Navigating menopause: Namaganda’s journey and insights

Namaganda began embracing the morning sun every day, but that was the last time she did her favourite squats.

“One time I tried to squat and I heard a snapping sound in my right knee. I found it hard to get back up on my feet. That is when I hit the Internet and put two and two together. It dawned on me that I might be approaching menopause,” she says.  

Like someone had opened the floodgates, other symptoms followed on the heels of her snapping knees. The worst were the hot flashes.

“I would feel hot when everyone else around me is feeling cold. My body does not sweat as such, but the heat! I could sense it coming. It can wake you up at night, forcing you to throw off the covers. Then, in just under three minutes, the cold sets in. You begin shivering,” she says.

Namaganda adds that the hot flashes reached their peak last year when every day she would wake up, she did not feel like getting out of bed.

“I gave the people in my workplace such a hard time because I would complain bitterly about the air conditioner. In the middle of a very hot day, I would demand that they switch it off because I was feeling very cold. That made the office very uncomfortable for them. It made me want to stay away from people. I did not want to talk to anyone,” she says.   

Namaganda endured three months of continuous hot flashes and by the end of that time, she was completely exhausted. She began going to work with a hot water bottle, which she held to her stomach whenever she felt extremely cold. 

“It took too much effort to do the tasks that I used to do normally. The joints in my fingers began to hurt. One day, I fell asleep in a taxi and when I woke up and tried to stretch my fingers, my left thumb got stuck in one position. I love crocheting and cooking, but after the joints in my fingers began hurting, I lost interest in both,” she says.

In despair, Namaganda talked to a younger subordinate at work, who is a born-again Christian. The workmate asked the older woman at her church to pray for her boss. 

“They prayed for me. They also told me that what I was going through was normal and had happened to many other women. That is when I began to relax,” she adds. 

Transitioning to menopause 

For many women, the years leading up to the last menstrual period can be difficult to navigate because of the decline in the production of, and hence the levels of hormones. 

They experience irritability, irregular periods, which are sometimes very heavy, hot flashes, and poor sleep. However, like Namaganda, few of them know what they are going through.

Dr Miriam Ajambo, a senior medical officer with the Ministry of Health, says although the perimenopause age varies for every woman, the average onset is 49 years. 

“It also depends on when you had your first menarche. Those who had it early, like at 13 years, are likely to experience menopause later in life, while those who got it late, say at 16 years, may experience menopause early,” she says.

Menarche is the first menstrual period in a female adolescent. It typically occurs between the ages of 10 and 16.

“During perimenopause, the ovaries begin to produce less estrogen up to the point when they completely stop releasing eggs. The process might begin when one is in their mid-40s but the real symptoms intensify towards the late-forties and usually last three months to one year,” Dr Ajambo says.

Other symptoms include vaginal dryness, urinary incontinence, a frequent urgent need to urinate, breast tenderness, short-term memory problems, sleeping problems and fatigue. 

The silence

While everyone talks about menstruation, there is almost a loud silence around women who are going through perimenopause symptoms. This is true even for those who have not thought about the day approaching when they will reach menopause. 

“When I was younger, I did not get any sexual education beyond biology class. My mother did not sit me down and talk to me. Neither did my older sisters. I discovered everything on my own. When I began going through the perimenopausal changes, I felt extremely lonely because it was a heavy secret to bear,” Namaganda says.

She adds that she was lucky to have read about it and thus, anticipate the changes at some point in life.

“I had a hysterectomy 12 years ago, and the gynaecologist talked to me about it. He said he would leave my ovaries intact so that I do not get early menopause. But last year, I needed people to talk to. Sometimes, I would see old women and wonder if I could approach them to ask them about the symptoms I was going through,” she adds. 

Dr Ajambo adds that the sensitivity of perimenopausal issues can be tied to the fear of growing old. In the society we live in that glorifies youth, oldness is undesirable.

“Generally, as human beings, especially women, we fear ageing. So, it is with dread that we approach certain stages in life. As much as every woman knows she will reach menopause, we live in denial. And so, even when one is experiencing these symptoms, they keep quiet because they will be looked at as old. They would rather struggle alone than consult others,” she says.

Dr Ajambo says it is this irrational fear that ensures that some women keep adjusting their ages downwards to continue being referred to as young. 

Namaganda says she consulted with a female gynaecologist who expressed shock at what she was going through. She puts this down to the fact that the gynaecologist is in her early 30s and does not know what older women experience. 

“I visited the gynaecologist when my fatigue levels were too much. She said she thought I had the symptoms because I had high blood pressure. We laughed and I joked with her, saying maybe I was going through menopause. She laughed. When I asked if there was a doctor I could comfortably talk to about what I was going through, she looked at me in shock,” she says.

The gynaecologist did not know what Namaganda was going through. 

“She was a young woman. She asked me if women go through ‘that.’ It was my turn to be shocked because I thought their education covered menopause. That is when I realised this was not a topic that everyone usually discusses.” 

