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Menopause: The Healthy Perspective

By Terry Bullen

Our bodies undergo many developmental changes throughout our lifetimes. Menopause is only one of them. Yet women have been receiving negative messages about this natural occurrence from society in general and from the medical profession in particular for too many years. We have, until most recently, been taught to expect the worst. Menopause was to be dreaded and feared. It was the harbinger of old age the curse in a youth-oriented, youthworshipping culture such as ours. We were told repeatedly how we would become irritable, nervous, sexually unattractive and inhibited, emotionally unstable, and just plain hard to live with. We were led to believe that menopause was a "disease" and had to be "treated" as such. We were taught to view our body's natural re-adjustment of our hormonal level as a "deficiency". The medical profession and the drug industry, with the help of media hype, offered us ERT (Estrogen Replacement Therapy) as a panacea. (See ERT Products, page 7.)

However, as we become more and more selfconfident and self-determining, as we learn to value ourselves and our bodies, we are taking a new, closer look at the phenomenon of menopause. Menopause is a normal biological cycle which has its beginnings at puberty with the onset of menstrual periods and ends somewhere between the ages of 45 and 50 with the cessation of the menses. Many authorities say menopause takes about 5 years to complete, but this varies from woman to woman. A woman today can expect to live at least thirty years after menopause. Life certainly is far from "being over" for her. Her reproductive years are over, true. But a woman cannot allow herself to be defined by her ovaries.

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Despite the fact that a few centuries ago few women lived long enough to experience menopause, there are historical records of various "glandular" therapies. The Greek word for "uterus" is "hysteria," and the "connection" between a woman's emotional state and her reproductive organs has lasted well into the twentieth century. The surgical removal of the ovaries, performed under the guise to "cure hysteria" in the early 1800's and still performed today, is an all too routine practice when performing hysterectomies. The reason most doctors give for this premature, and most cases unnecessary, removal of healthy ovaries is to prevent ovarian cancer. Yet studies indicate that ovarian cancer occurs in about one in every 2500 women 45 years or older.

Most of the literature on menopause, and there has not been a great deal, has led us to believe that once the ovaries stop functioning our bodies no longer produce estrogen, a primary female hormone. At menopause, the estrogen level diminishes, as it has been doing all along since we were about 25. As the hormonal level in our bodies changes, the endocrine glands which secrete various hormones readjust and eventually the estrogen supply levels off and reaches a plateau. There is evidence to substantiate that other glands (e.g., adrenal) and extraglandular sources produce estrogen as well.

The one undeniable sign of menopause is the final cessation of menses. Other "symptoms" of menopause are difficult to define and are often clouded by cultural, social and psychological prejudices. Most women experience minimal changes, requiring little or no medical attention, which do not interfere with their daily routines. Some women's periods cease abruptly and with no other apparent symptoms. Other women may experience gradual changes in their periods; for example, the flow diminishes or the length of time varies. Others may have irregular periods, ceasing for a few months, then recurring. Just as each woman's menstrual cycle varies, so does

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her menopause.

Hot flashes, the most talked about symptom, can begin at the time the menstrual flow begins to decrease and can continue until after the periods have stopped completely. Their frequency is unpredictable, but they usually last from 15 seconds to a minute or two. They may be accompanied by chills or cold sweats. Hot flashes are medically described as a vasomotor disturbance. The hormonal changes cause the nerves and blood vessels to react, causing the vessels to over-dilate. All women do not have hot flashes. One of the most important things to remember is that they are harmless. Although ERT can be effective in alleviating hot flashes, alternative remedies, such as Vitamin E and/or ginseng, should be investigated. It is also important for a woman on ERT to know she is taking a powerful drug in order to treat a condition that likely will recur when she stops her medication, at a time when she is older and her body may be less resilient and capable of adjusting to hormonal change.

In the normal progression of the aging process, a woman's cervix and uterus get smaller. The medical profession again has unduly frightened women with their sexist, prejudicial language such as "atrophic vaginitis". Thinning of the cells of the walls of the vagina is normal. The vagina shortens, becomes narrower and less elastic. Most women enjoying good 'sex and masturbation find this condition barely noticeable. The Merck Manual of Diagnosis and Therapy, the physicians' handbook, mentions the "preservation of a serviceable vagina". The overriding sexism here is more than one of language. We are told that in order to keep a "youthful vagina" we should go on ERT. Yet again there are less risky alternatives possible. Harmless natural lubricants, tender and considerate lovemaking, and most naturally of all, masturbation to induce secretion are the answer for many women.

Osteoporosis, or loss of bone mass, is a problem of aging per se and not necessary related to menopause. There is no real evidence that ERT can prevent brittle bones. Bone density depends upon how the bone is used and how often it is used. The incidence of osteoporosis is lower in individuals who maintain regular exercise programs. Calcium therapy coupled with other vitamin and mineral therapy have proven very effective in combating this particular problem.

Psychological and emotional problems such as depression, anxiety and insomnia usually attributed to menopausal women are more likely culturally and socially induced. Menopause comes to a woman at a time when she may be undergoing other changes in her life; personal relationships, economic conditions, employment or educational conditions all may be in upheaval. Our society does not offer much to a

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woman in her middle years. Her age is a detriment in finding employment and finding lovers. She has been told for so long that she is no longer valued that she believes it. Who wouldn't get depressed, irritable, and angry?

If a woman is in emotional turmoil during menopause, it is not because of menopause. It is a direct result of the longstanding sexist conditioning that all women endure from early childhood. It is a culturally engendered condition and not one likely to be cured with ERT or other drugs. We must work to change society's as well as our own attitudes toward women, aging, menstruation and menopause, to name a few areas, in order to eliminate the psychological and emotional problems of many women today.

In 1975, scientific reports published in the New England Journal of Medicine indicated that ERT increased 5 to 14 times the risk of developing endometrial cancer (cancer of the lining of the uterus). In 1976, further research showed a significant risk increase in breast cancer. Long-term use of ERT has been linked to other effects such as heart disease, post-menopausal bleeding, thrombosis (blood clotting), increased incidence of pancreatitis and gallstones, nausea and fluid retention. Incredibly, there are over 20 million women on some kind of ERT.

One of the most significant reasons for the continued use of ERT is the claim made by its proponents that it retards aging. Women have been promised the dream of eternal youth and cannot seem to let go. Again we may have been duped by patriarchal socicty. Estrogen is not the only factor involved in the aging process and to think so is both invalid and potentially life-threatening. ERT will not insure healthy skin tone and hair, good bones or preservation of the body. Sound nutrition, regulated vitamin and mineral therapy, vigorous exercise and

sufficient sleep will go much further in assuring a sound body and healthy appearance.

Menopause is not a disease and does not need to be cured. It is normal and comes to all women. It is an experience that all women should be able to have in the most positive and healthy manner. It can be a time of great excitement; a time when we finally shed the monthly nuisance of periods; a time for greater sexual freedom and experimentation. It can be a time for women to look toward themselves and realize new ambitions, reach new goals.

We have a right to information about the truths regarding menopause. We need to speak with other women who have experienced this phase of living. We need to provide good low-cost clinics with quality

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