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Navigating the menopause. Taboo or not taboo? What every man and woman should know.

Navigating the menopause. Taboo or not taboo? What every man and woman should know.
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August 22, 2022
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Should the menopause be taboo or not?

The topic of menopause has been taboo for centuries and particularly within culture, it is not a topic that one likes to discuss publicly. Yet the Quran never shies away from uncomfortable or embarrassing topics, rather it broaches them in a positive way.

We certainly need more awareness of this topic as it affects half the population directly and the rest of it indirectly by being in the company of women who are going through it at some point in time.

Though it is expected and unavoidable, no one talks about it.

Male menopause

Allah Almighty has created seasons in our lives with different levels of energy, focus and responsibilities. Just as women typically undergo menopause changes in their 40’s and 50’s, often men also experience what has been termed the “male menopause”. This can be associated with symptoms such as erectile dysfunction, mood swings, depression, abdominal obesity, poor memory and loss of muscle mass. However, unlike in women where there is a sharp drop in hormones, in men, there is only a gradual decline in testosterone levels and often there are significant psychological factors underlying the symptoms.

Nonetheless, it is a change of season from the summer to the autumn of their lives in men and women, which needs to be navigated with patience and compassion on both parts. Whilst women, often younger than their husbands and therefore possibly still at the peak of their libido, are expected to patiently and quietly deal with sexual dysfunction in their spouses, likewise, men need to respect and support the changes in their wives.

Let’s talk

As women transition through this difficult time, it would be better for their families to have awareness of what they are experiencing so that it makes this transition as smooth as possible for everyone.

When women go through the menopause, they should be able to talk about with their family members and friends and employer to elicit support. Husbands may suddenly find that their spouse is not the person they were and not in the mood and this can create friction in a marriage which handled badly can end in divorce.

The menopause should not, however be used by a woman for an excuse for behaving badly, or by men as a weapon against her, as a means of dismissing her opinion as irrational and blaming it on her menopause.

Advice for men and women during the menopause

Practical steps include maintaining open and clear communication, managing stress and energy levels and new ways of connecting such as switching to a healthier lifestyle with regular physical activity and a diet rich in plant-based foods and protein. Women suffering with hot flushes might wish to sleep separately at times or wear silk pyjamas and couples may wish to use lubricants during intimacy.

Other practical steps may include the use of a shared diary or note-making to help manage forgetfulness and a more evenly shared burden of responsibilities. It is important that husbands accept and love them for who they are and for the years of dedicated support they have given during their youth as they go through this stage of vulnerability- this reassurance is hugely helpful. Occasionally, women experience very high levels of anxiety, often anxiety and depression peak in women when they are in unsupported relationships or even abusive relationships, in which case they may benefit from CBT or relationship counselling.

A natural phase of life

Allah says in the Qur’an:

Whomsoever We grant a long life, We reverse him in his constitution. Do they still not understand? [36:68]

The cycle of life is one of Allah’s creations. All humans, who reach old age have experienced growth, transitioned through various stages, reached maturity and then embarked on a reversal. In the life of a woman, the menopause is a significant change which she navigates silently, as society has kept it a taboo for centuries.

Menstruation

Allah Almighty created the menstrual cycle as a means of perpetuating the human race. While it provides the ability for a woman to have children, it can also accompanied by discomfort and inconvenience. During menstruation intimate relations are prohibited.

وَيَسْأَلُونَكَ عَنِ الْمَحِيضِ ۖ قُلْ هُوَ أَذًى فَاعْتَزِلُوا النِّسَاءَ فِي الْمَحِيضِ ۖ وَلَا تَقْرَبُوهُنَّ حَتَّىٰ يَطْهُرْنَ ۖ فَإِذَا تَطَهَّرْنَ فَأْتُوهُنَّ مِنْ حَيْثُ أَمَرَكُمُ اللَّهُ ۚ إِنَّ اللَّهَ يُحِبُّ التَّوَّابِينَ وَيُحِبُّ الْمُتَطَهِّرِينَ

And they ask you about menstruation: say, “It is harmful, so keep away from women during menstruation. And do not approach them until they have become pure. Once they have become pure, approach them in the way God has directed you.” God loves the repentant, and He loves those who keep clean.” [2:222]

Not knowing what is going on

Many women will not realise the changes in their moods or energy levels are being caused by the changes in her hormone production.