Dr Godfrey Alia, an obstetrician and gynaecologist with Mulago Specialised Women and Neonatal Hospital, agrees, saying not many recognise the symptoms for what they are.

“Some women go to hospital thinking they have malaria. They treat the disease and are sometimes put on multiple medications, yet all they are going through are hot flashes, joint pains, and generalised weakness, all of which are perimenopausal symptoms. If the health worker can recognise the symptoms for what they are, then they would explain what the woman is going through,” he says.  

However, Dr Ajambo says it depends on how long the medical worker has practised. 

“I expect an obstetrician to be able to relate age with given symptoms and the changes in menstrual flows. A young gynaecologist, who has studied how women age and how their cycles change, should be able to guide appropriately. Maybe, the problem lies in the lack of understanding about how to counsel someone,” she says.

Mental health issues 

Depression is common during the perimenopause transition, although it can be treated. Some of the symptoms of depression include frequent crying, feelings of hopelessness, loneliness, anxiety and loss of interest in normal activities. All of these symptoms make it hard for the woman to concentrate on her work, or even to sleep.

“The loneliness forced me to seek out younger people who I could talk to, sure that they would not be judgmental in their diagnosis of what I was going through,” Namaganda says.

Ajambo says mood swings are common among perimenopausal women, because of hormonal changes and also the fear of ageing.

“These women get mood swings, especially if they have dreams that have not been achieved. If one had anticipated that by 50 they would have settled down with a family and things have not gone the way they wished, it could lead to constant mood swings. Or maybe they feel they are getting too old for their partner, or if he has complained of certain things deteriorating,” she says. 

Loss of libido, which is mainly driven by hormones such as estrogen and progesterone, can also lead to mental health issues. 

“Estrogen is the hormone that is essential for women’s libido, and as the body menstruates, you gradually lose what we refer to as the ‘eggs.’ They are the ones responsible for the sex hormones that keep you active sexually as a woman,” Dr Ajambo says.

A woman is born with a particular number of eggs and as she ages, those eggs are not replaced. They keep reducing until they get finished.

“When those eggs are not there, you cannot have estrogen to keep you sexually active. That is why some women who can afford to, go for hormonal therapy to keep them going,” she adds. 

Working women who are going through perimenopausal symptoms have a hard time with it, especially when their workmates do not understand what they are going through. 

“I used to hear the nasty comments they would make behind my back,” Namaganda says, adding, “One time one of my male colleagues, who surprisingly is a counsellor, told people that I might be going through menopause. He said it in a mean way, implying that I was too old for the workplace.” 

Prevalence

In 2019, a survey of 1,000 women, all aged 45 or older, was carried out across the United Kingdom to determine how significantly women in both full-time and part-time employment were affected by symptoms of menopause. The survey was done by FORTH, an organisation that empowers women to become experts on their bodies through scientific knowledge and understanding.

The survey found that 63 percent of women had been negatively affected in some way by their symptoms. Of these, 73 percent reported having hot flashes, 63 percent regularly felt tired or drowsy, 48 percent suffered from low mood, 47 percent struggled to concentrate and 43 percent had trouble with their memory. 

Of the women, 34 percent said they developed depression and anxiety, while 29 percent had significantly lost self-confidence.  

Not many workplaces offer help to female employees going through perimenopause and menopause. Dr Ajambo calls for more sensitisation on the transition period to menopause.

“There should be an intentional lookout for people who are behaving differently in the workplace. We should not just judge them because of their symptoms, because even young women who are premenstrual will shout at people. Those who have gone through it should be able to counsel those who are at the beginning of perimenopause,” she says.

Conversations about perimenopause should not be locked up in the heads of older women who are struggling with the symptoms. Instead, they need to be able to talk to other women to get support. Just like menstruation, perimenopause should be normalised as a part of life that every woman will have to face one day.

Effects

It took too much effort to do the tasks that I used to do normally. The joints in my fingers began to hurt. One day, I fell asleep in a taxi and when I woke up and tried to stretch my fingers, my left thumb got stuck in one position," says Airleen Namaganda.

How to live normally

Dr Miriam Ajambo, a senior medical officer with the Ministry of Health, encourages perimenopausal women to join group therapy where they can talk about what they are going through and encourage each other.

“Women can form groups or online communities to support other women and share ideas of the best advice gynaecologists have given them. They can also talk about what remedies have worked for them to alleviate some of the symptoms,” she says. 

Visiting an obstetrician, gynaecologist, and sometimes, a mental health expert, can help one get through this phase in life. Women should also ensure they get good quality sleep to alleviate problems such as lack of concentration and memory loss as well as exercise often to reduce stress. Massage therapy is also good. 

“Some women are encouraged to take Vitamin E supplements, which have been known to suppress some of the perimenopause symptoms. Others go for hormone replacement therapy, although it has its issues,” Dr Godfrey Alia, an obstetrician and gynaecologist with Mulago Specialised Women and Neonatal Hospital, says.