Menopause Without Medicine: The Trusted Women's Resource with the Latest Information on HRT, Breast Cancer, Heart Disease, and Natural Estrogens

INTRODUCTION

Never say never. After writing the fourth edition of Menopause Without Medicine, I vowed it would be the last. I had gotten through menopause myself, had experienced each phase publicly, and I was ready to move on to new challenges. With heartfelt conviction I told my publisher that I could not return to this subject, that I had nothing to add, no more to contribute. Then, amidst major reconstruction on my home and pressing personal problems, something happened that changed my mind. Headlines hit the news that hormone replacement therapy (HRT) increased the risk of breast cancer and heart disease. Women and their doctors panicked, throwing out the pills that the day before had promised to curb their hot flashes, protect their hearts, and strengthen their bones. I could not understand the hoopla, especially among the medical community. The evidence of harm caused by certain kinds of HRT has been showing up for decades. For thirteen years I’ve cautioned women in previous editions of this book alone. But now, many researchers, scientists, and clinicians have denounced the hormone preparation that was abruptly withdrawn from the market, advising women to seek alternatives. (Not all hormones were condemned with this announcement; only the ones that most women take, a combination of synthetic estrogen plus progestins.)

Doctors are currently at a loss as to how best to advise women. I’ve been watching the morning TV shows, which feature the most learned medical authorities, and they say nothing that provides direction, nothing that gives hope. All in all, I find TV doctors and the major media extremely disappointing when it comes to offering real solutions. This morning, a doctor from the National Institutes of Health said that the bottom line is we need to know more. I don’t know about you, but I don’t find that statement too helpful. When interviewed, the medical minds continue to rehash the dilemma but don’t know where to go from there. What a shame they haven’t investigated remedies outside their discipline. What a pity they offer women no answers.

All this is why I cannot remain in the shadows. In a glimpse of a moment I knew I had to complete what I had started so many years ago—long before menopause was a newsworthy topic. I feel compelled to reassure women that they indeed do have options. There are a slew of natural remedies—vitamins, herbs, and foods —that work to control menopausal symptoms. I’ve tried them and found them effective. Additionally, however, if these nonhormonal remedies prove ineffective for you, there are safer hormonal alternatives to the potentially cancer-producing hormones that have been foisted upon us by the drug companies. Research concerning natural (bioidentical) hormones remains in its infancy because multi-million-dollar drug companies cannot profit as heavily from natural products and therefore won’t fund major studies on them. Still, independent research in the United States and Europe has shown that hormone preparations are not all equal, and that gentler versions not only minimize menopausal symptoms, but they also build bone and may actually protect against breast cancer. I advise you to read the research, investigate other sources, consult with a variety of health professionals, and decide for yourself—especially if you are not ready to give up your hormones.

A Little Personal History

Let me share with you a little personal history before I tackle these topics. Almost twenty years have passed since I first started poring over medical journals searching for information about menopause—a topic that, at the time, was largely ignored by the medical community. Only a handful of books could be found on the shelves, and even women’s magazines omitted stories of the experiences and dilemmas women face during this major life transition. How times have changed! Walk into any bookstore today and check out the women’s health section: The racks are crammed with books on all aspects of midlife, from physical to psychological, from experiential to spiritual. Menopause not only is out of the closet; it’s the hottest topic of the new millennium.

I remember collecting data for the first edition of this book and eagerly sharing my findings with friends and acquaintances. I was startled to realize how uncomfortable people became at the mere mention of the M word. Responses ranged from nervous laughter and bewilderment to downright embarrassment. I learned to lower my voice when asked how I spent my day. Only in these past few years has the topic of menopause filtered into everyday conversation. My book preceded Gail Sheehy’s The Silent Passage by a few years; it came out at a time when women were not yet comfortable complaining publicly about hot flashes and night sweats. It’s hard to believe, but women in my mother’s generation didn’t even tell their best friends when they were entering The Change. Fast forward two decades, and Menopause: The Musical plays off-Broadway and travels from coast to coast sharing the tale of menopausal misery while women become increasingly able to laugh at themselves and commiserate with others about their mutual experiences. Both women and men seem quite comfortable discussing hot flashes, mood swings, and hormone therapy. At the gym, in the office, in business meetings, in restaurants, and at parties, everyone has an opinion to offer or a story to tell.

