by Heather McKnight

… it feels like the volume has been turned up on everything, it feels like you are hanging on by a thread, it feels like you are losing your mind, it feels like no one will believe you, it feels like you are what’s wrong with the world, nothing here is real your paranoia is your reality, it is like you are standing in a dark room staring at the worst of yourself with no hope of escape…

It took me a while to figure out what was going on, and it has taken me longer to put what I have written out there, in the knowledge I present only one perspective, and I may be getting it all wrong… but here is the starting point of my attempt to make sense of and see menopause from a critical utopian perspective, to my community of utopians, to my climacteric companions and to everyone beyond.

About a year and a half ago I had an unshakable feeling something had ‘shifted’ inside, something that I couldn’t quite put my finger on. I was exhausted, moody, panicking, crying spontaneously, paranoid (and on top of that for those that know me!) physically exhausted, aching, periods of hypersensitivity to noise, headaches, night chills. I was close to submission of my research thesis isn’t that meant to be ‘normal’ aren’t we meant to ago ‘crazy’ at this time? A problematic narrative, but that’s for another time… In addition, we were in the middle of a lock down and global pandemic, my job prospects and finances were insecure, surely I was just on this messy physical and psychological precipice because of stress..?

The thought of menopause had flitted through my mind six months earlier. I’m in my late 30s so I thought it was unlikely (the average reported age in the UK is 51).[i]  It wasn’t until I had a complete breakdown over new year that I realised what was going on. Speaking with my mother we started to put together the pieces of a pattern of early perimenopause in the family (probably linked with autoimmune disorders). I held out for an appointment with my own GP who I knew had expertise in this area who diagnosed me as perimenopausal.[ii] A term I only just learnt in my ignorance, but had I known earlier may have been a helpful one.  It is the time leading up to the menopause when hormonal swings occur and symptoms we associate with ‘the menopause’ begin.

Raised in a heteronormative patriarchal world, I am now challenging prejudices I didn’t realise I held. I realise I have internalised beliefs that menopause only happens to “older women” (wherever that line is drawn in age and genders) and was mainly marked by irritability, mood swings and hot flushes. Now I realise everyone’s experience is different, for example, cold flushes as well as hot ones, and tinnitus among many other symptoms. This is part of a spectrum of change, and I know that I have between 4 – 15 years of change as part of this transformative part of my life. There is a real feeling of uncertainty, trepidation and deep-seated fear.

In 2019 a BJFM survey found 48% of GPs had no training in menopause.[iii] 33 of 41% of UK universities do not have mandatory menopause education on the curriculum.[iv] The NHS page is basic for early and perimenopause, focused on a loss of fertility rather than general wellbeing, so I dig deeper. An article explaining perimenopausal moods swings notes that they “can be severe, but it is important that there are very real physical changes that are happening in your body which are impacting how you feel and behave.”[v]  Another description fills me with dread:

“Although it is a physiological process, especially the fluctuations and final loss of estrogen activity may have a negative impact on mental well-being; lead to vasomotor symptoms, sleep disturbances, sexual problems, cognitive decline, and depressive symptoms; and may even contribute to an upsurge in the incidence of severe mental disorders, such as depressive disorders or schizophrenic psychoses. In addition to these biological changes, for women this phase of life is often burdened with numerous psychosocial stressors, role changes, losses, and the experience of aging.”[vi]

As I read through medical journals, I find that perimenopause may lead to an enhanced risk of first onset psychoses, for those with existing mental health issues a time where they may experience a second wave.[vii]  While I am interested in replacing negative terms as psychoses with less medicalised understandings of our mind, self and relation to reality, the terms shocked me into realising that we need to be talking about the menopause and mental health and urgently.

Another article notes:

“I also see clients presenting with what I call brain fog—cognitive impairment. They have trouble concentrating at work, they have difficulty with their thoughts and communicating, for example. That can be scary.”[viii]

That chilled me, it feels already that the slightest slip is fatal to your reputation, particularly as a woman or non-binary individual in our patriarchal system. How will I cope? How do others or have others coped…?  

As a white Scottish woman, living in Brighton where there are a lot of progressive health services, and with a strong support network, I know I am extremely privileged despite the early onset. However, issues faced by many have been accentuated by the pandemic and by Brexit, for other further by the impact of war and climate crisis. This includes lack of access to medication, misdiagnosis and misinformation that are particularly problematic for those entering this transition early or from a trans or non-binary perspective.[ix] While changes are happening in law in the UK, we are a long way from moving away from over-pathologising menopause and moving to a bio-psycho-socio-cultural model that properly recognises the multiple issues, and the need for social as well as medical adaptations.

