This article is neither a scholarly publication nor to be taken as medical advice, but rather an essay in the spirit of "what I have learned from my personal and professional experience". This is an invitation to all females and males, employers and employees, young, middle-aged and senior members of the communities to talk fearlessly about menopause. The lack of knowledge, education and action on menopause in our society and its institutions, including many public and private health organisations, is concerning.
If you are a female - or a caring male of a beloved partner, daughter, mother, sister, colleague- I have some news for you: Now is the time to raise your awareness about menopause.
While no female is "too young" to go through this phase of womanhood - yes! even a young girl or woman in her 20s or 30s can experience menopause - especially women in their 40s should educate themselves about menopause as much as possible. This is very important to experience a positive, healthy and happy transition into their second spring as part of the natural aging process of women.
Today, 13-14 million women in the UK are going through menopause, and according to the British Menopause Society’s 2016 study, one in two women between the ages of 45 and 65 with menopausal symptoms continue their lives without consulting a healthcare professional about their medical needs. These women suffer in silence or resort to self-management of menopausal symptoms and often make them worse.
Moreover, many women, regardless of age, go through the perimenopause stage without realising that they are actually perimenopausal. As a result, due to the lack of knowledge and doubt about menopause and its treatments, many do not seek timely menopause support or receive adequate treatment from their GPs. Because of this low level of awareness, these women experience serious life difficulties at home, at work, in friendship groups or in their communities.
Whether or not menopause symptoms show, women who do not seek help or guidance in this natural and important period of their lives take a risk of severe health issues such as bone, heart and brain diseases - including osteoporosis, hip and bone fractures, stroke, heart attack, dementia, depression with suicidal thoughts, self-doubt which may result in broken relationships and divorce, inability to fully enjoy life and so on.
Let’s Talk About Aging
“Aging can be defined as the time-related deterioration of the physiological functions necessary for survival and fertility. The characteristics of aging—as distinguished from diseases of aging (such as cancer and heart disease)—affect all the individuals of a species.” 
It’s certain that men and women age differently in terms of rate and way of aging process- not only physiologically but also psychologically. There are genetical, nutritional, environmental and lifestyle influences on how people of both genders age.
The aging process of women normally accelerates tremendously in their 40s and over compared to their early years. A woman's body responds dramatically to aging through menopause, while a man's body responds more slowly throughout his life.
The key word here is hormones! While men and women age, different hormones in their bodies are affected. For women, the fluctuating oestrogen level with aging is a major concern and manifests itself impressively in the menopausal stages. They can profoundly affect a woman’s physical, psychological and psychosocial constitution.
What Is Menopause Then?
The word meno refers to female’s monthly cycle and pause literally means stop. Menopause, also known as the climacteric, is the time in a human female’s life when her ovaries gradually stop releasing eggs from her finite reserves. As a result, her hormone levels fluctuate and eventually her menstrual periods stop permanently. Menopause can be experienced naturally, surgically or medically. This is the stage in a human female’s life when she is no longer able to produce any offspring.
Under this heading, our key word is more specific, oestrogen! In humans (and apparently also in killer whales) a female body begins to slow down the production of oestrogen, progesterone and testosterone hormones usually in midlife, around the age of 40-45, then the level of these hormones decline significantly and hormone production stays at a very low level between the ages of 45 and 55 - if not before. Then she may start to show some symptoms such as irregular menstrual periods in occurrence or flow, the well-known hot flushes & night sweats (but not necessarily), mood swings, irritability, rage, anxiety, panic attacks, sudden crying spells or excitability, loss of libido and no sex drive, trouble sleeping, difficulty in concentrating, fatigue and lack of energy, loss of interest in most things and more. There are more than 40 symptoms of menopause that can occur due to low oestrogen levels. - you can check these symptoms here on the highlights! Peri-menopause: Hormone fluctuations during the perimenopause stage of a menopause journey are like a rollercoaster. Especially during perimenopause, oestrogen levels rise & fall irregularly. Monthly cycles become irregular, but they do not stop. While symptoms like hot flushes may be noticeable, getting pregnant is still a possibility. Menopause: When a woman reaches to the menopause stage, the roller-coaster effect of oestrogen level settles to some extent. This is the time when she has her final menstrual period. However, she won’t know for sure it’s happened until she has gone a year without one. Hot flushes, vaginal dryness, sleep problems, and other symptoms are common in this stage. Post-menopause: This starts when she reaches the year mark from her last menstrual period. Once this happens, she’ll be referred to as postmenopausal for the rest of her life. However, after entering into postmenopause stage, this fluctuation usually slows down significantly (some women may still experience long-term side effects). At this stage she may or may not experience menopause symptoms. For this reason, postmenopause is called Second Spring of the woman. Keep in mind that vaginal bleeding isn't normal after more than a year of no menstrual periods due to menopause, so let your doctor know if you have any ASAP.
