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The Silent Passage: Menopause

The Silent Passage: Menopause

by Gail Sheehy

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Gail Sheehy's landmark bestseller has become the bible for women concerned about menopause. Since The Silent Passage was originally published in the early 1990s, Gail Sheehy, a member of the board of the New York Menopause Research Foundation, has been at the forefront of the newest research on menopause. She has also continued to interview countless women


Gail Sheehy's landmark bestseller has become the bible for women concerned about menopause. Since The Silent Passage was originally published in the early 1990s, Gail Sheehy, a member of the board of the New York Menopause Research Foundation, has been at the forefront of the newest research on menopause. She has also continued to interview countless women throughout the country on the subject. In this updated and expanded edition, she presents essential new data in chapters on The Perimenopause Panic, Menopause in the Workplace, Estrogen and Brainpower, and New Frontiers in Treatment. Candid, enlightening, inspiring, and witty, with the latest information on everything from early menopause to Chinese medicine and natural remedies, The Silent Passage is an indispensable reference for every woman.

Editorial Reviews

Publishers Weekly - Publisher's Weekly
Sheehy's popular guide has been revised and updated. (June)
Library Journal
When Sheehy, author of the classic Passages ( LJ 5/15/76) and The Man Who Changed the World: The Lives of Mikhail S. Gorbachev ( LJ 12/90), wrote about her personal experience with menopause in the October 1991 issue of Vanity Fair , the response from readers was overwhelming and compelled her to expand the article into this surprisingly slim book. Interviewing over 100 women in various stages of menopause and 75 experts, she examines the medical, psychological, and social aspects of this ``silent passage.'' A biological change that spans five to seven years, this ``second adulthood,'' according to Sheehy, has three stages: perimenopause, menopause, and coalescence. While Sheehy performs a valuable service in bringing this topic out into the open, her book is weakened by her cliched Cosmopolitan -style prose and New Age psychobabble. Still, with the older members of the Baby Boom generation entering menopause, there will be demand for this book. Readers seeking practical advice should consult Winnifred Cutler and Celso-Ramon Garcia's Menopause ( LJ 11/1/91). Previewed in Prepub Alert, LJ 12/91.-- Wilda Williams, ``Library Journal''
Carol Peace
Makes a convincing argument that the change of life can be the beginning of something positive. -- People Magazine
Kirkus Reviews
A compelling discussion about menopause, packed with facts and anecdotes that are right on target for the baby-boom women about to encounter change of life. This short volume is an outgrowth of an article that Sheehy wrote for Vanity Fair when she began to experience menopausal symptoms. The response from readers was immediate, clearly confirming that the article had cracked "the last taboo." To rephrase an old saw, nobody wants to talk about menopause, but everybody wants to do something about it. Laid out eloquently here are the facts, the folklore, and the fears, revealed by interviews with scientists, medical professionals, and dozens of women. Many of the women were frightened by the idea that, as menopause neared, they would begin to "lose it upstairs." But the symptoms that accompany menopause make "losing it" almost appealing. They include: depression, headaches, itchy skin, mood swings, hot flashes, reduced sex drive, fatigue, irritability, osteoporosis, sleep deprivation, memory loss—and more. Not all symptoms afflict all women—some have none—and, most comforting, the symptoms are almost always temporary or easily treatable. Sheehy takes on the medical establishment, calling the lack of data about hormone therapy a "scandal," placing current knowledge about change of life on the level of "leeches and roots and shamans." But she also sees the stages of menopause as the gateway to a new life, in which revived energy and earned wisdom can be harnessed to the community. Many of the interviews are moving, and some are funny; but there is a disproportionate emphasis on the experiences of upper-income women who can afford bone-density analysis andhormone-replacement therapy. It's reported that there are 43 million American women in or past menopause, with another half million to join them each year in the 90's. Sheehy's book will be a bible for them—and hopefully for the doctors who treat them.

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Random House Publishing Group
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from The Need to Know and the Fear of Knowing

We think of ourselves as so liberated today that we can talk about anything. In an Oprahfied age people will tell strangers about their abortions or alcoholism, even declare on national television that they are dying of AIDS, yet just let a man suggest to his sleepless, perspiring, weepy wife that her uncharacteristic moods and symptoms might have something to do with menopause and he's bound to get a blanket denial: "What are you talking about! I'm too young!"