The Climacteric

“Most of all I think of how important it is for us to share with each other the powers buried within the breaking of silence about our bodies and our health, even though we have been schooled to be secret and stoical about pain and disease. But that stoicism and silence does not serve us nor our communities, only the forces of things as they are.”[x]

– Audrey Lorde

Through this time I have learnt that medically the menopause it is only one day, the day one year from which your periods stop. One semantic issue with the menopause is its retrospective diagnosis. This is of little use for those going into sudden menopause, for many trans people going through menopause, or to those of us who experience little or no periods anyway due to health reasons or contraceptive choices. I need to consider the possibility I won’t ever be able to put in a pin in that day. This has left me feeling uncentred and adrift.  It is easier to deal with things when you can name them and ascribe an origin point, however arbitrary.

In my frantic research in the medical journals have found a name that makes more sense to me, finding solace in academic wordplay. I realise I am now entering into the climacteric, a term that is medically used to describe the spectrum of “perimenopause, menopause and post-menopause”.[xi]  One medical article on the climacteric argues strongly for increased use of this terminology:

“… we should leave the term ‘menopause’ only for naming the event of cessation of menstruation that will happen later as the consequence of the decline in ovarian activity… that it does not seem proper to wait for the cessation of menstrual bleeding before some intervention is started”[xii]

I recognise that perhaps a new medical word is not helpful now. Many more celebrities and other people are speaking out about going through the menopause and it is gaining greater understanding. Perhaps changing the word in the popular imaginary now is way off the mark, and just my way of distancing and dealing with this myself.  However, this word has positively changed how I approach this for me, even if it is not useful for anyone else.

Rather than perpetuating problematic norms and silences around this, I want to join the chorus of people who are transforming the narrative, and sharing the way in which the medical tradition is challenging itself, as well as being challenged.  Selfishly, I also want to lay claim to my climacteric in a way that helps me to bear it and even learn from it. 

To establish new practices, we must first look at the problems raise, the “darkness of the lived moment” when it comes to climacteric matters.[xiii] Beyond this, I want to suggest we can utopianise the climacteric as an open space of transformation, however ridiculous that may seem. I want it to be full of hope that things can be better, for this time to be part of a material change in how I approach my role in society as a utopian citizen stumbling towards the vague possibility of a brighter future in dark times.

Utopian philosopher Ernst Bloch notes that we must start from where we are by trying to understand the darkness of the lived moment, or in this case the darkness of the lived menopause.[xiv] Perhaps we can draw from Tom Moylan’s notes in Becoming Utopian and the climacteric can be a process of becoming utopian of connection rather than isolation a “locus of person and community where the education of desire takes hold.”[xv] I find inspiration in local groups who ambitiously “want to share their experiences and help each other stay positive, strong, re-energised and content.”[xvi]

I want to explore how it can be a process of becoming and understanding myself as a human being,an “incremental process of moving from passive suffering to active struggle, experiencing thoughts and feelings about their new lives in nascent solution, and thereby garnering  the wherewithal to negotiate the difficult steps required to move toward that [new] world.”[xvii]  However, I don’t want to step into this new world naively, but critically, as I know, there are so many potential health issues. I can’t just say everything is alright and thus it becomes so magically around me. 

The World Health Organisation noted that the factors influencing quality of life during what they refer to as the “menopause transition” are previous emotional and physical health, social situation, the experience of stressful life events, and the beliefs about menopause and female ageing in their culture.  We should not discard the socio-economic ramifications of this and how poverty, access to healthcare, racism, sexism, ableism, and transphobia bring to the lived experience of people entering the climacteric. 

I have many questions I don’t know the answers. Looking inward, how this will play out for me, and what impact it might have on my future health or prospects? While I am looking at this positively others may see me as a lesser person because of existing preconceptions? How will I respond?

As 12% of Millennials and 20% of Generation Z identify as non-binary, what does our current culture mean for prejudice against trans and non-binary menopause?[xviii] How can we bring understandings from dealing with hormonal imbalances during menopause to and from people using IVF or who are transitioning gender, for example, who also must cope with experiences in hormonal mental and physical turmoil?

