Menopause is a normal stage that all women will go through, sooner or later. However, it is still spoken in hushed tones, it is still surrounded by stigmas and labels and there is still a great lack of knowledge about its symptoms or how to deal with it. Elena del Estal, Alberta María Fabris, Adriana Caamaño and Tania Manglano, who have jointly written the book Señoras (Arpa), talk about all this and how to approach menopause from a feminist perspective.
The four authors are specialists in physiotherapy, nutrition, gynecology, sexology and psychology, and have joined forces to create a comprehensive guide to health during menopause, as indicated in the subtitle of the book. Because the reality is that it is a process with numerous symptoms that can harm the quality of life, although not everything that happens to women at a certain age has to do with menopause, as the authors maintain, nor is it advisable to live it as if it were a pathology.
In fact, a recent study on climacteric carried out by Domma, a startup dedicated to the health of mature women, indicates that more than 84.5% of those surveyed acknowledged suffering from discomforts linked to menopause and needing help to master or overcome them. Symptoms such as low libido affected 66.8% of the study participants, while others were also very common, such as insomnia (63.8%), hot flashes (63.2%) and weight gain ( 61.5%).
Talking about menopause in many environments is still a taboo topic, the authors of the book acknowledge, and there are many reasons behind it. “One of them is because it is ‘a woman thing’ and since it is, the stages are ‘psychopathologized’, especially from an industry point of view,” says physiotherapist Tania R. Manglano. “In addition, it is interesting that there is a lack of knowledge because when you have self-knowledge you become empowered and are more aware of how you want to experience these discomforts,” concludes Manglano, who is also an osteopath specialized in obstetrics and urogynecology.
“It also happens that there is very biased information about this stage, hence certain stereotypes and myths appear in which it is valued that the relationship with women’s health is reproduction and a very specific beauty system; So, when they stop being reproductive, this ‘pathologization’ of the industry remains obstructed,” adds Adriana F. Caamaño, sexologist and psychologist expert in women’s health and diversity.
Likewise, menopause is still a time of change and insecurity in which women do not know what they are going to do, recognizes Elena del Estal Pérez, dietician and nutritionist. “And given the lack of information or narratives in general, it is easy for it to turn out as you have been told it will happen: those changes have been ‘pathologized’ or they tend to see them in a negative way, I am sure that I will gain weight, have hot flashes, I’m not going to have sexual relations… all the fears appear!”, explains del Estal.
It is no secret to anyone that fears at this stage are inevitable. Manglano identifies three main lines that the vast majority of women often experience: the first of them is linked to fears of those changes typical of menopause. “It hasn’t happened to me yet, but I experience them as an illness, I have symptoms and I assume that I will have them all,” says the expert. The second has to do with the narrative that translates into fear of hot flashes, lack of libido, gaining weight, wrinkles, aesthetic violence, fractures, etc. And the last one is related to the fear of aging, “since in this society a model of beauty prevails and so I want to continue being who I was,” Manglano points out. “Also in consultation I see that many women come with a very learned discourse of a female body, lacking, sick, strange, which is what they have told me it will be,” the expert clarifies.
There is also a lot of fear of loneliness and how at this stage one experiences a readjustment of expectations, in the end one experiences grief, says Caamaño. “There is a review of how our life has been and how I have to face these new changes. But it happens that, since we have no references in this grief, since there is no support from the environment or having a discourse to understand this new stage, we live with a traumatic perspective, which implies that there are blockages and it appears as something emotional or experience that is difficult for us and over which we do not have as much control,” indicates the psychologist.
What to do then? As Caamaño indicates, although a paradigm shift does not mean entering into it happily, it is about giving a more realistic message and being able to accompany this grief: “if there are no references, in the end a single perspective is created, pathological problems, that hot flashes are bad…etc.”, says the specialist and invites us to naturalize this stage and look for a reference since this will help to live it in a more diverse way. “Sometimes, those myths and fears are not that they are not real, of course the body changes, there are some types of symptoms but we have to review how we live it, what alternatives there are. For example, ask yourself: what do these hot flashes imply? Are they false? Are they telling me something? When we review that entire stage it allows us to also review an entire system,” emphasizes Caamaño.
Gaining weight is one of the most feared aspects during menopause “and it is a real alteration that happens because there is a change in body composition; when estrogen stops, more muscle mass is lost and more fat tends to accumulate,” explains Elena del Estal. “However – the expert clarifies – that does not mean that it will happen to all women or that they will all experience it in a negative way, since not all experience the same alterations, there is a large percentage that will go through menopause. without feeling that their quality of life changes.”
