Menopause

                                                                                                                            Menopause 1


Menopause
Menopause – A Transition

Silva Redigonda
 Psychology AK/PSYC 3170.3.0A
Professor Goldberg
November 26, 2003












                                                                                                                           Menopause 2
Menopause – A Transition

For some women menopause is a phase with little if any interruptions from their

daily lives. For other women menopause conjures images of desperation. Symptoms associated with menopause may include headaches, joint pains, memory loss, and mood swings, leaving some women feeling confused, anxious and worried. Women are not always aware of what is happening to them, especially since many of the symptoms they feel may account for conditions other than menopause. Though menopause is a natural transition, the difficulty women may
face needs to be further investigated and solutions found by addressing the following questions:

1.      What is menopause and how effective is hormone replacement therapy?

2.       How do the experts at workshops/seminars explain menopause and what
 solutions are offered to ease this transition?

3.      What is the belief system that women share regarding their experiences with 

menopause?

This paper regarding the transition of menopause will focus on these three questions.

What is menopause and how effective is hormone replacement therapy?

A woman is considered menopausal when she has ceased menses for one year.

Menopause is associated with reduced functioning of the ovaries, resulting in lower levels of ovarian hormones, primarily estrogen.  Serious health problems may also arise when changing hormone levels and the physical effects of aging are coupled with the stresses of midlife (North American Menopause Society, 2003, p2).  Barbach (2000, pp 41,56,75 & 267) reports that there

 

                                                                                                                         Menopause 3

are direct reactions to decreased estrogen such as headaches, which 40 percent of American women experience, joint pain or breast tenderness. Fatigue also often comes on suddenly. Extreme emotional reactions can occur as estrogen levels decrease. 15% to 20 % of women

suffer from periods of serious emotional upheaval during menopause. Some become so anxious that they cannot leave their homes, so angry they cannot control their tempers, and so depressed that they cannot get out of bed.  Matlin (2004, p 468) indicates that hot flashes is the most known symptom associated with menopause.
            Though menopause deals with issues that may resemble illness by some, Taylor (2003, p40) argues that menopause is not a disorder of the reproductive system but rather the end of a woman's reproductive life. Cobb reports that menopause has never been a major part of medical studies but that there are more resources than five years previous (2001, pp 35 & 253). It is established that menopause is not a medical disorder but a natural process which women go through, some with great difficulty because of estrogen decrease.  Hormone Replacement Therapy substitutes what is lost through menopause.

How effective is Hormone Replacement Therapy?

            The Society of Obstetricians and Gynaecologists of Canada report that Hormone Replacement Therapy (HRT) which contains estrogen alone or can be an estrogen progestin combination replaces the hormones that decrease during menopause in order to relieve distressing menopausal associated symptoms (2000). Barback refers to HRT as estrogen and progesterone taken in combination and explains that it was designed for postmenopausal woman.

                                                                                                                                    Menopause 4

Originally estrogen was given alone, and the result was a devastatingly high increase in cases of cancer of the endometrium, the lining of the uterus. This happened because estrogen was continuously building up the uterine lining but without the progesterone, this lining was never sloughed off, as naturally occurs every month during reproductive years (2001, p 157). The Women's Health Initiative (WHI) Hormone Replacement study was the longest largest clinical controlled trial on HRT, whose primarily goal was to determine if taking estrogen and progesterone over a long period of time reduced a woman's risk of coronary heart disease. The study that began in June 1995 was discontinued July 8, 2002, because of increased health risks to the women (Schumaker (2002). Though HRT appears to be effective in replacing decreased hormones in women there may be some risk to women. 

How do the experts at workshops/seminars explain menopause and what solutions
are offered to ease this transition?

