Unveiling Its Secrets

AS WOMEN age, menopause is an occurrence in their lives. Yet, it has been greatly misunderstood. According to the book The Silent Passage​—Menopause, 19th-​century obstetricians believed that menopause “unhinges the female nervous system and deprives women of their personal charm.”

Such misconceptions persist. As a result, many women are fearful and apprehensive about the prospect of menopause. Overcoming the psychological problems associated with it was referred to as “one of the most difficult tasks of a woman’s life,” in the book Natural Menopause​—The Complete Guide to a Woman’s Most Misunderstood Passage.

In societies in which emphasis is placed on youthfulness and youthful appearance, the onset of menopausal symptoms may herald a misconception: an abrupt end of youth and the beginning of old age. Thus, some women have come to fear menopause because it seems to represent the threshold of a new, less desirable period in life. It has even been viewed by some as “partial death.”

Modern women need not suffer in ignorance as they pass through this period of life. The secrets of menopause are being unveiled. More research is being done, and therapies to ease the transition are being developed. Magazines, newspapers, and books are focusing on the topic, providing explanations for questions that some were once embarrassed to ask. The medical profession, too, is more informed on the problems women may encounter.

Why all the attention to this subject? Because a better understanding of menopause can remove the fears, the superstitions, and the frustrations that many women have. Women in many countries are living longer, and they want to break what has seemed to be a conspiracy of silence on the subject and to be informed. They want simple, straightforward answers. Rightfully so, since many of them have over one third of their life to live after menopause.

Demographic patterns in the United States predict a 50-​percent increase over the next decade in the number of women of menopausal age. Such women desire to know about the health risks, the hot flashes (also called hot flushes), the mood swings, the discomforts, and the physical and emotional changes. Why do these things happen? Does a woman’s productive life finish at menopause? Does menopause alter a woman’s personality? The following articles will examine these questions.

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.

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Menopause often coincides with other stressful circumstances, including caring for aged parents

Coping With Menopause

MENOPAUSE is “a uniquely individual experience” and “the beginning of a new and liberating chapter in your life,” say the authors of Natural Menopause​—The Complete Guide to a Woman’s Most Misunderstood Passage. Research shows that the better you feel about yourself and your life​—your own sense of worth and identity—​the easier the transition will be.

Granted, it is more difficult during this time of life for some women than for others. If you are having difficulties, this does not mean that you have self-​esteem problems or that you are losing your mind, your femininity, your intelligence, or your interest in sex. The problem, rather, is generally biological.

“Even women who suffered terrible symptoms during menopause say they emerged on the other side with a new sense of purpose and vigor,” reports Newsweek. In the words of one 42-​year-​old: “I’m looking forward to the calm, to having my body quit playing tricks on me.”

When Women Cope Better

How older women are viewed is an important factor in how well they cope with menopause. In places where their maturity, wisdom, and experience are valued, the menopausal time is attended by far fewer physical and emotional ailments.

For example, The Woman’s Encyclopedia of Health and Natural Healing reports that in African tribes “where menopause is embraced as a welcomed passage in life, and postmenopausal women are respected for their experience and wisdom, women rarely complain of menopausal symptoms.” Similarly, The Silent Passage​—Menopause says: “Indian women of the Rajput caste do not complain of depression or psychological symptoms” during menopause.

In Japan too where elderly women are highly respected, hormone treatment for menopause is virtually unknown. Further, Asian women apparently have fewer and less severe symptoms of menopause than those of Western culture. Their diet appears to be a factor that contributes to this.

Maya women actually looked forward to menopause, according to the studies of one anthropologist. To those women the menopause meant relief from continuous childbearing. Undoubtedly, it also brought them freedom to pursue other interests in life.

At the same time, the fears associated with menopause should not be lightly dismissed. In cultures that stress the value of youth and youthful appearance, women who have not yet experienced menopause often fear it. For such individuals what can be done to alleviate the difficulties of transition?

What Women Need

Janine O’Leary Cobb, author and pioneer in menopausal education, explains: “What a lot of women need is some sort of validation for the way they are feeling​—that they are not alone.”

