THE SATURDAY TIMES MAGAZINE
25 APRIL 2015
MINI SKIRTS AND HOT FLUSHES
When Christa D’Souza’s periods stopped last summer, she thought her life was over. Then she opened a Tinder account and started taking testosterone...
I am at Clinique La Prairie, the famous anti-ageing spa in Montreux, Switzerland, where Marlene Dietrich and Winston Churchill used to be injected with cells from lamb foetuses, and where I have booked in for the next three days. Not for the anti-ageing injections (it no longer does them), but to check into its Menopause Centre, a facility dedicated to the treatment of women at the onset of perimenopause and menopause proper.
I know. Stop right there. Twelve months ago, I’d have been about to turn the page too. It’s not so much that I thought the subject of the menopause was taboo – Angelina Jolie has taken care of that – more as plain irrelevant. Flash forward to now, though, and it’s all I want to talk about. For at 54 and three quarters, what I thought would never happen has happened. I’ve undergone the Change.
The Montreux Menopause Centre is the only one of its kind in mainland Europe. This is where a team of cardiologists, gynaecologists, anaesthetists, radiologists and imaging consultants specialise in women like me. As long as you are very, very rich, that is. Their six-day deluxe “revitalisation” programme costs €27,000-plus (£19,300). That’s for a “standard” room, not for a suite. (It’s so popular with rich Middle Eastern women they come here in their hordes, often booking out whole wings for months at a time for group reservicings.)
Here I am, then, having been put up in a splendid room in the original building, a former girls’ boarding school, with a Tobleronesque view of the Alps and a red emergency button by my bed. The vibe is reassuringly Swiss, reassuringly state of the art. Take the gleaming ultrasound machine, a stirrup-and-wand contraption combining endovaginal and transabdominal imaging with Doppler technology on top to detect the tiniest of ovarian tumours. Or the treatment to test your metabolic rate, which involves putting on a sort of astronaut helmet and lying still for half an hour.
After meeting a nutritionist, a psychotherapist, a cardiologist and a plastic surgeon – who trained with the legendary founding father of plastic surgery, Dr Ivo Pitanguy, and suggests thermage for my “pebbly” jawline – I have an appointment with the centre’s founder, Dr Thierry Pache. Dr Pache has an impressive background in genetics and gynaecological endocrinology, and a vineyard in Argentina, which is where he plans to retire if he ever can, such is the demand for this “niche” arm of gynaecology. (Niche. Hah. It’s been calculated that by 2020 there’ll be almost 60 million peri and postmenopausal women living in America alone.)
“Of course, there was a lot of criticism when I first started,” says Dr Pache, a jolly, bespectacled man who speaks five languages fluently. “The least nasty comment I heard was, ‘Pache, what are you doing with all these old ladies?’ When I was training and I expressed an interest in pursuing this field, they basically said, ‘You are here to remove uteruses and deliver babies. Now get to work and shut up.’”
Back then, menopausal women were clinically redundant. “I felt such shame for my profession when I discovered the average length of a gynaecological patient’s consultation was 12.5 minutes, including the time it takes to take off and put back on your clothes. Menopause requires at least 30 minutes, just to speak about the symptoms. There were obviously women out there who needed help.” It usually takes two years to build up a practice; it took Dr Pache just three months to be fully booked.
How marvellous. I am sitting opposite a man who doesn’t run away at the mention of the menopause. Where do I begin?
First, there was the odd night sweat. Then there was constantly getting up to pee in the middle of the night. Plus, my body began to feel different. Not bigger, necessarily, more like I had added some duvet “togs” to it. For the first time ever I suddenly noticed I had back fat. And when I looked down at myself in the shower all trace of hipbone had disappeared.
But I was still getting periods. Boy, was I. Look away now if you must, but after I hit 50, they became not only more regular and closer together but almost Roman candle-like in their heaviness – a gynaecological indicator, apparently, that everything is gearing up for that one last chance (to reproduce) before it all disappears.
And then, last summer, they stopped. Whooompfh. Just like that. My “Woman”, as some tiresome Hollywood stylist I once interviewed insisted on calling it, had gone for ever. In its place I had all those symptoms I ludicrously assumed I’d be spared. Hot flashes. Palpitations. Insomnia. Restless legs syndrome. A complete lack of desire. You name it; I got it.
