On pausing #2
This week I saw the Barbie movie with my youngest daughter. I had never intended to see it. There was a ‘nah ah’ internally. But then I had a change of heart. My daughter had a day free due to her shift pattern, and I took a last-minute TOIL day. It felt like we were playing hooky from school and that alone was enough to feed the rebel that still lurks within.
Whilst there are many standout moments in the film, many of which you may have heard or seen on social media which is awash with pink and memes, there was one line1 delivered by America Ferrara that hooked me and had me blubbing:
We mothers stand still so our daughters can look back and see how far they’ve come
Standing still.
Pausing.
Stopping.
Waiting.
All of these pretty much describe the past few months for me, hence my absence from your inbox.
I’ve deliberated for a long time on how much to share in such a public space, but then my not sharing reminds me of the words of a nature mentor I worked with a few years ago, who advised our not sharing creates a barren* landscape. Therefore the content is very much a deviation from my usual sharing.
Being on pause - (meno)pause means the cessation of our monthly cycles. Having completed many moon-trips lasting some 43 years I was caught out. I had a bleed. One that medically was noted as a ‘very significant bleed’.
This led to lots of tests and culminated in some surgery. I found out this week I have a further surgical procedure to come.
At times it has been overwhelming, humbling along with moments of despair due to discrepancies of information within the medical system and amongst GPs.
It is literally impossible to be a woman
Things I discovered that some of you may find useful either for yourself or others:
Ovestin (Estriol) vaginal cream is only licensed for use for 6 months
Peri / menopausal women should not be sitting for long periods of time
The UK’s cervical screening system is ineffective and is a barrier to BAME women, and women under 30
Women are better off attending A&E with issues to trigger the 2-week pathway protocol than suffering the interminable wait for a GP appointment
Let’s take each of these in turn.
Ovestin / Estriol is delivered via an applicator internally. This can be the difference between heaven and hell (literally). Women in peri / menopause typically experience thinning of vaginal tissue leading to reoccurring UTIs, thrush, discomfort both sitting and walking, inability to have intimate relationships as well as an overall diminishment in mood and sense of wellbeing. (I ticked all of those boxes five years ago).
This cream is prescribed (generally) for use twice-a-week.
When prescribed to me, I was advised by my specialist gynae GP, (she is wonderful, highly experienced and other local surgeries refer women to her for treatment), that I would be using this forever.
I asked if that was for real?!
She said it was for the rest of my life. Use it and have your symptoms reduce / disappear, stop using and they return. I can attest to the miraculous properties of this cream and couldn’t imagine life without it.
Fast forward five years: sitting across from the consultant at the hospital during my first visit. Let me stress right now that he was charming, attentive and had put me at my ease from the get go. (Note: my gynae history is very dense and my previous consultants had retired, so I could suss out a good consultant).
Upon asking about using any medications I proffered my use of Ovestin and pulled out the tube from my bag (can never be too prepared for these things!)
When he heard how long I’d been taking it there was a palpable change. He was outraged that I’d not only taken it continuously without a break, but also that it hadn’t been balanced with progesterone.
Pause.
I pointed out that at no point during any review was I advised of this over the years, but also to take progesterone would in effect be full HRT and that was not something I (personally) was willing to entertain.
From that point on he was convinced we had found the culprit.
But never forget that the system is rigged
Following various conversations recently and with my GP, it seems that a warning has only just started to make its way onto the pharmacy label for this cream, advising to take a 4-week break after a certain period of use.
I have subsequently been advised of the important, but hidden until now, finer detail.
Ovestin / estriol is only licensed to be used for 6 months.
This is because there is no long-term data for its use or safety beyond this period of time. Hence this recent advisory note appearing. Previous information had suggested its usage was ‘not limited’2
In addition, there are misunderstandings about dosages and absorption between creams, gels and patches - not all are equal it seems.
Please always check with a medical professional and do not take recommendations or advice from online forums / social media. I came across one popular site of mothers advising each other that despite the worries of the particular poster, her fears were unfounded.
I have since had my prescription changed, and I am now on a lower dose product (vaginal tablet) that has much longer term data available.
Sitting for longer periods of time is a no-no. The radiographer who carried out my trans-vaginal scan was amazing. One of those that restores your faith in everything and everyone. A real gem of a woman.
