Gaining a Better Understanding
“I WOULDN’T say it’s such a pleasant period in a woman’s life,” admitted one woman who had passed through menopause, “but I think you can learn from it. I have learned how to respect my limits. If my body needs to have a little more care or rest, I listen and give it the respect it’s due.”
A survey of women that was reported in the magazine Canadian Family Physician revealed that “not knowing what to expect” was the worst thing about menopause. However, women who came to understand menopause to be a natural transition felt “less anxious, depressed, and irritable and more hopeful about their lives.”
What It Is
Webster’s Ninth New Collegiate Dictionary defines menopause this way: “The period of natural cessation of menstruation occurring usu[ally] between the ages of 45 and 50.” Menopause has also been identified arbitrarily as the final cessation of menstruation.
With some women, the end of menstruation happens suddenly; one menstrual period finishes and another never occurs. For others, the periods become erratic, occurring at intervals of three weeks to several months. When one full year passes without a woman’s experiencing a period, she can reliably conclude that menopause occurred at the time of her last menstruation.
When and Why It Occurs
Inherited disposition, illness, stress, medications, and surgery can influence the time of occurrence. In North America the average age when menopause occurs is about 51. The time of occurrence generally ranges from the early 40’s to the mid-50’s and rarely earlier or later. Statistics indicate that women who smoke tend to have an earlier menopause and that women who weigh more tend to have a later menopause.
At birth a woman’s ovaries contain all the eggs she will ever have, several hundred thousand in number. During each menstrual cycle, from 20 to 1,000 eggs mature. Then one, or occasionally more than one, is released from the ovary and is available for fertilization. The other mature eggs wither away. Also, in concert with the process of egg maturation, the levels of estrogen and progesterone hormones regularly increase and decrease.
As a woman passes her late 30’s, the levels of estrogen and progesterone start to decline, either gradually or erratically, and egg release may no longer occur with every cycle. Menstrual periods become less regular, usually occurring at longer intervals; menstrual flow changes in pattern, becoming lighter or heavier. Eventually no further eggs are released, and the menstrual periods stop.
The final menstruation is the culmination of a process of changes in hormone levels and ovarian function that may have taken up to ten years. However, smaller amounts of estrogen continue to be produced by the ovaries for 10 to 20 years after menopause. The adrenal glands and fat cells also produce estrogen.
Significant Changes in Life
Tissues sensitive to or dependent on estrogen are affected as the estrogen level declines. Hot flashes are thought to result from hormonal effects on the part of the brain responsible for regulating body temperature. The exact mechanism is unknown, but it seems that the body’s thermostat is adjusted downward so that temperatures previously felt to be comfortable suddenly become too warm, and the body proceeds to flush and perspire to cool itself.
In her book, The Silent Passage—Menopause, Gail Sheehy notes: “Half of all women who have hot flashes will begin feeling them while they are still menstruating normally, starting as early as age forty. Studies show that most women have hot flashes for two years. One quarter of women have them for five years. And 10 percent have them for the rest of their lives.”
At this time of a woman’s life, vaginal tissues become thinner and less moist as estrogen levels decline. Other symptoms women experience, says Gail Sheehy, can include “night sweats, insomnia, incontinence, sudden bouts of waistline bloat, heart palpitations, crying for no reason, temper outbursts, migraines, itchy, crawly skin, [and] memory lapses.”
Periods of Depression
Does the decrease in estrogen cause depression? This question has been the topic of much debate. The answer seems to be that it does in some women, such as those who had mood swings prior to their menstrual periods and those who suffer sleep deprivation as a result of night sweats. Women in this group seem to be very sensitive to the emotional effects of hormonal fluctuations. According to Gail Sheehy, these women usually “experience great relief when they reach the postmenopausal period” and hormone levels stabilize.
More severe symptoms are likely to be experienced by women who go through menopause abruptly as a result of radiation, chemotherapy, or the surgical removal of both ovaries. These procedures can cause a sudden drop in estrogen levels and thus an onset of menopausal symptoms. Estrogen replacement medication may be prescribed in these cases, depending on the woman’s health.
The severity and the type of symptoms experienced vary considerably from one woman to another, even among women related to one another. This is because hormone levels differ from one woman to another and decline at varying rates. In addition, women bring differing emotions, stresses, coping abilities, and expectations with them as they approach menopause.
The time of menopause often coincides with other stressful circumstances in a woman’s life, such as caring for aged parents, entering the work force, seeing children grow up and leave home, and other mid-life adjustments. These stresses may cause physical and emotional symptoms, including memory loss, attention deficits, anxiety, irritability, and depression, which may be erroneously attributed to menopause.
A Stage of Life
Menopause is not the end of a woman’s productive life—only of her reproductive life. After a woman’s last menstrual period, her moods are usually more stable, not fluctuating with monthly hormone cycles.
While we have focused on the cessation of menstruation because it is an obvious change, that is only a manifestation of the process of transition as a woman leaves the reproductive time of her life. Puberty, pregnancy, and childbirth are also times of transition attended by hormonal, physical, and emotional changes. Menopause, then, is the last, but not the only, time of hormonally induced changes in a woman’s life.
Thus, menopause is a stage of life. “Perhaps,” wrote a former editor in chief of the Journal of the American Medical Women’s Association, “people will stop viewing menopause as a crisis, or even as ‘the change,’ and see it more appropriately as ‘yet another change.’”
Reassuringly, the book Women Coming of Age says that the end of a woman’s fertility “is as natural and inevitable as was its preordained beginning. Arriving at menopause is actually a sign of physical health—a sign that [her] body’s inner clock is humming along.”
What, though, can be done to make the transition as smooth as possible? And how can a spouse and family members be of support during this transition in life? The next article will consider these matters.
[Picture on page 6]
Menopause often coincides with other stressful circumstances, including caring for aged parents