"We don’t want to be seen as the crazy old woman who’s emotionally unstable."

Women in Ireland aren't talking about the menopause - neither those who are going through it, nor those who aren't. Founder of the Menopause Hub Loretta Dignam says although society tends to associate the menopause with "older women," perceptions around age are changing, while understandings of the menopause, largely, are not. In her 40s, Loretta was perimenopausal, and like the majority of women, she didn't have a clue what was happening. “I had never heard of it before," she tells Her. "I knew what symptoms I was experiencing but I never connected the dots. I was ignorant, and a lot of women still are.” Sometimes known as the transitional stage, perimenopause affects different women at different ages, preparing the body for the end of its reproductive years. It's one of the many facets of the menopause that most Irish women know little to nothing about. Lack of education is an issue, says Loretta, not just because women are afraid to talk, but because they're afraid to talk about something they're going to be experiencing for a large portion of their lives.

"Over one hundred years ago, the average woman started the menopause at 47," she says. "Now the average age is 51. These days women are living so much longer, so for an average of one third of your life, you’re menopausal.

“We also tend to associate the menopause with older women, simply because women of previous generations seemed a lot older. My mother seemed much older than a 50 year old woman would nowadays." [caption id="attachment_519968" align="aligncenter" width="990"] Loretta Dignam[/caption] The most common symptoms of the menopause are hot flushes, night sweats, sleeping problems, weight gain, and mood swings. Most women will experience at least one of these symptoms, and yet there are a whole host of others that are less frequently recognised, and less spoken about. Loretta says that emotional symptoms are often overlooked when it comes to menopausal women. "Anxiety and depression, things I would have been unaware of, are huge for menopausal women," she says. "So many people present with anxiety having never experienced it in their lives. Mood swings, panic attacks, and depression, they all feed into the stereotypical 'crazy lady' characteristic, and we don't want to be seen as that. "We don’t want to be on the scrap heap, or seen as the crazy old woman who’s emotionally unstable. Nobody wants that." And so, says Loretta, women don't talk about it. Some do, but a lot don't - for fear of embarrassment, shame, or not realising that what they're experiencing can, in fact, be treated. Vaginal dryness and incontinence are both common enough menopausal symptoms, but according to Loretta they are rarely spoken about among Irish women - or rarely seen as issues that can be addressed and treated accordingly.

“Nobody talks about vaginal dryness, patients don’t spontaneously bring it up," she says. "We’ll ask them if they’re experiencing painful sex and they’ll say “Oh yeah, I am,” thinking that it just happens as a result of ageing. And it does naturally get worse with age - the skin becomes papery and is more prone to infections and irritation - but it can be treated.

"It's the same with incontinence. There’s all these ad on TV saying: it’s normal. It’s not normal. They say it’s part of ageing, and that if you’ve had kids you’re prone to leaking as you get older. They say it’s part of being a woman, but the reality is, you can get help for it. It’s so common but it doesn't have to be."

A 2020 study showed that most women had delayed telling their partner about the menopause, with most waiting over five months before informing their other half. The research also showed that while most women turned to a doctor for advice during the menopause, 16 percent didn't tell anyone what they were experiencing.

Research conducted by the Menopause Hub details similar findings. Last World Menopause Day, Loretta asked 12,050 women on a scale of one to 10, how ashamed they were of the menopause. The average response was eight out of 10.

80% of women said they felt underprepared for the menopause, while 66% said they knew little or nothing about the menopause before they started experiencing it. "Some women are so embarrassed, others want the world to know," says Loretta. "Younger generations aren’t afraid to speak out about health issues and period poverty and painful sex, but my generation is. They’re saying I’m not afraid or ashamed, but the majority of women my age wouldn’t be happy to do that. "I don’t think people mourn fertility, they mourn vitality. In the Western world, youth is revered, and that’s why women don’t want to talk. When you get the menopause, you’re seen as old, you’re over the hill, you’re past it. "Women will come into focus groups and say they haven’t even told their husbands what they’re going through. They won’t go to the pharmacy. They’re too embarrassed and they think they’re completely alone.” But where there is silence and shame, there is also hope. Loretta points to celebrities like Meg Mathews, Davina McCall, Gwyneth Paltrow and other high profile female figures who have spoken openly and honestly about the menopause and how it has affected them. Back in 2019, music PR Mathews told the Guardian that when she began experiencing perimenopausal symptoms, she presumed her "rock n roll lifestyle" had simply caught up with her. “I told everyone I had glandular fever and didn’t go out of the house for three months," she said. As well as this, accurate references to the menopause in pop culture have increased in recent years, as more and more of our favourite female leads are depicted dealing with hot flushes, navigating mood swings, and seeking help for their changing bodies. Loretta says that change is happening, slowly but surely - but that we've still got a long way to go. "Before I set up the clinic, I considered myself to be intelligent and and reasonable, and I knew so little," she says. "A lot of women have no idea why they’re feeling this way. They feel like they’re going mad. “We’re definitely more educated now, but the level of understanding is still shocking. But knowledge is power, and it's important to remember that. I don’t care if you come in and don’t take any of my recommendations. I just want you to be informed."