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MENOPAUSE WITHOUT MEDICINE
By LINDA OJEDA
Hunter House Inc., PublishersCopyright © 2003 Linda Ojeda
All right reserved.
The woman who wants her second-chance years to be the best of all has to work at shaping her future. - DR. JOYCE BROTHERS, Better than Ever
Our society today, the society in which most of us have grown up, is clearly youth oriented. As much as we would like to believe that vitality and beauty are possible at any age, magazine ads and television commercials glaringly remind us that the emphasis on young bodies still prevails. Given our aging population and the host of beautiful older role models who now grace the screen, political arena, and corporate sector, I am beginning to believe that trends might be shifting from the overwhelming focus on nubile, wrinkle-free bodies. Young feminine forms still dominate the newsstand, but more and more older models like Lauren Hutton, Beverly John, and Cheryl Tiegs, and actresses such as Susan Sarandon, Goldie Hawn, and Candice Bergen stare at us from the checkout stand. They appear confident and seemingly comfortable with their age. Sure, they're airbrushed, and their lines and wrinkles have been swept away with a soft-lens camera, but midlife women are no longer hidden from view. This is progress. Even twenty years ago, when I first started writing about menopause, you could not find one positive midlife role model on the cover of a national magazine. Menopausal women were characterized as pleasingly plump matrons who had lost interest in looking good and were given to frequent hysterical outbursts. They were never depicted as sexy (imagine your grandmother wearing Victoria's Secret lingerie and enjoying sex), and as for creativity and adventure and starting a new career, those aspects of life were never even presented as possibilities. Gladly, times are a-changing.
Historically, medical attitudes toward menopause mirrored the negative stereotypes. Many earlier medical texts listed menopause as a disease or an unnatural phenomenon. The terms most commonly used to describe it included climacteric, endocrine starvation, involutionary years, female trouble, and living decay. No wonder women dreaded the so-called change of life! Descriptions such as these significantly warped their attitudes and responses to menopause, especially if they were poorly informed, which most were. Up until two decades ago, few books had been written about menopause, so women did not know what to expect, other than what their male doctors told them. There were no seminars or talk-radio discussions, and few women shared their personal experiences with even the closest of friends. Lack of information and negative conditioning certainly contributed to the physical and psychological symptoms that many of us "older" women remember as the typical stereotype of the menopausal woman. How could midlife women in the 1960s feel good about growing older when writers and doctors were telling women that their lives, essentially, were no longer relevant?
Robert Wilson, in his supposedly profemale book Feminine Forever, titled one of his chapters "The Loss of Womanhood and the Loss of Good Health." He described the menopausal woman as the equivalent of a eunuch: unbearable, suicidal, incapacitated, and incapable of rationally perceiving her situation. Equally degrading was the work of David Reuben, M.D., author of the popular Everything You Always Wanted to Know about Sex. This authority maintained that the essence of femininity is tied to a woman's ovaries; once the estrogen is virtually shut off, a woman comes as close as she can to being a man. Such a woman is not really a man, he explains, but she is no longer a functional woman; according to Reuben, menopausal women live in the "world of intersex." This is absurd. A woman's femininity is not defined by the amount of estrogen in her body any more than a man's masculinity is measured by his testosterone output. But this is what women were led to believe at that time.
Menopause is no longer regarded solely as an estrogen deficiency and a medical disease that requires intervention. Rather, the accepted view of menopause is that it is a major cultural, psychological, and physiological milestone for women. Its definition is now broader in scope, with symptoms linked to the consequences of aging as well as hormonal imbalance. The implication still exists, however, that menopause is predominately a negative event, like divorce or loss of a job. Many experts agree that menopause is a biological marker for aging; it signifies the end of reproduction in a culture where sexuality and childbearing are equated with female fulfillment, and it signifies the beginning of old age in a culture that extols youthfulness. Some still cling to this view, but is it true for all women, some women, or just a handful of women? Or is it an obsolete model reflective of antiquated ideas?
