The Pause that Distresses


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“Women have been scared out of their gourds for no damn good reason. The real tragedy is that thousands of menopausal women are going undertreated because they’re worried about that slight increased risk [of cancer].”

For women who live long enough, menopause—the retirement of our reproductive cycle, signalled by the end of monthly menstruation (occuring naturally or as the result of medical intervention)—is as inevitable as death or taxes. The average age for natural menopause has stayed fairly stable over the last few centuries at 51 years, but as we know, the number of us “living long enough” has risen markedly in the same time period. Nowadays, most women can expect to live at least one-third of their lives post-menopause. How happy and healthy those years are depends greatly on how robustly we greet “the change.”

On the one hand, menopause is a liberating time in a woman’s life: No more running to the pharmacy to stock up on tampons and menstrual pads, no more cramps or PMS or “accidents,” no more worries about getting pregnant. But it brings a whole new set of challenges, largely because our ovaries stop producing the hormones estradiol (a form of estrogen) and progesterone, sending their levels into free fall and playing havoc with bodily functions from the skin to the brain. Resulting problems can include hot flashes, insomnia, memory lapses, mood swings and depression, bone loss, heart palpitations (and elevated risk of heart disease), lowered sex drive, achy joints, dry eyes, incontinence/constipation and, according to a recent survey conducted by the online menopause compendium, even gout.

Up until about 40 years ago, menopause was seldom discussed and even less understood, says Mary Jane Minkin, M.D., author, practitioner and clinical professor of Obstetrics, Gynecology and Reproductive Services at the Yale University School of Medicine. “There’s a theory about 19th-century British literature I’d like to explore in my retirement,” she says, tongue just a bit in cheek, “concerning all those stories about kooky ladies in attics. My guess is that Rochester’s wife in Jane Eyre was menopausal when she burned the house down.”

She credits Phil Donahue’s afternoon talk show—which devoted full hours to the subject back in the 1970s—with being among the first public forums to showcase serious discussion about menopause, even though at the time everyone believed “the change” to be an overnight phenomenon. “You know, you go to bed one night pre-menopausal and wake up the next morning post-menopausal,” says Minkin. “It’s only in the last 30 years that the concept of perimenopause has emerged.” Typically, a woman will go through menopause sometime between the ages of 40 to 55 (though menopause before 45 is considered premature, one percent of all women experience it at 40) but many women struggle with the symptoms of menopause for up to 10 years prior to the total stoppage of their menstrual cycles. Problems like hot flashes and mood swings can be especially intense during perimenopause. “So, for these women the transition is tougher than getting to the other side,” Minkin says.

The Pause that Distresses

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