About 8 in 10 women experience some symptoms of menopause, and these can vary from one woman to another. It doesn’t necessarily mean that hot flushes, night sweats or mood swings would be case at any stage of women’s menopause journey. In the UK, many GPs and medical professionals misdiagnose menopause due to their lack of female health training and fail to provide the support and guidance necessary. Many of these doctors are also not confident of offering the right menopause treatments and eventually just say that hot flushes and night sweats are a few natural symptoms a woman can deal with during menopause.
In my story, I was referred from blood tests to x-rays, from ultrasound scans to cancer screenings for over a year until I insisted on the Follicle Stimulating Hormone Level Tests (FSH) because of my age. Although FSH tests do not always confirm menopause accurately, after several intermittent tests, finally I was told that I “could” be in the perimenopause stage. After this "enlightening" moment, I was left alone. No further information was given, no Greene Climacteric Scale assessment was done (other than being asked for hot flushes and night sweats as if they were the only symptoms), no follow-up appointments were arranged, no guidance or support were offered, not even an information booklet on menopause was given.
This "jolly" news was quite unexpected, as I never thought that menopause was so close to me. I didn't know much about it back then, and damn, I didn't know how to deal with it!
Since then, I have had my menopause self-study, which led me to receive specific professional trainings on menopause, as well as to lots of reading, research, listening to podcasts, and nutrition experiments to find out what was awaiting me ahead. Today, when I think about my life a few years ago, I can relate many worrying and fearful events, doctor visits, and symptoms to perimenopause.
Now I understand that these symptoms have affected my life in many areas, and if I knew what they were about, I would definitely be able to deal with them in a more positive and conscious way. Thanks to yoga that has been in my life for many years, I haven't suffered much so far, but these symptoms were very frustrating, distracting, and worrying at the time. Stress in my past career was another major trigger of symptoms (and unfortunately, I wasn't aware of it at the time either).
Today, I know there are many other women who have not yet fully developed awareness of menopause. Many suffer quietly at home or at work without adequate support and assistance. This is why we should make menopause matter; but how?
It cannot be denied that all female people on earth will sooner or later have a deficiency of oestrogen, progesterone, and testosterone, naturally, surgically or for medical reasons. Therefore, it is important to know the facts and myths about menopause, to make informed choices, to decide their own treatment options, and to feel empowered by connecting with the right people in personal, professional and medical relationships; and the time is NOW!
Our body is covered with oestrogen receptors all over. During menopause, some of the most important parts of the body affected by oestrogen deficiency are bones, heart, brain, and vagina. In postmenopause stage, our oestrogen storage is very limited, which can significantly increase the risk of heart disease, stroke, osteoporosis and bone fractures, dementia, and / or hormonal weight gain for women. Also, the highest female suicide rates are among women aged 45-50, where perimenopause often begins. The high divorce rates between the ages of 40 and 55 may also be related to sex and relationship issues associated with vaginal dryness, low libido, mood swings, depression and brain fog.
As a highly trained and experienced British Wheel of Yoga Diploma teacher and an expert in Menopause Yoga, one of my experiences with women led me to the mission of marking the importance of educating women about menopause. When one of the women who has been in the postmenopausal phase for a long time asked me about the difference between the stages of menopause, it was the moment when I decided to shout out about this mysterious phenomenon in women's life.
