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The Pause (Revised Edition): The Landmark Guide

The Pause (Revised Edition): The Landmark Guide

by Lonnie Barbach

Since its original publication in 1993, The Pause has become known as the authoritative guide to menopause—a previously overlooked topic of great importance to women. The significant amount of new research on menopause and perimenopause amassed in recent years has led bestselling author Lonnie Barbach to completely revise and update this


Since its original publication in 1993, The Pause has become known as the authoritative guide to menopause—a previously overlooked topic of great importance to women. The significant amount of new research on menopause and perimenopause amassed in recent years has led bestselling author Lonnie Barbach to completely revise and update this groundbreaking classic. Important additions include eight entirely new sections on topics such as SERMs (selective estrogen receptor modulators), phytoestrogens, and the impact of menopause on the female immune system. This additional research is combined with new information about menopause and mood, weight gain during menopausal transition, breast cancer survivors taking estrogen, the positive effect of estrogen on dementia and Alzheimer's, and new alternatives to traditional HRT (hormone replacement therapy) for managing hot flashes, improving bone density, and assisting breast cancer survivors. All together, the latest edition of The Pause is a must-have resource for any woman facing the "next third" of her life.

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Penguin Publishing Group
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Product dimensions:
5.31(w) x 7.96(h) x 0.75(d)
Age Range:
18 Years

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Read an Excerpt

Chapter One

Is Power

It was September 1987, a month before my forty-third birthday. My life was going well. My daughter was nearly two years old and except for her erratic sleeping patterns was a total delight. David was a supportive, wonderful partner. I was excited about finishing my first videotape, Falling in Love Again, when suddenly the rug was pulled out from under me.

    I began feeling so fatigued that I was forced to take a nap each afternoon. Certainly being the working mother of a two-year-old can be exhausting, but this fatigue was different. I felt the way I had during the first three months of my pregnancy, but then I knew the cause. In addition to the fatigue, I was having strange heart palpitations, and I was waking up three to five times a night to urinate. One of my fingernails constantly felt cold and a vertebra in my neck was suspiciously tender.

    By the morning of the final shoot for the videotape, instead of feeling like celebrating, I wanted to crawl into a hole. I did not know whether I would be able to make it through the day. All I knew was that there was something terribly wrong with me.

    In the following year I trekked from doctor to doctor, trying to find the cause of these strange symptoms. One physician thought I had chronic fatigue syndrome and another suggested systemic candida. Since I could not do anything about chronic fatigue syndrome, I chose systemic candida as my diagnosis and religiously followed a strict diet, free of yeast, wheat, and sugar. In four months, I lostfifteen pounds, looked awful, and still felt terrible.

    Yet another doctor diagnosed me as having low thyroid. My blood tests showed that I was on the very low end of normal. I was given thyroid medication, the minimum dose. Even when I cut the dose in half and then in half again, I could not sleep more than three hours a night and I shook as if I had been mainlining coffee. So my thyroid was not the problem.

    During that year, my menstrual cycles had shortened to twenty-eight days from the usual thirty-one to thirty-three. I even had a couple of twenty-six-day cycles and one that was just twenty-one days long. But I thought this irregularity was the result of my mysterious illness rather than the cause of it. All I could think of was Gilda Radner, dying of ovarian cancer, which none in her parade of doctors had diagnosed until it was too late.

    I remained confused and frustrated for more than a year. Then one morning I took a walk with a friend, two years my senior. She informed me that the strange symptoms she had been experiencing were menopause and that maybe that was my problem.

    Menopause? Me? No way! That couldn't be what I was going through—I was too young. I had no idea that symptoms could begin before age fifty. In fact, except for hot flashes, I did not know there were any symptoms at all—and I had never had a hot flash.

    My immediate fear was that my years of productivity were over. Not reproductivity, but productivity. I love my work as psychologist, author, and lecturer. I couldn't imagine it all ending. During the next few weeks, I began to do some serious thinking. I had at least two decades before retirement age, which meant I had as many productive years ahead as I had behind. In fact, my increased life experience was making my work deeper and better. As I reflected, I realized that menopause did not have to mean the beginning of the end of my life. Instead, it could mark the beginning of a powerful and productive time. I was actually at the height of my career. I had attained a degree of financial security and commanded a certain professional freedom which meant that I had more choices than ever before.

    I discovered that my fear and ignorance were not unique. A successful TV producer told me that, at forty-six, she was puzzled by strange symptoms. Her periods were so heavy she had to use a "super" Tampax plus two pads. The periods were accompanied by excessive cramping and fatigue and she often felt crabby and on the edge of anger. But when I suggested that her symptoms could be signs of the beginning of her menopausal transition, she was devastated, just as I had been. "Oh no, I'm not ready for this," she said. "I have so much left to accomplish and I'm having a wonderful life." When I asked her what part of her life had been the best, she replied, "The last few years, without a doubt, both in my marriage and my career." With menopause, she expected it all to end.