Coinciding with the publication of the third edition of this book came my own real-life menopausal experience. The symptoms that were once technical terms took on an entirely different meaning: hot flashes, sleepless nights, irregular periods, heart flutters, weight gain, and the decision about hormones faced me head-on. I found myself turning to my own words, seeking remedies I’d discovered long ago. I also experimented with new foods, nutrients, and herbs that had come to my attention since the publication of the first two editions. No longer was Menopause Without Medicine just the product of my extensive research as a nutritionist; it ranked second to the Bible as my daily guide. And I can say with a new confidence that the recommendations in the book did work for me. Even though menopause is now behind me, I continue to follow the same dietary program of nutrients and soy that I recommend in these pages, and I still do the exercises presented in Appendix D.

As I entered the year 2000 and completed the fourth edition, I faced yet another stage in my life: postmenopause. Three years prior I’d celebrated my menopausal birthday (meaning I ended a full year without having a menstrual period) and parted with most of the bothersome symptoms, sighing with relief that I had made it through without relying on hormone replacement. Many of my friends who vowed with me to abstain from conventional hormone therapy had changed their minds once the symptoms took over the quality of their lives. I know they were riddled with guilt because they, too, wanted to ride it out without using drugs. Unfortunately, diet, herbs, and exercise aren’t enough for everyone, and outside intervention is sometimes necessary. I continually reassured them that for some women hormone replacement is the best choice, and I have not changed my opinion. Be kind to yourself whatever decision you make.

Since I made it through menopause without the use of hormones, I never guessed that I would reconsider them as a possible treatment for me. Symptoms were no longer the issue; the health of my bones was. Since I fit the profile of a woman at risk for osteoporosis—petite, light-complexioned, and small-boned—and having undergone a DEXA test that indicated loss of bone to the point of osteopenia, I felt it was time to revisit my options. I was already exercising regularly, eating bone-building foods, and taking the requisite supplements, yet it wasn’t enough to stave off osteoporosis. I was crushed, but I knew I had to do something. The choices before me were to take HRT (natural estrogen plus progesterone; I didn’t consider synthetic hormones an option) or to try one of the nonhormonal drugs prescribed to treat osteoporosis. It didn’t take long for me to eliminate the popular osteoporosis drugs; there were no long-term studies on their safety, and early reports indicated that the bone produced was inferior to normal bone. And then there were the drugs’ nasty side effects, as is the case with many alien substances we introduce into our bodies. If my only other option had been synthetic estrogen plus progestin, I would have done nothing. But there exists a solution few women know about: natural hormones that appear to be safer and yet are still effective for preventing loss of bone. Another factor that swayed me was a heart irregularity I have that is helped by estrogen. I decided to give HRT a try for one year, retest my bones, check my blood for the heart problem, and then reevaluate. The results of my DEXA test have arrived just in time to make publication. According to the report summary, there is a slight negative change compared to the previous X ray; however, it is not considered statistically significant. So I guess I’m holding my own. Still, I’m not entirely satisfied with these results. I think I can do better. After discussing the possibilities with my compounding pharmacist, we decided that I will take a saliva test to determine the exact status of my hormones—estrogen, progesterone, and testosterone. Even though I have no other symptoms to suggest they may be deficient, there is a possibility that one or all may require a boost. I’m also considering upping my supplements of calcium, magnesium, and vitamin D, possibly by 200 mg to 500 mg per day. And the final phase of my new and improved bone-building plan is to add a ten-pound weight that I will carry in a backpack when I walk the hills in my town. I’ll give this regimen a year and then retest to determine how well the program is working.

Women Have Options

I have devoted an entire chapter in this new edition to describing the differences between synthetic hormones and natural, or bioidentical, hormones. The synthetic hormones that are now shunned by most doctors have been suspect for years. Because they are not recognized, utilized, and excreted by the female body in the way that the body’s own hormones are, they build up inside the cells, potentially causing cancer, blood clots, and a host of other devastating side effects that have been downplayed in the brochures we’ve read at the doctor’s office. They have also been overprescribed to women over forty who endure perimenopausal symptoms, many of whom could have managed well with herbs and nutrients. Furthermore, many medical doctors automatically handed out the same dosage to every woman over forty-five who visited their office, when smaller amounts could still have helped and been safer for the individual.

