What is Menopause?

A Gatk ermg of Women

At the turn of the last century not so very long ago women’s lives generally ended at just about the same time as their reproductive lives. Those who lived beyond that period were considered to be old.‚ They even considered themselves to be old and were accepting of the miseries of old age.

Not so anymore. Today, statistics show that a woman who is healthy in her fifties will probably live into her mid-eighties. Every woman wants to have a good and active life during those bonus years. So women, in increasing numbers, are gathering together wherever good information is available about the midlife changes caused by menopause, that universal rite of passage.

And women are asking questions, hundreds of questions. They want to know how to stay in control during the transition from their reproductive years to their non-reproductive years, which is simply what menopause represents. This blog contains the one hundred fifty most-asked questions at the educational programs at which I spoke and the good answers that were provided by the experts. Those questions and answers start in Chapter 2 and continue throughout the remainder of this blog. Before we get into them, however, let’s look at the programs themselves and at some new information on the subject of menopause.

These women’s health programs deal with how to stay in control at midlife, the facts about menopause, and the facts about estrogen replacement therapy (ERT). The programs have been held in many cities throughout the United States. They’ve taken me from coast to coast Arizona, California, Colorado, Louisiana, Pennsylvania, Minnesota and I’m still on the road.‚ Women are attending these meetings in ever-increasing numbers. In Minneapolis in the summer of 1991, more than a thousand persons attended; half that number were expected. The ballroom of the hotel was filled to capacity and I was told that more than two hundred cars were turned away because the parking capacity had been exhausted, as well. I was delighted to learn that the North Women’s Center, which had sponsored the program, gave a repeat performance some weeks later for those who could not be accommodated.

There have been other significant changes in the attendance at these lectures. Previously, only women were present. Lately, men, as a logical extension of their presence in childbirth classes, in the delivery room, and as

sharetakers‚ in the care of the children and of the home, make up anywhere from 10 percent to 20 percent of our audience, and their presence continues to grow. That’s appropriate, because menopausal changes are family matters.

Women appear to be seeking information about menopause at an earlier age. The average age of the women in our audiences is now forty-seven years old and it seems to be dropping: Women in their thirties are beginning to show up. That’s appropriate, too, because that’s the age when you can start to make vital changes in your life-style concerning your diet, your exercise program, eliminating abusive substances such as cigarettes, and begin gaining skills for reducing negative stresses in your life wherever possible.

In all, more than ten thousand women and men have gathered at these programs to hear about menopause and to ask questions. They are asked to write their questions on index cards. These are collected prior to the lengthy question-and-answer period that concludes each program. Guests are also given an evaluation form to let us know their vital statistics (such as age and reproductive stage) and to tell us whether the programs have been helpful to them.

Many very interesting facts emerge from these index cards. Surprisingly, there are almost an equal number of questions concerning the basics of menopause as there are questions about more esoteric or special concerns. So questions such as What is menopause?‚ and When does it occur?‚ appear as often as Does estrogen replacement therapy cause cancer?‚ and I’ve had breast cancer; can I safely take estrogen to help me get through these hot flashes?‚

In this blog, I have selected the one hundred fifty most frequently asked questions and organized them so that you can find information easily, whatever your degree of familiarity with the subject. But, I caution you: This blog offers information in an easy question-and-answer format, but it does not replace the good information that you should obtain from your own physician. It is meant to make you an educated consumer of health care related to menopausal symptoms, but only your own doctor has the final word on these subjects, because only he or she is familiar with your particular medical history.

For example, I remember standing in an enormous assembly hall in one large midwestern city listening carefully to the comments of the women who had drifted down to the podium to ask questions after the program concluded. One question stands out in my mind. It was asked by a beautiful young blond woman, who said, I went through a natural menopause last year when I was thirty-seven. Does this mean that I’m fifty?‚ Try to answer that one! I asked her if she was on HRT. When she said, Yes, I take estrogen and progestin,‚ I told her No you are just thirty-seven and on hormone replacement therapy.‚ Her equally attractive sister was standing next to her and said, I’m thirty-five now. Will the same thing happen to me?‚ Naturally, I asked whether they knew their mother’s history with menopause, because that could be an indicator of what their own experience might be. They told me that their mother had had a surgical menopause in her very early thirties and that, therefore, they did not know how her natural menopausal process might have occurred. Obviously, in this instance I couldn’t offer any help, but I did suggest that these young women take these important questions to their gynecologist, which they had not done. Even though she was on hormone replacement therapy, the thirty-seven-year-old had not asked her doctor the question she had asked me. I hope both of these young women got their questions answered to their satisfaction.

Several months later, in Minneapolis, a woman came up to me after the program to ask whether I really knew how hard it is to get a doctor to take these midlife complaints seriously. I assured her that I did and that it worried me. That’s why I continue to stress the forging of a patient/physician partnership a liaison from which both partners will benefit. A knowledgeable patient is a joy to most physicians, because the doctor can render good care in a relatively short, easy visit and can feel fairly assured that the informed patient will comply with the decisions and directives that result from the visit.

