Something’s Gotta Change

By Sharon Livingstone

It’s winter. You put the heater on in the massage treatment room, warm the towels, warm the treatment table, provide a cosy blanket across the client. How lovely. How thoughtful. Clients love it. Then, about 10 minutes into the treatment, your female client kicks those thoughtful towels and covers off, and the oil has gone tacky from their perspiration.

Peri-menopause and post-menopause can be unsettled times for women but open discussions on menopause are rare.

Massage therapists are in the privileged position of being a trusted practitioner for our clients. People are comfortable discussing health matters with us. And we need to be able to discuss menopause with our female clients because there’s a likelihood that they may experience a symptom in our treatment room.

The Secret That No One Discusses

My mother died when I was in my early 20s, a time when “menopause” was, to me, a social construct. By the time I started to think about what menopause might mean for me, my grandmother had also died, leaving me with no direct maternal guidance on what lay ahead for me.

I asked my doctor for some information. Her answer was “Google it”. I wanted an easy to access brochure with all the information and options laid out in plain English. I was quite cross with her answer but the more I’ve learnt about menopause, the more I understand why my doctor sent me down the interwebs rabbit hole. I stumbled out of that rabbit hole with more questions than answers. Should I take hormone replacement therapy? Or will that give me breast cancer? What about an investment in lubricants and creams for vaginal dryness? Will I lose the will for intercourse? Do I need a good lawyer for my impending kleptomania? Should I put a rubber sheet on the bed for night sweats?

We discuss female puberty ad nauseam and even dudes are quite knowledgeable with menstruation and the menstrual cycle. We’re also content to chat loudly about menstruation as we sip our flat whites. But while we’re all experts on what happens when you have your first period, we’re not so expert about your final period.

Menopause is the secret that society doesn’t seem interested in.

What is Menopause?

Menopause is the final menstrual period a woman experiences. 12 months later, she is deemed “post-menopausal”.

Peri-menopause refers to the time leading up to menopause when a woman may start experiencing changes in her menstrual periods such as, irregular periods or changes in flow. Cycles can be shorter or longer in length. Symptoms may also include hot flushes and night sweats, aches and pains, fatigue or irritability as well as premenstrual symptoms such as sore breasts. These changes may be caused by fluctuations in the production of hormones from the ovary. Some women can experience menopausal symptoms for 5-10 years before their final menstrual period. There is no way to predict the age at which a woman’s menopausal symptoms will start or how long they will last.¹

Did you see that bit about there being no way to predict when menopausal symptoms start or how long they’ll hang around for? That means not knowing how long you’ll need to pack your sanitary items every time you leave the house (not just when your period is “due” because of that whole “irregular periods” bit). That means not knowing when you’re going to stop feeling like you’re about to internally combust. That means not knowing when your moods will fluctuate from calm to freaking furious in the snap of your fingers.

Imagine how a client with menopause symptoms might be feeling.

Menopause means different things to different women. Some see it as a freedom – no more periods or (pregnancy related) contraception and a time to think more about themselves. Others see it as an ending or loss of purpose – they’re no longer able to have children. Others yet see it as yet another sign of getting old. Women report feeling “invisible” in a sexual and literal way. One menopausal client told me how she sat in a cafe for ten minutes watching everyone else being served while she wasn’t. When she went to the counter to place her order, the staff apologised profusely, saying “I didn’t see you over there.”

There is a popular, although questionable, “Grandmother Theory” of why menopause happens. This theory further pushes women into a role where their identity and purpose is defined by their usefulness to others.

Symptoms

Some of the common symptoms of peri- and post-menopause are:¹

• Hot flushes
• Light-headedness
• Night sweats
• Headaches
• Irritability
• Depression
• Unloved feelings
• Anxiety
• Mood changes
• Sleeplessness
• Unusual tiredness
• Backache
• Joint pains
• Muscle pains
• New facial hair
• Dry skin
• Crawling sensation under the skin
• Decreased sexual feelings
• Dry vagina
• Uncomfortable intercourse
• Urinary frequency

What’s this got to do with how I massage women?

When I was in my first year as a massage therapist, I’d left my 50-something client to get changed after her treatment. She took ages. Then I heard her in the bathroom. By the time she came out to reception, her face was scarlet with embarrassment.

“I hadn’t had a period for months but I’ve bled all over your towels.”

I understood nothing about menopause up to that point. I didn’t know how unpredictable menstruation was in peri-menopause. Thankfully I masked my ignorance by reassuring my client that it was no big deal. It wasn’t and shouldn’t be.

Menopause isn’t visible. Not all symptoms of peri- and post-menopause are visible. It can’t be assumed that a woman has reached menopause based on her age because of that whole “we have no way of knowing when menopause will happen”. And there’s the small matter of early menopause or menopause as the result of surgery (some hysterectomies) or other medical issues, like cancer treatment.

