What other condition gets all the stars of a 'certain age' talking? Oprah Winfrey, Gillian Anderson and Emma Thompson have all gone there; Julie Walters described her hot flushes as 'a chimney that came from the base of my spine'. And now, welcome to the world of the 'menopreneur'. These include, inevitably, Goop goddess Gwyneth Paltrow, who wants to 'rebrand' menopause and has already created her own Madame Ovary supplements. She's joined by Noel Gallagher's ex-wife, Meg Mathews, with her MegsMenopause website, which sells, among other delights, lubricants packaged in pink called Motion Lotion. Beauty tycoon Liz Earle offers The Good Menopause Guide to help us navigate the A to Z of this confusing time.
All these women have realised that the menopause is big business. The industry is estimated to be worth $14.7 billion globally, with a 5.7 per cent annual growth rate. No wonder a host of satellite industries are popping up to cater for wealthy women going through 'the change', including fashion, travel, beauty, even show business (anyone for Menopause the Musical? And Just Like That, series two?). Menopause is a hot topic. 'We're in a moment where women's health is being discussed,' says Daisy Robinton, aka the Ovarian Queen, a Harvard research scientist who works on molecular, cellular and developmental biology as well as gene editing. 'Female physiology has historically been overlooked, partly due to the perceived complexity of female hormones.'
Robinton's particular interest is the role of anti-Müllerian hormone, or AMH, which declines with age. Along with other researchers, she has developed a recombinant form of AMH, which is now in preclinical development as a drug to delay the natural menopause. We could be looking at the delay (even end) of menopause by the end of the decade.
The possibilities of Robinton's work will not only affect the menopausal landscape: it will potentially redefine what it means to age. Inevitably, as with stem cell therapy, those with deep pockets will benefit first, after which it could be rolled out to all. Robinton's goal isn't to extend life, but to age better. 'Currently we're constrained by a fertility cliff,' she says.
Menopause is defined as the point 12 months after the cessation of periods. The ovaries stop producing the hormones oestrogen and progesterone, and this marks the conclusion of a woman's reproductive cycle. In Britain the average age of menopause is 51. But perimenopause - when oestrogen and progesterone production begin to go haywire - can begin in a woman's mid-40s and last for up to a decade. This is the discombobulating spell when a plethora of distressing symptoms emerge. These can include (deep breath): hot flushes, vaginal dryness, depression, exhaustion, difficulty sleeping, anxiety, weight gain, painful sex, loss of libido, and brain fog. For many it's the wrinkles and sagging skin that push them over the edge. A menopauser myself, I am intrigued by all the fashionable kit, including anti-perspiration clothes, but I had an easy ride of it because the moment I started having hot flushes and feeling grumpy, I asked for HRT. I can tell it does the trick because it gave me an instant breast lift.
I was lucky. In extreme cases, the menopause can lead to what feels like an out-of-body experience. One of my friends had such bad hallucinations that she was briefly checked into a hospital for medical supervision. When oestrogen production stops, we basically go into biological free fall. Reverse that and we could all live happily ever after with our ageing frozen somewhere around our mid-40s. No wonder this is a hot topic.
Increasingly, doctors consider menopause to be as much a psychological condition as it is a physical one. 'If you think about the hot flushes, the night sweats, the anxiety, the depression, the insomnia, the mental fog - those are brain symptoms, and we should look at the brain as something that is impacted by menopause at least as much as your ovaries are,' says Lisa Mosconi, an Italian-American neuroscientist. Indeed, many women go on antidepressants at this time.
'One third of women will cruise through menopause,' says Professor Simon Fishel. 'One third will have it mildly, and one third will have real problems.' Prof Fishel is a Nottingham-based in-vitro fertilisation pioneer who has now turned his attention to a woman's later years. 'Two hundred years ago,' he says, 'women died 10 years after menopause. Now they can live longer post menopause than pre.' But he has an answer: a woman's own frozen ovarian tissue can now be used to postpone her menopause. The procedure is invasive, it comes with a price tag of £10,000, and it has to be performed while a woman is still fertile. These drawbacks mean that it isn't widely used... yet. But an end to menopausal suffering would make economic sense for the country, he says, because those for whom it is really bad have to stop working. So 'a menopause bill offering free HRT to all women is on the table,' he says.
With more than 4.3 million women over 50 in work in the UK, many of them in senior positions, menopause is a subject no employer can afford to ignore. In fact, many companies (including the BBC) are already adapting offices to include fans to cool the air around an overheating midlifer, and bringing in hormone specialists to treat anxiety and mood swings.
Hormone replacement therapy does exactly what is says on the tin. I use the continuous combined oestrogen and progesterone patch along with a synthetic version of DHEA (the adrenal hormone dehydroepiandrosterone), prescribed by Dr Tamsin Lewis (of whom more later), for an extra 'kick'. It is a game changer for many women but it is not always effective. What's more, HRT only alleviates some symptoms (such as anxiety, hot flushes, anxiety, joint ache, skin dullness) but doesn't address the bigger emotional and spiritual issues that menopause throws up. 'Women are often going through great change in their lives at the same time as menopause,' says Sophie Benge, a biodynamic coach and 'menopause concierge' who runs six-day retreats at the Six Senses in Ibiza (£3,300 single occupancy). 'They often lose confidence and libido at that time,' says Benge, who uses yoga and breathwork to help women reclaim their 'sexual intimacy'.
