Menopause: It's hot, it's flashy

Mary* is my regular supplier of traditional vegetables. The start of our business relationship was stormy.

Traditional vegetables are a hot cake in my neighbourhood and so to avoid missing out on the supply, I would pay in advance. But when I went to collect my lot she would tell me: “Oh my! I'm out of stock. I'm sorry I forgot about you.”

This happened three times. The fourth time, I decided I would remind her until she tells me “the vegetables are ready, send someone to pick them.”

It is now my habit to remind her and she prefers it that way because she forgets a lot. We have even developed a daughter-mother relationship.

The 55-year-old often tells me: “Mtoto wangu, sio wewe peke yako. Customers wengi hukasirika na mimi sababu ya kusahau order zao na sio kupenda kwangu (My child, you're not the only one. I often forget my customers’ orders and that angers them, but it is not deliberate).”

The last time she had her menses was in 2018. Mary falls in the category of women in menopause, a stage that comes with a stint of forgetfulness owing to the decline in production of oestrogen.

Also read: Why we are still afraid to talk about menopause

As explained by the American Psychological Association, oestrogen increases the concentration of an enzyme needed to synthesise acetylcholine, a brain chemical that's critical for memory.

Other studies have shown that oestrogen depletion during perimenopause causes memory loss, even resulting in a decline in verbal memory but improves after menopause.

However, a 2014 study concluded that “it is likely that cognitive deficits are not solely caused by declines in oestrogen production, but are also likely to stem from reductions in sleep quality, increased depression levels, and the onset of hot flashes.”

Menopausal women also exhibit symptoms such as hot flashes and night sweats, commonly known as vasomotor symptoms. They also experience vaginal dryness and discomfort during sex, difficulty sleeping, low mood or anxiety, reduced sex drive, reduction in breast fullness, slowing metabolism and weight gain.

I ask Mary if she is aware that her forgetfulness may be a result of menopause. She vehemently objects: “Hapana! Hii ni kuzeeka tu. Menopause inaingilia wapi na kusahau? (No. I’m only ageing. How does my forgetfulness relate with being menopausal?”

She says she has never had hot flashes or night sweats; and that she only knew she had reached menopause when she stopped having her menses. Mary’s unawareness of menopausal symptoms is not peculiar.

Most women in Kenya do not know about menopause, hence, cannot prepare for it like people ready themselves for retirement in the form of buying property and saving.

There is very little understanding and education about menopause. A lot of this is down to stigma and ageism, when actually it's just very natural.

“Most of the women in this part of the world have no idea about menopause. It is an area we have no data at all,” says Dr Kireki Omanwa, president of the Kenya Obstetricians and Gynaecologists Society, and a fertility specialist.

“In Europe and in America, they even have societies and doctors who have specialised in menopause; they have journals where they publish research on menopause.”

The 2014 Kenya Demographic and Health Survey (KDHS) outlined the percentage of the 30–49-year-olds who have reached menopause. But these statistics are missing in the 2022 KDHS released on January 17, 2023.

Going by the 2014 KDHS, the highest number (45 per cent) of menopausal women were in the 48–49 age bracket, followed by the 46–47-year-olds at 24.4 per cent. The 30–34-year-olds were least (4.7 per cent) menopausal.

But what is menopause and when does it start?

The National Institute on Aging, a division of the United States of America, National Institutes of Health says menopausal transition often begins between the ages of 45 and 55.

Early menopause

But women aged 44 and below do hit menopause such as those recorded in the 2014 KDHS and for them, this is premature menopause.

A 2017 study linked early menstruation to early menopause. Published in Human Reproduction, a medicine journal, the study sampled 51,450 women drawn from Australia, England, Denmark and Japan.

The researchers found women who started their menstrual periods aged 11 or younger had an 80 per cent higher risk of experiencing a premature menopause before the age of 40. While 30 per cent had a higher risk of early menopause between the ages of 40–44.

But there are also other factors that can lead to premature menopause including when a woman's ovaries stop making normal levels of certain hormones, particularly the oestrogen, cancer treatments and surgery to remove the ovaries.