Understanding, as well as a cheerful outlook, is vital. One 51-​year-​old mother going through menopause said: “I honestly believe that it’s your general outlook on life that will guide how you go through menopause. . . . I know aging is there. Whether or not we like it, it is going to happen. . . . I decided that this [menopause] is not a disease. This is my life.”

So as this new chapter in your life approaches, make time for deep reflection on new, challenging interests. Not to be overlooked are the physical effects of menopause on the body. Doctors and other authorities recommend following general principles of good health in preparing for the transition​—wholesome food, sufficient rest, and moderate exercise.

Diet and Exercise

The need for nutrients (proteins, carbohydrates, fats, vitamins, minerals) does not decrease as a woman gets older, but her need for calories decreases. It is important, therefore, to eat foods that have a high concentration of nutrients and to avoid sugary, fatty foods that are “empty calories.”

Regular exercise enhances the ability to cope with stress and depression. It increases energy and helps keep weight off. The basal metabolic rate gradually declines with age, and unless boosted by exercise, the tendency is to gain weight gradually.

It is most important for women to know that exercise combined with calcium supplementation can slow the development of osteoporosis, a bone condition producing porosity and fragility. The book Women Coming of Age states that “properly performed studio aerobics, walking, running, cycling and other aerobic sports, as well as weight-​training,” are thought to be especially good. Interestingly, osteoporosis is not found in certain remote communities where people remain physically active far into their old age. In such places women routinely live well into their 80’s and 90’s. Before commencing any exercise program, however, it would be wise to consult your doctor.

Coping With Hot Flashes

For most women, hot flashes are a nuisance. For some, though, these become a real problem because either they are very frequent or they constantly disrupt sleep. What can be done?

First of all, don’t panic. Adding anxiety to the situation will only worsen it. Regular vigorous exercise is beneficial because it helps the body learn to cope with excess heat and to cool down more quickly. Also try the simple measure of drinking a glass of cold water or placing your hands in cold water.

In addition, make a practice of wearing loose clothes in layers so they can easily be removed or added. Cotton and linen allow perspiration to evaporate better than synthetic fabrics. At night try the layered approach, with several blankets that can be individually added or removed as needed. Keep a change of sleepwear close at hand.

Try to determine what seems to precipitate your hot flashes. Consumption of alcohol, caffeine, sugars, and hot or spicy foods can trigger them, as can smoking. Keeping a diary of when and where hot flashes occur may help you identify the foods and activities that precipitate them. Then avoid these things.

Physicians that specialize in nutritional medicine recommend various remedies to reduce hot flashes, such as vitamin E, evening primrose oil, and the herbs ginseng, dong quai, and black cohosh. According to some doctors, the prescription medications Bellergal and clonidine provide relief, but estrogen pills or patches are said to be the most effective.a

Vaginal dryness can be remedied by the application of vegetable or fruit oils, vitamin-E oil, and lubricant gels. If these prove insufficient, estrogen cream will help the vaginal walls thicken and lubricate. Before starting any regimen, it is wise first to consult with a physician.

What About Stress?

At the same time that a woman must deal with the hormonal and physical changes that come with menopause, she often must face other stressful events, a number of which were mentioned in the preceding article. On the other hand, positive things like the birth of a grandchild or the pursuing of new activities after the children have left home can counterbalance negative stress.

In their book Natural Menopause, Susan Perry and Dr. Katherine A. O’Hanlan give some practical suggestions for handling stress better. They point to the need of identifying the sources of stress and then taking a break from time to time. This may mean getting help in caring for a chronically ill family member. “Pace yourself,” they urge. “Try to avoid overscheduling . . . Listen to your body.” They add: “Providing a service to others . . . can be a great stress-​reducer. . . . Exercise regularly. . . . Seek professional help if the stress in your life gets out of control.”

Family Members Can Help

A woman experiencing menopause needs emotional understanding and practical support. Describing what she would do when beset with periods of anxiety, one wife said: “I would talk matters over with my husband, and after his sympathetic understanding, I would see that the problems weren’t as big as my anxious state of mind made them.”

A sensitive husband also recognizes that his wife will not always be able to keep the same pace while going through menopause. So he will be alert to take the initiative to assist with family responsibilities, perhaps doing the laundry, shopping for food, and so forth. Compassionately, he will put his wife’s needs ahead of his own. (Philippians 2:4) He might suggest going out for a meal occasionally or in some other way make a pleasant break in the daily routine. He will avoid disagreements to the extent possible and support her efforts to maintain healthy eating habits.

