What is your professional background and how did you come to specialise in the menopause?
It goes back many years; back to when I was a child and our house was next to a chemist. I studied medicine in Greece, my home country, and came to the UK in 1996. When I was a medical student I saw my mum, who was in her early 50s, suffering from menopausal symptoms, particularly sudden hot flushes and day and night sweats. She couldn’t really do anything about it, there wasn’t any access to help or treatments – it was something you had to just put up with. And she was very busy at the time with her career and looking after the family. When I did my GP training here in the UK, I used to see a lot of female patients who had perimenopause and menopausal symptoms. I started looking into it more and asking questions – and I wasn’t very satisfied with the response. I found myself looking for information and specialist courses and further training, and there was very little available at the time. I eventually found a specialist NHS menopause clinic in London and I approached the consultant there and asked to shadow. I ended up doing menopause training at Queen Charlotte’s and Chelsea & Westminster Hospitals, and that’s how it all started.
How did you end up setting up your specialist clinic, Medical Prime, in the City?
After I completed my training, which took about three years, I tried to set up an NHS community clinic, because I felt my colleagues weren’t really aware of the best way to approach the menopause. At the time there was a huge negative atmosphere about HRT, meaning GPs were reluctant to prescribe it, so there was also a rise in referrals at the hospital. I spent two years trying to set up a community-based clinic and had no luck at all, so I just carried on with my work as a GP. Fast forward to 15 years later, I went into a phase in my life where I started to reflect on what I wanted to do work-wise and what I could put my energy into. Starting a menopause service was one of the areas that I felt very passionate about, so I set up the clinic four years ago. I wanted to set up Medical Prime in the City, it was a conscious decision. I love the City. I love its diversity and energy. This is where I wanted to be based, in the heart of this pulsating neighbourhood. There is such a pool of talent and ambition here and I want to help these women. It’s such a vital workforce.
What do we actually mean by “menopause”?
It’s a Greek word, meaning the end of periods. And this is really what it is, in medical terms; it is the end of natural periods. But usually it’s very difficult to know when your last period is. Typically, we define it as when there hasn’t been a period for 12 months, then we can say you’ve reached the menopause. The average age in the UK is 51 – but this is average, so it can start earlier or later. The common spectrum of age where it starts is from 45 to 59. So, women in their late 50s can still have periods, and they can still go through the transition. What people don’t realise is that, although this is the usual age range, it can actually happen earlier. If it happens below the age of 45, we call it the early menopause. But 1 in 100 will experience it below the age of 40, and there can be different causes for this, both natural and medical. So, it’s not as rare as people think and it can happen at any age. There have even been cases of women aged 20 or younger starting the menopause.
There is such a pool of talent and ambition in the City and I want to help these women.
What are other misconceptions?
People still believe that menopause is something that happens to older women. That’s the big myth; it can happen at any age. Then there’s the misconception that it happens just once, then that’s it. You are always in a post-menopausal state, it can be a good three or four decades of your life. So yes, the menopause is one event in a lifespan, but then the stage you enter is a very significant part of your life.
What are the symptoms of menopause?
The majority of people associate the menopause with hot flushes but you can also experience joint pains, migraines or muscle stiffness. Then there are also emotional symptoms. They can range from low mood to severe depression. There’s also anxiety, panic attacks, irritability and even an impact on memory and concentration. Physical symptoms can also trigger and contribute to emotional symptoms. You can’t underestimate the effect that severe hot flush – something that’s out of your control – has on your confidence. They can make you feel that you can’t cope or carry on with your work. Nowadays, I see more and more women coming to me for emotional symptoms. These women want a better quality of life overall and to start treatment early.
Is menopause still a taboo subject, especially when it comes to the workplace?
Common findings in recent surveys and research are that women are reluctant to talk about the menopause and discuss it with their line manager, or even to use it as the cause of being off sick. Recently the results of a survey put together by the Finance Service Skill Commission (FSSC), which focussed on women in financial services, found that 8 in 10 would not be willing to talk about the menopause in the workplace. It just shows that we are at the tip of the iceberg. It’s about time that we move away from the stigma and the culture of silence.
You mentioned the perimenopause. What is this?
The perimenopause is the build-up to your last period. It’s a transition stage, which, again, can happen or be present for many years. It’s when our ovaries start changing in terms of the amount of hormones they produce, and this can be a trigger for symptoms. It can start in your early 40s, or sometimes mid-30s, and it presents with various symptoms. It’s important to talk about the perimenopause because many women have never heard of it. And because you’re still having your periods during perimenopause, many women and, actually, quite a few of my colleagues, don’t consider it an area that requires treatment. Again, emotional symptoms can be very common, and they can be the first to start. A lot of these symptoms are similar to depression, and this is where we have misunderstanding and misdiagnosis. Many women are diagnosed with depression or anxiety, and they’re offered antidepressants and counselling, but a lot of them feel that there’s something different going on, but they can’t quite pinpoint what it is. Everything in their life can be ‘fine’ but they’re suddenly losing their temper or feeling panicky. You have so many different aspects of these emotional symptoms, and it could well be because of the perimenopause. I think what will become more of the norm in the future, as we learn more about female physiology, is that, from at least the age of 40 onwards, we should always consider perimenopause before diagnosing anything else.
What about treatments?
The main message about treatment is that it’s not one size fits all. This is really what we practice in the clinic; it’s about tailored treatment. Every woman is different and I’m here to offer you a medical explanation, but the way we talk about treatment puts a focus on what feels right and working together. We offer HRT as the first line as it is the most effective treatment in terms of managing the symptoms that relate to the hormone changes. Having said that, not every woman is suitable or wants HRT. There are other treatments we can discuss and even things such as supplements, exercise, mindfulness, meditation and cognitive behavioural therapy (CBT) can help.
Discover more about Dr Kalentzi and the services at Medical Prime by visiting medicalprime.co.uk
Dr Kalentzi was photographed exclusively at The Royal Exchange by Tami Aftab
A conversation with… is a monthly series that invites today’s leading minds to discuss current topics, exchange points of view and explore new ideas with The Royal Exchange.