Menopause may be the last taboo. The first friend to whom I ever mentioned the subject was a sultry-looking woman of fifty. She had always prided herself on her appearance and gained much of her status from creatively supporting her husband, a successful author who looks somewhat younger than she. I asked if she had ever talked with anyone about menopause.

"No. And I don't want to."

"Women don't bring up the subject around you?"

"One friend did," she said sourly. "I haven't seen her since."

Another friend, a public television producer whose natural temperament is appallingly calm, recalled with rueful laughter her first sign of the Change of Life. She was seated between two titans of industry at a high-protocol Park Avenue dinner party, the kind where the place cards look like tracings from the Book of Kells and she was feeling particularly confident and pretty in her new black designer suit with its flattering white satin collar, when out of the blue a droplet of something hit her collar. Then another drop. What the — was the help dribbling wine? Could there be a leaky ceiling under all that gorgeous boiserie? Suddenly she noticed herhusband's gaze turn to alarm from across the table: What horrible thing was happening to her? She put a hand to her face. Her forehead was wet as a swamp.

Oh no, said her eyes, not me! as the moisture began running in rivulets down her face and slipping off her chin — plop — onto her pearly satin collar. Should I pick up the white linen napkin and wipe my forehead? She reached for the five-hundred-threads-per-inch napery, hesitated — no, all the makeup will come off on the damn napkin — when a few more plops fell into her decolletage. Frantic, she began dabbing at her face. Trying to pretend it wasn't happening, she turned to her dinner partner and began smiling and mopping, chatting and fanning, laughing at his jokes and dabbing, trying to keep up her end of the conversation while she wanted nothing more in this world than to disappear into the kitchen and tear off her clothes and open the freezer door — never mind that it was February — and just stand there.

She and her husband have since had the Thermostat Wars usual in menopausal households — "It's freezing in here!" "No, it's boiling." "Did you turn the thermostat below fifty again?" "Oh, why don't you just get flannel pajamas!" But the producer is one of the lucky ones: She has had no other indicators beyond hot flashes that she is passing into another stage of life.

It happens to every woman. Pregnancy we can choose to go through or not. With menopause there is no choice. It happens to teachers and discount store clerks and dental hygienists, who nonetheless have to function in public, on their feet, every day. It happens to Navy pilots and gray-haired graduate students and former Olympic athletes, who are accustomed to demanding the highest physical and mental performance from themselves. It happens to women of color, to women in the home, it happens even in Hollywood. Gorgeous Goldie, Whoopi Goldberg, Susan Sarandon, Diane Keaton, Jessica Lange, and Candy Bergen, too, must deal with menopause. These women are hardly over the hill. In fact, they are more potent than ever.

But they never mention the big M.

The central myth is that menopause is a time in a woman's life when she goes batty for a few years — subject to wild rages and deep depressions — and after it she mourns her lost youth and fades into the woodwork. In truth, menopause is a bridge to the most vital and liberated period in a woman's life.

Certainly hormones have a powerful effect on our physical life and our mood, just as hormones underlie male aggression and affect potency as men age. During the passage through menopause, when hormones are spiking and falling a few times every day, or possibly within an hour, many women do experience waves of fatigue and bouts of the blues. But that is very different from clinical depression. And most important, it is temporary.

In fact, women in their fifties, once through menopause, have the lowest rates of clinical depression compared to women at any other stage of life. Depression actually subsides with age for women.

Ironically, the people who are the most evasive and unsympathetic about menopause tend to be women in their forties. Slouching toward the bridge to that unknown and frightening new territory of "postmenopausal woman," they may become "menophobic." Their own resistance to identifying with the stage of life beyond reproductivity is sometimes expressed in an uncharacteristic intolerance of their own friends.

A thirty-nine-year-old Chicago woman moved to a new city the year her premature menopause came on. Although she made new friends quickly, they began to shun her as soon as she mentioned physical signs associated with the Change. The ostracized woman struggled through five years with a large fibroid cyst and digestive problems before her friends and doctors acknowledged the source of her difficulties.

