The Disney villainesses of medical menopause

For some, this article will be like that novel about the virus that invades the world…Sci-fi…till it’s COVID-19. But for others, it will be reality: medical menopause.


Going through menopause is a reality of life. We all age, and our hormone levels change, resulting in a loss in mental clarity and focus; change in sense of well-being and sexual desire; and other functions that may affect how we behave and enjoy life. 

Author, Suzanne Somers, described menopause as the renamed seven dwarfs: Itchy, Bitchy, Sweaty, Bloaty, Sleepy, Forgetful and Psycho.

I’m going to explain how medical menopause (caused by chemo; need for endocrine treatment related to breast cancer; and procedures, such as a total hysterectomy) can upscale menopausal symptoms so that the dwarfs morph into Disney villainesses.

Disclaimers

Menopause isn’t a disease; but a phase of life. We don’t medicate a toddler for throwing a tantrum. We don’t medicate a teenager with raging hormones. So, why is society so into medicating menopausal women? 

Male menopause is a thing and most seem to manage it; with a few men going the MAMIL (middle age men in Lycra) route.

I’m not anti hormone replacement therapy (HRT), but let’s be clear. You don’t need it just because. Just like you don’t take Paracetamol if you don’t have a headache. You can manage vaginal dryness; bladder symptoms; low bone density; flushes, etc. without popping a pill.

Finally, bio-identical isn’t safer than chemically-made in a factory. 

If you fertilise the rose garden with 3.2.1 from the nursery or from the herbalist section, you’re still fertilising the roses, and weeds (cancers) not planted by the fertilisers (hormones) will grow faster.

Do it princess style

Sometimes medical treatment throws you a curve ball: medically-induced menopause (medical menopause). The stress of going through a diagnosis and being placed into medical menopause from either chemo and/or other medication, and not being allowed to just deal with the seven dwarfs but the whole Disney villainesses, is just sadly in need of a hero. That is why all cancer patients are princesses. So, let’s put medical menopause on steroids without the help of HRT and manage it ‘princess style’.

Ursula, back to the water

The general princess rule is all menopausal symptoms are better if you exercise and maintain a normal BMI (below 25). So, Ursula, back to the water! 

Swimming is a great exercise, particularly if your joints ache and knees crunch when on the treadmill.

I’ve also dreaded that menopausal body shape change: thickening around the waist. We need less calories as we age unless we burn them. Unfortunately, you can’t outrun your fork. Exercise counts for 25% of your calorie burn. The rest is unfortunately what you put into your mouth. So, always check for hidden calories; those many cups of coffee.

Calm (and cool) down, Lady Tremaine 

It looks like the flushes and night sweats are making the step-monster miserable. There is no barometer of who gets night sweats worse. They can be managed with fans next to beds; separate bed linen to your partner; bed hygiene, such as yoga, before bed; or drink calming herbal tea (no sugar). Sage tea helps especially. Cannabinoids help with sweats and sleep. 

Hot flushes can be triggered by food, certain drinks and stress. Know your triggers. Check your thyroid levels. Simple tricks: drink cold water; exercise helps and vitamin E. If you need to scale up, see your primary care physician for medication.

Venlafaxine is an anxiolytic that helps with flushes and anxiety. This medicine needs to be weaned; stopping it suddenly can cause severe depressive thoughts. Menograine or Dixarit (clonidine) is an old centrally-acting hypertensive medication that helps with flushes. 

These group of medications (SSRI and SNRI) should only be prescribed by your primary care clinician as some may interact with cancer medicine. All these anti-depressant and anxiolytics should be weaned up and down over a two-week period. Another option is certain anticonvulsant medication. I’m enjoying the info on purified pollen extract. Other possibilities are cognitive behavioural therapy; relaxation therapy; acupuncture; and stellate ganglion block (cautionary). My best is ‘cooling down the motor’; for me this is swimming, cold showers, ice cold water, and fans that spray water.

Off with the mood swings, Queen of Hearts

The problem with menopausal mood swings is you may be shouting ‘Off with your head’ to everyone. This behaviour isn’t acceptable. Don’t excuse it, rather accept and recognise it. So, like a toddler needs time out, so do you. 

Options are yoga; exercise; shut your door and listen to calming music; or a hobby that allows you to diffuse. I’ve taken up piano, dancing, Krav maga, and Duolingo. Am I nicer? Probably not. But, rather me take my surgical irritation out on a paid instructor, piano or an app.

Talk to a friend or partner. Again, you may be thinking it and wanting to say it. But, walk away and don’t. You may not have control of your bladder, but of your tongue, you do. And if you lose it, apologise. 

Unexplained tears can be had in your space or time. Not in front of your kids. Or watch a sad film, cry till you can’t anymore and blame the movie.