Most of all, a husband will fulfill his wife’s need to be regularly reassured of his continued love for her. He should be discerning and should recognize that this is not a time to tease his wife about personal things. A husband who treats his wife in a loving way is following the Scriptural admonition to ‘dwell with her according to knowledge, assigning her honor as the feminine one.’​—1 Peter 3:7.

Similarly, children should make a genuine effort to understand the reason for their mother’s emotional swings. They need to recognize her need for private time. Exhibiting sensitivity to their mother’s moods will send a reassuring message that they really care about her. On the other hand, joking about her unpredictable nature will only aggravate the situation. Ask appropriate questions to understand better what is going on, and help with household duties without being asked. These are but a few ways to give a mother support during this stage in her life.

Life After Menopause

When this chapter in a woman’s life concludes, many years often lie ahead. The wisdom and experience she has gained is priceless. Author Gail Sheehy’s studies of “sixty thousand adult Americans established that women in their fifties, by self-​report, had a greater sense of well-​being than at any previous stage in their lives.”

Yes, many women who have gone through these transition years find renewed spirit. Their creativity is revitalized. They get on with living, involving themselves in productive activity. “I keep my mind active. I keep looking into new things and studying,” said one woman who is past menopause. She added: “I may be a little slower, but I don’t feel that this is the end of my life. I’m looking forward to many more years.”

Significantly, in interviewing women, Sheehy found that those “who enjoy a boost in postmenopausal status and self-​esteem are those who perform roles in which intellect, judgment, creativity, or spiritual strength is primarily valued.” There is a throng of such women who are happily devoted to expanding their knowledge and understanding of the Bible and are teaching others its worthwhile values.​—Psalm 68:11.

Besides keeping a positive outlook on life and performing meaningful work, women of all ages are wise to remind themselves that our loving Creator knows our feelings and truly cares for us. (1 Peter 5:7) Indeed, Jehovah God has made provision for all who serve him to enjoy life eventually in a righteous new world where there will be no more sickness, suffering, or even death.​—2 Peter 3:13; Revelation 21:3, 4.

Therefore, you who are going through menopause, remember that it is a stage of life. It will pass, leaving years of life that will be richly rewarding if used profitably in serving our loving Creator.

[Footnotes]

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What About Estrogen Replacement Therapy?

Estrogen may offer protection against heart disease and osteoporosis, two main causes of illness in postmenopausal women. As the estrogen levels decline, these illnesses start to develop and become manifest in five or ten years. Estrogen replacement therapy or hormone (estrogen and progesterone) replacement therapy has been recommended to prevent these diseases.

Estrogen replacement can reduce the rate of bone loss and stave off the onset of heart disease. Adding progesterone to the hormone replacement regimen reduces the incidence of breast and uterine cancer but counteracts the beneficial effect of estrogen on heart disease.

The decision whether or not to use hormone replacement therapy must be based on an evaluation of each woman’s circumstances, health, and family history.b

[Footnotes]

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What Diet Is Best?

The following suggestions are excerpted from the book Natural Menopause​—The Complete Guide to a Woman’s Most Misunderstood Passage, by Susan Perry and Dr. Katherine A. O’Hanlan.

Protein

• Reduce your protein intake to no more than 15 percent of your total caloric intake.

• Get more of your protein from vegetable sources and less from animal sources.

Carbohydrates

• Eat more complex carbohydrates, such as whole grains, breads and pastas, beans, nuts, rice, vegetables, and fruits.

• Eat less sugar and fewer foods containing large amounts of sugar.

• Eat more food rich in fiber.

Fats

• Reduce your total fat intake to no more than 25 to 30 percent of your total calorie consumption.

• As you decrease your total fat intake, increase the ratio of ‘good fats’ (polyunsaturated) to ‘bad fats’ (saturated).

Water

• Drink six to eight eight-​ounce glasses of water each day.

Vitamins and Minerals

• Eat a variety of vegetables and fruits each day.

• Milk, dairy products, broccoli, and green leafy vegetables are good sources of calcium.

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What family members can do to help: Show affection, help with housework, be an attentive listener, occasionally do something different