The ‘M’ word: it’s not spoken about, but it comes at us like a train — a whooshing express of hormones, disrupted sleep patterns, body and identity changes, and a whole lot of crying.

Motherhood changes you emotionally and physically, but this particular M is not about that. It’s about the onset of the menopause — something that, for many women, is coming closer and closer to their baby-rearing years and, in some cases, almost overlapping.

The HSE classes cases of early menopause as women for whom periods stop before the age of 45. According to their website, most of us will go through it between 45 and 55 (the average age in Ireland is 50). But with the trend towards women having babies later — last year, new statistics showed that the over-40s were the only age group with a rising conception rate — the gap between the perinatal and perimenopausal periods is gradually being squeezed. And, like motherhood, no one tells you honestly what it’s going to be like.

My own knowledge of “The Change” was restricted to the expectation of hot flushes and disappearing periods, until my friend, the home improvement guru and author Jo Behari, went through it when she was just 37. At the time, her son, Ray, was 18-months-old.

Jo has an unusual genetic condition called Fragile X syndrome, which led to Premature Ovulation Failure — or, as she prefers to call her lack of oestrogen: early menopause.

“I was on the Pill, the same one I’d been taking for years, apart from the breaks to have my children. But it wasn’t working for me. I kept having strange intermittent bleeds or bleeds that would last weeks,” she says.

“I very quickly started having night sweats and raging moods. One minute I would be screaming blue murder at my kids, ready to throw something (at least not someone) against a wall, the next I would be weeping inconsolably because Marshall fell over in Paw Patrol.”

She experienced low libido, vaginal dryness, hot flushes, mood swings, night sweats and insomnia before it clicked that something was really wrong. Luckily, with her health history and genetic predisposition to early menopause, Jo’s GP was quick to send her for blood tests and a diagnosis was relatively straightforward. But this isn’t always the case.

Almost no one talks honestly about the reality of becoming a mother, because we might never do it otherwise. And it’s the same with menopause — even odder, considering that all women will go through it.

Indeed, there are a lot of similarities between the transition in and out of motherhood — they might even be confused for one another.

Debra found out she was pregnant with her little girl at 38, when she went to her doctor about perimenopausal symptoms. She’d assumed the chances of getting pregnant post-35 were slim. “I never wanted children, I was really settled in all areas of my life. When I went to the doctor, I assumed I was perimenopausal — I’d even done a pregnancy test which was positive, but I’d read the leaflet carefully and it said that you can get a false-positive result if you’re menopausal,” she says.

Both her mother and sister had entered menopause in their early 40s: “I felt more prepared for the menopause than I did for motherhood,” she adds.

And now? “I’m scared, because though I never wanted [a child] but now I want to have the option, but it might be too late.”

Hot flushes are infamous; hormonal fluctuations and the end of periods we know about. But sex drive havoc? Pelvic floor weakness? Bone density decreases? Core strength and muscle degradation? Brittle hair? Abundance of body hair? These are all less well-covered. How does the mythical HRT work? And what happens when you’ve got a toddler on top of all this?

Not to mention that, as we’re living longer, the British Medical Journal estimates that millions of women are now living 30-40pc of their lives post-menopause. Of course, there is no equivalent for men (despite the much discussed so-called “manopause”), who can father children into old age. Would society be so coy if our husbands and partners underwent a similar journey?

Amanda Savage, a physiotherapist specialising in women’s health, says that timing is a big factor.

“As women, we push our own needs down the list over and over again. So sometimes it’s only as we are ‘older’ and the children are older, that we get time to do something about it,” she explains. “Mood swings and the physical changes of menopause are probably easier to cope with if your children are more independent than if you still have pre-primary school age infants to care for.”

She continues: “I don’t think many women realise that menopausal hormone changes affect the muscle tissues and the membranes of the vagina, so things like dryness, pelvic floor laxity, painful intercourse and pelvic organ prolapse are not expected and can be a shock.”

Anna Shepherd was diagnosed with breast cancer in the same year as having her third child, who was then nine-months-old. Following a course of chemotherapy, she had a preventative ovary removal and double mastectomy, which of course meant goodbye periods; hello, menopause.

“[I was given] absolutely no information. In the cancer arena, there is a very real feeling that anything deemed to reduce the severity or prevent recurrent [cancer] are gifts that we should be very grateful for,” she says. “It’s almost as if we aren’t allowed to even consider the downsides of such a radical event, because it’s effectively seen as something that is stopping us from dying”.

Worse still was the confusion around how to deal with menopausal symptoms at the same time as having young children. She says: “The hot flushes and night sweats were tough. And the general rage — although how much of this was due to my hormone deficit and how much was due to the kids is debatable... Absolutely nothing was discussed, even with the surgeon, and I was treated privately”.

The experience has also made Anna feel adrift from friends with young families. She describes how it’s almost a taboo topic with her other mum-friends and they seem surprised she wants to talk about it at all.

This all feeds into the wider lack of knowledge about our hormones and menstrual cycles, and the impact we feel when they disappear. Books such as Maisie Hill’s, Period Power, are starting to help enlighten us, but we need to do a better job of normalising the situation and letting others know they’re not alone — much like the shock of motherhood.

Luckily, there are increasing resources out there, if you know where to look, from anti-hot flush clothing, passion igniters and organic lube, to supportive and honest communities.

The BBC ran a menopause awareness week this May, in which presenter Louise Minchin’s film tackled the subject honestly and with humour, and more high-profile women such as Meg Matthews are speaking out in order to help others.

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With our ageing population, we’re going to be a veritable menopausal army in the not-too-distant future. What better time to rally the troops?

Herald