Some women experience negative mood and depressive symptoms during the menopausal transition, sleep disturbance and cognitive problems which can affect their work and relationships.

While women often felt isolated, they may be reluctant to talk openly about the menopause or consult a healthcare professional.

The men around them, and society at large – neighbours, colleagues and friends will be none the wiser, and so the menopause years can be tough at the very least, suffered in silence and severely challenging at worst, particularly if they contribute to family problems, divorce and even suicide.

Being kind to women and aware of what she is going through

It is therefore important that men and women are aware of what a woman goes through so that they can extend the extra respect, care and support that she needs during this time.

If they are not aware of the turbulence women are experiencing they are unlikely to make allowances for the changes in their emotional reactions or compromised mental agility.

It may be a mother, wife or sister who is going through these changes and while a man cannot know what it feels like to experience hot flushes and brain fog at the most inconvenient moments, they can make allowances for women to get through them. The Prophet (peace be on him) said in many hadith that men should show kindness to women and especially their wives.

In a largely masculine society, women’s emotional nature is often considered inferior to a rational, emotionally devoid approach. Yet Allah Almighty has bestowed this huge favour and balance in the world through this emotional nature; indeed, emotional literacy and intelligence is a strength that allows women to build families through compassion. Studies have shown that households with more female members are generally happier and more emotionally settled than households with predominantly males.

Abu Hurayrah (may Allah be pleased with him) reported: The Messenger of Allah, peace and blessings be upon him, said:

أَكْمَلُالْمُؤْمِنِينَإِيمَانًاأَحْسَنُهُمْخُلُقًاوَخِيَارُكُمْخِيَارُكُمْلِنِسَائِهِمْخُلُقًا

“The most complete of the believers in faith are those with the best character, and the best of you are the best in behaviour to their women.” [Abu Dawood]

حَدَّثَنَا أَبُو بِشْرٍ، بَكْرُ بْنُ خَلَفٍ وَمُحَمَّدُ بْنُ يَحْيَى قَالاَ حَدَّثَنَا أَبُو عَاصِمٍ، عَنْ جَعْفَرِ بْنِ يَحْيَى بْنِ ثَوْبَانَ، عَنْ عَمِّهِ، عُمَارَةَ بْنِ ثَوْبَانَ عَنْ عَطَاءٍ، عَنِ ابْنِ عَبَّاسٍ، عَنِ النَّبِيِّ ـ صلى الله عليه وسلم ـ قَالَ ‏ “‏ خَيْرُكُمْ خَيْرُكُمْ لأَهْلِهِ وَأَنَا خَيْرُكُمْ لأَهْلِي ‏”‏ ‏.‏

Ibn ‘Abbas narrated that the Prophet said:

“The best of you is the one who is best to his wife, and I am the best of you to my wives.”

This change in a woman’s life which usually can take place anytime between her mid-forties and mid-fifties does not happen overnight. Rather it is spread over numerous years and while each woman may experience it differently, it is not only a process of physical changes but alters her mentally and emotionally during that time.

Many women will find it a mercy from Allah to cease having periods, while others will be filled with sadness at the sense of loss. Women who undergo medical treatment such as chemotherapy and radiotherapy and other procedures such as certain forms of gynaecological surgery, which may involve removing or treating the uterus, may also lead to an early menopause. Family history is important. Stress is known to disturb female hormones and libido; however, it can also lead to premature reproductive ageing and depletion of ovarian reserves. The cessation of menstruation can trigger complex changes in the woman’s sense of self, her self-esteem and relationships and may be associated with stigma where she is unable to bear children in the case of premature menopause.

Increasing awareness

The mainstream media has raised awareness about the effects of the menopause, which may often affect women as they are reaching the peaks of their careers. The World Health Organisation holds World Menopause Day every 18th October and recently more and more workplaces have made pledges to recognise the impact of the menopause and actively support women who are affected. For instance, the NHS and Civil Service which has become the biggest organisation to sign the pledge to create an open environment to talk about the issue and provide support. More than half of the Civil Service comprises women and the median age of civil servants is 45, when they will be going through the perimenopause or menopause.

