It’s time to make the menopause conversation global

At last, menopause is being talked about as more than ‘something to be got through’. But as we start to have more menopause conversations, we need to listen to more and different voices from those already being heard. Launching for World Menopause Day, 18 October 2020, M‑Boldened: Menopause Conversations We Need to Have is a groundbreaking book that brings together an astonishing range of menopause perspectives and experiences from across the world. The team behind the book – Consultant Editor, Jo de Vries and Caroline Harris, General Editor – got together earlier this year to discuss the inspiration behind the book and why World Menopause Day 2020 really matters:

General Editor Caroline Harris

Jo: This World Menopause Day will shine a light on the menopause conversation, but it will also take place at a time when we’re facing huge challenges and uncertainties across society. Global Health advocate Dr Padmini Murthy talks in the book about menopause care and recognition as a human right. What does this World Menopause Day mean for you, particularly in the current context?

Caroline: Launching the book at this time feels particularly poignant as we see how women’s lives are being disproportionately affected economically and in terms of workload by Covid-19 and also recognising the caring roles that women play (both paid and unpaid). Working on the book has also made me starkly aware of issues around access to healthcare, for example in countries like Afghanistan the healthcare system is already under great pressure and activists are working hard to improve access for women. Many contributors to the book have spoken about very different experiences with their doctors and the importance of being listened to, particularly when these conversations are by their very nature sensitive. I worry that the complexities of the menopause conversation could make it even harder for women to be heard in the kind of online consultations that have recently been announced in the UK. Another thing that concerns me, including from my own experience, are the limitations on access to hormone treatments due to shortages.

Jo: I agree the current situation throws a number of these issues into stark relief. One of the things that we were both adamant about when conceiving the book was that the conversation needed to move beyond just medicalising menopause and talking about it in the individual sense. So, one of the things I think we’re both really proud of is the diversity of perspectives, many of which haven’t really been brought together on this subject before. What are the things that have most surprised, shocked or moved you?

Caroline: I’ve been really moved by the honesty of the contributors and their willingness to share their stories, often retelling or confronting extremely difficult experiences. We have some amazing accounts of how women have harnessed their knowledge, their energy and their unwillingness to compromise any longer to benefit others and to move in new directions. It’s truly inspiring. It has also become apparent to me how much the societal attitudes, the available support and life situations you experience at this time dictate your long-term health outcomes and life chances. When speaking with Dr Christine Ekechi from Imperial Healthcare Trust in London, she highlighted the shocking differences in gynaecological health outcomes for BAME and particularly Black women. Shad Begum, the social rights campaigner, tells of how in her Pashtun region of Pakistan women’s health is deeply undervalued. There is no word for menopause in Pashtun and in many ways this is the ultimate embodiment of the lack of visibility that women in midlife experience in this culture. This lack of visibility and of not being heard and taken seriously are also recurring themes in the book. One of the contributions that shocked me the most in this respect was an account of life as a menopausal woman in the UK criminal justice system, where the lack of provision is dehumanising.

Consultant Editor Jo de Vries

Jo: Yes, I found that profoundly disturbing. For me some of the things that resonated most were around how as women we often deprioritise our own gynaecological health through shame, fear or just plain embarrassment. Reading Carol Russell’s chapter on the rage she felt as a girl and the constrictions of menstruation, moved me as did so many of the chapters in which women ignored symptoms or pushed them to one side – I’ve done that at lots of points to do with my own gynaecological health and now feel such rage that women do that – it’s so unnecessary. In the introduction, Mandu Reid (leader of the Women’s Equality Party) talks about how it often doesn’t matter where we come from because menstrual literacy is staggeringly poor across the world – regardless of class or culture, and that rings true. The period and menopause conversation is opening up, but we still shy away from M-words. It is something I really hope we can change with our campaign – we need better words – in which we want to encourage women to choose words that speak to their own journey to help open up those discussions.

Jo: If there is one thing you hope to shine a light on this World Menopause Day, and also hope to achieve with the book in general – what would it be?

Caroline: It’s difficult to narrow this down to a single answer. One thing is that I hope the book helps people going through difficult symptoms to know that they’re not alone. From all I’ve heard, this connection makes so much difference. Another is that we understand our connections across the globe, it feels incredibly important to appreciate the ways in which are linked and how we can empower each other by opening up these conversations. I hope that this book adds to the groundbreaking activism that is happening across the world, and here at home campaigns such as #MakeMenopauseMatter led by Diane Danzebrink.

Jo: Absolutely. For me, I also hope that this sparks a much-needed intergenerational conversation. BAFTA-nominated screenwriter, Carol Russell talks powerfully in her chapter about this dynamic between women and how the appreciation and understanding of all life stages is so vital for our society to move forward. In her words, “As we celebrate World Menopause Day in 2020 the world is going through a tremendous change and I believe that women over 50 have a lot to offer that conversation. Our lives have not ended, a new chapter has begun.”