"I clearly remember not being sympathetic," recalled one of her friends with considerable regret. Others of the woman's friends remembered their impatience. "We'd talk about her among ourselves: 'She's complaining about hot flashes and stomach problems again this week. Why doesn't she just get over it?' We never really said, 'She's suffering.' We certainly never mentioned the possibility of menopause. And here we are, women."

"Women can be the worst," acknowledged her best friend.

The formerly shunned woman now realizes, "People wouldn't relate my problems to menopause because that would automatically classify them as old." Menopause must be one of the most misunderstood passages in a woman's life. One study showed that two-thirds of all American women say nothing to anybody as they approach what may be a distressing and even fearsome Change. But who can blame us? Menopause is inextricably linked with middle age, and in the youth-oriented societies of North America and Europe even the mention of middle age has a stigma about it. Shame, fear, and misinformation are the vague demons that have kept us silent about a passage that could not be more universal among females. The most common fears are: I'll lose my looks, I'II lose in my sex appeal, I'll get depressed, I'll become invisible. We don't have to lose any of these things. Yet the obvious sources of information and comfort — mothers, doctors, academics — have shied away from the subject. All that is changing as the subject of menopause becomes part of our public conversation.

Today fifty is the apex of the female life cycle. And menopause is more properly seen as the gateway to a Second Adulthood, a series of stages never before part of the predictable life cycle for other than the very long-lived.

If forty-five is the old age of youth, fifty is the youth of a woman's Second Adulthood. In fact, we can anticipate at least as many years of life after menopause as we have already lived as reproductive women. You don't believe it? Consider. Most women begin menstruating around thirteen and begin stopping at around forty-eight — remaining defined, and confined, to some degree by their procreative abilities for thirty-five years. The life expectancy of an average woman who lives to age fifty in the U.S. or U.K. is now eighty-one. (A man of fifty can expect to live until seventy-six.) So, from the time she reaches perimenopause, the average woman has thirty-three more years.

The projected life span of the current generation of women now hitting fifty in the U.S. is beyond anything known by the human species. They can expect to live routinely into their eighties and nineties. Here is the most stunning statistic, affirmed by Kenneth Manton, research professor of demographic studies at Duke University.

A healthy, fifty-year-old American woman who does not succumb to heart disease or cancer can expect to see her ninety-second birthday.

Whoever prepared us for the possibility that we might live long enough to forget the name of our first husband?

Since there has been virtually no period in the history of the human species when evolution has favored postmenopausal females, we shall have to favor ourselves. We shall have to intervene — medically, hormonally, psychologically, spiritually — because we cannot assume that aging will go smoothly. Evolution didn't provide for it.

The main point is that we are living longer lives than ever before. But my impression from talking to thousands of women all over America and Europe is that this new perspective — only milliseconds old in evolutionary terms — has not caught up with most people.

Women today often believe they are well-informed about menopause. But the majority of women regard menopause as a short-term event and do not connect it with long-term health problems in postmenopausal life, such as heart disease, osteoporosis, or cancer. Less than half the women in a recent Gallup survey related the Change to these important issues, and more than one in four did not see a doctor at all, because they felt their symptoms were a natural part of menopause.

A keen social observer, British novelist Fay Weldon, points to the psychology of these women: "They'd on the whole rather not know — for if we don't know, it doesn't matter." But it does matter. It matters whether or not a woman in her sixties finds it painful to walk or even bend as a result of osteoporosis. It matters when a woman in her fifties has a heart attack. It matters that women look these possibilities in the eye, because the way in which they approach menopause will affect the risk of their suffering from these diseases. Naturally, parts of our bodies are going to break down with the aging process. Since many of us can expect to live into our eighties or nineties — whether we wish to or not — do we want to have bones and hearts that break down while the rest of us keeps going?

Menopause must be approached today with a different attitude, one that is self-valuing, rather than self-deprecating. Making the effort to change eating, smoking, sleeping, and exercise habits, or taking the time to experiment with hormone replacement or homeopathic practices to help rebalance the body around its new hormonal state, is not an issue of vanity, or attracting men, or succumbing to Western culture's preoccupation with youth. It is an issue of physical and mental health.

It is time to render normalcy to a normal physical process that ushers in the youth of our Second Adulthood. This is a passage as momentous as the rite of passage into adolescence. Indeed, the menopausal passage is almost the mirror image of the transition to adolescence for females, and it will take just as many years. Jolted into menstruating at twelve or thirteen — remember? — it took five years or more for our bodies to adjust to our uniquely altered chemistry, while our minds struggled to incorporate our new self-image. So, too, must we readjust to not menstruating.