Accessing help and advice

Within Muslim communities, there is still silence which means that women often do not access the medical services available. If they are better equipped with the knowledge of what they are experiencing and have people they can ask for advice it would make this transition more bearable. They can be told what to expect, what treatments options are available and how to alleviate the symptoms proactively by looking after their health, for instance through regular exercise and adopting healthy eating habits.

It is also important that healthcare professionals are non-judgmental and respectful of the traditions of Muslim women, as they may not always feel their situations and cultural backgrounds are understood.

What is the menopause?

The menopause is a natural transition in life, and despite its negative connotations, is a blessing when viewed in its true form. It is a time of renewal, maturity and celebrating accomplishment, a new phase of life described by the Japanese as the ‘Second Spring.’ However, as in all transitions, the change requires education, and the tools to navigate and thrive during this stage of life.

Biology of menopause

Leading up to menopause is characterised by a time of hormonal fluctuations where the sex hormones Oestrogen and Progesterone begin to fluctuate as egg production from the ovaries becomes erratic. When Menopause is reached, and no more eggs are being produced, menstrual periods stop, and levels of Oestrogen, Progesterone, and to some extent, Testosterone become very low.

The time hormone fluctuations start in the menopause transition is known as the perimenopause. The transition is divided into 2 phases: early and late. In the early phase a woman is likely to see some of her menstrual cycle lengthen by seven or more days, or she may even skip an occasional period. The late transition is characterised by several skipped periods, and often symptoms such as insomnia and hot flushes. However, there is no hard and fast rule, some women have symptoms earlier and others can be close to their final period and have no symptoms at all.

Overall, menopause symptoms may be ongoing for up to 10 years before the cessation of periods and may lead to symptoms which are often attributed to other causes. Nonetheless, it remains important to consider permissible forms of contraception throughout this period  and for 1-2 years afterwards due to an increased risk of serious complications in the mother and the baby.

Common symptoms are hot flushes, night sweats, vaginal dryness, sleep disturbance, mood swings and joint pain. Many women may suffer with joint pains, migraines and anxiety. Overall, there are more than 50 symptoms attributed to the menopause, some rarer than others, such as burning mouth or formication (the feelings of insects crawling under skin). Vaginal dryness decreases libido and pain with sexual intercourse is also common.

Emotional impact

Mood and psychological symptoms can often be the most difficult to deal with, including temporary cognitive changes, brain fog, low mood and anxiety. Women frequently report feelings of anhedonia (deriving little pleasure from activities they would normally enjoy) or a sense of losing their ‘mojo.’ Psychological symptoms can be the first to appear, creep up insidiously, and be incorrectly put down to a busy lifestyle rather than hormonal change. Whilst a busy lifestyle is no doubt relevant in driving burnout and hormonal disturbances, many of these women end up being medicated with antidepressants, sometimes for years.

Wider implications

The menopause can have wider implications on marriage, families and working life. Women may experience moments of rage, when hormones swing to a low, felt primarily by family members and affecting relationships. The changes in menopause can give way to intimacy problems within a marriage, both physical and emotional. It is no surprise that divorce rates are highest in women aged between 45 and 60. The anxiety, mood changes and other symptoms are often poorly understood by family and wider society, sometimes even viewed as a taboo, leaving the woman feeling isolated.

Many women struggle with work and leave employment due to their menopause symptoms. In fact 1 in 4 women think about leaving their job due to their menopause symptoms, with 1 in 7 leaving work completely, resulting in wider, economic implications.

Health implications of women living longer and spending more years in the menopause, means women after age 50 have higher levels of heart disease and osteoporosis, diseases that are affected by low oestrogen levels. Focus on disease prevention is more important now than ever, especially women at higher risk through the transition.

What can help

Diet

Diet and lifestyle changes can significantly improve menopause symptoms, and women who start these changes early benefit from an easy transition. Nutrition is essential for menopause management. Balancing blood sugars and eating nutrient-dense meals can reduce symptoms. Swings in blood sugars exacerbate hot flushes, mood changes and energy levels. Eating more protein, reducing refined carbohydrates and intermittent fasting are ways to keep blood sugars stable.

There may be a particular role in incorporating plant-based oestrogens (phyto-oestrogens such as soy and tofu) as well as seeds and a rich, diverse diet with plenty of plants. It is also important to consider that it is not essential to consume dairy to maintain bone health at this time; consuming excessive amounts of conventional dairy may contain synthetic oestrogens which could be associated with an increased risk of breast and endometrial cancers, the rates of which increase considerably post-menopause.

