Menopause is the stage of life where women's hormones decide to throw a surprise party that no-one asked for — complete with hot flashes as unruly guests and mood swings as the DJ playing too many sad songs.
It's that time in a woman's life when their bodies goes through changes that make puberty look like child's play.
More than 2.5 million Australians are approaching perimenopause or in menopause, with the average age between 47 to 53.
Kaz Cooke has been helping generations of girls and women with her practical, reassuring, and fun guides to life stages. Now, she's tackling menopause with her new book, It's the Menopause.
So, what is menopause exactly?
"Menopause is that moment in time when it has been 12 months since a woman's last menstrual cycle and her ovaries have decided to retire," says Dr Natasha Vavrek, a women's health specialist and member of the Australasian Menopause Society.
"The time leading into this is called the perimenopause. This is a time when women are still menstruating but may be experiencing symptoms of menopause transition.
"The post-menopause is the time after a woman has passed more than 12 months with no menstruation."
Ms Cooke's online menopause survey, which featured in her book, found that many women didn't even know the symptoms they were experiencing were related to hormones or the menopause.
Almost 9,000 women took part in the survey, which covered women's knowledge, thoughts, feelings and experiences of perimenopause and menopause.
"This gives us an unprecedented amount of info about what Australian women are going through, in perimenopause and menopause – the statistics, and what they are feeling," Ms Cooke says.
"There were some really surprising results especially on previously taboo subjects."
The symptoms that are often kept secret
Hot flushes were a minor symptom for some women, who were much more plagued by symptoms they kept secret: a crash in self-confidence, unpredictable very heavy periods going for weeks, unexpected weeing, and sex being "as painful as razor blades".
"A lot of women will experience vaginal symptoms. Quite often those symptoms will be dryness, but it can be irritability, itchiness. And that obviously is going to lessen your desire to have sex," Dr Vavrek says.
"It's all very normal, but [it's] very distressing for a lot of women to go through."
The opt-in survey included a mix of open-ended questions as well as multiple-choice questions and rating scales. The results garnered 75,000 answers in the respondents' own words.
"While the results of this survey can't be extrapolated to an entire population, they're still significant," Ms Cooke says.
"As well as being able to quote questions and comments from real women in the book, I could also see where large numbers of people were affected by something that's rarely reflected in articles about menopause."
Why women can feel let down by the medical system
Thousands of women had bad experiences with their GPs and felt uninformed, dismissed, and let down.
"Unfortunately, a lot of women do leave doctors' appointments feeling quite deflated [and] feeling like they have to suck it up," Dr Vavrek says.
"And a lot of the time women feel like, 'Oh well, it'll be over soon.' But it just keeps going on and on.
"To get the right help, women need to speak to GPs who have special interests in women's health and menopause.
"There are many women's health clinics now that are easy to access. If women can't access a women's health clinic and they are feeling dismissed by their own GP, then requesting a referral to a gynaecologist would be the next step."
Women with early menopause at risk of misdiagnosis
The menopause survey results made it clear that many younger women are being misdiagnosed even though they are showing signs of early menopause.
"Early menopause is when periods stop between 40 and 45 and premature ovarian insufficiency (POI) is when periods stop before the age of 40," says Dr Vavrek.
"POI is thought to affect about 1 per cent of the population. There are a few causes … [such as] a family history or autoimmune conditions.
"Genetic causes are usually Turner's syndrome or Fragile X Premutation (many women don't know they have this premutation until we test for it due to POI). Smoking can also be associated with an earlier onset of menopause.
"And surgical menopause occurs when a woman has had her ovaries surgically removed or had chemotherapy/ radiotherapy that has affected her ovaries."
Can you prepare for menopause?
"Yes, absolutely," says Dr Vavrek.
"I am 39 this year and I am already preparing for my perimenopause, which could begin in the next few years," she says.
"Education is the key. Sourcing as much evidence-based advice as you can so you can be ready to seek management is the best preparation."
Diet and exercise are important, too.
"My daily routine includes a focus on consuming nutritious foods like vegetables, fruits, and legumes, while also reducing my alcohol intake," Dr Varek says.
"[Each week I do] at least one hour of weight-based training to support my bone health, along with one hour of Pilates to enhance my flexibility, balance, and pelvic floor health.
"This exercise regimen also plays a vital role in maintaining my mental well-being, as mood changes are often among the initial symptoms experienced during the menopausal transition."
October is World Menopause Awareness Month.
This is general information only. For detailed personal advice, you should see a qualified medical practitioner who knows your medical history.
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