Finding the right doctor takes serious and strenuous pursuit on the part of each woman. You should be looking for a doctor who does not consider the care of women at midlife to be his or her way to slow down toward retirement, but rather as a challenging and rewarding area of medicine in which to practice. Each woman needs to permit herself the liberty of asking her doctor this question directly: Are you interested in the care of the menopausal woman?‚ And be prepared to discuss the situation. Perhaps your doctor is thrilled to deliver babies and is fascinated by work in the field of infertility, but is only lukewarm about the changes that can occur with menopause and the challenges of prescribing the right kind of HRT or ERT. In such an instance, you may need to ask your doctor to recommend another physician whose interest is more in line with your needs. No harm done and probably a happier situation for physician and patient alike.

That bit of advice reminds me of the gentleman who came up to me after a program in New Orleans and sort of hung around until the crowd thinned. He finally seemed to summon the courage to ask what I thought he could do to make his wife admit that something strange was going on with her.‚ He told me that her mood swings caused arguments that were alienating their children and that her headaches often kept her home from work and away from social activities. He had witnessed her hot flashes and felt the effect of her night sweats, but she continued to look for some remote medical or psychological problem rather than take her symptoms to the doctor. He didn’t discuss their sex life with me, but I would be willing to bet that it had diminished or disappeared.

It took real love and concern for this man to show up at our program in a sincere effort to get the facts so that he could help his wife, his children, himself, and his marriage. Why, why do we women deny? I think some of us don’t want to know the facts. Others simply choose to ignore them, as I did. It seems that for some of us, any problem is better than the natural process of aging.

When I was invited to participate in a blog fair in Ohio, two interesting things occurred that demonstrated the family involvement in menopause. Along with the eighty other participating authors, I was seated in a booth, which was set up to offer my blog for sale. Several times that day young women came to buy the blog for their mothers, and their comments were fascinating and revealing. A couple of young ladies had been asked directly by their mothers to pick up the blog for them. But many of the other young women had read about the menopause blog in the fair’s publicity releases and were buying it on speculation. They were hoping to get their mothers to read it. I did a lot of informal counseling that day. I also found the behavior of one attractive middle-aged couple to be very interesting. They circled my booth several times, in deep discussion, occasionally glancing up at me. Finally, as the fair began to wind down and the crowd began to dwindle, they stopped to talk to me. The woman explained hesitantly that her husband was really the one who wanted her to buy our blog. I smiled and hurried with my inscription as I sensed that she wanted to get away from the menopause booth quickly. Then, as I handed her the blog and wished her good luck, she turned back to me and said passionately, I need it.‚ Her final request of me was for a bag to cover the beautiful purple volume that had the word Menopause emblazoned on its front and spine. That encounter made me wonder how long menopause would have to be treated as an undercover subject by some people.

As I tried to gain perspective on why this particular rite of passage was so threatening to women, I remembered that we women have fought long and hard for equality and that aging, as well as some of the more damaging symptoms of menopause forgetfulness, nervousness, hot flashes may feel as unbecoming to us in the workplace as they do in our family and social situations. Why is it that to this day, an aging man, graying at the temples, is labeled dignified,‚ while a woman with salt-and-pepper hair is considered old‚?

Americans have never rewarded aging, although the elderly are venerated in other cultures, such as in parts of India, where aging and wisdom are often synonymous. Now, however, demographics show that America is graying. That large group of postwar babies who were born between 1946 and 1964, nicknamed baby boomers‚ by marketers, are quickly moving into the menopausal age range. Current advertising is being increasingly directed toward the baby boomers at midlife. An article in the business section of The New York Times (August 27, 1991) revealed that marketers have shifted their focus from yuppies‚ to grumpies‚ that’s what demographers are calling the grown-up mature professionals. So, for the first time, the 78 million Americans, born between 1946 and 1964, are being courted because of their encroaching middle age.‚ Just as the boomers have changed many aspects of our cultural, social, and business fabric by their sheer numbers, so, too, will they alter significantly the respect awarded the experience of age. It’s about time!

Women often ask me if men go through menopause. The answer is no. Men do lose hormones just as women do, but they lose them slowly and much later in life. There is nothing in the male physiology that compares with the abrupt loss of estrogen at menopause, nor with the many body processes affected by that loss.

A 1991 Gallup study consisting of 1,410 interviews with both men and women revealed some new and interesting information about attitudes toward menopause. The large majority of the 705 women interviewed (all married and between the ages of forty and sixty) believed that they had a thorough knowledge of menopause and knew what to expect. Most of the Gallup respondents did not express anxiety about the onset of menopause. In fact, almost half of the women interviewed were looking forward to it! Just think: no more pregnancy worries! Many of the premenopausal women (40 percent) agreed. It is also interesting to note that most of these women did not express concern about the effects of menopause on their sexual relationships with their mates.

Men’s expectations, however, were quite another matter. The husbands polled and they were not the husbands of the women polled (only one person in any household was polled) were less likely to say that they had a thorough understanding of menopause and were more likely than women to express concerns about the effects of menopause on their sexual relationships with their wives.