She asked me if I sat a lot. I explained my work - since being remote, my sitting has increased as I’m no longer walking to various parts of the building to interact with colleagues in my day-to-day. Whilst I aim to walk every day, this clearly isn’t enough.
It was explained that the thinning of our vaginal tissues is compounded by the pressure of sitting. In fact, it can also increase the risk of pelvic floor issues.
It’s too hard! It’s too contradictory
There’s a growing body of evidence out there and I would suggest you do your own research on this. Here’s one such link you may find as a good starting point3 Needless to say we gotta keep moving our bodies.
Cervical Screening is now carried out every 5 years for women over 50 in the UK. I even have this in writing from the NHS National Cervical Screening Authority with whom I currently have a complaint pending.
My smear test (PAP as is known in the US) was due in March this year. So, my very kind, understanding and thorough consultant carried out a smear amidst everything else that was going on. Let’s just say dotting the ‘i’s and crossing the ‘t’s.
The cervical screening service rejected my test and refused to carry out the screening.
Why? Because it was ‘carried out outside of the screening programme’. This means, because they had not invited me to be screened, (erm…it was due in March and was overdue?) it was therefore ‘invalid’.
And it turns out in fact that not only are you doing everything wrong, but also everything is your fault.
I appreciate this is not every woman’s experience, but many women are not accessing the screening programme due to fears4 and poor understanding which is especially prevalent with twice as many BAME women5 saying improved understanding would help them attend.
This is a crucial area of healthcare for women and the system needs an urgent overhaul. The scope of this is too wide for my museletter, but I would urge you to not let this slip. If you are unsure if you are due to be screened, your GP receptionist will be able to advise.
A two-week pathway exists for anyone with symptoms that could indicate underlying cancer to be seen as quickly as possible. Referrals are typically done by GPs but we all know the increasing pressure on the NHS system, that getting to see your doctor can be harder to navigate than the Crystal Maze.
For me, I spoke to 111 and was given an immediate appointment to A&E. This triggered the two-week pathway and it has been brilliant. My first consult was within two weeks and every test and procedure that followed was within this timescale.
I totally appreciate that not every CCG across the UK is the same (sadly) and this leads to huge discrepancies in care. Should you have any concerns, do not put them off, please seek assistance.
you’re supposed to be a part of the sisterhood
Being part of the sisterhood is the sharing from a place of good intentions, and I do hope that some of what I’ve shared is of use.
Other modalities that I’ve drawn on the past few months include…
Meditation
Visualisation of my womb / cervix and releasing ancestral trauma
Counselling
Nutrition - finding ways to restore balance from within through diet
More daylight / reduced blue light from screens and incorporating a deadline for artificial light of an evening to increase better sleep and therefore promote healing
Dancing - crazy, full-on rave at odd moments to move body and energy
Sleeping without underwear / PJ bottoms - we need to breathe ladies!
Love everything and everyone
*The narrative is changing around menopause and I do not want this museletter to suggest in any way it is all doom, gloom and a dry landscape. It isn’t. We have greater access to information and support than at any time in our ancestral lineage.
I’m just so tired of watching myself and every single other woman tie herself into knots
Upcoming opportunities to unravel / untie the knots…
Saturday 19 August: in-person gathering of meditation group (and others if you want to find out more), for a walk and informal practice at Cassiobury Park (weather permitting!) Drop me an email for more information.
Saturday 09 September: women’s online meditation returns following summer break. What can I say about these sessions?! They offer sisterhood and so much more. Details on website
Dharma Book Club: I shall be looking to launch the monthly dharma book club on behalf of Sakyadhita UK in September. To register your interest, do drop me an email. This will be an online event, offered one evening per month.
This and all quotes are from the monologue delivered by America Ferrera in the Barbie movie / Mattel & Warner Bros 2023
https://pubmed.ncbi.nlm.nih.gov/12621967/#:~:text=Urogenital%20atrophy%20manifests%20as%20stress,the%20treatment%20is%20not%20limited.
https://www.feistymenopause.com/blog/how-to-keep-sitting-time-from-wrecking-your-health
https://www.jostrust.org.uk/about-us/our-research-and-policy-work/our-research/barriers-cervical-screening-among-25-29-year-olds
https://www.gov.uk/government/publications/health-matters-making-cervical-screening-more-accessible/health-matters-making-cervical-screening-more-accessible--2#:~:text=Poor%20understanding%20of%20what%20the,them%20to%20attend%20the%20screening.