What if I told you our profession was largely ignoring an insidious disease among 50% of the pet population? What if I went on to say the symptoms were preventable, yet due to a lack of awareness and understanding, the condition largely went untreated? If I expanded to say it caused increased morbidity and mortality from middle age onward in otherwise healthy animals — through increasing risk of cardiovascular disease, urogenital disease, musculoskeletal weakening, changes to coat and skin health, brain aging, behavioral shifts and sleep disturbance — would you feel deeply concerned that we weren’t doing more? How about the fact that the owners were devastated, as they no longer recognized their beloved pet, which had changed beyond recognition and sadly lost its joie de vivre? And then, I dropped the bombshell that the condition is highly treatable and that the majority of animals aren’t being helped, as either their owners aren’t seeking advice or when they do, veterinarians don’t have all the needed information, so they provide only partial treatment or write off the symptoms as “old age.”
In such a world, I have no doubt we’d be highly motivated as a profession to research the heck out of the condition, find the best treatments, launch awareness campaigns and provide comprehensive CE.
And yet, we essentially ignore it in our wonderful veterinary colleagues.
I am talking about menopause and am on a mission to make sure we do better for anyone with ovaries who crosses our path, whether that person is a friend, a colleague, a partner, a family member or even a client.
A Brief Overview
Menopause is the day 12 months after a person with ovaries has had her last menstrual cycle. (I will refer to women/females through this article for consistency with the literature, but I recognize that all genders with these hormonal changes might be impacted.) The average age for menopause is 51.
Perimenopause is the period leading up to and following menopause, where fluctuations in sex hormones (predominantly estrogens but also progesterone and testosterone) can cause physical and psychological symptoms. As sex hormone receptors exist in most organs, the symptoms vary widely both within and between individuals. Nearly three dozen symptoms are recognized, but over 100 have been described. Most women (80% to 96% in the literature) experience some symptoms, which can vary from hot flashes and itchy ears to sleeplessness and anxiety to muscle weakness and joint pain, with no predictable pattern or consistency. Perimenopause lasts, on average, for eight years but can persist for decades.
Even among women who experience no symptoms — some find this stage of life liberating — there are still significant underlying changes to organ structure and function. If the changes are not addressed through the perimenopause period, the likelihood of serious health conditions increases later in life and includes stroke, urinary tract infections and incontinence, pathological fractures and dementia.
So, I urge all individuals with ovaries to take proactive preventive action through lifestyle adjustments that can boost health and longevity in their older age.
The Workplace Crisis
Here’s some stark data for you:
- 1 in 10 women who worked during menopause have left a job due to their symptoms.
- 26% took time off work.
- The Mayo Clinic estimates an annual workday loss of $1.8 billion in the United States.
- Around 1 in 6 people consider leaving work due to a lack of symptom support.
Money talks is a simple fact. I urge readers to consider the enormous potential in improving retention, performance and career progression in women through this stage of life. Doing so can bolster your practice revenue and staff and client satisfaction, leading to significant cumulative gains.
Though I’m talking money, I believe the facts that follow are far more compelling. I urge you to do the right thing for your teams, more for the sake of our humanity than the financial benefits.
The Mental Health Crisis
The peak age for women to die by suicide is 45 to 54 years old (compared to 75 years and over for men, according to Statista). We also know that veterinary professionals are two to four times more likely than any other profession or the general population to die by suicide. Those sad statistics are a huge wake-up call for our industry. While the impact of perimenopause on mental health is well documented (with links to depression, anxiety, mood changes and suicidal ideation), I cannot find any published research exploring potential links between death by suicide and perimenopause. It’s a yawning gap in knowledge and remains an association only by correlation.
We must do more for those women and their devastated and bereaved loved ones. A nationwide campaign, GenM, aimed at raising awareness among men in the United Kingdom, began in 2022 following the story of David Salmon, whose wife died by suicide during perimenopause.
We can and should do more.