What Women Really Think about Menopause
The North American Menopause Society (NAMS) wanted to find out exactly how women felt about their menopausal experiences. In 1998, NAMS developed a set of questions and, with help from the Gallup Organization, conducted 752 telephone interviews across the United States, using a randomly selected sample of postmenopausal women ages fifty to sixty-five. Although individual postmenopausal women surveyed held differing views of menopause, the majority (51 percent) reported being happiest and most fulfilled during this time of their lives, compared to when they were in their twenties (10 percent), thirties (17 percent), or forties (16 percent). They reported that many areas of their lives had improved since menopause, including family and home life, sense of personal fulfillment, ability to focus on hobbies or other interests, relationship with spouse/partner, and friendships. Sixteen percent of women felt their sexual relationship had gotten better since menopause, while an equal number said it had worsened; however, more than half (51 percent) said it had remained unchanged.
Approximately three-quarters of women also reported making some type of lifestyle change at midlife, including changes in their nutritional or exercise habits, reducing alcohol intake, reducing stress levels, stopping smoking, taking more time for themselves, and using alternative and holistic treatments. One reason for women's positive experiences, according to Wulf Utian, M.D., executive director of NAMS, is that women are talking to each other about their experiences. Rather than looking to their mothers' generation for advice (since their mothers were uncomfortable discussing the subject), they look to friends and other women who are going through the same experience. "We see an increasing trend toward women supporting other women and guiding their peers and the next generation through the many phases of life," Dr. Utian said. "Menopausal women see themselves as role models, and seem to be very interested in helping other women, as well as improving their own health."
The thought of menopause should not and need not produce anxiety. A study of other societies indicates that the stereotype of the distraught woman is not universal, that our negative reactions to common physiological processes, such as menstruation and menopause, are culturally engendered. In countries where age is venerated and elders enjoy respect for their experience and wisdom, older women seem to manifest fewer physical and psychological symptoms. For example, South African, Asian, and Arabic women, who, it is said, welcome the end of the childbearing years, are reported to have positive attitudes about the change of life. Where there are different predefined concepts, aging seems to be more natural, less confusing, and not overlaid with negative images.
Mayan women in Mexico have been studied by researchers because they do not complain of the characteristic symptoms of menopause and do not suffer from osteoporosis and bone fractures. Endocrinologically, they are no different from women in the United States. In fact, estrogen levels in Mayan postmenopausal women were at or below the values expected for U.S. women. Something that is significantly different is their attitude. Mayan women welcome the transition, as they will be relieved of many household chores and regarded as respected elders. In addition, they will become free from the taboos associated with menstruation. Menstruating women are believed to carry an "evil wind" during their periods, so the cessation of periods raises a woman's status in the community.
Menopause, like menarche, is natural. We experience hormonal changes at menopause, just as we did in our adolescence. Any lifetime change may be accompanied by uneasiness and disequilibrium; it is normal and it will pass. How smoothly a woman adapts to any transition depends largely on her overall health-that of her body, her mind, and her spirit.
Menopause Is Big Business
In the West, historically, the menopausal woman was regarded with pity and indifference. Because she complained of symptoms that were as yet unexplained, she was labeled a neurotic hypochondriac, then sedated and left to suffer in silence. I am sure no one regrets leaving behind those days of disbelief and intolerance. But what replaced the ignorance-namely, the medical model of midlife-may be equally destructive.
Women who are fifty-something are no longer ignored; they are actively courted. They are presently a prime target of the medical industry, drug companies, and other interests that can benefit from an aging population. And the market is growing: Fifty million baby boomers are going through menopause, entering at a rate of between two thousand and four thousand per day. By the year 2015, nearly one-half of the female population will be menopausal. Talk about global warming.
Industry-financed medical researchers inundate us with information about the benefits of treating all menopausal signs and symptoms, severe or insignificant, with hormones. The assumption that menopause is associated with chronic disease further encourages widespread use of prescription drugs. While earlier hormonal therapies were marketed only to physicians, major drug companies now directly target female consumers in the grocery-store magazines. Before they experience their first hint of oncoming menopause, women are already primed to run to the doctor for pills.
Menopause is now a big business, and we women consumers need to be alert to what we hear and read. The fact that there is a strong bias toward medicalizing menopause is obvious. Now that hormone replacement therapy (HRT) no longer commands the primary focus since its reputation has been tarnished, an abundance of prescription drugs are primed to fill the void and sell us treatments for osteoporosis, vaginal dryness, hot flashes, and heart disease. Our buying power is huge and we are going to be courted and cajoled into taking drugs that we may not need. Before you decide on a new medication, please do some homework. Check with a few health professionals who are not quick to medicate, check out the Internet, read the latest in research, talk to your friends who may be knowledgeable, and trust your own instincts about what is appropriate for your body. Just because a product is advertised on TV and just because thousands of women are taking it, that doesn't mean it is the best drug for you. Also, find out if a natural, less potentially harmful remedy exists for your symptom. Often it does.