Natural hormone therapy differs completely from synthetic HRT. For starters, the hormones are called bioidentical because they exactly match the hormones our bodies make naturally. This means that they are recognized by the body and are therefore better utilized. Women who have switched to natural hormones from synthetic ones find them more tolerable, and with fewer to no side effects. Just like the synthetics, natural hormones are FDA-approved and are regulated by licensed compounding pharmacies. And just like the synthetics, a doctor must prescribe them. The difference is that natural hormones can be custom-made to fit your hormonal profile and your individual symptoms. In prescribing natural hormones, it is the goal of the health professional to bring your body back into hormonal balance by testing the levels of all your sex hormones (not just estrogen) and determining the smallest amount that will effectively treat your particular need, whether it be a reduction of symptoms or preventing further loss of bone. Using these preparations requires more time and effort from you, your doctor, and your pharmacist, but it’s worth it to know that you’re not taking too much of a hormone that you don’t need. Even if you haven’t heard of natural HRT, be aware that the treatment has been evolving for more than fifteen years in the United States and is used by millions of women here and in Europe.

Few women’s health issues are as beset with confusion and controversy as developing an appropriate treatment for menopause. Just using the word treatment suggests that menopause is a disease requiring medical care, doctor’s visits, and prescription drugs. The medicalization of menopause has given birth to a giant industry composed of products, drugs, books, and nutritional supplements. Big business has discovered a dynamic market in aging baby boomers. But before you are convinced by the well-designed advertisements of vibrant, healthy midlife women popping pills, consider the possibility that the drug companies selling those multicolored tablets for menopausal relief may not have your best interests at heart. I am not antidoctor, antimedicine, or antihormones. What I wish to emphasize is that a hierarchy of questions and treatments needs to be considered prior to taking any drug. First, how bad is the symptom? Feeling distress at menopause does not always indicate that something has gone awry. It could be a normal sign of transitioning hormones. Remember when you started your periods? For a few months you felt physically and emotionally out of sync, but your body adjusted and you eventually adapted to your new cycle. As you leave your periods in the past, you may experience discomfort. If it is minimal, and if you are relieved to know that some discomfort is normal, can you tolerate it without medication?

Second, are there natural, dietary, or lifestyle changes you can make to ease the symptoms? This book provides many alternatives that have been scientifically proven to work effectively for a wide variety of complaints. Nutritional and lifestyle alterations take time to pay off, but stick with them for a few months and you will see noticeable differences.

There are women for whom diet, exercise, stress reduction, and supplements aren’t appropriate or do not work quickly enough. If your symptoms are intolerable and interfere with your work, relationships, and enjoyment of life, by all means get help. But even if you reach this point, you have options. You can ask for lowpotency pills, take them only as long as necessary, and then slowly taper off—always in consultation with your health-care provider. Many women are never informed that hormone replacement therapy doesn’t have to last forever.

There is a growing appreciation of the role of nutrition in determining one’s level of health. Even staunchly traditional physicians now admit that diet and lifestyle play a major role in many of the major diseases. This was hardly the case ten years ago—but time lags always exist between theory, accumulated evidence, and public awareness. It took fifty years for the medical community to indisputably link cigarette smoking to lung cancer. Decades passed before the medical establishment accepted that increased cholesterol levels were linked to heart disease. Studies showing the benefits of vitamin E in the prevention of heart disease and the treatment of hot flashes go back to the 1940s. And yet I still hear physicians say they need more studies before they can endorse diet and nutritional supplements as a part of health care. Given the scientific evidence in support of nutritional supplements and the absence of risks surrounding them, waiting to inform the public that nutrients may save their lives seems irresponsible.