Just as we were apprehensive as eleven-year-olds, standing on the doorsill of childhood, about to be pushed out into the unknown turbulence of puberty, so are we naturally nervous at the approach of menopause, about letting go of aspects of femininity that have defined us. We become more acutely aware of health, appearance, economic security, and the harbingers of mortality.

Another reason for the fear inspired by the prospect of menopause is the assumption that it takes place at a single point in time. Women are very frightened that at age forty-nine, all these things they've read about — heart disease, osteoporosis, vaginal atrophy — will happen at once. No distinction is made between women's lives at fifty and at seventy. We would never do this with men.

It is important, then, to distinguish among the various phases of the long menopausal passage. Archie Bunker probably spoke for many impatient husbands when he pressed his long-suffering wife in a 1972 episode of All in the Family.

ARCHIE: Edith, if you're gonna have a change of life, you gotta do it right now. I'm gonna give you just thirty seconds. Now come on, CHANGE!

EDITH: Can I finish my soup first?

Linda Lavin, in her role as Edie Kurland on ABC's series, Room for Two, opened the window to this subject on prime time TV in 1993 when she did an episode entitled "A Pause for Menopause." From Roseanne to Murphy Brown, sitcoms are beginning to reverberate with menopause humor. Women are writing novels and producing films that encompass the rite of passage that transforms them from childbearers to wisewomen.

In the hugely popular film First Wives Club, three college friends are reunited at the age of forty-six at the funeral of a friend. They discover they have all been left by their husbands for younger women and set out to get revenge by ruining their exes financially. One of the three is Goldie Hawn who plays an actress. The husband of Hawn's character has stolen her business. When she charges into her ex's office to confiscate his possessions, he wheedles and gets nowhere. Finally, he throws his hands up in the air and strikes back where he knows she will be vulnerable: "It's hormonal!"

But he still gets nowhere. The moral of the story is that revenge is not so sweet but justice is. And the three wives can best do justice by helping other women.

At what age can a woman be said to be "hormonal"? It's not a simple answer.

Menopause is arbitrarily defined as "the final cessation of menstruation," as if it were a single point in time when the switch is turned off on those fabulous egg-ripening machines, the ovaries. In fact, it's a much more gradual, stop-start series of pauses in ovarian function that are part of that mysterious process called aging.

More changes probably take place during this passage than at any other time in a woman's adult life. It is fortunate, then, that this passage takes some years to complete. As one moves through the physical, psychological, social and spiritual aspects of the transition, dramatic shifts in perspective occur. There may be a transformation in the sense of time, of self in relation to others, and a rethinking of the negative vs. positive aspects of moving into a new and unfamiliar state of being.

The acute period of biological passage, or ovarian transition, spans five to seven years — usually forty-seven or forty-eight to the mid-fifties. But it is the beginning of a long and little-mapped stage of postreproductive life.

I propose three demarcations of this Second Adulthood for contemporary Western women: perimenopause (start of the transition); the menopause gateway (completion of the ovarian transition); and a stage I will call postmenopause and coalescence — the mirror image of adolescence — in which women can tap into the new vitality Margaret Mead called "postmenopausal zest."

I know what you're thinking. Thank God this is a book that I don't have to read. Because you're not fifty yet, or even close. That's the first misconception.

Copyright © 1991, 1992, 1993, 1995, 1998 by G. Merritt Corporation

Meet the Author

Gail Sheehy, the author of eleven hooks including her most recent work, New Passages: Mapping Your Life Across Time, is best known for her landmark work, Passages, named in a 1991 Library of Congress survey among the top ten books that have most influenced people's lives.

One of the original contributors to New York magazine, Ms. Sheehy is also a political journalist and contributing editor to Vanity Fair. She is the mother of two daughters and divides her time between New York City and Berkeley, California, where she lives with her husband, Clay Felker, who teaches at the University of California, Berkeley, school of journalism.

Brief Biography

New York City and Berkeley, California
Date of Birth:
November 27, 1937
B.A., University of Vermont; M.A., Columbia School of Journalism

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