However, beyond weight gain, Del Estal identifies other changes that can also be experienced, such as the process of bone degeneration, since they become more porous and it is easier for them to break if there is a fall, so Hence the importance of proper nutrition and exercises that help gain muscle mass. There may also be changes in the vulva and vagina, which tends to have drier, thinner skin or may atrophy. Likewise, there may be metabolic transformations such as alterations in blood pressure, blood glucose and fluctuations in blood cholesterol levels. And many may suffer from insomnia. “But not all women are going to experience these changes,” recalls Del Estal.
There is no doubt that menopause is surrounded by great myths and some are related to nutrition at that stage: are there really forbidden foods? “No. But it is true that we must adapt what we eat to this vital period. The ideal is a plant-based diet and avoiding less interesting foods such as processed meats, pizzas or comfort foods,” Del Estal responds. It is important to always include protein in sufficient quantities and if it is of plant origin, better, in addition to omega 3, which is found in small oily fish, seeds and nuts. Likewise, antioxidants such as those present in red fruits, orange fruits and vegetables are important, adds the nutritionist.
Manglano also talks about the importance of exercising the pelvic area. “In consultation I see women aged 45-46 who are entering the climacteric and, since they do not move their pelvis, they create a lot of tension in that area,” he says. The physiotherapist recommends moving, dancing, connecting with the body, that is, exercising not only strength and impact but also physical and psychological balance. Swimming, walking and doing yoga are important activities to work on strength, which is key for the climacteric.
And very important: strength training is the one that best adapts to this stage, according to Manglano. “It reduces the level of vasomotor symptoms, the tendency to hypertension, heart disease problems, the risk of fractures due to falls, increases insulin resistance or generating problems at the level of diabetes and contributes to balance,” explains the physiotherapist. “Likewise, feminist training with a differential health point of view is important, because women’s bodies are not the same as men’s,” insists the expert.
Sexuality has been and is a taboo par excellence within the stage of menopause, “first because sexual relations have always been understood as ‘couple-centrism’, from the vision of having a partner and placing all the weight of pleasure on sexual in the male partner”, assesses Caamaño. “And from the perspective of withdrawal from life with menopause they have given us the perfect shield to say I no longer want to have sexual relations. And if we review the cases of many patients, what we find are unsatisfactory relationships, lack of knowledge of one’s own body, shame, guilt even for feeling pleasure,” the sexologist clarifies.
“But if we look at the other side of the coin, there are also those women who at this stage see the opportunity for sexual freedom and live it by setting limits, with wisdom and connecting with themselves to establish relationships from well-being, they even begin to talk about it with other women,” says Caamaño.
The authors of the book Ladies also focus on the importance of masturbation at this stage of life; Manglano insists on the need to naturalize this aspect. “If you have a garden that is not watered, it dries out. We need blood accumulation, nervous impulse to arrive and the mucosa to be hydrated. If we forget about pleasure, we connect a lot with the sick body, the lacking one, the joint pain,” she warns.
“I don’t know anyone who has pleasurable sexual relations with other people without knowing their own body, but for them to be satisfactory, assertiveness and empathy are necessary, and to practice it we have to know what we like, how we like it, how it works, and that.” It has to start by knowing ourselves,” says Caamaño. “We have divided women’s lives into family, partners, work, sons and daughters – continues the sexologist and psychologist – and sometimes we forget to look at the relationship with ourselves and it is something that we have to be able to cultivate because Only by being aware of how I relate to myself alone will I be able to be aware of how I relate to others. And in that loneliness, the pleasure of the body, let’s say that the tip of the iceberg and the most instrumental thing is masturbation, it is like taking pleasure purely for ourselves, and it is fundamental when it comes to living our sexuality.”
One of the classic symptoms of menopause is hot flashes and although it is logical to always have a fan on hand and not be embarrassed when taking it out, the authors of the book point out other recommendations to prevent and deal with it. Simple gestures help, such as avoiding eating very hot things, doing breathing and relaxation exercises, or even dressing in layers. “And don’t be ashamed of sweating or turning red because you see that it is an ugly self-image. Just like men who sweat and it shows on their shirt and don’t care, you have to feel safe and natural,” advises Del Estal.