“The way a woman's body has been created is that it will reach a time when it stops having periods and basically aging sets in,” explains Dr Omanwa.

“The periods stop because the ovaries are no longer working the way they should; the normal hormones are not produced the way they should.”

Post-menopause

Menopause comes in three stages—perimenopause, menopause and post-menopause. Perimenopause is similar to the start of climbing down a hill. Just like taking one step down, so does the oestrogen levels drop inch by inch.

For a woman, oestrogen regulates her growth, development, and reproductive system. This powerful hormone is responsible for growing and maturing the uterine lining that sheds during menstruation. Women at the perimenopause stage experience irregular periods and hot flashes, and vaginal dryness sets in.

When you get to the middle of the hill, you’ve drunk all your water and you’re carrying empty jerricans. You’re in a menopause stage. Here a woman is no longer producing oestrogen and she has clocked a year without having her menses.

Finally, you reach the foot of the hill; the post-menopause place where the fate for no more children is sealed. The body has finally confirmed that it is no longer ovulating. And for some, the symptoms have disappeared and the body has settled in its new formation.

Just like the time and how one descends a hill varies, so does the women’s menopausal transition from stage one to three.

“For some women, it takes two to three years to reach post-menopause. For others, it takes longer. The difference is all about how their bodies respond to the changes just like the way women respond differently to pregnancy,” expounds Dr John Ong’ech, an obstetrician and gynaecologist.

Opportunistic character

For instance, unlike Mary who has not experienced vasomotor symptoms, Esther*, a corporate career woman in her early 50s, has had it rough with hot flashes. And they have lasted for nearly a decade.

Worse still, they have an opportunistic character. They do the rounds when their visits are an abomination. They just whoosh when she has done her make-up and ready for a take-off to work, or one second away from making a presentation before her bosses.

“My hot flashes are extreme. When they come, I either turn on my electric fan, or use a manual one,” she says.

But her girlfriends’ reaction to her tribulation is a manifestation of just how even educated women lack knowledge of how the transition affects their fellows. “At some point, they thought I’m pretending and only seeking attention,” she says.

Also read: My Story: I went through menopause at 27 and it was hell on earth

Over time, she has learnt to be herself, notwithstanding that she has to indirectly explain to her male co-workers, trainees, acquaintances, and relatives of her menopausal transition.

She confesses that “the explaining is a lot of work and I wish communities were sensitised to menopause so that everywhere a woman goes, she doesn’t have to suffer because of the symptoms associated with menopause.”

Often, her explanation is: “I sweat a lot and if you see me fanning myself, all of a sudden, don’t presume I’m a snob.”

But at the core of the changes is oestrogen, which the fertility expert describes as “makes a woman, a woman.” It is central to a woman's proper functioning of the physical, psychological, cardiovascular, skeletal, muscular, and reproductive systems.

“Imagine you have been doing well all this time and you reach 48 or 50 years and this hormone is not there,” exemplifies the fertility expert.

“What happens, you start having hot flashes, sometimes you feel your heart beating faster than normal, you start palpitations, you start having issues with mood swings and memory, the vagina starts to dry up and your bones become lighter because the mineral density has decreased.

Andropause

“When you see our mothers who were once tall, when we were young, now looking shorter and with bent backs or a hump on the back, it all comes with menopause,” he says.

Men too, have menopause known as andropause. The difference between the women and men is how and when it happens as explained by Dr Omanwa.

“It has been estimated that by the time a girl is born, her ovaries store about a million eggs. By the time she starts menstruating at around age 13, 14 (or) 15 years, the number has decreased to about half a million (to) 450,000,” he says.

“When she starts her menses, she loses a certain number of eggs every month. By the time she reaches 35 years, that number has reduced drastically. When she hits 40 to 45 years, the ovarian reserve is very small, and at 48 to 50 years, the number of eggs in the reserve is very very low. This coincides with menopause, so, essentially, she can’t naturally get a baby. But of course there are outliers; women who have a child in their late 40s.”