Do you include menopause on your intake form?

Ask about temperature – as with all clients, it’s important to know how warm or cool they like to be. Just because it’s 3 below outside doesn’t mean a client wants equatorial temperatures in the treatment room.

It’s easy to see that some menopausal symptoms – aches, pains, depression, fatigue, headaches, crawling sensations under the skin – might be reported to a massage therapist and be unrelated to any injury or overuse or posture.

Tim Clark, massage therapist and psychotherapist, offers further guidance on discussing menopause with clients:

Consider what your relationship with the client is like. Is there a strong bond of trust? Does it feel like the client knows you hold them in unconditional positive regard? If it doesn’t feel like the connection is very strong or if you’ve only recently started working with them, a question like “Are you menopausal?” might be perceived as too intrusive or judgemental.

If you’re confident that:

a) you hold the client in unconditional positive regard,

b) you don’t believe that menopause is something to be ashamed of, and

c) the client knows both of these things,

then talking about menopause should be an anxiety-free experience. And talking about it, as with other socially stigmatised experiences like mental illness, can help to normalise it and take the sting out of it.

(As a massage therapist) I need to be very clear about what insecurities I might have around the topic of menopause. Might I hold unconscious beliefs that make me shy away from discussing it? Might this serve to reinforce a client’s insecurities? It’s entirely possible that the client holds no such sensitivity around the topic, and assuming that they do might send the message that you think they should.

What Can I Do To Stop The Secrecy?

Education helps. In the “Further Reading” section below are links to research and reviews, and relevant articles.

The Australasian Menopause Society website offers lots of information and AMS members can access menopause focused webinars and online courses.

Tim also suggests that “If the client thinks (or knows – it could be a useful piece of self-disclosure) that you, the therapist, have experienced menopause, it could be easier to hear that question”.

How do Massage Therapists manage their menopause symptoms at work?

Because no two women have exactly the same experience, there are no hard and fast rules on how to do this. Some suggestions:

• Wear natural fibres that breathe, e.g. merino (hot flushes/overheating/sweating)
• Avoid man-made fibres like polyester (they don’t breathe and get stinky with sweat)
• Moisturise hands regularly (to stop skin splitting as a result of dry skin and frequent washing)
• Reduce working hours or increase gaps between appointments (fatigue, toilet breaks)
• Use a stool (light headedness, aches/pains, fatigue)
• Write notes up as soon as possible after treatment (brain fog/cognition)
• While this isn’t strictly “at work”, some research² suggests that regular strenuous exercise may reduce the severity and frequency of hot flushes. Regular exercise may also be helpful for managing mood and depression.
• Have a good support network of people happy to talk about the menopause experience or, at least, happy to listen to your experience.
• Consider letting colleagues know that you’re peri- or post-menopausal.
• Talk therapy may also help – psychology or counselling.

Are You Ready to Talk?

We don’t understand menopause and how it affects women by maintaining silence or stigma around it. Women are often quite eager to discuss their experience of peri-menopause and post-menopause, especially if they know someone is receptive.

When I had a client experience a hot flush as they greeted me, it was a great opening for her to share her menopause journey. I was as keen to let my clients express themselves as I was to learn from their experience.

Has menopause been a discussion point in your clinic room? Share your thoughts in the comments below.

References

1. Source: Australasian Menopause Society

2. Exercise training reduces the frequency of menopausal hot flushes by improving thermoregulatory control, Bailey TG et al, Menopause 2016 Jul;23(7):708-18

Further reading

The Australasian Menopause Society put together some fact sheets.

Australasian Menopause Society has a list of Cochrane reviews on all matters around menopause

Science Daily collates menopause research news

Menopause Doesn’t Make Me Invisible by Jill Gleeson, Good Housekeeping

The Gift of Menopause by Margaret Renkl, The New York Times

Does Menopause Affect Mental Health by Tanya Peisley, SANE Australia (if you can forgive them misspelling oestrogen)

Cognition in peri-menopause: the effect of transition stage, Weber MT et al, Menopause 2013 May;20(5):511-7

Cognition and the menopausal transition: is perception reality? Thurston, Rebecca C. PhD Menopause: December 2013 Volume 20 Issue 12 p 1231-1232

What Causes Menopause Brain Fog and How’s It Treated? By Ashley Marcin, Healthline, December 2017

About the Author

Sharon Livingstone is a massage therapist in Sydney, NSW. A love of sport drew her to the industry but discovering job satisfaction came from helping people live with less pain keeps her in it. Sharon is a writer, keen bushwalker and frustrated traveller who is also a coffee snob.