Before the second round of the women circle talk, she stopped me and asked with a puzzled look, "Sorry, you keep talking about the peri-, meno- and post-stages of menopause but I'm not sure what stage I am on. Tell me more!” I apologised to my student for not clarifying this point before, thanked her for challenging me with her great question and giving me the opportunity to re-talk about the menopause stages. On this occasion, it was very clear to me that women assumed they knew everything about menopause and its stages.
What a naive delusion this is!
Women (and men) need to be educated about menopause; just as young girls and women are educated about puberty, menstruation, pregnancy, sex and relationship, or how to keep boobs healthy. Yes ladies, unfortunately we do not know much, because we do not have complete and comprehensive information about our body and vagina at every stage of our lives- from menarche to postmenopause! Yet, we demand that other men and women around us understand our circumstances in our most sensitive times and that they do not withhold their unconditional love and affection from us.
NO WOMAN IS TOO YOUNG FOR MENOPAUSE! Even your beloved teens!
Since I started keeping an open menopause diary on social media (@my_menopause_diary), one day I received a private message from a dear friend saying I am "TOO YOUNG" to talk about menopause. Bless her!
It made me think that either everyone knows everything about menopause except me; or people unfortunately ignore the fact that menopause affects life as a whole, not only at the personal level, but also at the social, political and economic level; or there is a tremendous level of ignorance out there, and people are fine with it.
Sooner or later, naturally or not, with or without menopausal symptoms, as long as she completes her life cycle in its expected flow, every woman will enter menopause one day. Regardless of her background, social class, how fit or healthy her body is, what her occupation is, how much organic vegetables she eats or kefir she drinks, where she lives or where she is from, what holistic, alternative, spiritual or transformational activities she performs and what her age is. And these days usually come in the 40s to the 50s. However, although it is a rare phenomenon, it can also come in the teen years or in the 20s or 30s, and her body will be lacking a significant amount of oestrogen that will cause many physical, psychological or cognitive changes.
If anyone claims that this is not the case, I'd love to hear more!
Yoga & Mindfulness to Enhance Positive Menopause
So far, I think I have addressed a few foundational key points of menopause. Of course, this is a very wide-range topic and includes many other important issues to discuss such as HRT.
Now I want to talk about how yoga and mindfulness practices can empower and nurture women towards and through a positive menopause experience. After all, this is my own expertise and comfort zone.
Alongside many types of exercise, a good diet and / or CBT, yoga and mindfulness practices, too, are necessary to keep the body and mind healthy at different stages of menopause. Non-hormonal medical treatments and / or HRT may also be an option to improve women's quality of life, but this is another lengthy topic that could be another blog post.
Not showing any symptom doesn't mean you're okay!!
So far, you may have noticed that almost half of menopausal symptoms are related to cognitive and psychological functions and the other half to physical functions. However, these functions should not be considered as separate and disconnected responses of the human body and mind. Due to the lack of oestrogen in female body systems, they blend with each other, trigger each other and react to each other.
General yoga and mindfulness practices already play a huge role in regulating a woman's body to work well at the physical, emotional and mental level during the menopausal stages. They help women develop a sense of balance and harmony inside and outside. In addition, since they are specifically designed with the needs of women in the menopause phase, it is often extra beneficial to practise with a dedicated menopause yoga teacher in customised menopause yoga classes. These sessions are systematically and carefully tailored for women at different stages of menopause, and help them develop and achieve different goals for their overall health.
HOW SPECIALLY DESIGNED YOGA & MINDFULNESS CLASSES WOULD HELP WOMEN TOWARDS A POSITIVE MENOPAUSE EXPERIENCE?