Nutritional and herbal remedies, as effective as they are and as much as they have been studied, fail to reach the consumer to the extent that hormones and other drugs do. Up until 2002, we were still led to believe that supplements ranked only slightly higher than snake oil and placebos. Doctors on talk shows condescendingly shook their heads when someone brought up the necessity and validity of supplementing one’s diet with vitamins and herbs. We were warned more about the potential toxic effects of these concentrated nutrient sources than we were about the potential risks of prescription drugs. Then, just when we nutritionists thought all hope was gone, another long-awaited landmark study made front-page headlines. After many years of reviewing data presented in writing, the medical community endorsed vitamin supplements. In a complete reversal of policy, the prestigious Journal of the American Medical Association recommended that all adults should take a daily multivitamin to help stave off heart disease, cancer, and osteoporosis. I am frustrated that it took them so long to arrive at this conclusion but happy that it finally did happen. This fact was as true thirty years ago when I first spoke of widespread nutrient deficiency as it is today, but it took that many years to prove beyond a shadow of a doubt that few individuals are adequately nourished. I’m at a loss to count the number of health advisories that are familiar to researchers yet have failed to receive the medical blessing that, if acted upon, could increase both the quality of our lives and the quantity of our days.

The time is ripe for us to take action. A door has been cracked open that will allow us the opportunity to talk to our doctors about natural remedies and natural hormones. More and more we are seeing individuals taking responsibility for their own health care. According to a 1993 study, one in three Americans uses alternative therapies and pays for them out of pocket. The cost of health (sick) care has skyrocketed, and people are seeking less expensive methods of treatment. The concept of prevention is finally reaching public awareness and medical acceptance. It took three decades to convince doctors that vitamin supplements can prevent disease and encourage health; hopefully, we can help close the time gap with our knowledge and interest in finding safer remedies.

We baby boomers are the trailblazers for the next generation. We have changed women’s roles in the workplace, family, and society. Now we must be advocates for our own health care. We can no longer complacently accept a drug or medical procedure that seems wrong to us, even if everyone else is using it. We must ask the difficult questions and stand up for what we think is right. We cannot remain passive about our health care, even if being proactive means doing more research on our own, getting second and third opinions, talking to our friends about their decisions, and moving beyond our sphere of comfort into alternative areas of healing. We must decide when traditional medicine isn’t adequate and also when alternative medicine isn’t working for us. We need to tell our physicians about any alternative treatments we are undertaking, both to avoid compromising either therapy and also to educate our physicians. As difficult as it is for us to assume a larger role in our health, it also can be a challenge for our traditionally trained doctors to admit they don’t know everything. It is my hope that some day our allopathic doctors, chiropractors, Chinese medical doctors, and holistic healers will join forces and work with each other, respecting and complementing each other’s unique capabilities. We must work to this end, but until then, we must remain our own best advocates.

Menopause is an exciting time—a time when we have gained a better sense of ourselves, an appreciation for the cycles of our lives, and a clearer perspective on the future. Although menopause is a universal experience, each woman goes through it in her own way and in her own time. There are many difficult decisions to make about your health, and I don’t claim to have all the answers, but I do offer you some new ideas, suggestions, and thoughts on easing your immediate symptoms and improving your future years.

I want to encourage you to feel good about whatever decisions you make regarding your health and well-being during your midlife years. Maybe you decided in advance not to take any drugs for your menopausal symptoms, but when the hot flashes kept you up for months, you reluctantly succumbed. Resist blaming yourself or blaming others for their choices. Rather, let us encourage each other, share our stories, learn, grow, and be happy that we live in a time when we are free to talk about women’s health concerns and to pass this legacy on to our daughters.

An exciting avenue has opened up to us in the last several years—the Internet. It has brought so many special-interest groups together, and, speaking personally, it has placed me in contact with other women who are sharing their menopausal experiences. I have been fortunate to participate as a speaker and health educator on several Internet sites, to listen to women’s conversations, and to hear other authors, doctors, and specialists in the field discuss the multitude of issues that arise during midlife. I encourage you to join in and hear what others have to offer, have your personal questions answered, and stay current with the latest information. The Internet is the best way I know to connect with other women and with authorities in this field. The websites I recommend that are related to women’s issues and specifically to menopause are www.power-surge.com and www.families-first.com/hotflash. Tune in, learn more about medical and natural options, and share your questions and concerns with other wonderful menopausal women.