Yzma, strengthen your bones and get some sun

I didn’t know about Yzma (The Emperor’s New Groove) until my kids likened me to her. She has osteoporosis. Although this is best prevented by regular exercise in your pre-menopausal years, if you’re already osteoporotic, make sure there isn’t a medical cause. Check parathyroid and quit smoking. 

To fix or prevent this, requires weight-bearing exercise (I like Bodytech for the osteo data) and supplement with calcium and calciferol (vit D – sunshine vitamin).

The addition of bisphosphonates help with improving bone density. Some studies predict that it’s also protective against little cancers nesting and growing in the bone.

Switch on the desire hormones, Cruella de Vil

No sexual desire? That can make any female a little cra-cra! Vaginal dryness is managed not by grabbing K-Y Jelly before you score. But long-term preparedness.

So, awkward question and complex answer. Why is it you aren’t doing the horizontal dance as much as when you were in your 20s? Is it your partner? Life? Is it that you don’t feel the gorgeous new you, that you should feel after surgery and treatment, or is it painful and uncomfortable? It’s probably a combination of many factors.If you want to improve your physical relationship, physical intimacy is a choice, but is fun!

As we age, we may lose the desire due to many factors, not least of which is that we’re now not programmed to procreating. So, our menopausal bodies may switch off the desire hormones. But you can switch them on (if you want). 

With weekly and safe vaginal oestrogen, comfortable physical intimacy can be achieved. There are also excellent therapists that one can talk to. Vaginal oestrogen also helps prevent urinary tract infections; so, it’s something I advocate. 

Evil Queen, you can’t defy age

Aging skin and body; what are you doing about it? So, the mirror shows more wrinkles and your skin is dry. 

Use lots of moisturisers, dehydration is a curse. There are few magic take-away-your-wrinkle creams: Retinol – once a week in small doses on your skin is good. 

Facial hair is best lasered, but check reputable sources. You can pluck the hair on your chinny chin chin. As a product addict, be careful about being sucked into the youth nirvana. Yes, it’s unfair that fair skin seems to show age worse and dark skin tones better. But, women with dark tones may have to battle with pigmentation post chemo.

From Botox to fillers and vampire facials, remember to see a specialist and not ‘buy one, get two free’. At the end of day, looking 20 at 60 is a bit like mutton dressed up as lamb. But, looking healthy and a few years younger is a different story.

Mother Gothel, find a new hairdresser

My kids cruelly point out my thinning scalp and rat’s tail. From the fear of hair not growing back post chemo to menopausal grey thinning and balding hair. 

Stay away from hectic colouring agents, and too much heat and chemicals. 

Although many vitamins have been lauded as the solution for hair growth from biotin (may not be safe for cancer patients) to vitamin A and C, they may interfere with medication. Use a reputable site for assessing whether your vitamins may interfere with your medication. 

Topical oils help in that they lubricate the scalp and promote hair growth. From Bergamot oil and Kair placenta to a range of more expensive products, including the Nioxin range. I feel that your hairdresser probably knows more about you than your doctor, so this is a good starting point. After that see your survivorship physician for topical prescriptions or a hair clinic. DermaPen is thought to be good for hair growth.

Madame Medusa, it’s time to remember

Do you remember Madame Medusa looking for the diamond in the swamp in The Rescuers? Are you losing your mind? Forgetting where you put your keys or where you parked? Worried about dementia? Does it run in your family? Or maybe you suffer from those unseen forgetful word fart moments…

Well, there is no doubt that oestrogen helps the female brain. It looks like the changes occur in the peri-menopausal years. How oestrogen, if taken as oral HRT, crosses blood brain barrier, we are not sure. 

If you can’t or won’t take HRT, the data again shows that exercise, the dark berries, and decreasing stress and improving sleep help. Taking HRT when in menopause hasn’t been shown to necessarily help. Again, much controversial data. Talk with your medical team.

Dear Maleficent, what might your complaint be?

Maybe you are that bad fairy that manages medical menopause. From the old movie to the new. Yes, you too can change from the old fairy of menopause to the new; send ideas of how you’ve achieved this. 

Prof Carol-Ann Benn heads up internationally accredited, multi-disciplinary breast cancer centres at Helen Joseph Hospital and Netcare Milpark Hospital. She lectures at Wits University and, in 2002, established The Breast Health Foundation.

MEET THE EXPERT – Prof Carol-Ann Benn

Prof Carol-Ann Benn heads up internationally accredited, multi-disciplinary breast cancer centres at Helen Joseph Hospital and Netcare Milpark Hospital. She lectures at Wits University and, in 2002, established the Breast Health Foundation.


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