Women should be encouraged to practice self-care and self-compassion, with gratitude, reflection and renewal. In terms of supplements, some people may find Bergen bread, a soy and linseed bread might help symptoms. Another popular supplement is black cohosh- the evidence base for both of these is mixed/ not substantial and limited. Some women find having a womb massage (womb massage) helpful and healing. More recently, women are coming together to go on menopause retreats where they are understood by fellow women and experience the change collectively.

Managing Stress

Stress management is integral during menopause as increased stress will increase cortisol levels, which plays havoc with sex hormones. Building in self-care and relaxation will keep cortisol levels stable and symptoms controlled.

Exercise

Exercise, when done regularly is also important. For some women, certain exercises such as running or HIIT may exacerbate symptoms as the body will perceive this as ‘stress ‘. But exercises that help the body recuperate, such as Yoga, Pilates, and walking, can benefit midlife.

HRT

When diet and lifestyle changes have not entirely controlled symptoms, HRT (hormone replacement therapy) is the most effective method in alleviating symptoms. Despite the concerns about HRT in the last 20 years, the newer forms of HRT now prescribed are very safe for most women. The aim of HRT, as its name would suggest, is to replace the hormone that the body ceases to produce during the menopause, namely oestrogen. Body identical HRT is the closest in molecular structure to our body’s own hormones and thought to be the safest (derived from the yam). When started early, in the perimenopause or early menopause, the benefits of HRT outweigh the risks, as these women have been found to have lower rates of heart disease, dementia and osteoporosis.

If struggling with any symptoms, it is important to discuss your concerns with a health care professional. Speaking to friends and family is also important, as support through the transition is key to thriving in menopause.

Divorce during the menopause

Women who are divorced once they have reached the menopause have a shorter ‘iddah (waiting period before they remarry) is reduced to three (lunar) months from the date of divorce, compared to menstruating women who have to wait three menstrual cycles as per the verse in the Quran:

وَاللَّائِي يَئِسْنَ مِنَ الْمَحِيضِ مِن نِّسَائِكُمْ إِنِ ارْتَبْتُمْ فَعِدَّتُهُنَّ ثَلَاثَةُ أَشْهُرٍ وَاللَّائِي لَمْ يَحِضْنَ ۚ وَأُولَاتُ الْأَحْمَالِ أَجَلُهُنَّ أَن يَضَعْنَ حَمْلَهُنَّ ۚ وَمَن يَتَّقِ اللَّهَ يَجْعَل لَّهُ مِنْ أَمْرِهِ يُسْرًا

As for those of your women who have reached menopause, if you have any doubts, their term shall be three months—and also for those who have not yet menstruated. As for those who are pregnant, their term shall be until they have delivered. Whoever fears God—He will make things easy for him. [65:4]

For a man to divorce his wife during her menstrual cycle is sinful although the divorce is valid; he is obliged to take her back as his wife if the divorce was revocable. He must then wait for that period and the following period to end and then decide to remain in the marriage or to end it with another divorce. Subhan Allah- this reflects the vulnerability of the woman at this time, the impatience of the man when his anger is not soothed through intimacy and Allah’s mercy in protecting families.

A study carried out among Malaysian women in 2021 uncovered a knowledge gap and a lack of support for women impacted by menopause. Though many Muslim women regard the menopause as a time to where they can increase fasting and salah, unencumbered by periods. The main findings were the need for awareness among women and for more support to help them during these significant biological transition.

Written by Dr Ferhat Uddin GP and Accredited Menopause Specialist, Liberty Health Clinics and Dr Saania Bhatti, North London GP, Functional Medicine doctor, Lifestyle Medicine and Wellbeing Specialist.

(www.libertyhealthclinics.com, quote UTRUJJ50 for a 50% discount on consultations).

The opinions expressed in this publication are those of the authors. They do not purport to reflect the opinions or views of Utrujj or its members. Utrujj does not accept any liability to any party for any loss, damage or costs howsoever arising, whether directly or indirectly, whether in contract, tort or otherwise from any action or decision taken (or not taken) as a result of any person relying on or otherwise using the information provided through this consultation or arising from any omission from it.

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