies, but suddenly it starts to catch you off guard." In extreme cases, difficult menopause may even prompt women to consider exiting hard-won careers, when they should be there. The pinnacle of career.

For some women, the end of reproductive life may mean missing a few periods. But the “Guardian” readers asked about their pre-menopausal experience, and showed that for others, menopause, menopause, more frequent or unpredictable bleeding make them feel vulnerable, anxious, and exhausted.

"Menopause has broken my life," 48-year-old nurse Joey reports that her irregular menstrual periods and menstrual flow can now last for several weeks. "I am no longer the person I was two years ago. I often feel exhausted and can't cope at work and at home." She said that although she received professional training, she was "completely unprepared." "If men go through menopause and the hormonal roller coaster that comes with it, there will be more research and attention."

Dawn, 53 years old, is in the midst of a nervous divorce, and to her horror, she began to bleed non-stop. "I can't tolerate building a new life under such circumstances. I know that when I am fragile, this will seriously affect my mental health and happiness."

When Sonia, a 50-year-old university lecturer, was running in the park, her shorts and legs were suddenly flooded with blood: "I had to call my partner and ask me to pick me up in the car. Fortunately, this is It has never happened in my work, but I always think about what I would do if it happened."

This makes others afraid of returning to the office after the pandemic. Mona is a 46-year-old NHS worker. She breathed a sigh of relief. Her busiest day so far is the weekend: "Otherwise I think I have to take sick leave. I work with a lot of men. I can't stay in one last Thinking in a one-hour meeting: Did I leak secrets? I work in an office, but God knows how people spend 12-hour shifts."

Although 52-year-old Nicola was forced to sit on a blanket to protect her sofa, there are still some people who are unwilling to seek treatment for 52-year-old Nicola who still believes that “inconvenience is not a disease”. But others described the struggle with the indifferent doctor. "I often see people who have been abandoned feel that there is nothing to do," said Gunter, who has a whole chapter in his book about middle age, aimed at demystifying the problem. "But no one has ever said that erectile dysfunction is'just part of a man's life', right? We can say that this is a typical situation-if you want, there is treatment."

The official guidance of the National Institute of Health and Care Excellence (Nice) is that changes in bleeding patterns over 45 years of age should be investigated to exclude diseases including fibroids (non-cancerous growths in the uterus), polyps, and some rare diseases Cases, cancer. (Bleeding in postmenopausal women who had previously been menopausal should also be checked, as it may be a symptom of a more serious disease.) However, Dr. Paula Briggs, a reproductive and sexual health consultant at the Southport and Ormskirk NHS Hospital Trust, said that perimenopausal women have menorrhagia , A common culprit is hormonal fluctuations.

"This may be one of the most common symptoms of menopausal transition, and there is a logical reason," she said. When the body tries to stimulate the crumbling ovaries to release eggs, estrogen levels rise, causing the endometrium to thicken; but women who no longer ovulate regularly do not always produce enough progesterone to balance estrogen. The result is that the abnormally thick endometrium will fall off chaotically. Women may have large blood clots or sudden gushing of blood, forcing them to pay more attention to hygiene protection, or replace them every hour or even more frequently.

Briggs said that treatment options include the use of Mirena coils to regulate hormones, or combined or mini-contraceptives, but there are also non-hormonal alternatives, including endometrial ablation (surgical removal of the endometrium) or the drug tranexamic acid. Some women also find HRT useful. But she said that the first step is to help older women realize that "this is not a taboo, it is completely okay to talk about it." It can be said that the same openness can also help in the workplace.

Helen Claire encourages her teacher clients to consider practical solutions when they are afraid of being caught midway through the course, such as being with colleagues and calling for emergency cover if they need to sprint to the toilet. But it first depends on whether women are shameless enough to propose it. "If women can't talk about it, they can't come up with a solution," she said. "Until the problem is solved, women tend to stay away. I have met women who had long sick leave because they felt they couldn't control their bleeding."

In a 2019 survey by the Chartered Institute of Personnel and Development, nearly one-third of women with various menopausal and perimenopausal symptoms took sick leave, and most people also said that they could not tell their managers the real reason . "This is not only embarrassment, but also a shame, because when you are no longer seen as useful and fertile, you lose your social value as a woman," Claire said. Older women may be reluctant to admit that they have experienced something they fear will cause them to be considered unreliable or in the past.

"I think if you really do a deep research, there are still many women who leave their jobs in their 40s and 50s because they can't face menopause in front of people, so they turn to the counseling route," says Annie-Mary. Marie Boyle is an employment lawyer for Menzies Law, a Bristol company, and an expert on menopausal discrimination. "This is a classic trap for women: I see women leaving with their children, doing part-time jobs, and then I see them coming back, and then withdrawing again or being forced to leave again. This is a double-glazed ceiling that men will not face. "However, with a generation of women doing their best to keep working full-time during their childbearing years, and now approaching menopause, is anything starting to break down?

When Carolyn Harris, a Labour MP and chairperson of the All-Party Menopause Parliamentary Group, was 50 years old, she finally saw her doctor and learned about the severe menstruation she had suffered over the years. "I'll sit in a chair, as long as I sit down, it's okay, but when I stand up, it does come out, I'm just completely saturated," Harris said. Assistant to the parliamentarian. "A girl working in the office is on vacation. I will never forget. She said to me:'I am leaving now. See you when I come back, if you are still alive.' I said, "What do you mean? She said: "The color on your body; you look at the door of death." I passed out in the office before. "

A large amount of blood loss can lead to anemia, and tests showed that Harris' hemoglobin level was so low that she was sent to the hospital. She said that there, the nurse greeted her: "Ah, you are the walking dead woman." Before that, she had not connected her menorrhagia with the upcoming menopause.

"A lot of women don't realize it," Harris said, and his team has begun to collect evidence of various forms of menopause from women. "I never thought it was menopause, I just thought it was my cycle." She is now determined to break the taboo surrounding this topic and is optimistic that Nadine Doris, the Minister of Public Health who currently leads the review of women's health care (Nadine Dorries) has the same goal. She once talked publicly about her fight against the hot flashes in Parliament. "Nadine surprised me," she said. "Like me, she believes that there is no such thing as [party] politics when it comes to women's health."

Boyle also sees a glimmer of hope, because some employers are now formulating policies to help menopausal employees. Earlier this month, financial services company Hargreaves Lansdown launched a menopause and menstrual policy, including free office hygiene products, common symptom education, and flexible work policies; at the same time, the sustainable menstrual pants brand Modibodi is designed for menstruation that affects employees’ ability to work. , Menopause and miscarriage symptoms provide paid leave. Boyle believes that the craze of working from home after the pandemic may also change the lives of some people. “You can adjust your temperature and go to the bathroom whenever you want.”

But where this doesn’t work, the most practical advice for employers may come from an angry Pickett’s Twitter post in April: If a middle-aged colleague or friend says they suddenly need to go to the bathroom, trust them .

This article was revised on July 26, 2021. The early version called Dr. Jen Gunter an "American Gynecologist"; although she lives in the United States, she was born and raised in Canada.