Most women in the Gallup telephone survey (96 percent) agreed that menopause is a normal state in a woman’s life cycle. However, approximately 75 percent didn’t accept the idea that menopause would change their lifestyles or that they must suffer without taking action. The husbands questioned were somewhat less positive. Forty percent believed that menopause would change lifestyles, no matter what women did about it. They were also less sure that their wives could avoid the physical symptoms of menopause.

The questions concerning sex showed interesting and positive results. Only 10 percent of the women surveyed thought that after menopause a woman’s ability to enjoy sex is greatly reduced.‚ Once again, the men weren’t so sure though they appeared to question that assumption. This indicates to me that we women must educate the men in our lives, as well as ourselves.

From the studies and questionnaires I reviewed and the women I talked with, I found that the college-ed-ucated respondents believed that they had the facts and felt fairly comfortable about issues of control believing that they could help themselves by monitoring their diets, exercising more, and taking better care of them- selves in general. Yet when asked specific questions about estrogen replacement therapy and its role in protecting and prolonging life, these women did not have a clear picture of what ERT can and cannot do or who can and cannot take it. So although the women polled seemed long on their optimism and determination to make menopause a nondisruptive force in their lives, they fell short on having the state-of-the-art facts and knowledge about what to do to help themselves. It is that kind of information that led me to write this blog.

Finally, it seemed clear from the women surveyed that those who had a comfortable relationship with their physicians who felt that their doctors’ were individuals with whom they could communicate had a better understanding of menopause in general as well as of the long-term benefits of ERT.

These Gallup survey results are important because they show an increased awareness of menopause on the part of both the men and women studied and a higher incidence of knowledge than a Harris telephone study done in 1987, in which five hundred women surveyed in ten major cities across the United States clearly showed confusion about menopause and its treatment. This indicates that new and increased information about menopause, coupled with a more general acceptance of talking about it, is helping women and men alike.

The Gallup survey appears to contradict the information provided by the women and men who attend the educational programs, but let’s look at the differences carefully. The women and men who attend the programs are self-selected: They learn about the free program and choose to attend; some choose to ask questions and fill out the evaluation forms. In contrast, the women and men surveyed in the Gallup study, through the use of standard random-digit dialing technique, are selected at random. Yet, they do not always trust that their identities are not known (they are unknown) and they may be less comfortable giving information over the telephone to faceless strangers, particularly about their attitudes toward sexual matters. I believe this disparity is understandable, but the comments from both sources are interesting nevertheless.

You can start to see the mainstreaming of menopause all around you. For example, on television Barbara Walters (a woman of a certain age herself) devoted a 20120 segment to menopause. Reporters, newscasters, and talk-show hosts have become more comfortable in reporting menopause news, covering the results of each new study concerning estrogen replacement therapy, particularly those concerned with its effects on heart disease (see Chapter 9 for more on this subject). And some of our most frequently watched television situation comedies have dealt with menopause. It wasn’t easy for me to hear the end-of-productive-life concerns of her family when Clair Huxtable, on The Cosby Show, made her midlife transition, and even sadder when Mariette Hartley, on the short-lived sitcom, WIOU, mistook the symptoms caused by menopause for the symptoms of late pregnancy. That episode ended with her in end-of-produc-tive-life‚ tears. So we’re talking and we’re clearing the air and we’re loading the airwaves with menopause talk.

Menopause has even crept into some of the bestselling blogs of the past couple of years, although mostly in a negative manner. For example, at the denouement of P. D. James’s Devices and Desires, when the killer is admitting her crime, she explains to her closest friend how the police will view her: They’ll just see me as a postmenopausal neurotic woman gone temporarily off her head,‚ she says.

In Scott Turow’s recent blog, Burden of Proof, the protagonist, lawyer Allesandro Stern, has sex for the first time after his wife’s suicide and he and his partner are talking in the afterglow. What are they discussing? Right! Menopause.

In Peter Furth’s blog entitled An American Cassandra, about famed journalist Dorothy Thompson, he writes of the well-known quote of Alice Roosevelt Longworth, who said, to explain Thompson’s tartness, She is the first woman in history who has had her menopause in public and made it pay.‚ Also from the very public political arena comes a story in Keeper of the Gate by Selwa Lucky‚ Roosevelt, former President Ronald Reagan’s chief of protocol. In it she talks of her dinner in Bangkok with the king and queen of Thailand in which the queen, explaining her absence from the world political/ social scene, says to Lucky, I have fought the Communists all my life, but I cannot fight the menopause.‚

Even though these references are not menopause-positive, they do indicate that menopause is being recognized and discussed openly at last!

These are just a few of the many places and ways that menopause is becoming a socially acceptable and useful word. The importance of that acceptance is vital to all of us. It empowers us with the strength and knowledge to become our own ombudswomen to find the doctor most helpful to us and it gives us the savvy to engage in life-styles that may reward us with not just more years, but more good years.

To live effectively is to live with adequate information,‚ wrote Norbert Wiener in 1954 in his blog The Human Use of Human Beings. With the recent explosion of information about menopause and its effective management, those words are especially true for women today.

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