Dare to dream – The menopause.

By Dr Julia West - Goalkeeper Coach

For World Menopause Day 2024, WCWFC’s Goalkeeping Coach, Dr Julia West, opened up about her personal experiences with menopause, how sport can help ease symptoms, and what life is like using Hormone Replacement Therapy. 

I am older than most coaches I know, but I still dream. Making it big in football is still the dream. If I can’t get there, can I get my club there, can I get my players there?  

You could be forgiven for thinking that the menopause came along and crushed all my desires, all of those dreams. Yet still, they lurk.   

“We never used to talk about the menopause at all.” 

Apart from menstrual cycle changes, menopausal symptoms are many and varied*1. Every woman who experiences perimenopause (the start of menopause where hormones begin to change) and then menopause, may talk about the different things that affect them in their daily lives.   

We never used to talk about the menopause at all. No, it used to be and still is a secretive thing. Hidden behind the wooden facades of everyday faces. Women struggling to cope with daily challenges, and these weren’t all made up. And who was there to listen anyway? We still don’t talk about it much; it’s a woman thing.  

“What is this overwhelming feeling, and where did it come from?” 

Shifts in women’s roles and increasing involvement in the workplace and sporting environments mean that lifecycle and menopausal changes are starting to become more noticeable and more public. Before I knew that I was going through the menopause, I was asking, what is this overwhelming feeling and where did it come from? Why can’t I remember the names of authors who wrote the theories that I study and teach? Why am I left groping for words to articulate how I feel or express what I want to say? Yet, I can still define these things quite precisely. Why do I suddenly sweat so much that I feel as though I am burning up from the inside? Why do I sweat so much that I have to change my clothes even before I have started warming up for my exercise session? Why me?  

It's not all about me though, approximately half of the population will go through the menopause and may experience some or all of these symptoms and maybe more. By 2025, it is estimated that 1.1 billion women will be experiencing the menopause; 85% of these will experience menopause symptoms, but only half of those will seek treatment*2. Again, of those who experience menopause symptoms, one-third of women will report their symptoms as severe, impacting their quality of life*3.  

I experienced hot flushes. It got so bad I had to take another set of clothes to work with me. I would walk from my office to the classroom, and the flush would start again, soaking my change of clothes and dripping down my back. My face would flush bright red. I would think that my colleagues and students would wonder why I was looking so guilty. But I never got a hot flush when I was cold. Standing on the sideline at matches, I could have done with a quick hot flush, but no.   

Actually though, hot flushes are one of the most commonly recognised symptoms of the menopause*2, along with reported ‘brain fog’*4 and many more complex and individual signs.  

Menopause and sport 

The more we talk about and share our symptoms experienced during menopause and perimenopause, the more we can learn about different strategies others have used to help mitigate these*5. Although there has been an increase in the number of women participating in sports, physical activity and exercise, we really know very little about how women’s bodies work. We have mainly used a 70kg referenced male to support our understanding of training and recovery*6.   

Sport, exercise and physical activity, along with other lifestyle changes (reduced alcohol, healthier diet and weight control), are reported to be beneficial in reducing the impact of some of the menopause symptoms reported by women*2. Regular participation helps counteract hypertension and is becoming a widely reported strategy for helping cope with changes and adaptations for women entering menopause*7.   

I am active and exercise helps me. I ran a lot to ‘keep myself sane’ as I used to tell anyone who asked. I now lift fairly heavy weights, again to help counteract menopause symptoms, reducing the speed of muscle loss and helping maintain bone density. I complete balance and mobility exercises as well, hoping to slow down inevitable ageing effects.  

Hormone Replacement Therapy (HRT) 

I also use hormone replacement therapy (HRT). I was initially prescribed selective serotonin reuptake inhibitors (SSRIs; common medication for depression and anxiety), but I was sceptical, I read about it and discussed it with knowledgeable colleagues and friends. We worked out that I have unmanageable hot flushes and brain fog, not depression. I persevered until my GP agreed. Menopausal women (I am learning) can be quite persuasive!   

HRT is considered the gold standard of therapy for hot flushes and brain fog, especially for those women with no history of breast cancer*2. The dosages prescribed can be tricky to get right. Some of my friends use a daily gel, I use patches which I change twice per week. If you are still experiencing periods, you will get a different prescription. There are no guarantees that this will work for you and you may have to go back to your GP to tweak your prescription for a better fit. 

SSRIs are largely prescribed for the treatment of anxiety and depression. However, in women who are already experiencing increased anxiety, where anxiety and stress can be a cause of hot flushes, they may be effective*4.  

The trouble is, menopause can exacerbate already presenting symptoms. Changes in mood and thinking can be easily confused for stress and other mental health diagnoses and this may well be the case. However, menopausal symptoms can also show similar signs as these and that’s where initial identification can be difficult.   

“I am so very glad that I take HRT.” 

So, who is listening now? The media can jump right into the negative impact of the menopause, which can leave women vulnerable to ‘predatory product promotion*’5. Me personally, I am so very glad that I take HRT, I change my patches twice per week (a fact that becomes noticeable by those around me!). With my flushes under control and my brain fog mostly at bay, I feel as though I can continue to contribute to the club and work towards my dreams. Making it big in football. I dare to dream…   

For further information on menopause: https://www.nhs.uk/live-well/   

References.  

1 Hickey, M., LaCroix, A.Z., Doust, J., Mishra, G.D., Sivakami, M., Garlick, D. and Hunter, M.S. (2024) An empowerment model for managing menopause. Lancet. 403, 947-957. https://doi.org/10.1016/S0140-6736(23)02799-X    

2 Cameron, C.R., Cohen, S., Sewell, K. and Lee, M. (2024) The art of hormone replacement therapy (HRT) in menopause management. Journal of Pharmacy Practice. 37 (3), 736-740. https://doi.org/10.1177/08971900231167925   

3 Gatenby, C. and Simpson, P. (2024) Menopause: Physiology, definition, and symptoms. Best Practice & Research Clinical Endocrinology & Metabolism. 38, 101855. https://doi.org/10.1016/j.beem.2023.101855   

4 Kulkarni, J., Gurvich, C., Mu, E., Molloy, G., Lovell, S., Mansberg, G., Horton, S., Morton, E., Uppal, T., Cashell, C., de Castella, A., Reisel, D., Dear, L., Weatherburn-Reeves, N., Harris, K., Pietrobon, K., Teagle, K., Kim, B.Y., Newson, L. and Szoeke, C. (20024) Menopause depression: Under recognised and poorly treated. Australian and New Zealand Journal of Psychiatry. 58 (8), 636-640. https://doi.org/10.1177/00048674241253944   

5 Burgin, J., Pyne, Y. and Hickey, M. (2024) Helping women prepare for menopause. British Medical Journal. 386, q1512. https://doi.org/10.1136/bmj.q1512   

6 McNulty, K., Olenick, A., Moore, S. and Cowley, E. (2024) Invisibility of female participants in midlife and beyond in sport and exercise science research: A call to action. British Journal of Sports Medicine. 0, 1-2. https://doi.org/10.1136/bjsports-2023-107165   

7 Mohr, M., Sjurdarson, T., Skoradal, M.B., Nordsborg, N.B. and Krustrup, P. (2024) Long-term continuous exercise training counteracts the negative impact of the menopause transition on cardiometabolic health in hypertensive women – a 9-year RCT follow-up. Progress in Cardiovascular Diseases. 85, 54-62. https://doi.org/10.1016/j.pcad.2023.12.001   

With special thanks to Dr Jessica Mee for her expert advice and knowledge.