A few words about the way the book is organized: Part One deals with immediate concerns; it gives you the straight dope on hormones and offers help for relief of menopausal symptoms. If you are desperately seeking a natural solution to a distressing condition, you may want to start with the specific chapter dealing with your concern and begin your program there. Part Two deals more generally with preparing for your future health. Among other things, it examines risk factors for the common killers of postmenopausal women: heart disease and cancer. Becoming aware of the dietary and lifestyle factors that influence these diseases and taking action to prevent them are the best insurance you have for future healthy years. The title of Part Three, Nutrition for Life: A Woman’s Guide, is self-explanatory. The section details strategies for optimizing your health through a program of diet and supplementation that you can tailor to fit your own needs and lifestyle. In it, I have provided outlines, questionnaires, and charts to help you plan a course of action.

The years to come, I believe, will be the most fulfilling, rewarding, inspiring, and fun. I know this because every day I am more awake and alive to the reality of what life has to offer. It is my prayer that you, too, will see the second half as the part of life for which we have been preparing. Rehearsals are over; let the show begin.

— Linda Ojeda, Ph.D., January 2003

PART I

MENOPAUSE

SYMPTOMS AND REMEDIES

CHAPTER 1

MENOPAUSE

THE REALITY

The woman who wants her second-chance years to be the best of all has to work at shaping her future.

— DR. JOYCE BROTHERS, Better than Ever

Our society today, the society in which most of us have grown up, is clearly youth oriented. As much as we would like to believe that vitality and beauty are possible at any age, magazine ads and television commercials glaringly remind us that the emphasis on young bodies still prevails. Given our aging population and the host of beautiful older role models who now grace the screen, political arena, and corporate sector, I am beginning to believe that trends might be shifting from the overwhelming focus on nubile, wrinkle-free bodies. Young feminine forms still dominate the newsstand, but more and more older models like Lauren Hutton, Beverly John, and Cheryl Tiegs, and actresses such as Susan Sarandon, Goldie Hawn, and Candice Bergen stare at us from the checkout stand. They appear confident and seemingly comfortable with their age. Sure, they’re airbrushed, and their lines and wrinkles have been swept away with a soft-lens camera, but midlife women are no longer hidden from view. This is progress. Even twenty years ago, when I first started writing about menopause, you could not find one positive midlife role model on the cover of a national magazine. Menopausal women were characterized as pleasingly plump matrons who had lost interest in looking good and were given to frequent hysterical outbursts. They were never depicted as sexy (imagine your grandmother wearing Victoria’s Secret lingerie and enjoying sex), and as for creativity and adventure and starting a new career, those aspects of life were never even presented as possibilities. Gladly, times are a-changing.

Historically, medical attitudes toward menopause mirrored the negative stereotypes. Many earlier medical texts listed menopause as a disease or an unnatural phenomenon. The terms most commonly used to describe it included climacteric, endocrine starvation, involutionary years, female trouble, and living decay. No wonder women dreaded the so-called change of life! Descriptions such as these significantly warped their attitudes and responses to menopause, especially if they were poorly informed, which most were. Up until two decades ago, few books had been written about menopause, so women did not know what to expect, other than what their male doctors told them. There were no seminars or talk-radio discussions, and few women shared their personal experiences with even the closest of friends. Lack of information and negative conditioning certainly contributed to the physical and psychological symptoms that many of us older women remember as the typical stereotype of the menopausal woman. How could midlife women in the 1960s feel good about growing older when writers and doctors were telling women that their lives, essentially, were no longer relevant?

Robert Wilson, in his supposedly profemale book Feminine Forever, titled one of his chapters The Loss of Womanhood and the Loss of Good Health.¹ He described the menopausal woman as the equivalent of a eunuch: unbearable, suicidal, incapacitated, and incapable of rationally perceiving her situation. Equally degrading was the work of David Reuben, M.D., author of the popular Everything You Always Wanted to Know about Sex. This authority maintained that the essence of femininity is tied to a woman’s ovaries; once the estrogen is virtually shut off, a woman comes as close as she can to being a man. Such a woman is not really a man, he explains, but she is no longer a functional woman; according to Reuben, menopausal women live in the world of intersex.² This is absurd. A woman’s femininity is not defined by the amount of estrogen in her body any more than a man’s masculinity is measured by his testosterone output. But this is what women were led to believe at that time.