The Range of Symptoms
I was raised in an era when normal female topics, such as menstruation and menopause, were not openly discussed even among close friends. Our bodies, we were led to believe, were too mysterious to understand and too base to mention. Our intimate parts were ignored as if they did not exist. Even today, unfortunately, these childhood attitudes linger, preventing many of us from confronting and accepting problems and feelings that cry out to be addressed.
Attitudes concerning the menopausal experience have changed in the last few years, and they continue to evolve as women read, learn, and discuss their individual experiences. In the mid-1990s, a questionnaire designed by Fredi Kronenberg, director of menopause research at the Center for Women's Health at Columbia-Presbyterian Medical Center, New York City, was given to readers of Prevention magazine. The results of the two thousand randomly chosen respondents (fifteen thousand actually provided information) may help us understand and appreciate the menopausal experience. The results of this extensive questionnaire include the following:
* Intensity of symptoms ranged from stormy to breezy. Fifty-eight percent considered the process more of an annoyance than a major life disruption, and more than half agreed the symptoms were, for the most part, mild. * The younger the woman is at the onset of menopause, the more difficult the experience. The average age at which women enter menopause is fifty years, and a woman who has, for example, postponed motherhood, thinking she still has ten years left, and then suddenly finds herself starting menopause, probably has both physical and psychological issues to confront. * Weight gain is not inevitable at fifty; however, 42 percent of respondents gained in excess of ten pounds. Current research indicates that this additional poundage is more a function of aging than of estrogen decline. * The fact that sleep problems were prevalent was not surprising. Sixty-two percent of the respondents reported that hot flashes kept them awake. Frequent urination, which is related to lower estrogen levels, may also keep women awake; aging itself has an effect on muscle tone, and illnesses, such as diabetes, impact bladder function. * The years prior to menopause, called perimenopause, seem to account for most of the annoying symptoms, such as severe hormonal fluctuations. Once a woman has stopped having periods for a year, things usually stabilize. * Good health habits correlated with a more positive menopausal experience. Exercising three or more times a week was associated with fewer symptoms and a generally better transition. It is unclear whether exercise reduced the stress of menopause or had other benefits, but the more stress a woman reported in her life, the more difficult her menopause. * The relationship between a positive menopausal experience and a low-fat diet was even stronger than that for exercise. Women who described their diet as primarily vegetarian generally reported fewer symptoms. Eating soy products, such as tofu, correlated strongly with fewer symptoms. It may be that women who eat soy and vegetable products enjoy a lifestyle that is healthier in other ways, but the benefit might also be attributed to the large amounts of phytohormones in soy. Certain plants contain estrogen-like substances, called phytohormones, that appear to provide just enough hormonal effect to prevent menopausal symptoms. In countries where women consume large amounts of soy products, menopausal symptoms are appreciably reduced or nonexistent.
It appears that women with certain personalities may tend to develop certain menopausal symptoms. Although the evidence is not conclusive, there is value in relaying this information, because it may apply to and help a number of women.
Researchers have found that certain personality types find it more traumatic to adjust to changes during the menopausal years. Gynecologist Sheldon Cherry finds that women with a history of emotional problems have the hardest time. These include women with chronic sexual difficulties, immature women with narcissistic tendencies, women whose erotic attractiveness was the chief element of their personal worth, childless women facing the undeniable loss of fertility, and married women who feel that their meaningful years are over.
Several authorities have observed that the manner in which women react to the change may be related to how they perceive themselves as women. Particularly vulnerable, according to British physician Barbara Evans, are women who over the years have defined their femininity in terms of bodily functions-menstruation, pregnancy-and motherhood. For them, menopause represents the end of their womanly identity; it removes the purpose of their existence.
Excerpted from MENOPAUSE WITHOUT MEDICINE by LINDA OJEDA Copyright © 2003 by Linda Ojeda. Excerpted by permission.
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