For men, it’s different.

“When puberty kicks in at age 13 or 14 (teenage) he starts producing semen every two-and-a-half to three months. This continues even up to the late 50s and afterwards. That is why a man in his 60s or 70s, if okay, is able to have an erection and can impregnate a girl,” he elaborates.

How women deal with the menopausal symptoms vary depending on their social class and geographical location.

Esther, a working urban woman, for instance, can afford a fan for her hot flashes. A rechargeable unit costs her Sh1,000 ($8.05) and it breaks down after a short while.

Every time they spoil, she has to buy a new one because she says they cannot be fixed. She also has the luxury of a support partner in another menopausal woman, who is also of a high social class. To encourage each other to beat the symptoms, they share their experiences.

Esther says her support partner uses supplements to lessen the effects. Her attempts to pull her into the bandwagon have failed; her refusal is informed by the fear of ending up with detrimental side effects.

She also encouraged her to eat Weetabix, but Esther says “it did not work for me.”

Her girlfriends, too, have often told her to stop drinking tea as it aggravates hot flashes. But Esther’s love for the beverage is unbreakable.

A 2015 study looking at the link between caffeine and menopausal symptoms found that caffeine use resulted in greater vasomotor symptom bother in postmenopausal women.

According to the Tea Research Institute, on average, tea leaves contain three per cent caffeine by weight, although this can range from 1.4 per cent to 4.5 per cent.

Selina*, 73, is a peasant farmer in Nyamira County. She says she heard of the word menopause from her son, a business executive who lives in Nairobi County.

“I have had chronic muscle pains for years. Sometimes my legs ache so much and they swell that I cannot walk. It is my son who takes me to hospital or buys me pain relievers,” she says.

“So one time, he explained to me that I have reached the age of menopause, hence the pains. From then on, my mind settled that I’m not sick but just ageing. But he takes good care of me because he buys me soybean powder for making tea.”

She says many years ago, she would sweat a lot at night, a menopausal symptom, which she says stopped years later.

Are these remedies effective?

Dr Omanwa says supplements can only reduce the effects of menopause but not take them away completely.

He says cereals such as pumpkin seeds, flax seeds and black seeds are recommended for menopausal women because they are rich in nutrients that support their physical, psychological, cardiovascular, skeletal, muscular, and reproductive systems.

“Vitamin E has been shown to reduce the effects of menopause…Vitamin D also goes into strengthening the bones. But can they remove them completely, I think no?” he says.

Dr John Ong'ech, an obstetrician and gynaecologist says menopause is a lifetime permanent change.

And taking vitamin, mineral or soya based supplements cannot reverse aging but only lessen the symptoms. He adds that although some women prefer going for hormone replacement therapy, they highly advise against the procedure because it predisposes them to breast and uterine cancer.

Meanwhile, the fertility specialist Dr Omanwa, emphasises adopting a healthy lifestyle as this also contributes to the lessening menopause effects.

He says in countries like Japan where there is a high consumption of soya bean foods, rich in phytoestrogens, women have mild menopausal symptoms.

Since menopausal transition has been associated with loss of bone mineral density, lean body mass, and increase of fibromyalgia, professional bodies such as North American Menopause Society recommend a certain dietary intake.

For instance, adequate intake of calcium, vitamin D, vitamin K, selenium, magnesium, and beta-carotene ensures a better bone mineral density in postmenopausal women.

Additionally, they recommend intake of a low-energy diet to prevent metabolic disturbance.

Knowledge gap

As Dr Ong’ech puts it, ageing is irreversible, hence women have no option but to prepare for menopause. Their communities also ought to support them have an easy transition, which points to the need of bridging the knowledge gap.

To do so, Esther says the menopause subject should be integrated into the education curriculum so that girls and boys grow up knowing what it is all about.

Meanwhile, she believes the government and non-State actors can help in raising awareness through grassroots campaigns and the media.

“Women also need to start support groups to learn from each other,” she recommends.

*Names have been changed to protect identities.

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