• To the question: How has your figure changed?, the answers ranged from ‘losing it completely along with my libido’ to ‘everyone says I look the same, but I don’t believe them.’
• To the question: How would you describe the intensity of your experience?, the answers ranged from mild to moderate to massive – with most leaning towards the massive changes.
• To the question: How does your experience compare with your mother’s?, the answers varied from a handful saying ‘exactly the same’ to most reporting ‘there is no comparison.’
If you look to your mother’s perimenopausal experience for a sense of what’s to come, most of you will find few similarities to your own. Her transition averaged six months to three years; yours will be 10 to 20 years. She may have experienced weight gain, hot flushes, mood swings, memory loss and insomnia too, but nowhere near the degree you are. She gained 8 pounds compared to your 12, and reported 3 hot flushes a day to your 15.
Over the past few decades, there has been an amazing demographic shift for the menopause. It no longer starts in the late forties, but in the late thirties. It doesn’t last a couple of years; it lasts more than a decade. It doesn’t produce mild changes; it causes megamenopausal changes.
What makes our generation so different?
In the same group of women I surveyed on midlife body changes, I asked this very question. Before you read on, think about how you might explain this menopausal shift.
One group member said, ‘I think it’s because more of us have decided not to have children.’ Another immediately interjected, ‘You’re right, and even when we do have children, we’re having fewer, later in life.’
This is true and explains at least part of the difference. Each full-term pregnancy pushes off the menopause by five months. So if your mother had five children, her transition began 25 months later, and this explains about two years of the difference.
A third group member said, ‘I think it’s because we’ve taken birth control pills for years, some since our teens.’ To my knowledge, the effect of long-term oral contraceptive use on the menopause has never been studied, but a theory has been proposed. Taking the Pill for years may cause our bodies to become dependent on an external source of hormones and, therefore, our ovaries get lazy and produce less oestrogen over time. Thus, earlier perimenopause.
Another woman asked, ‘Could it be because we started puberty earlier? And if so, what does this mean for my daughter? She started her period a year before I did.’ The relationship between age at puberty and age at the perimenopause has been studied, and there appears to be a correlation. We entered puberty at an earlier age than our mothers did, and we’re entering the transition at a much earlier age. As for our daughters’ generation, only time will tell.
Then a determined woman took the floor. ‘I know why our generation is so different. It’s because we’re too stressed, and stress affects everything, so it must affect the menopause. My mother didn’t have a career outside of the home, she didn’t commute three hours a day, and she didn’t have to worry as much about crime, teen pregnancy, drugs and AIDS.’
Stress, although difficult to study because it’s so subjective, has been linked to an earlier menopause. When we are under chronic stress, the adrenal glands are constantly releasing Cortisol, and this competes with their ability to release testosterone, the precursor to oestrogen.
When I asked, ‘What else have we been doing that adds an immense amount of stress to our bodies and lives?’ everyone drew a blank.
The answer is dieting.
Dieting is both a physiological and psychological stress and may be the most influential factor for our longer transition and megamenopausal experience. It triggers a release of stress hormones, preoccupies our minds and causes feelings of guilt when we eat and depression when we don’t reach our goals. Everything about dieting is stressful: undereating, overexercising, bingeing, skipping meals and taking diet pills. Studies have shown that undernourished women enter the menopause four years earlier than those who eat an adequate amount of calories for their bodies.
Half of us started undernourishing our bodies as teenagers, and most of the rest of us had joined in by the time we reached 25. Our mothers came of age when thinness wasn’t a primary goal and dieting was not a national pastime. Their bodies were better nourished and in a better balance to help them through the transition. We are coming of age at a time when thinness and dieting are obsessions, and our bodies are out of balance long before we enter the perimenopause.
Depending on your mother’s age, this generational analysis may be better suited for comparing and contrasting your grandmother’s experience. If you are 35 years old and your mother is 55, she’s at the tail end of the transition and, as a younger woman, was very much affected by the same contemporary issues – stress, dieting practices and reproductive choices – as you have been.
Let’s move this discussion from your mother (or your grandmother) to you: How much weight have you gained? How has your body shape changed? What factors do you think are responsible for magnifying your changes?
One of my clients answered, ‘I’ve gained nearly 2 stone since my late thirties, my hourglass figure “ran out” years ago, and I think I have every factor working against me to cause massive body changes. I started dieting when I was 11 years old and have yo-yoed too many times to count. I started the Pill at age 18, had one child at age 38, and stress is the first thing I feel when I get up in the morning and the last thing I feel when I can’t fall asleep at night. No wonder I’ve gained so much!’
The amount of weight you gain and where you gain it depends on your current and past lifestyle, dieting practices, medical history, hormone use and, to some extent, genetics. Draw a ring round all the factors that are influencing or have influenced the power and efficiency of your midlife fat cells.
For those variables that you can’t control, such as premature menopause, genetics and late pregnancy, it’s important to acknowledge their influence for a better understanding of how your body is travelling through the menopause. For those you can control, such as stress, inactivity, dieting and other eating habits, it’s not only important to understand their past influence, but also to take future action. This chapter will continue to build on your understanding of midlife fat cells, and the remainder of this book will give you the skills to outsmart them.
Fat Cells Prematurely Forced into the Menopause
If you’ve had a complete hysterectomy (where your ovaries as well as your uterus were surgically removed) or had chemotherapy or radiation, or were on a particular drug that interfered with your sex hormones, your body was forced into premature menopause. You experienced many of the same changes as women who undergo a natural menopause, except that it wasn’t a transition; it was an abrupt loss of female hormones. Your primary source of oestrogen was removed, and your weight gain and body-shape changes occurred within a few months instead of over a decade or more.
If you had a partial hysterectomy, where your ovaries are still intact, your body continued to produce oestrogen and you were not classified as menopausal. However, the uterus also produces a small amount of oestrogen, so you may have found that your body shape did go through some transformations, becoming a little more apple-shaped right after the surgery.
Most women who had complete hysterectomies in their twenties or early thirties experienced weight gain in the upper body, but interestingly enough, not quite as much as women who entered the menopause naturally. Studies have shown that women with hysterectomies gain about one-half of the weight of women who have a natural menopause. Why? At least part of the answer is that