Breaking the M-word taboo

A cartoon jingle rings out as a word splashed in Barbie pink flashes on screen. At first glance it’s an unlikely video game from an equally unexpected game master.

‘Menopause The Game’, which in truth is less video game and more social media lark, sees British-born Australian actor Naomi Watts portray a character navigating the tyrannous landscape of hot flushes, migraines, mood swings and brain fog.

“Finally… a game you can beat your kids at,” Watts teased last month in a social post accompanying the video.

Despite her jest, the Oscar nominated actress is true to the cause. Watts is among a group of next generation women publicly speaking out on hormones, ageing and the workplace. This month the 55-year-old recounted a workplace story to an audience in Sydney. It was a conversation with a Hollywood agent who told her she needed to “work, work, work” because she only had until she was 40 to “play a leading lady”.

Watts noticed her first menopause symptoms at just 36. Her mission now is to use her profile to raise awareness on menopause and help prepare others. She’s even founded a company Stripes, which focuses on hormonal wellbeing. 

“Over the course of my career as an actor, I’ve outrun tsunamis and come face-to-face with ‘King Kong.’ But nothing prepared me for early menopause,” Watts says.

“I’d wake up in the middle of the night, drenched in sweat. My skin was dry and itchy. My hormones were all over the place. I remember feeling so confused and alone, like I didn’t have control over my own body.”

Naomi Watts celebrating her beauty and wellness menopause brand, Stripes. Image credit: Getty Images for Stripes

Early menopause affects four per cent of women aged under 40 in Australia. The average age of menopause is 51. Outside these figures, some women know little else about ‘the change’.

“It’s always good to start simple, because you don’t have open conversations on a taboo subject. A lot of women won’t even know the basic definition,” Dr Fatima Khan, a peri-menopause and menopause specialist tells FW. 

“So I think it’s always good to not make that assumption. So menopause is defined as your last menstrual period and that diagnosis is made in retrospect. Now, that’s an easy one to identify. So it’s marked by 12 months of no period, the end of your fertility or the end of the ovarian activity.”

Dr Kahn explains the lack of understanding about menopause for a lot of women is because it was a topic not openly discussed. It wasn’t discussed in the home, among friends, anywhere.

Unlike today where menstrual care is open slather for younger generations, older generations were introduced to puberty through the veil of a brown paper bag. It’s a veil many equate to embarrassment and shame and is something many women have held onto for decades.  

“I went into, ‘Oh my God, I’m finished,'” she said. “‘I’m no longer sexy. I work in Hollywood.’” 

This comes as little surprise given the origins of the hormonal changes. There is little detail as to the first known reference to menopause. Aristotle is said to have determined the age of the change to be 40, while, in 1821, a French physician coined the term menopause. By the 1930s it was considered a deficiency disease. 

“Before, if you went through menopause, you wouldn’t even talk to your girlfriend about it,” Dr Kahn says. 

“And it’s that isolation that makes the experience even more, because you think you’re the only one going through it.”

Dr Kahn breaks down the hormonal change chronologically in terms of milestones in a woman’s reproductive lifespan.First comes puberty, then pregnancy and menopause. 

She says it all comes to an end at menopause. Tied into this change is perimenopause.

“With perimenopause it’s peri, so around the time – and it’s the time leading up to the menopause – where your hormones are fluctuating because the ovaries are still producing, but it’s an erratic manner,” she says.

Perimenopause is where women, particularly in their early to mid 40s, can really struggle, she says. They grapple with emotional and physical change.

Image credit: Instagram @iam_stripes

“There’s two aspects to that. So the symptoms are not just physical. So we always think, ‘Oh, they’re a bit of hot flashes, night sweats, everyone can put up with that’”, Dr Kahn says. 

“But the less commonly talked about are other mental health symptoms. So each woman will complain about the mental health impact, that anxiety, low mood, irritability, but we don’t talk much about cognitive function. That’s our executive processing.”

In daily reality this can look like shortfalls in new learning, short term memory recall, and focus. Some women also experience migraines, heart palpitations and joint pain.

“Where you’re not able to recall information, mood disturbance such as anxiety and overthinking, you could just see how that poses a problem in a woman’s ability to work,” Dr Khan explains.

“I think it’s very difficult because when it comes to the workplace, most women will be entering the peak of their careers. But it’s also a very busy time in their family lives. They’re all full time in the workforce. But a lot of them will either say, ‘I’m going part time’. If that employer is not able to offer them part time work, they will leave and go and find a part-time job elsewhere. So we’ve got a huge issue of the workforce being lost.”