Menopause is no longer regarded solely as an estrogen deficiency and a medical disease that requires intervention. Rather, the accepted view of menopause is that it is a major cultural, psychological, and physiological milestone for women. Its definition is now broader in scope, with symptoms linked to the consequences of aging as well as hormonal imbalance. The implication still exists, however, that menopause is predominately a negative event, like divorce or loss of a job. Many experts agree that menopause is a biological marker for aging; it signifies the end of reproduction in a culture where sexuality and childbearing are equated with female fulfillment, and it signifies the beginning of old age in a culture that extols youthfulness. Some still cling to this view, but is it true for all women, some women, or just a handful of women? Or is it an obsolete model reflective of antiquated ideas?

What Women Really Think about Menopause

The North American Menopause Society (NAMS) wanted to find out exactly how women felt about their menopausal experiences. In 1998, NAMS developed a set of questions and, with help from the Gallup Organization, conducted 752 telephone interviews across the United States, using a randomly selected sample of postmenopausal women ages fifty to sixty-five. Although individual postmenopausal women surveyed held differing views of menopause, the majority (51 percent) reported being happiest and most fulfilled during this time of their lives, compared to when they were in their twenties (10 percent), thirties (17 percent), or forties (16 percent).³ They reported that many areas of their lives had improved since menopause, including family and home life, sense of personal fulfillment, ability to focus on hobbies or other interests, relationship with spouse/partner, and friendships. Sixteen percent of women felt their sexual relationship had gotten better since menopause, while an equal number said it had worsened; however, more than half (51 percent) said it had remained unchanged.

Approximately three-quarters of women also reported making some type of lifestyle change at midlife, including changes in their nutritional or exercise habits, reducing alcohol intake, reducing stress levels, stopping smoking, taking more time for themselves, and using alternative and holistic treatments. One reason for women’s positive experiences, according to Wulf Utian, M.D., executive director of NAMS, is that women are talking to each other about their experiences. Rather than looking to their mothers’ generation for advice (since their mothers were uncomfortable discussing the subject), they look to friends and other women who are going through the same experience. We see an increasing trend toward women supporting other women and guiding their peers and the next generation through the many phases of life, Dr. Utian said. Menopausal women see themselves as role models, and seem to be very interested in helping other women, as well as improving their own health.⁴

The thought of menopause should not and need not produce anxiety. A study of other societies indicates that the stereotype of the distraught woman is not universal, that our negative reactions to common physiological processes, such as menstruation and menopause, are culturally engendered. In countries where age is venerated and elders enjoy respect for their experience and wisdom, older women seem to manifest fewer physical and psychological symptoms. For example, South African, Asian, and Arabic women, who, it is said, welcome the end of the child-bearing years, are reported to have positive attitudes about the change of life. Where there are different predefined concepts, aging seems to be more natural, less confusing, and not overlaid with negative images.⁵

Mayan women in Mexico have been studied by researchers because they do not complain of the characteristic symptoms of menopause and do not suffer from osteoporosis and bone fractures. Endocrinologically, they are no different from women in the United States. In fact, estrogen levels in Mayan postmenopausal women were at or below the values expected for U.S. women. Something that is significantly different is their attitude. Mayan women welcome the transition, as they will be relieved of many household chores and regarded as respected elders. In addition, they will become free from the taboos associated with menstruation. Menstruating women are believed to carry an evil wind during their periods, so the cessation of periods raises a woman’s status in the community.⁶

Menopause, like menarche, is natural. We experience hormonal changes at menopause, just as we did in our adolescence. Any lifetime change may be accompanied by uneasiness and disequilibrium; it is normal and it will pass. How smoothly a woman adapts to any transition depends largely on her overall health— that of her body, her mind, and her spirit.

Menopause Is Big Business

In the West, historically, the menopausal woman was regarded with pity and indifference. Because she complained of symptoms that were as yet unexplained, she was labeled a neurotic hypochondriac, then sedated and left to suffer in silence. I am sure no one regrets leaving behind those days of disbelief and intolerance. But what replaced the ignorance—namely, the medical model of midlife—may be equally destructive.

Women who are fifty-something are no longer ignored; they are actively courted. They are presently a prime target of the medical industry, drug companies, and other interests that can benefit from an aging population. And the market is growing: Fifty million baby boomers are going through menopause, entering at a rate of between two thousand and four thousand per day. By the year 2015, nearly one-half of the female population will be menopausal. Talk about global warming.

