When the topic of menopausal symptoms arises, we often acknowledge the common physiological effects; the hot flushes/flashes, night sweats, insomnia, tiredness, fatigue, weight gain or digestive problems. It is not widely recognised that many people going through the menopause also suffer from psychological issues, such as lack of confidence, poor memory, lack of concentration, depression, anxiety, irritability and/or mental clarity. Symptoms are generally more severe during the first few years, before the complete cessation of menstruation, which is also known as the perimenopause. In some individuals, the range and severity of symptoms can last the full duration of the menopause (more than 10 years).
The effects
During the menopause, one experiences a broad range of physiological and psychological symptoms because the body gradually reduces the production of the reproductive hormones. The primary reproductive hormone, oestrogen, is not only responsible for regulating the menstrual cycle and preparing the body for conception and pregnancy, but also influences bone mass and the cardiovascular system and produces collagen and protein fibre required by muscles, joints and connective tissue. Fluctuating levels of oestrogen (before and during the menopause) have been found to affect the hair, heart, bones and breasts, among others, but also cognitive functioning.
It is widely accepted that the brain requires oestrogen to function efficiently. The hippocampus, the part of the brain responsible for memory, appears most greatly affected by reducing levels of oestrogen. Oestrogen acts as an antioxidant, providing a defence against free-radicals responsible for destroying tissue associated with dementia and Alzheimer's disease. Studies have shown that 33% of women, over the age of 65, suffer from dementia in comparison to 20% of men.
Experiencing memory difficulties as an instrumental and vocal performer, could potentially be career changing. There is generally an expectation (particularly at professional level) that musicians must perform from memory. However, lack of concentration and/or difficulties with mental clarity could inhibit a performers ability to effectively memorise new pieces or recall old repertoire. This could increase feelings of anxiety and lack of confidence and cause performers to lose faith in their abilities, leading to early retirement or career changes.
Instrumental and vocal teachers and mature students are equally likely to experience difficulties. Teachers may find dealing with administrative tasks, handling technology and management of students more difficult. This may cause feelings of frustration and lead to early retirement. Similarly, mature students may experience problems acquiring musical skills and instrumental techniques or learning new material. Which in turn, could make them feel discouraged and have them discontinuing their learning.
Easing the symptoms
The most common form of management for the menopause is Hormone Replacement Therapy (HRT). HRT consists of varying quantities of oestrogen, progestogen and testosterone to suit the individual's needs. It can usually be prescribed in multiple forms, including tablets, patches, gel, implants, cream and pessary. Although HRT is primarily prescribed to menopausal people it also has additional, lesser known benefits, such as reducing the chances of osteoporosis, coronary heart disease, dementia and Alzheimer's However, despite the numerous benefits, in recent years HRT has received negative and conflicting media coverage highlighting and focusing on the risks of breast cancer and thromboembolism (blood clots). While the risks may be high for some women, it is advisable to speak to your GP to discuss your suitability for HRT before ruling it out as a form of symptom management.
Alternatively, there are various natural/herbal medicines available including; red clover, black kohash (believed to balance hormones), dong quai (helps hot flushes and night sweats), hops and valerian (insomnia), St. john's wart (anti-depressant), evening primrose oil (pre-menstrual stress), ginseng (increases energy levels and balances hormones), Yarrow (lowers body temperature) and motherwort (anxiety and sleep) to name a few. Many of these can be found in any health food store.
In my own research – that investigated the menopause and its effects on the ageing female classical singer – all 27 participants indicated that they experienced psychological symptoms. Participants also reported a wider range and severity of psychological symptoms in comparison to physiological symptoms. Interestingly, more than two thirds of participants were not taking any form of prescription or natural/herbal medication to manage symptoms. Reasons for not managing symptoms included, they were natural/normal, they felt unable to speak to a GP or they had a negative GP experience.
To some extent making dietary and lifestyle changes has shown to improve the management of menopausal symptoms. For example, reducing your consumption of spicy food, alcohol, caffeinated drinks, sugar and salt can help to improve the severity of hot flushes/flashes. Eating a high fibre diet that includes large quantities of fruit and vegetables and drinking more water can reduce digestive problems, while increasing your vitamin B intake by eating meat, dairy, wholegrains, green vegetables and fruits, can help to combat depression.
Overall, there is very little research that investigates the psychological impact of the menopause. What is understood is that as life expectancies have increased, and therefore more people live long enough to reach the menopause, societal views and opinions have changed. During the Victorian period, someone going through the menopause might have felt able to work and go about daily life with a renewed sense of freedom. In more recent times, the menopause is viewed with negativity because it is associated with ageing. Medical literature also continues this negative view as it frequently refers to the menopause as a deficiency disease. This negative perspective can leave menopausal people feeling a sense of loss, shame, sadness, fear, surprise, frustration, anger, grief and even embarrassment although it is a natural and unavoidable life-transition.
More research into this field could potentially lead to a greater awareness of the difficulties facing menopausal people and would subsequently work towards improving mental health and wellbeing. The benefits for the music industry could include retaining skilled and experienced musicians and teachers, as well as the development of effective strategies to support teachers and mature students. Ultimately, this would ensure that instrumentalists and vocalists could continue performing and learning for as long as possible.
For information on the menopause visit: nhs.uk/conditions/menopause. Alternatively, you can find out more at thebms.org.uk
