Inside the hidden pressures that come with menopause

Women who have reached the age of menopause are beginning to speak openly about the hidden pressure they face to prove their femininity after their monthly periods stop.

Some say they have to continue buying sanitary pads to maintain the appearance of menstruation because of beliefs held by partners and the community tying womanhood to periods.

One such woman is Caroline Ogot. Ogot, 58, is based in Kisumu and identifies herself as an African feminist.

She is the founder of Seasons of a Woman, an initiative dedicated to perimenopause and menopause challenges.

Ogot says she is committed to amplifying the voices of women navigating a stage of life often silenced or misunderstood. This advocacy comes from experience.

Her journey began a decade ago, at the age of 48.

“I started noticing changes in my body. My nails became brittle, my hair thinned, my bones started aching, and I had frequent urinary tract infections. I felt this crawling sensation on my skin, hot flashes that made me constantly adjust my clothing, memory lapses, and mood swings,” she recalls.

At first, she struggled to understand what was happening. Like many women, Ogot initially attributed the changes to external factors. She even confronted a nail parlour worker, convinced that poor manicure practices were harming her nails. She stopped swimming, thinking chlorine was affecting her hair and skin.

It took a conversation with a health professional friend for the reality to hit her: she was entering perimenopause, the transitional period before full menopause.

“It was a revelation,” she says. “I realised these symptoms were not random. My body was changing, naturally, and it was a season I had to navigate.”

By the age of 52, her periods had become exceptionally heavy, and urinary tract infections increased in frequency. She remembers wondering why her body was suddenly rebelling, and why the symptoms seemed relentless.

The societal silence around these changes compounded the difficulty.

Perimenopause, she explains, is not just a physiological experience. It affects the mental, emotional, and social dimensions of a woman’s life. The changes in libido, energy, and mood can strain marital intimacy, relationships with children, and personal confidence.

The 2014 Kenya Demographic and Health Survey (KDHS) provided detailed statistics on menopause among women aged between 30 and 49, though such data is notably absent from the 2022 KDHS, released on January 17, 2023.

According to the 2014 survey, the highest proportion of menopausal women, 45 per cent, were in the 48-49 age bracket, followed by 24.4 per cent among 46-47-year-olds. Women aged 30-34 were least likely to have reached menopause, accounting for just 4.7 per cent.

Globally, research has shown that early menstruation can be linked to early menopause. A 2017 study published in the journal Human Reproduction examined 51,450 women from Australia, England, Denmark, and Japan.

The findings indicated that women who began menstruating at 11 years or younger had an 80 per cent higher risk of experiencing premature menopause before age 40. Additionally, these women faced a 30 per cent higher risk of early menopause between the ages of 40 and 44.

To navigate these challenges, Ogot turned to knowledge, experimentation, and self-care.

Exercise became essential, including walking regularly, engaging in light physical activity, and ensuring her body stayed active. She increased her water intake to help manage urinary health and maintain hydration.

Despite being a universal stage of life, menopause is often treated as a taboo topic. Ogot describes a pervasive culture of silence and shame around the subject.

“Menopause has been given a negative lens by society,” she explains. “Some women buy dignity packs they don’t need, just to signal to their husbands that they are still ‘women.’ Others hide symptoms, fearing ridicule or misunderstanding.”

The impact extends to intimate relationships. Dryness, decreased libido, and mood swings can make intimacy uncomfortable. Many men do not understand these changes, leading to confusion or conflict in marriages. Now this is where the importance of education for both women and men comes in handy in navigating this stage with empathy and dignity.

Ogot founded Seasons of a Woman to break the silence, educate, and empower. The initiative guides diet, exercise, mental health, intimacy, and coping mechanisms.

For Mary Were, 48, menopause did not arrive gradually. It came suddenly, as a result of a medical condition that required her to undergo a hysterectomy, which removes the entire uterus.

“It is not just me,” Ms Were says. “I have learned that several other women go through the same, not to end life but to manage severe health issues. For me, it was uncontrollable bleeding caused by fibroids.”

What Were didn’t anticipate was how her body would react when her ovaries were removed along with her uterus.

“Ideally, my doctor should have explained what it meant, what to expect afterwards. But the oncologist believed the fibroid could be cancer-related. So, instead of testing first and giving me options, they went ahead and removed everything. My only regret today is that I never got the chance to understand my choices. If I had, I would have strongly opted to keep my ovaries,” Were says.

For Pamela Akinyi, 50, the menopause journey began quietly but with a series of unsettling symptoms.

“I think I first noticed something was wrong around the age of 48,” she recalls. “I was constantly falling sick. Most of the time it was diagnosed as pneumonia. I would go to the hospital, get medication, go home, only to return weeks later with the same symptoms. Nothing seemed to change.”

Caroline Ouma, 55, also from Kisumu, describes menopause as a challenging and confusing experience that began unexpectedly.

She recalls that the first symptoms started about a year ago, but she had no idea what her body was going through.

“I didn’t understand what was happening to me,” she says.

According to Saudah Farooqui, a consultant obstetrician-gynaecologist and founder of Saudah Femcare Specialists, the ovaries produce oestrogen, progesterone, and testosterone, and during perimenopause and menopause, the levels of oestrogen and progesterone drop significantly.

This hormonal change causes a variety of physical and emotional symptoms, with the most obvious being the cessation of menstruation.

Follicle-stimulating hormone (FSH) levels often rise during this period.