Ms Addison who is a nurse at the Women's Health Center was interviewed by phone (Oct 2003). Ms Addison offers counseling sessions at the Center. She reported that women in the past discussed their problems associated with menopause in a group setting. She indicated that this pattern has changed and women now prefer counseling in private.  Ms Addison reports that the WHI study totally changed how women were treated for symptoms associated with menopause.  It was very clear that women's health was put at risk by using HRT. Lifestyle changes such as incorporating exercise in a person's life is more of a focus in easing women's transition through menopause.  Ms Addison described midlife as a watershed. Parents are older, there are changes in relationships and there is a re-thinking about a lot of issues based on a person's own medical

        

                                                                                                        Menopause 5

status. There is a huge change around midlife with physical changes. Depression, violence and anxiety come into play through midlife that covers a broad spectrum. When women are

 menopausal there are issues that are created, dealing with sexuality that may become painful and it moves towards the relationship.   

During 18 October 2003 a Menopause Seminar took place at Sunnybrook Campus. The cost was $40.00 to attend which included a buffet and distribution of booklets, a pen, and other paperwork having to do with nutrition, HRT and natural alternatives. The speakers were Dr Nickell, Ms Creighton, and Ms Manson. The 30 women in attendance were mostly nurses from the hospital and a few patients from the hospital who were advised about the seminar by their physicians at Sunnybrook. 

Ms Manson reported that women on average start menopause at 51 years of age and a few years earlier if they smoke.  10% of women display no symptoms other then ceasing mensus.

Ms Creighton described menopause as a bridge, a development stage.  She described intense emotional highs and lows some women experience, a roller coaster ride of emotions.  Ms Creighton reported that a symptom of being out of control is very common which can be very discouraging especially if a woman felt very much in control prior to menopause.  Other common emotional symptoms associated with menopause are anxiety, panic attacks, irritability, absolute rage, depression, memory lapses and moodiness.  Menopause becomes very visual and final and menses itself is missed by some as is the realization that she will not be able to have children.  Body image may be affected since our society worships youth and firm flesh.  Sexuality changes as arousal is slower and orgasm is less intense.  There is less lubrication and the vaginal walls become thinner, which may make intercourse painful. Self-esteem takes a

                                                                                                               Menopause 6

beating during this time.  Ms Creighton provided a lecture on coping strategies; she explained that women should nurture themselves and not skip meals.  She recommended Dr Barbach's book, The Pause and described how Dr Barbach, who has a PHD in Clinical Psychology and is presently faculty at the University of California and in private practice as well as an author, experienced her own hardships dealing with menopause.  Dr Barbach went from physician to physician trying to find the cause of her strange symptoms such as intense fatigue and waking up frequently at night to urinate.  She thought she had a mysterious illness.

Dr Nickell spoke about the WHI study in depth, simplifying the results.  She reported that over one year of 10,000 women taking hormone therapy versus placebo there would be 7 more cardiac events, 8 more strokes, 18 more blood clots, 8 more cases of breast cancers, 5 fewer hip fractures and 6 fewer colorectal cancers.  Dr Nickell encouraged her audience to consider the study lightly, as the health risks are small.  She said that she has not taken her patients off HRT and indicated that the results of the WHI study caused many doctors in Toronto to immediately have their patients stop taking HRT. She indicated that this abrupt stop of HRT would have the patient feel the effects of Menopause full force when normally the effects are gradual.  She suggested that women might want to consider taking HRT when they are suffering a lot and it is affecting their quality of life.  Handouts consisted of Canada's Food Guide, natural alternatives such as Black cohosh, soy, red clovers, and ginseng for symptoms related to menopause.  Vitamins were encouraged and exercise regimes suggested.  Information regarding alternative therapies such as acupuncture, and reflexology was also provided.

                                                                                                             Menopause 7

The Women's Health Center held a small group of only seven women.  It was free of charge and handouts were provided.  Again the WHI was discussed suggesting alternative ways for women to seek help for menopause related symptoms.   Ms Morrow reported that menopause

does not usually cause depression, though it can.  She explained that when one is not sleeping properly or tired then one can become depressed.  She stated that menopause is a reminder to

women that they are aging.  She added that women have a right to be irritable when everyone including mates, children, and parents are demanding something.  Menopause can be socially isolating.  People may not want to understand.  Ms Morrow also spoke about the importance of diet and exercise and pampering oneself.  She warned that natural alternatives are still chemically engineered and not regulated.  