It was the absence of bleeding that was concrete, irrefutable proof that I had passed into the next stage. Although I’m not clinically menopausal until a year after my last period (four months to go and counting), it still feels as momentous a rite of passage as the time when I was 11 years old, in 1971, on a school trip to the Tower of London and got my first period. And yes, although I should be grateful that I don’t have to play that old wad-of-toilet-paper-in-an-emergency trick any more, symbolically, I mourn its death. Is unsuitable nail polish the only appropriate way for me to express my inner teenager from now on? Does it mean no more sex?
In a way, I’m not sure why I came all this way to a menopause centre in Switzerland, because having had breast cancer a decade ago – only grade I and treated with a mere lumpectomy plus a quick blast of radiation – I cannot be treated with hormone replacement therapy. (That includes, by the way, these magic bioidentical hormones all my fiftysomething friends are raving about.) Dammit. So are the hot flashes and, more importantly, my “menopot” here to stay? Is that what we’re talking here?
Luckily, says Dr Pache, there is something I can take for the hot flashes. A root called cimicifuga (also known as black cohosh), which he recommends to former breast cancer sufferers in tandem with acupuncture. Mood swings? There is always Prozac, he says. The spreading waistline? This I may have to accept.
“Look,” he shrugs, “you will gain weight with the menopause, whatever your genes. Simply put, you just can’t be what you were five years ago, unless you are Jane Fonda and doing four hours of exercise a day. The key here, for me, is not anti-ageing but better ageing. A woman is never going to keep the body she had at 40, but the issue is, can she feel well? And if she can feel well and stay that way until she is 120, why not?
“Besides,” he adds kindly, “the changes a woman’s body goes through when she reaches menopause, they’re kind of beautiful, I think …”
Back to London, then, with my prescription for cimicifuga, feeling slightly dejected. Maybe I have to accept that it is time to stop wearing a bikini. Or drastically change my lifestyle, perhaps. For according to the super-sensible Swedish cardiologist across the way from Dr Pache’s office, lifestyle counts for 80 per cent of our health once we hit middle age.
Doesn’t matter how many hormones anyone is taking, if they’re not upping their exercise and eating more healthily, their symptoms will be worse. So no more sea salt truffles on the sofa after supper. No more carbohydrates. No more sugar, which means no more alcohol. More exercise, preferably on an empty stomach (according to the cardiologist, we burn more fat if our tummies are empty). And let’s throw in the 5:2 diet as well. Just for three weeks. Just to see if I am more in control of this wretched rite of passage than I think.
I’m lucky, in the grand scheme of things. Having children later (one at 37, one at 42) means I’ve felt young for longer. Combine that with a decade-long addiction to hot yoga and a slim physique, and I’ve held up pretty well. But in a sense this is my downfall too. It has given me a false sense of security. Like death and taxes, menopause is inevitable.
Yes, yes, I know American women go on about power surges and the Second Half of Your Life and all that, and how is it possible not to be profoundly moved by Germaine Greer’s tub-thumping 1991 polemic, The Change. And yet. If women like me feel irrelevant, then that is probably because, relatively, biologically speaking, we are.
An informal poll reveals the majority of my menopausal female friends, whether they are on HRT or not, look at it that way too.
“Are you kidding?” says my sister Heloise, 53. “What’s good about every ounce of womanhood seeping out from every pore of your body, never to return? Yes, I’m on HRT, which means I can sleep at night, but emotionally, I feel done. For example, I’m having a tooth removed next week because it hurts. Before I would have had a root canal but now I feel, what’s the point?”
“There’s nothing good about the actual process of menopause,” agrees my friend Emily, 54. “It’s like the hormonal insanity of adolescence, but without the promise of lots of sex. Your pubic hairs go grey; your toes start to curl under, you cry at dog food adverts and you make sounds like ‘Ooof’ when you sit down. I could go on and on.” HRT, she adds, has helped her symptoms.
Unlike Emily, my sexy red-headed friend Frances, 55, an advertising executive, has made a conscious decision not to go down the HRT route. “I remember when the menopause happened having this really powerful feeling of being deselected by nature. What was my purpose?” she tells me from her impressive office in Soho. “You think you are an individual and you have a free will and then suddenly, when it happened, I realised everything that had motivated me had been towards erotic possibility and attraction. You can’t argue with hormones, I guess. My desire just disappeared. And that was a devastating thing to adjust to.”