Industry-financed medical researchers inundate us with information about the benefits of treating all menopausal signs and symptoms, severe or insignificant, with hormones. The assumption that menopause is associated with chronic disease further encourages widespread use of prescription drugs. While earlier hormonal therapies were marketed only to physicians, major drug companies now directly target female consumers in the grocery-store magazines. Before they experience their first hint of oncoming menopause, women are already primed to run to the doctor for pills.

Menopause is now a big business, and we women consumers need to be alert to what we hear and read. The fact that there is a strong bias toward medicalizing menopause is obvious. Now that hormone replacement therapy (HRT) no longer commands the primary focus since its reputation has been tarnished, an abundance of prescription drugs are primed to fill the void and sell us treatments for osteoporosis, vaginal dryness, hot flashes, and heart disease. Our buying power is huge and we are going to be courted and cajoled into taking drugs that we may not need. Before you decide on a new medication, please do some homework. Check with a few health professionals who are not quick to medicate, check out the Internet, read the latest in research, talk to your friends who may be knowledgeable, and trust your own instincts about what is appropriate for your body. Just because a product is advertised on TV and just because thousands of women are taking it, that doesn’t mean it is the best drug for you. Also, find out if a natural, less potentially harmful remedy exists for your symptom. Often it does.

The Range of Symptoms

I was raised in an era when normal female topics, such as menstruation and menopause, were not openly discussed even among close friends. Our bodies, we were led to believe, were too mysterious to understand and too base to mention. Our intimate parts were ignored as if they did not exist. Even today, unfortunately, these childhood attitudes linger, preventing many of us from confronting and accepting problems and feelings that cry out to be addressed.

Attitudes concerning the menopausal experience have changed in the last few years, and they continue to evolve as women read, learn, and discuss their individual experiences. In the mid-1990s, a questionnaire designed by Fredi Kronenberg, director of menopause research at the Center for Women’s Health at Columbia-Presbyterian Medical Center, New York City, was given to readers of Prevention magazine.⁷ The results of the two thousand randomly chosen respondents (fifteen thousand actually provided information) may help us understand and appreciate the menopausal experience. The results of this extensive questionnaire include the following:

Intensity of symptoms ranged from stormy to breezy. Fifty-eight percent considered the process more of an annoyance than a major life disruption, and more than half agreed the symptoms were, for the most part, mild.

The younger the woman is at the onset of menopause, the more difficult the experience. The average age at which women enter menopause is fifty years, and a woman who has, for example, postponed motherhood, thinking she still has ten years left, and then suddenly finds herself starting menopause, probably has both physical and psychological issues to confront.

Weight gain is not inevitable at fifty; however, 42 percent of respondents gained in excess of ten pounds. Current research indicates that this additional poundage is more a function of aging than of estrogen decline.

The fact that sleep problems were prevalent was not surprising. Sixty-two percent of the respondents reported that hot flashes kept them awake. Frequent urination, which is related to lower estrogen levels, may also keep women awake; aging itself has an effect on muscle tone, and illnesses, such as diabetes, impact bladder function.

The years prior to menopause, called perimenopause, seem to account for most of the annoying symptoms, such as severe hormonal fluctuations. Once a woman has stopped having periods for a year, things usually stabilize.

Good health habits correlated with a more positive menopausal experience. Exercising three or more times a week was associated with fewer symptoms and a generally better transition. It is unclear whether exercise reduced the stress of menopause or had other benefits, but the more stress a woman reported in her life, the more difficult her menopause.

The relationship between a positive menopausal experience and a low-fat diet was even stronger than that for exercise. Women who described their diet as primarily vegetarian generally reported fewer symptoms. Eating soy products, such as tofu, correlated strongly with fewer symptoms. It may be that women who eat soy and vegetable products enjoy a lifestyle that is healthier in other ways, but the benefit might also be attributed to the large amounts of phytohormones in soy. Certain plants contain estrogen-like substances, called phytohormones, that appear to provide just enough hormonal effect to prevent menopausal symptoms. In countries where women consume large amounts of soy products, menopausal symptoms are appreciably reduced or nonexistent.

