What Midlife Means to You

What Midlife Means to You? Menopause is an event common to all women. For some women, it is not difficult, but for many it arrives with complications, both physio­logical and psychological.

Today, a healthy fifty-year-old woman can reasonably expect to live for another thirty to forty years. Doctors are now becoming more aware of the need to help women turn these postmenopausal years into quality years.

In an ideal scenario, long before menopause, each woman would have found her ideal physician. Over the years, she would have been able to sit for hours with her doctor and acquaint him or her with all the details relevant to her medical history. She would visit the doctor with a complete list of pertinent questions and the doctor would have all the right answers and take the time to share them with her.

Yet, how many women actually have this experience? Very few. One reason is because the medical care for women at midlife has been so haphazard. Physicians are only now beginning to understand the female climacteric—that ten-year transitional period surrounding menopause. Perhaps many women feel that they are lucky if they can get through menopause, by themselves, without seeking the often complicating and shifting views of doctors.

So much happens in your life when you are approaching and experi­encing the years that surround that milestone—menopause—that oc­curs around the age of fifty. Your work life may be gearing up or down. Your children may marry and leave home. You may have to handle your parents’ illnesses or death. You may become a grand­mother for the first time. You will also experience menopause. It is apparent that an incredible amount of change will be going on in your life.

In an effort to learn how women view menopause, the International Health Foundation surveyed four hundred women in each of five countries: Belgium, France, Great Britain, Italy, and West Ger­many—a total of two thousand postmenopausal women. The results of the 1970 survey concluded that for many women, menopause is a period of disorientation, physical discomfort, and emotional upheaval. The postmenopausal period was described as a time when women could not feel as content as they had in their premenopausal state. Further, the survey revealed that menopause is more difficult for women who lack the social supports that more affluent women have available to them. Women who engaged in activities such as those described in my program seemed to bounce back better from “the menopause crisis,” as the study termed it.

I want to assure you that menopause is not a “crisis.” It is, however, a transitional process that occurs on social, emotional, and medical levels. To make menopause a comfortable transition, I believe that doctors must offer preventive medical programs to women over the age of forty-five that prevent estrogen deficiency and its subsequent medical and psychological problems, as well as offer a way to affirm productive attitudes and actions for midlife women.

Today, nearly twenty years after the International Health Founda­tion’s survey, women still are not sure what to do about menopause. A 1987 Harris Survey showed that American women are confused and misinformed about menopause and its treatment. The survey results were compiled following telephone interviews with five hun­dred women between the ages of forty-five and seventy, evenly di­vided among ten major U.S. cities: Boston, New York, Washington, Atlanta, Seattle, Los Angeles, Phoenix, Chicago, Memphis, and Hous­ton. These are all cities in which the best of American medicine is provided. The interviews covered the subject of menopause, its treat­ment, its symptoms, and other related women’s health issues. Sixty percent of the interviewees were postmenopausal, 22 percent were experiencing menopause, and 16 percent were premenopausal.

The dismal findings indicated that a very small percentage of the women knew the long-term consequences of estrogen deficiency.

Fewer than half of the study participants could name a single treatment for the common menopausal symptoms that affect more than 85 per­cent of all women at menopause such as night sweats, vaginal dryness, and hot flashes.

Although this menopause survey drew similar responses through­out the country, there were some interesting regional differences. For example, the highest level of confusion about effective treatment of menopausal symptoms was in the Southeast, where a significant num­ber of women mistakenly believed that antidepressants, aspirin, and tranquilizers were effective therapy. The Northeast registered the highest number of women who were unable to name any form of treatment. Just 40 percent of the women in the West knew about the role of the ovaries and estrogens in preventing osteoporosis—a seri­ous degenerative condition of the bone that afflicts women—which made them the most knowledgeable group about hormone replace­ment therapy in the country!

These survey results reflect a high level of confusion among women about menopause. How can a woman get the medical help she needs if she is not informed about what is happening to her, what to expect, and how to get help when help is needed?

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What Hormone Replacement Therapy Can Do for You

What Hormone Replacement Therapy Can Do for You. Most of the changes that happen to your body when your hormone production slows down can be prevented, and many others can be reversed.

Exciting scientific advances in the last fifty years have given rise to whole new groups of hormonal and nonhormonal medications for use during and after menopause. These are not remedies prescribed over the telephone or obtained over the counter, but ones that must be discussed with and carefully prescribed by your own physician and taken under your doctor’s supervision.

There is nothing new about the theory of “rejuvenation” therapy. Ancient Egyptians introduced organotherapy, or glandular therapy, and ate the penis of the ass for this purpose. Ancient Greeks and Romans changed the prescription to asses’ testicles. Early scientists of the 1800s added other ideas to that kind of treatment. More than one hundred years ago, in 1888, a seventy-two-year-old famous French physiologist, Brown-Sequard, reported that he had rejuvenated him­self by taking injections of “testicular juice.” He wrote that he achieved greater body vigor, improved bladder and intestinal func­tion, and that his wife used the testicular extract to combat feminine discomforts.

By the close of the nineteenth century, ovarian therapy started, with ovarian juice, powdered ovaries, and powdered ovarian tablets pre­scribed for surgical menopause, dysmenorrhea, and obesity. In 1926, A. S. Parkes and C. W. Bellerby, two scientists in Great Britain, extracted female hormone from an ovary for the first time. They named it estrin. A few years later, a German chemist, A. Butenandt, isolated and synthesized a pure form of estrogen and progesterone. He won the Nobel Prize for his work. Now that these hormones were available, physicians prescribed them for a wide range of women’s symptoms.

The wholesale prescription of this treatment became so popular that by the 1960s many books and articles ascribed all sorts of value to it, but did not describe any of the risks. The use of these powerful hormones escalated. Physicians and women alike were shocked when, in December 1975, scientific papers were released showing a causal relationship between hormone therapy and cancer of the uterus.

Women became afraid to use these medications. Fear, coupled with confusion and combined with a lack of comprehensive information, reigned. The only redeeming feature of this frightening dilemma was that scientists, physicians, and paramedical specialists finally began to conduct intensive research on the phenomenon of menopause. As a result, today physicians are able to reassure women because they have a fuller understanding of how menopause works. They now know much more about how the hormones function, how they can safely be prescribed, and what other forms of observation and treatment are necessary for their female patients.

While hormone replacement therapy (HRT) for postmenopausal women continues to be somewhat controversial, it is growing in popu­larity. Earlier, we described how the ovary starts to lose certain hor­mones and what happens to women as a result. Remember, too, that this hormone deficiency is more severe in some women than in others. The purpose of HRT is to make up for that deficiency. Not all women can take HRT, and not all women need to. For women who can, and who choose to, HRT holds the promise of preventing or reversing many of the negative effects on the body caused by the lack of estrogen.

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