She describes what she vividly calls her “prowler” phase in her late forties “where you get thin and wear lots of glittery eyeshadow and you could literally f*** the milkman without caring about the consequences”. She calls it the Forty-Niner club, “and it really was like the Last Chance Saloon”.
“Part of me will always want that feeling of pure desire just one more time,” she goes on, “but at the same time the arrival of the menopause feels like I’ve been unchained from the proverbial beast. It has freed me to discover something else. Ambition. It is as though the oestrogen in my body, which made me so focused on being sexually attractive, has been replaced by this drive to succeed. I fantasize about running companies and leadership, which is not to say I lived a life of domesticity before, but I wasn’t pushy about my work the way I am now.”
Leaving her office I feel cautiously optimistic. “Ambition”, that’s still a tricky word for us women. As a late developer, though, I can go with that.
But am I quite ready yet? I may not want or need to pull men any more, but there’s a huge part of me that wants to be the sort of woman who, if she wanted to, still could.
With the full complicity of my partner, I put myself on Tinder. What I mean is I ask my hairdresser, Roi, to put me on Tinder – because for an old person, what with having to do it through Facebook, etc, it’s quite difficult to figure out. I carry out an experiment with two personas (with exactly the same pictures): Christa, 54, who is interested in men between the ages of 31 and 49, and “Claire”, 36, who is interested in men between the ages of 25 and 45. It is Roi’s idea to be 36 (personally, I didn’t think anyone would buy it), but guess what? They do. And interestingly the age thing is pretty immaterial.
At last count, Christa has 31 matches and Claire has 27. What does this mean? I scrub up good for 54? Maybe perception really is everything. Perhaps it’s me who has the problem and you really are only as old as you feel.
Meanwhile, a friend – a former model, irritatingly well preserved – urges me to see a doctor from New York, Dr Erika Schwartz, who specialises in bioidentical hormone therapy, even though she knows I have had breast cancer. So popular, apparently, is Dr Schwartz’s practice on 57th Street in Manhattan, you can only see her by membership. Her clientele? New York’s alpha women. (Although she is not exclusively about the menopause. She recently wrote a book about treating teen eating disorders with hormones.)
Let us clarify here the difference between bioidenticals and HRT – which is not much. Although the former are alluringly defined as having the same molecular structure as a substance produced in the body, and are, in some cases, derived from soy or yams, as opposed to pregnant mare’s urine, they are no less manufactured in the laboratory than “normal” HRT. The difference is that bioidenticals, as opposed to the one-size-fits-all HRT prescribed by your average GP, is tailor-made for you, prohibitively expensive and isn’t available on the NHS.
Schwartz and I meet in the lobby of the Metropolitan Hotel, London, where she is staying while she looks for premises to set up an office in this country. “It’s kind of an urban myth, the idea that taking hormones increases your risk of breast cancer,” she says. “Nobody knows the significance of oestrogen receptor positive cancer. Is it fuelled by oestrogen? Or is it that you need more oestrogen? Nobody knows for sure.” Blonde, slim and wearing tight leather trousers, I estimate that she is about my age, maybe a tiny bit older. In fact, she is 65.
“In my opinion,” she goes on in her raspy New York accent, “now that you have lost your hormones you have two options. You can either choose to be intimidated by this foregone conclusion, skip the hormones and look forward to a wheelchair and an overflowing medicine cabinet for high blood pressure, high cholesterol, arthritis, etc, or you can make a conscious decision that it is all about you and you will do whatever it is to make yourself feel the best that you can until the day you drop dead, part of which involves taking hormones.
“If we don’t take care of ourselves, I’m sorry, but we become roadkill. I can tell by looking and talking to you that you are fine but you are running on empty. You just need a few tweaks …”
God, I love Americans. They’re so much more proactive than us Brits. Bring it on, then, sister. I am ready to go ahead.
And then I sleep on it.
“So many things are a matter of perception. It only matters as much as it means to me. Or you.” So speaks my journalist friend, Lucy. Lucy, still a bombshell at 53 and looking particularly so today in a stripy T-shirt and denim skirt, cannot help make me feel a little wistful. She is such a poster girl for bioidenticals, and although I’m very tempted to take them after my meeting with Dr Schwartz, the stigma of hormone treatment and its link to cancer won’t go away.