Personality Types

It appears that women with certain personalities may tend to develop certain menopausal symptoms. Although the evidence is not conclusive, there is value in relaying this information, because it may apply to and help a number of women.

Researchers have found that certain personality types find it more traumatic to adjust to changes during the menopausal years. Gynecologist Sheldon Cherry finds that women with a history of emotional problems have the hardest time. These include women with chronic sexual difficulties, immature women with narcissistic tendencies, women whose erotic attractiveness was the chief element of their personal worth, childless women facing the undeniable loss of fertility, and married women who feel that their meaningful years are over.⁸

Several authorities have observed that the manner in which women react to the change may be related to how they perceive themselves as women. Particularly vulnerable, according to British physician Barbara Evans, are women who over the years have defined their femininity in terms of bodily functions—menstruation, pregnancy—and motherhood.⁹ For them, menopause represents the end of their womanly identity; it removes the purpose of their existence.

Another all-too-common phenomenon is women who submerge their own desires, talents, and personal growth to live totally through their children’s activities and accomplishments. It is no wonder that, when their children leave home, these women undergo an emotional trauma similar to experiencing the death of a loved one. They have lost the chief component of their identity as women and as contributing members of society. This empty-nest syndrome often results in depression. The midlife woman must search for a new identity in her relationship to her grown children.

The degree to which a woman accepts or fears growing older also affects the transition. The reality of getting older has to be dealt with at some time in our lives, and often this time coincides with or begins at menopause. Since we can’t turn back the clock no matter how many antiaging products we consume or lather on our bodies, we need to find a way to accept growing old gracefully. I’m not at all opposed to using any cosmetic or procedure that helps us feel good about ourselves, but, more importantly, we need to look into our souls to find purpose and meaning in our new lives or we will never be happy with who we are.

If you find yourself struggling with these issues, read about other women who are also searching for a new frame of reference for themselves. I just finished reading Getting Over Getting Older, by Letty Cottin Pogrebin, and I found it an honest, humorous, and highly personal exploration into the perils and pleasures of aging. She tells the truth about her own body’s aging—being unable to read the print in the telephone book, letting out the waistband in all her skirts, her shoe size enlarging, her bra straps leaving permanent indentations, sleep creases that make her skin look like crepe paper. I can identify. As much as I want to accept the increasing wisdom and deepening spirituality that supposedly comes with years, I’m not always thrilled about the trade-offs: poor short-term memory, sagging breasts, purple veins in my neck, and cottage cheese–looking thighs. Pogrebin asks the question we all need to address: What good is it to turn fifty with an unwrinkled face if there’s no light behind the eyes, no passion in the voice, no new ideas happening inside the head?¹⁰ Some of us have more difficulty getting to this point than others, and I agree that it is sad if we find ourselves preoccupied with the physical signs of aging and miss the things we might contribute to our families and the world. Research indicates that women who accept menopause as a natural passage in life are likely to get through it unscathed. For them, the transition is comparatively uncomplicated, uneventful, and relatively symptomless. In addition, women whose educational skills make more options available to them are reported to handle the change with relative ease.¹¹ Numerous studies indicate that women with professional interests, intellectual and creative outlets, and challenging responsibilities have an easier time during menopause. It is not clear exactly why active women appear to suffer less physical and emotional pain than their homebound sisters, but some theories pose that they have less time to focus on their symptoms, are generally more knowledgeable about the physiological details of menopause and about their own bodies, and have higher self-esteem.

Whether a woman’s symptoms during menopause will be closely related to her personality type or feelings about herself cannot be predicted with any certainty. To portray such a complex psychophysiological process in black-and-white terms would be misleading. Each woman has a highly individual chemical makeup, genetic predisposition, and hormonal balance. Even the most secure, well-adjusted, and happy woman may experience emotional upheaval during menopause. Fortunately, the majority of women not only accept the multiple challenges of menopause, but find it to be the most enriching time of their lives.

Creating a Positive Attitude

Women entering menopause are approaching what can be the best years of their lives. The life span of the modern woman is currently seventy-eight to eighty-four years, and gerontologists anticipate that it will soon increase to beyond ninety. Even the conservative American Medical Association’s Council on Medical