To put this loss into financial terms, the latest data from the Australian Institute of Superannuation Trustees estimates menopause costs women more than $17 billion in lost earnings and superannuation. 

“I think the first thing, overall, is we all need to recognise the symptoms and acknowledge that it’s happening.”

Dr Kahn says she knows of some women who choose to walk away from their careers because of their hormonal changes.

“Some of them will quit altogether and then pivot into a different career. So you know, if you had a full time corporate career, you might do something else that’s less challenging,” she says. 

“But I think it’s important to note that the symptoms are transient. And so some women will make really major life, career changes like that, actually, I think we just need more awareness.”

The Australasian Menopause Society (AMS) said the number of postmenopausal women will rise to 1.1 billion worldwide by 2025. 

However, a new study predicts the number of women experiencing menopause-like symptoms will likely be much higher. This is because women in the late-reproductive stage experience multiple symptoms often associated with menopause years before the official transition.  

While there has been some medical research into menopause, more robust, focused research needs to be done.

Monash University called for greater research around the age of menopause onset and further studies on the impact on work and the workplace.

In the 2023 National Women’s Health Survey, co-authored by the university, AMS and Jean Hailes for Women’s Health, 37 per cent of all survey respondents said menopause symptoms made it hard to do daily activities.

Meanwhile, 31 per cent found it difficult to work or study, 22 per cent missed exercise and 12 per cent missed days of work or study.

Dr Fatima Khan, Peri-menopause and menopause specialist. Image credit: Instagram @menopausespecialist

“I think there’s a huge opportunity lost at the moment in the workforce,” Dr Khan says. 

“I see so many women who give up. They quit their jobs or go on sick leave and they either never go back to that job or they go to another sector.

“So obviously we need to do a lot more.”

Naomi Watts expressed concerns over her ability to maintain her career after hormonal change.

“As soon as I had my second child, I basically went into hardcore symptoms,” she told SXSW Sydney.

She spoke of the shame, panic and loneliness she felt, particularly as a Hollywood actor, and how she faced real life impacts on her career.

“I went into, ‘Oh my God, I’m finished,'” she said. “‘I’m no longer sexy. I work in Hollywood.’” 

Dr Khan says it’s important for women going through menopause to have support, particularly in a work environment.

“You just need a supportive work environment and you need a supportive home environment and society where we support you through this transition, and then you’ll be back at your baseline,” she says.

As for what this support looks like in the workplace, it varies. 

Workplace flexibility is a good start, with dedicated menopause leave. Though, the survey found great care is needed when considering menopause support.

“When we’re pregnant, we tend to look after ourselves, tend to sleep well. We remove all kinds of stimulus from our diet or we eat a healthier diet. We’re just a lot more kinder.”

Greater focus is needed on education at both the manager and employee levels. Consideration is needed to avoid ‘catastrophising’ or ‘specialling’ menopause to push employers into making their workplaces more flexible.

“I think women want to be recognised. I think the first thing, overall, is we all need to recognise the symptoms and acknowledge that it’s happening,” Dr Khan says.

“Some workplaces are doing webinars where they are creating awareness. The workplaces that are doing that they’re smart, because then that means the female employees are recognising the symptoms, they’re seeking help appropriately and early and their workplace retention is higher.”

Dr Kahn says 80 per cent of women will complain about both physical and mental health changes during their menopause experience. While 10 per cent of women will experience none of these symptoms.

A key point Dr Khan wishes to make is that it’s important for women to realise hormonal changes come with transient symptoms. They will fluctuate. Dr Khan, who has specialised in this area of women’s health since 2018, tells her clients to be kind and compassionate with themselves. And for her clients who were once pregnant, she reminds them of the self care they afforded themselves, and urges them to mirror similar activity.

“When we’re pregnant, we tend to look after ourselves, tend to sleep well. We remove all kinds of stimulus from our diet or we eat a healthier diet. We’re just a lot more kinder,” she says.

“Our body shape changes, we don’t say ‘you look fat’ in the mirror because the lens we’re using is ‘this is an amazing body and my body is going through this’ and we’re just so much more understanding as an individual, but also around society.”

Dr Kahn advises when it comes to perimenopause, women need to extend the same understanding, support and compassion. 

“It’s another transformative change in your body, at a biological level, physical level, emotional, psychological level, because we’ve not had education amongst women and in the healthcare profession, we don’t extend the same kind of compassion,” she says. 

“I will say, give yourself some time, and you will be fine.”

For further resources about coping with peri-menopause and menopause symptoms head to the Australasian Menopause Society.