“I was 48 when I got the perimenopause and was incredibly strung out by it,” recalls Lucy. “Unendurably so, which is not my way at all. I just felt so raw. I’d look at other people in the street and think, how can you be so happy?”
Within days of being prescribed a mixture of oestrogen, progesterone and testosterone, her life was turned upside down. “I don’t feel better than I did before the menopause,” she says. “I feel incredible. I get these real proper surges of wellbeing and my energy is sky high – so much so that I’ve taken on far too much work. My sleep isn’t great, and my weight hasn’t particularly changed. I’ve got a proper muffin top that I didn’t have when I was younger, but the difference is I don’t even care any more, because I feel so good.”
Too good, apparently, at first. “I was taken aback by the testosterone,” she says. “It was actually quite scary the way it made me want to have sex all the time. My husband was horrified! I suppose it is quite a fun thing to try, to put that particular hat on for two or three weeks, but actually I don’t need that roaring libido. Frankly, I’ve not got the time.”
Enough said. I want some of what she’s having. Off I trot, then, to the Wimpole Street practice of John Studd, professor of gynaecology at Imperial College and founder of the first menopause clinic in this country in 1969. (Two years after the very first one in the world was set up in 1967 in Cape Town, in the same hospital where Christiaan Barnard performed his first heart transplant.)
“Well, of course you can bloody take hormones,” he says, peering at me over the top of his glasses. “In fact, because of your weak bones and history of PMS, you must. Cimicifuga root? Pah. Sometimes I do despair …”
With his quiff of silver hair and booming patriarchal tone, Professor Studd reclines on a chaise longue with his shoes off. His speciality – and one he is addressing in the book he is in the middle of writing – is reproductive depression: the depression connected to menstruation, birth and menopause. “The barbaric things they have done to women with reproductive depression – months in the Priory, sessions of ECT, all because they’ve got a hormonal imbalance.” Professor Studd has not used anything other than bioidentical hormones in the past 20 years.
After taking my blood, which reveals my testosterone and oestradiol levels are so low as to be immeasurable, he sends me a prescription of three potions, Testim, Oestrogel and Utrogestan. The first two are creams, which must be rubbed into my tummy and inner thighs every morning; the third is a pill to be taken for the first seven days of every month. I am so apprehensive about the idea my fingers actually tremble as I hand the prescription over to my pharmacist.
Oestrogen and progesterone seem fair enough. I was briefly on the mini Pill in the Eighties. But the testosterone bit. Is it going to make me look like Fatima Whitbread? Is it going to make me want to mount the postman? For the next couple of days I can’t stop thinking about what taking this stuff is going to do to me and start seeing things. The Ideal Hormones Show at Olympia, and so forth. And then, inevitably, I kind of forget.
Six weeks on, I’ve transgressed only once on the drink front, and once on the sea salt truffle front. Do I feel different? The hot flashes are waning and I had the best sleep I’ve had in months last night. My skin is better, but this may be more to do with less alcohol than the hormones. On the extra duvet tog front, those hipbones still haven’t made a reappearance and I doubt I’ll ever look the way I did in a bikini 18 months ago, however much hot yoga on an empty stomach I do.
But for whatever reason, I’m feeling a grain of acceptance around both my waistline and my “pebbly” jawline. It’s not so much that I’m letting go, more that I am OK with slightly recalibrating. But it does pain me that all the precious Azzedine Alaïa I’ve been collecting since the Eighties I will probably never wear again; that I am slowly but surely dressing more the way my mother does (black trousers, baggy tops).
At first, the progesterone pills that I take over the first seven days of every month to balance the effect of the oestrogen and the testosterone make me feel like I am walking through treacle. So much so, I almost give up with the whole idea of HRT. But now when anyone asks “How are you?”, I can’t lie. I do feel good. Not more energetic, exactly, more … how to put it? Hopeful, perhaps? I don’t feel that tremendous, overwhelming ennui I did a few months ago at the idea of going out. My mother used to say that the only bad part of growing older was that the sense of promise disappeared. But I feel promise again. I don’t know what direction it will take, but it is back in some amorphous form.
And, no, I have not grown a beard or an Adam’s apple and our postman can sleep easy. Having said that, if I end up having a glorious affair with one of my matches on Tinder, I’ll be sure to let you know.