    My personal experiences led me to write The Pause. I wanted to create a more realistic picture of menopause and help dispel the notion that it means we are somehow finished or washed up when it occurs. I also wanted to provide information on the variety of early signs and symptoms of menopause so that others will not have to go through the emotional distress that lack of information caused me. And finally, I wanted to direct women experiencing uncomfortable symptoms toward traditional and alternative approaches to ameliorating them. Basically, I found myself writing the book that I wished had prepared me for this passage.

    With guidance and preparation, this transition can be as exciting as pregnancy. This episode in our lives can truly be thought of as a period of gestation, culminating in our own rebirth. This is a time of renewal, not the beginning of death. For this reason, I would like to start by renaming this phase of women's lives. We need to overcome the many negative expectations that surround the word "menopause." What shall we call it?

    "The change of life" is imposing and can easily be misinterpreted as the change from life to death. "The perimenopause," which is the proper medical term for the years of hormonal change preceding menopause, is just too unwieldy. I cannot imagine talking to a friend about my "perimenopausal" experience. While I like the meaning of the term "climacteric" (a major turning point or critical stage), it is awkward and somehow sounds like a climax that has not yet happened.

    "The Pause" really fits the most positive aspects of the experience for me. It speaks of a break, a time to reflect. This transition from our childbearing years to the next stage of life, in which our own needs can play a more central part in the story that unfolds, promises excitement.

    It's like pushing the pause button on your VCR player: you take a break for a few minutes to answer the phone or scoop out some frozen yogurt. You can do a lot of things during this interlude, but ultimately you expect to continue the program from where you left off. Or maybe the pause offered by a sabbatical is a better analogy. You take time out from the routine of your life. You encounter new experiences—often altering your point of view. Then you return to life as usual—the same person, yet somehow changed because of it all. While The Pause may be a period of disequilibrium, of physical discomfort, it also heralds a new equilibrium, a period of renewed energy, and often a new sense of purpose.

    I use "The Pause" to refer to the period of discomfort that precedes the last menstrual cycle and often continues for a few months to a couple of years thereafter. "Menopause," on the other hand, refers specifically to the date of the last menstrual period, and "postmenopause" addresses the years after that date.

    Many physicians simply do not understand that the transition to menopause is a process that can take years. The Pause can start as soon as our late thirties or early forties. The number of women who reported that their gynecologists told them that their symptoms had nothing to do with menopause because they were not yet fifty was simply astounding.

"With my yearly physical, I'd ask for information about menopause and I'd get a pat on the back and an, `Oh, don't worry about that until you're fifty-two.'"

"When I was forty-five, I was having horrible headaches, my periods were growing further apart, and I was flowing heavily. I asked if there wasn't a test I could take to find out if it was menopause. But the doctor said that it was all in my head, that I was too young, it couldn't be."

"In my early forties I was having these terrible mood swings so I made an appointment with my gynecologist, but he said I was too young for menopause and I shouldn't think any more about it."

    In the two to ten years before the last menstrual period, and the year or so after, women tend to experience the most difficult physical and emotional symptoms. If you are between thirty-eight and forty-five and going through this transition, doctors may ignore you—you may feel awful, but can't find out why.

"I was forty-two years old. I was starting to get these unusual headaches, a kind of numbness in one of my fingers, and incredible fatigue. I didn't know what it was and no doctor seemed to be able to provide me with a diagnosis. What really scared me at the time was that these were the cardinal symptoms of a brain tumor. It turned out to be menopause."

    It is not knowing, maybe more than anything, that holds women in the grip of fear. Had I known at the time that the physical problems I was experiencing were classic signs of menopause, I could have saved the time, money, and grief of visiting doctors. Not knowing the cause of my symptoms made it more difficult for me to deal with the physiological discomfort. For this reason, I have devoted Chapters 3 through 6, one chapter each, to the different constellations of emotional and physical symptoms that may accompany The Pause. Besides describing the various symptoms, I cover traditional and alternative solutions when appropriate. Chapter 7 deals specifically with the sexual changes that can occur during this period of our lives.

    With the dearth of information available to women, and the covert whisperings about what it all means, we find ourselves anxious and ignorant about a normal process that takes place within every woman who lives beyond her middle fifties. Chapter 2 describes this process simply and clearly. A postmenopausal woman is no more hormonally deficient than a girl of six with no breasts. Each is normal for a female of that age. Like puberty and childbirth—each with its own pleasures and problems—menopause is a normal and natural transition.

    It is more appropriate to look at The Pause and the postmenopausal period in the same way we view handling the reproductive period. We do not consider pregnancy a disease, although we may call upon medical support and guidance to help us through. If we have problems, intervention is appropriate. If not, nature takes its course.