The Identity Crisis
Thanks to the multiplicity and variety of symptoms, menopausal women can lose our very sense of self. Changes to our integument result in hair loss, brittle nails and wrinkled skin as our keratin and collagen production go into retirement. We don’t recognize ourselves in the mirror. While we may want to age gracefully, it’s challenging for a gender that is too often judged by appearance (whether intentionally or subconsciously). Add to that the fact that we fatigue more quickly, losing muscle mass and experiencing joint pains, so we feel weaker and unable to exercise, lift or move in the same way. It can be incredibly frustrating.
Meanwhile, our formerly reliable super brain suffers unpredictable blackouts as our frontal lobe, which has the highest concentration of estrogen receptors of any organ, is deprived of the hormone. And it’s no respecter of circumstance, choosing to clock out without notice amid sentences, whether during high-power meetings or challenging client conversations. The words just disappear. We don’t recognize our forgetful, unpredictable brain and begin to question our reliability, which can be a huge knock to our confidence.
Then there’s the emotional dragon that emerges inside — an intolerant, unpredictable, anxious, detached, fire-breathing beast that takes over our person at the most unexpected of times. The anger, fear, frustration and sheer force of emotion it unleashes are qualities we often fail to recognize in ourselves, and they take those around us by surprise.
To sum it up:
- We don’t recognize the changes in our body, brain and emotions.
- We can lose confidence in how we look, think and behave.
- We don’t want to inhibit our new self, especially when we have just built up the confidence, experience and self-awareness to start accepting even liking the old one.
The Working Life Crisis
All these changes affect how we think, feel and perform at home and in the workplace. At a time when we have accumulated a wealth of life and work experience (and should be peaking in our careers), perimenopause lurks around the corner like a tiger ready to pounce and shake our very foundation.
If workplaces don’t make allowances to manage symptoms and provide support, many women reduce their hours, step away from senior roles or leave work altogether. They are less likely to apply for promotions and, thanks to gendered ageism, are less likely to succeed when they do. Relationships with colleagues and at home suffer.
From Crisis to Opportunity
I initially posed this article’s title as a question. However, as I began writing, I convinced myself that “The Biggest Silent Health Crisis in Vet Med” is a statement of fact rather than a ponderable.
I encourage all readers, regardless of gender, to empower themselves with knowledge to support themselves or others during this significant life phase. By extension, we can then understand and help those with other symptoms of hormonal fluctuations throughout all stages of life. There’s a lot of intersectionality with premenstrual syndrome, premenstrual dysphoric disorder, endometriosis, and medically or surgically induced hormonal changes.
We have a tremendous opportunity to change the taboo, stigma and culture of acceptance of women’s suffering and turn menopause into Me.No.Pause. Women who receive support in their workplaces report significantly less impact of symptoms on their working life. Our majority female industry should be leading the way for other industries and helping so many people live happier, healthier, longer lives in the workplace and beyond.
A Call to Action
I urge you to access free bite-sized veterinary-specific resources through sponsor-supported WellVet at bit.ly/45WRVEs. You will find expert-provided information ranging from the neuropsychology of hormones and how they impact personalities to lifestyle changes, hormone therapies and practical symptom management to preventive self-care and how to have conversations with your team and men. There’s even a three-minute animation to give you a quick overview of the most important points to start a conversation.
I encourage readers to go a step further and share the resources with others. Also, request CE on menopause through webinars and at conferences. And join the peer Facebook group Veterinary Menopause Chats at bit.ly/4ltFp3P.
Finally, please email me at liz@wellvet.co.uk if you’re a veterinary leader or budget holder and would like to support the continuation of this work.
TIPS FOR EMPLOYERS
According to the U.S. Centers for Disease Control and Prevention, “Workplaces can support women who may be experiencing menopause by offering flexible working arrangements, adjustable room temperatures, nonrestrictive and breathable uniforms, and adequate access to restrooms.”