I have begun by speaking and writing and then will move to action. So, in the knowledge that I am speaking from ignorance at the beginning of this; these are my first utopian notes from my lived climacteric, the shards of light in the darkness of the lived perimenopause.

My Notes from the Climacteric

Studies have noted that a person’s own perceptions of what the menopause will entail impacts on how it is experienced. While coming from the UK, in a patriarchal society where it is consistent described as an illness, a lack or a loss, as an inconvenience and trauma; I can still challenge that narrative.  It is possible to write different stories, not to negate other people’s negative experiences but to understand and learn from them.  If we can ensure a diversity of voices and experiences are expressed, it can help at this time we can help it become more bearable for each other. These stories need not all need be the same, and from what I have read much is already being shared across different networks. Some research has noted that the climacteric is a “psychologically fertile time” in which to “master the tensions between expectations, realities, and possibilities.”[xix]

In a very straightforward way, one article reminds us this part of life:

“… should not be a negative experience. Remember, it is a phase, it is supposed to happen… Find some acceptance and compassion for yourself.”[xx] 

Also, there are many cultures that actively celebrate this transition. I am looking forward to researching further and learning about different perspectives from the narrow patriarchal western one.

Things that make life more difficult have been accentuated by the anxiety of the far-from-equilibrium situation combing the pandemic, climate crisis, many ongoing wars and nuclear threats. However, this has also been a period of deep reflection; perhaps it can give us a chance to share and connect, to see things across our history of the climacteric both personal and political that can help things happen differently in future. Perhaps in this dark and darkening world we can find a way to understand the climacteric, not be repressed by and ashamed of it, emerging as a force for radical change through deepening our knowledge of each other.

The advice I can share for others so far is basic (and echoes and is informed by existing voices out there) but here it is as such:

• There will be times when you cannot do as much, or think clearly, or manage your workload, be kind to yourself in these moments.
• Educate yourself, no matter what age or gender you are, transition to the climacteric it is something that will happens to us or someone around us. For example, I did not know that tinnitus and chills as well as flushes were potential symptoms. There is an overwhelming amount of info out there once you start looking, I have put some resources online here and will update as I find more: https://www.magneticideals.org/home/research/wisdom-in-the-climacteric-menopause-resources/
• Where possible, speak to your family about your medical history so you know when changes might happen. Having a medical history is particularly useful in the case of early-onset. I have been lucky, but I realise this may involve breaking down significant barriers for some people. There is so much work to be done in making this an open discussion.
• Listen to your body, speak to a GP and speak to others that have gone through this. If you are someone that wants children you will have more trouble if you ignore early signs, but we can all get lost and misdiagnosed which can have other repercussions.
• However, remember GPs are given little training in menopause at undergraduate level.  If you are entering the climacteric early (before 45) check with your GP’s surgery to find out who has the expertise in this area to ensure you are speaking to someone who will listen. Many people under 45 will find they are not believed when they first present with symptoms, completing some of the symptom sheets I link to above in the resource section and sending them to your Dr can be helpful to help them understand what you are experiencing.
• Reach out, we all experience this differently but the darkness I felt was worse than previous periods of paranoia, depression and anxiety, these are dangerous times to be in isolation. Talking to people you trust is so important. It is OK to ask for understanding, patience and compassion from those around you, particularly friends, partners, and colleagues.
• Practice where possible self-care basics of healthy eating, regular exercise and giving yourself time to rest. There is loads of advice on supplements and doing things naturally if you feel you can, if not the advice around natural menopause is helpful whatever route you take.
• Spread the word if you have the power in your institutions and workplaces. I hear that the YMCA in Brighton ran a menopause talk for any staff who wanted to attend. Although I’m sure it happens elsewhere, this is great practice and something we need to see more of, if you are a manager or in HR or responsible for worker wellbeing, please think about doing this.
• I am interested in actively awareness raising on this topic, and looking at creative ways of coping in the climacteric, if you are interested in writing on or liaising on this, and want to get in touch please drop me a line at climacteric@magneticideals.org

This is all I have for now, and in the recognition of the darkness of the lived menopause, I wish you all powerful, positive and transformative climacterics, whether you are the one experiencing it, or a climacteric companion.  To my partner Chris, my Mum and my friends who have granted me so much care, conversations, compassion, patience and understanding, I am deeply grateful.