● Breathing exercises can teach women how to stimulate the Parasympathetic Nervous System (PSNS) and regulate the Hypothalamic-Pituitary-Adrenal Axis (HPA axis). Thus, improving immunity, defeating the side effects of stress, counteracting the side effects of burnout and PTSD, promoting positive health such as reducing anxiety levels, cooling the body during hot flushes, pain management, better digestion, uplifting and energising the body, shifting the mood, prevention of insomnia, chronic fatigue, major depressive disorders and more may be possible. In some ancient yoga texts, it is even said that some regular breathing practices can slow the aging process at the cellular level;
● Mindfulnesscan increase women's awareness of their own reality and their needs during menopause. The holistic approach of yogic principles can make women's daily life with menopause more acceptable, make it easier for the women to be more tolerant of any meno-related difficult situation and to cope with them in a practical way;
● Meditationcan help improve focus, concentration and other brain functions to cease the negative pattern of mental fluctuations, strengthen memory, help increase awareness of the self;
● Deep relaxation & Yoga Nidra (yogic sleep) also work at PSNS & HPA axis level and can help combat fatigue and insomnia by promoting deep rest after a night of tossing and punching the pillows, prepare the body and mind for a good night sleep, stimulate the rest & digest response of the body to repair and recharge, also quite helpful and powerful in case of PTSD in some cases after experiencing premature menopause;
● Long hold of the yoga postures can help improve strength, flexibility and a sense of balance in the skeletal (bone health) and muscular systems, raise awareness about a sense of presence, forward bends can help inward turn and relieve stress, irritability and meno-rage, inversions against gravity can increase blood circulation and stimulate hormonal glands, gentle backbends can increase breathing and open the heart centre, producing a feeling of positivity and lightness;
● Yoga flows can help regulate hormones in the endocrine system and burn excess adrenaline and cortisol, improve cardiovascular (heart) health, release joints, promote better sleep quality, uplift the mood and cultivate positive emotions, may improve sexual and physical quality of life;
● Restorative forms of yoga can bring a sense of calmness, peace and relaxation to the body and mind, relieve joint and back pain, lowers body temperature through PSNS in the body - hence may sooth vasomotor symptoms such as hot flushes and night sweats, promote natural healing qualities in the body and may be useful to aid recovery; help sleeping better and reduce anxiety and depression. It is also an antidote to stress-related meno-symptoms;
● Yoga philosophy can guide women towards a deeper spiritual / personal growth or transformation to develop their values and purposes in life. By practicing this thousands-year-old wisdom, women can reunite with their truth, achieve emotional stability and enjoy life, merge with their wiser selves, and eventually blossom into their Second Spring.
Menopause stages, symptoms, causes, and treatments are a complex matter. Hormonal changes in the female body lead to a wide variety of physical, emotional, and cognitive adjustments that are often experienced as disrupting and distressing experiences.
Unfortunately, contemporary medical science cannot give a definite explanation for the causes of menopause symptoms apart from explaining this phenomenon as hormonal deficiency. Moreover, women's health and wellbeing research in the UK is chronically underfunded and as a result women’s health problems are under researched. Many health professionals fail to approach women as a holistic system in their suggested therapy and treatment methods. They discount the influence of many other factors such as diet, lifestyle, geographical and economic conditions, relationship quality, impact of employment and social support.
Yoga, Mindfulness, and their sister science Ayurveda have a lot to offer in this regard. Today, it is not surprising us to hear more about the debates on investment in social prescribing within the NHS, or to hear that more GPs are incorporating yoga and mindfulness practices either by offering yoga sessions in their health centres or by collaborating with local studios and yoga teachers. A scientific study in 2017 involving 151 NHS employees as participant subjects highlights that yoga not only improves the quality of life, but also saves costs for their employers. 
Hopefully, future medical, social and therapeutic studies and research will address women's health and well-being within diverse lifestyle factors rather than a single “one size fits all” attitude. So, we can better understand which approaches best serve menopausal women on an individual basis.
I believe this blog post and many others will guide you in raising awareness about every stage of menopause, as well as about its possible symptoms, treatment options and effective lifestyle changes. They may be a guide of how to communicate with your GPs. They also may help you how to manage menopause related relationships at home or at workplaces.
May this serve you well!
Breathe well, flow well, connect well!
With infinite Love and Gratitude!
Aslihan, the Crow
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Follow these spaces to hear more about current studies in Menopause, Yoga and Mindfulness, medical research, western and eastern approaches to women's health and beyond, and to learn from many women's health and wellbeing professionals, nutritionists, medical clinics and holistic therapists.
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 The Minded Institute
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