    In the same way, not every woman needs to be treated when going through The Pause. Many of us will experience virtually no distress whatsoever or only mild symptoms. However, when we do experience symptoms related to The Pause, we may not know where to turn. One major concern is whether or not to take hormones.

    The decision to take or not to take hormones reflects our individual approach to health care. Consequently, the pros and cons of this very personal decision are covered in Chapter 8. That chapter also presents the most up-to-date medical information from the North American Menopause Society's annual meetings, and research findings from professional journals. Despite the large numbers of women going through menopause, it has not been given real medical attention until very recently. Only during the past eight years has the North American Menopause Society been holding annual meetings to communicate new scientific information. Consequently, on a couple of issues there continues to be debate even among the experts, and there is still much that is not known.

    In addition to standard hormone replacement therapy, I will explore the positive and negative aspects of low-dose birth control pills and estrogen supplementation in the forms of pills, the estrogen patch, and estrogen cream—solutions appropriate to women in their forties who are still menstruating. New forms of progesterone will also be covered. Your physician, especially if he or she does not specialize in menopause, may not yet be aware of some of these alternatives.

    Hormones are not the only viable way to counter the discomforts of The Pause. Some women are wary of hormones or downright opposed to taking them. Others may have risk factors that do not permit them to take hormones. And many women prefer the least possible intervention or the most natural approach. For example, their first choice might be to do nothing at all, or to take vitamin supplements. Even when research is scanty or nonexistent, some women intuitively trust alternative therapies—herbs, homeopathy, or acupuncture—more than Western medicine.

    Chapter 9 explores a number of alternative treatment approaches. Herbs that balance your hormones or contain phytosterols (natural plant hormones) can provide relief from symptoms. Homeopaths are physicians or other health professionals specifically trained to use especially prepared micro-doses of herbs or other plants, minerals, or animal fluids to reduce menopausal discomfort. Acupuncturists rely on the use of needles or electrical stimulation of particular points in the body, often accompanied by Chinese herbs, to reequilibrate the energy flow in the body and alleviate symptoms. Each of these alternatives requires treatment by a specialist. This chapter discusses the benefits and limitations of each.

    I do not favor one treatment modality over another. Each has different strengths, and I have tried most of them with some degree of success. The final decision lies in your particular risk factors, and the way your body responds to hormones, homeopathic remedies, acupuncture treatments, or herbs. It also depends on how you feel about the different methods, about taking daily pills, for example, as opposed to having acupuncture needles inserted into your body.

    There is no one, right, risk-free answer. Every time you put something in your body you take a risk. You also take a risk when you do nothing, perhaps depriving your body of what it needs. And no single approach works all the time for any particular symptom. One woman might respond positively to one approach while another responds to a different one. But relief is possible. When you have choices, you can chart your own course.

"I'm really not afraid of getting old or losing my childbearing years. Still, I had problems with menopause. If I had known that I could change things with vitamins or homeopathy or something, I would have been better off. When you have no knowledge, you have no alternative."

    But concerns are not limited to the discomfort of menopausal symptoms. Many of us are equally concerned about our health in the years that lie beyond. Chapter 10 is devoted to the prevention of heart disease, osteoporosis, and dementia—to living the most healthful lives we can. The roles of hormones, diet, and exercise are all explored. Diet and exercise are also addressed in other sections where relevant.

    My goal in The Pause is to provide you with appropriate alternatives for handling your symptoms, whether they are hardly noticeable or overwhelming, including alternatives for minimizing future health problems. Without information, you may not know the appropriate questions to ask and are at the mercy of your health practitioner. With information comes power, power to seek the care you need.

    For most of you, The Pause is unlikely to be as difficult as you may anticipate. Much like a steep ski slope, it generally looks far worse from above. Once in the middle, you can find a way down. Research shows that women who experienced regret or mixed feelings at the beginning of The Pause were likely to change their minds in a positive direction. And those who felt relieved at the start of The Pause continued to feel that way.

    Even when the transition is difficult, the rewards can be great. Some of the most beautiful landscapes are accessible only after a rugged climb.

    As one woman said to me: "If I did a new résumé, I think I'd put down, `I went through menopause,' because it means something. I see it as another form of accomplishment. I went through it my own way, and I came out the other side. And I am a better person for it."

    Menopause is not the end of your life; it is the beginning of a new phase. Knowledge of what is to come can empower you to make this phase into the best one of all, and Chapter 11 shows you how women have done just this.

Meet the Author

Dr. Lonnie Barbach received her M.A. and Ph.D. in clinical social psychology from the Wright Institute in Berkeley, California. She is now on the clinical faculty of the University of California Medical School in San Francisco and also has a private practice. Among her several bestselling books on sex and relationships are For Yourself, Pleasures, Going the Distance, The Pause, Seductions, The Erotic Edge, and Erotic Interludes, her book with her partner, David Geisinger, Ph.D. They live in Mill Valley, California, with their daughter, Tess.

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