… as I realise I am in the climacteric my view is shifting, my eyes slowly adjusting to the dark.  However, my ears are still ringing, the world seems harsh, unwelcoming, and cruel, I feel my complicity more sharply than ever. It may take some time to adjust, that I may falter as I find my feet. I realise the experience of entering this new time-space has already taught me so much, opened up compassion for people I did not know I was shutting out, including that of my own body.  Allowing me to start to hear the voices of others here and their suffering, successes and wisdom, a place from which we transform ourselves through connections and through doing so can start to heal and transform what is inside and around us, becoming something new, full of hope…

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[i] “Menopause,” nhs.uk, October 23, 2017, https://www.nhs.uk/conditions/menopause/.

[ii] I will write a more detailed blog on getting diagnosed, and then the process of medication and HRT after this.

[iii] Jessica Bateman, “Menopause Health Has ‘few Specialists and a Lot of Myths’ – Can Tech Change That?,” the Guardian, May 2, 2019, http://www.theguardian.com/careers/2019/may/02/menopause-health-has-few-specialists-and-a-lot-of-myths-can-tech-change-that.

[iv] “Menopause Support Survey Reveals Shocking Disparity in Menopause Training in Medical Schools. – Menopausesupport.Co.Uk,” accessed August 16, 2021, https://menopausesupport.co.uk/?p=14434.

[v] “10 Reasons for Perimenopausal Mood Swings,” Psychology Today, accessed January 20, 2021, https://www.psychologytoday.com/blog/women-autism-spectrum-disorder/202005/10-reasons-perimenopausal-mood-swings.

[vi] Anita Riecher-Rössler, “Menopause and Mental Health,” in Mental Health and Illness of Women, ed. Prabha S. Chandra et al., Mental Health and Illness Worldwide (Singapore: Springer, 2020), 147–73, https://doi.org/10.1007/978-981-10-2369-9_9.

[vii] Anita Riecher-Rössler, “Psychotic Disorders and Menopause: The Untold Story,” The Menopausal Transition 175 (2009): 115–26, https://doi.org/10.1159/000209606.

[viii] “Men, Let’s Talk About Menopause and Perimenopause,” Psychology Today, accessed January 20, 2021, https://www.psychologytoday.com/blog/understanding-the-erotic-code/202008/men-let-s-talk-about-menopause-and-perimenopause.

[ix] “Transgender Health,” Rock My Menopause (blog), accessed August 16, 2021, https://rockmymenopause.com/get-informed/transgender-health/.

[x] Audre Lorde, A Burst of Light: And Other Essays, Later Edition (Mineola, New York: Dover Publications Inc., 2017).

[xi] Nimit Taechakraichana et al., “Climacteric: Concept, Consequence and Care,” Journal of the Medical Association of Thailand = Chotmaihet Thangphaet 85 Suppl 1 (June 2002): S1-15.

[xii] J. E. Blümel et al., “Menopause or Climacteric, Just a Semantic Discussion or Has It Clinical Implications?,” Climacteric: The Journal of the International Menopause Society 17, no. 3 (June 2014): 235–41, https://doi.org/10.3109/13697137.2013.838948.

[xiii] Ernst Bloch, The Principle of Hope, ed. Stephen Plaice and Paul Knight, vol. One (The MIT Press, 1995).

[xiv] Bloch, POH V1.

[xv] Tom Moylan, Becoming Utopian: The Culture and Politics of Radical Transformation (London, UK ; New York, NY: Bloomsbury Academic, 2020), 192.

[xvi] “Second Spring – Hove and Brighton Women’s Group (Hove, United Kingdom),” Meetup, accessed March 10, 2022, https://www.meetup.com/second_spring_brighton/.

[xvii] Moylan, Becoming Utopian, 193.

[xviii] Deborah Garlick, “How Do Hormonal Changes Affect the Trans and Non-Binary Community?,” Menopause in the Workplace | Henpicked (blog), July 21, 2020, https://menopauseintheworkplace.co.uk/articles/how-do-hormonal-changes-affect-the-trans-and-non-binary-community/.

[xix] N. L. Stotland, “Menopause: Social Expectations, Women’s Realities,” Archives of Women’s Mental Health 5, no. 1 (August 1, 2002): 5–8, https://doi.org/10.1007/s007370200016.

[xx] “Men, Let’s Talk About Menopause and Perimenopause.”