No two women have identical menopauses, which is why tailor-made treatments are now the norm for those who can afford them. Top of the pile is Dr Marion Gluck, the doctor Oprah Winfrey has on speed dial. 'The current "one-size-fits-all" approach does not work,' says Dr Ghazala Aziz-Scott, a specialist in integrative women's health and bioidentical hormone balancing for the Marion Gluck Clinic in London's Wimpole Street. Here women are put on an individually prescribed course of hormones. 'Bioidentical hormones are identical in structure to our own natural hormones and therefore produce similar physiological effects and fewer side effects,' she says. 'State-of-the-art treatment should also recognise that we need a balance of all the sex hormones - oestrogen, progesterone and testosterone - which all work synergistically to achieve the best hormonal balance and wellbeing.' Many of Dr Gluck's patients have anti-ageing DHEA, 'which provides a reservoir for these hormones after the menopause,' says Dr Aziz-Scott. An initial consultation is £320, with regular follow-ups at £160 a throw.
Hormones don't necessarily fix all the issues 'down there', though. And so technology is bursting on to the scene. Increasing numbers of women seem to be spending as much on 'tweakments' for their intimate parts as they are for their face, including fillers, lasers, and plasma and radio-frequency treatments. Dr Tania Adib, a consultant gynaecologist who runs Luminosa London, says depleting hormones affect all of our functions, including the sexual ones. 'Sex can be painful for some women, or they might complain of itchiness and dryness which gets worse with time.' Using lasers and injectables, Dr Adib restores fullness, moisture, volume and libido. Three sessions of vaginal radio-frequency come to £2,200, and a MonaLisa Touch laser session is £600.
Among the many victims of menopause are the muscles of a woman's pelvic floor. Enter BTL Emsella, a contraption that looks like a commode but stimulates the pelvic region and tightens everything up, ridding many women of another unspoken complaint: incontinence. And where should one find such a machine but within the walls of one of London's most luxurious cosmetic practices, Dr MediSpa in Knightsbridge. A course of six 20-minute treatments is recommended, at £2,000. It is effective and pleasant, and you can do it fully clothed.
And where machines don't work, there are dietary supplements. Lyma, the highest-end supplement on the market, which was created by Lucy Goff, a former PR, is one of the more visible. 'Currently menopause is not being addressed holistically,' says Goff. 'What are you going to do if you can't sleep for five years? Lyma's highly concentrated ingredients target inflammation, hair loss, skin tone and - crucially - sleep.' It certainly eases joint ache in this midlifer and is chock-a-block with mood-busting Affron and ashwagandha. Packaged in a copper jar costing £199 for the first order, the Chanel of supplements graces the kitchen of many a 40-plus Notting Hiller. One menopausal actor friend swears it restored her thinning hair. It certainly helps my brain fog.
When oestrogen goes, so does youthful skin. Dr Maryam Zamani, the go-to oculoplastic surgeon and facial aesthetic doctor for many menopausal women, myself included, works with plastic surgeon Olivier Amar, an innovator in cosmetic stem-cell science. At the end of the year he is introducing Uvence, taking regenerative cells from fat and in due course re-injecting the regenerative solution for skin rejuvenation. 'Filler makes people look puffy,' says Amar. Such youthful bloom will cost approximately £6,000. The skin-care company Dermanda uses stem-cell technology in its £285 Stem C20 Vitamin C serum, which, combined with the £225 Boto Lift face cream, acts like a mini face lift. And I can vouch for the tightening effect.
For those who shy away from doctors and needles, there's a brave new world of holistic treatments. Katie Brindle, an Instagram star who has made Chinese medicine popular, believes lifestyle plays a large part in how we cope with menopause. 'Our always-on mindset means we are chronically stressed,' she says. 'We are tired. We try and fit as much as possible into our work and home lives, and we don't allow our female, or yin, bodies the chance to rest. As modern-day women, we feel we should be able to have it all, to do it all, and to still look and feel great, so we push ourselves too hard and pay the price with increasingly difficult menopausal years.' Brindle has been treating menopause through breathwork and qigong for more than 20 years. 'I listen to my clients describe their symptoms. I hear the fear in their voices as they imagine a life of increasing debilitation and declining health ahead of them.' No wonder women are prepared to pay up to feel better.
As a result, menopause travel is a rapidly growing field. The Preidlhof Spa in South Tyrol leads the way. 'We treat menopause holistically,' says director Patrizia Bortolin. The six-night programme Glow & Flow in your Second Half first puts guests through a series of tests to calculate heart rate and sleep cycles. Treating menopause as a form of trauma, the programme offers water massage, acupuncture, dance, forest bathing, dietary advice and yoga (from £3,389 with flights). If tastes run to beaches rather than mountain air, there's Six Senses, Ibiza, with a RoseBar programme run by Dr Tamsin Lewis, who trained with Dr Gluck. Further afield is the RAKxa in Thailand, which combines Western and Eastern medicines to treat fluctuating hormones and fluctuating weight. A night here costs $2,000.
All of which hopefully means that instead of ageing being something to endure, it will become a process women can actively enjoy.