The emotional roller coaster of transitioning to menopause

It was the resounding laughter of her pharmacist friend. That was the moment when Philomena Minoo, a physiotherapy and wellness coach, came closer to understanding what was happening to her body. Her friend had said, “You are menopausal.”

Philomena was 49 years old when she noticed changes in her personality. The once cheerful fitness coach had become indifferent, full of mood swings and unbearable. In her own words, she was wretched.

“In 2022, I went to the Africa Athletics Championships in Mauritius to attend to one of the renowned athletes in Kenya. When he bagged a gold medal, a historic achievement for Kenya after 32 years, it should have been a moment of unparalleled joy and triumph for me as his wellness coach. However, amidst the jubilant cheers and celebration, an unexpected sentiment engulfed me—I yearned to retreat to my hotel room. 

“At that time of the year, the weather was terrible and I attributed my nonchalant character to harsh weather conditions. Back in my room, I was suffering from disrupted sleep,” says Philomena, now aged 53.

She adds: “Did I think about menopause? Absolutely, not.

“At 49, life was going on well for me. I was eating a balanced diet, leading a healthy lifestyle and didn’t have many career or personal stressors. In retrospect, the unusually heavy bleeding should have signalled the onset of menopause, but it didn’t occur to me. When I thought of menopause, I knew I would get there but as an occurrence of a distant future. I would say to myself, this thing, it wouldn’t quite come early especially given my fitness level. Even as a medical practitioner, I was mistaken in my assumptions.

It wasn't until I confided in a friend about my rock bottom feelings and she suggested that I might be experiencing menopausal symptoms, that I realised I had been grappling with it for about two years. By then, hot flushes had become a noticeable feature of my daily life. Picture this: I would be sharing a laugh and suddenly an intense heat would envelop me, leading to profuse sweating. Whenever that happened in a public setting, there were all manner of reactions, from widened eyes to quizzical facial expressions,” she offers.

The transition to menopause, a natural biological process that marks the end of a woman’s menstrual cycles and fertility, is confounding to many women, who contend with a myriad of symptoms from hot flashes, joint paints, irregular, heavy periods, vaginal dryness, hair loss, fuzzy brains and weight gain.

Dr Kireki Omwana, a consultant obstetrician and gynaecologist, and fertility specialist, says there are some women and couples who go to him looking for answers and reassurances. 

“To many quarters, menopause is considered as just one of those things that happen to a woman and don’t require medical interventions. Yet the consequences can be stark. When some of these symptoms go unchecked, they can be debilitating and are associated with risks of long-term chronic diseases. Also, menopausal symptoms can affect a woman’s mental health and quality of life,” he offers.

A 2021 study by the University of Pittsburgh found that women with frequent hot flashes who were not using hormonal treatment had an elevated risk of cardiovascular disease, including strokes and heart failure than women with fewer or no hot flashes.

 Until recent times, when menopause has emerged as an open subject, it was for a long time veiled in fear, secrecy and a sense of shame.

“While in my 20s, I associated this stage with mood swings. You get here and you become challenging to deal with. It was also an intimate issue that even my mother didn’t talk about. Now there’s a shift. It’s a slow swing but at least something is happening,” says  Philomena.

To understand the complexity of menopause, Dr Kireki, who is also a lecturer at the University of Nairobi, says we have to unpack the role of oestrogen, a hormone that plays an integral role in both the male and female reproductive systems.

“In simple terms, oestrogen is what makes a woman a woman. Oestrogen is the key factor that defines the characteristics of a woman—such as breasts, widened hips, smooth skin, the pitch of voice and even temperament. When oestrogen production decreases, significant changes occur in their bodies. At the onset of puberty, girls begin to experience menstrual cycles, marking the beginning of their reproductive life. This continues until their 30s or early 40s when menstrual periods may become irregular, signalling the onset of perimenopause. As women approach their late 40s and early 50s, menopause occurs, characterised by the cessation of menstrual periods. There's also a later stage, often referred to as the senile stage or post-menopause, where menstruation permanently ceases,” he says.

In an interesting twist, hot flashes, once considered to be the most common symptom among women going through the phase, have been knocked off by joint and muscle aches, according to two recent studies.

In one study, researchers found that three in five of the 1,054 women interviewed reported symptoms of joint and muscle pains during their menopause, compared with 27.5 per cent for sleep problems, 20.3 per cent for vaginal dryness and 19.6 per cent for mental illness. Hot flashes were the least reported at 18.6 per cent.

“The symptoms are diverse and unique. While one woman may experience a fuzzy brain, another may experience frequent urinary infections. At the heart of all this is the oestrogen hormone,” he says.

Just as women undergo menopause, Dr Kireki offers that men experience andropause, caused by a reduction of testosterone, which is vital for the development of male sexual characteristics. According to the American Urological Association, about two in 10 men over the age of 60 suffer from low testosterone levels, and the number increases to three in 10 men in their 70s and 80s.

Advancement of science has made it possible for women to access solutions to menopausal symptoms, including hormone replacement therapy (HRT), which in the context of menopause involves the administration of oestrogen to help alleviate symptoms like hot flashes, night sweats, mood swings, and other issues related to the decline in hormone levels.

“Besides this, we also recommend plant-based medications. However, before administering any form of treatment, especially HRT, which is still unpopular in Kenya, it is important to carry out a proper diagnosis to ascertain that there are no contraindications—factors that make a particular treatment potentially harmful for an individual. Where we are with science, we can help alleviate some of these symptoms and enable women to lead a normal life,” he says.

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