What is the belief system that women share regarding their experiences with menopause?

 Many of the women at the seminars who had attended expressed relief that they were experiencing menopause because too many had associated their symptoms with a mental disorder or unknown disease.  Women had been to several doctors to determine what was happening to them without any concrete results.  Several women had consulted other female friends and came to the conclusion that they must be experiencing menopause because they had ruled out all other options.  Some women reported that their mothers told them, they themselves had never experienced menopause, though the daughters remember their mother's symptoms associated with menopause very distinctly.  Does this mean that women are in denial of menopause or that medical staff are not proficient in helping women understand that they

Menopause 8

may be experiencing menopause? A common belief that women shared is that they associate menopause with being old.  They became aware that youth no longer belongs to them.  Some feared and resented aging feeling they are no longer attractive to men.

            Menopause is a transition women experience and not a disease.  The decrease in estrogen and other hormones may cause different emotional and physical reactions among women.  Menopause associated symptoms may account for other health or age related illnesses.  This can explain why some women may enter into menopause without being sure of what is happening to them.  Some women hold a belief system that they are aging or old and are therefore no longer desirable.  This belief is not discouraged by a society that equates youth with desirability.  In general, women hold a belief system that if they eat well, sleep enough hours and exercise it will ease their transition and make them stronger.  The WHI study caused an immediate reaction.  Physicians urged their patients to stop taking HRT while other physicians downplayed the study and encourage the use of HRT.  It would be interesting to know what the ratio of doctors prescribing HRT and doctors opposed is.  Unfortunately that question could not be answered but it may very well be of particular interest for Health Psychologists to conduct further studies in this field.  More studies are also required in determining the safety of HRT for women for the purposes of easing symptoms associated with menopause and natural alternatives which is also being introduced and encouraged by physicians and experts in the field.  Till then women must continue to search for answers trusting their own bodies and making their own decisions

 with the limited research information available.                                                                                                                          

                                                Menopause 9

References

A.    Morrow, Adult Education Student, Regional Women's Health Center, 8th Floor,
     Toronto (Menopause Seminar/workshop, November 8, 2003).

Barbach, S. (2000). The Pause: Positive Approaches To Perimenopause and  Menopause New York: New York.
Cobb, J. (2001). Understanding Menopause Toronto:Ontario.
J. Manson, BScN, Certified Qualified Menopause Lecturer, Sunnybrook and

Women's College Health Sciences Centre, Sunnybrook Campus (Menopause Seminar/work Shop, October 18, 2003) Lecture on definition of Menopause, signs and
symptoms, non-hormonal management/ exercise and nutrition.

L. Chreighton, MSW, Department of Family and Community Medicine, Sunnybrook

and Women's College Health Sciences Centre, Sunnybrook Campus
(Menopause Seminar/workshop, October 18, 2003) lectures on Historical/
cultural perspective, mid-life transition and coping strategies).

L. Nickell, MSW, MD. CCFP. The Family Practice Unit, Department of Family and

Community Medicine (Menopause Seminar/workshop, October 18, 2003) Lecture
on Medical Therapies 1 and 2.

M. Addison, counselor, Program for Midlife @ Older Women/Menopause Education

Regional Women's Health Centre, Toronto (416-351-3703) (personal
communication, October 2, 2003) describes symptoms associated with menopause, therapy and research consequences.

Menopause 10

Matlin, M. (2004). The Psychology Of Women, Fifth Editon, Belmont: CA.

Schumaker, S. (2002). Department of Public Health Services. Effect of Estrogen

Plus Progesterin on Global Cognitive Function in Postmenopausal Women: The Women's Health Initiative Memory Study: A randomized Control Trial, 289, 2663-2672.

Taylor, S. (2003). Health Psychology, Fifth Edition, New York: New York.
The North American Menopause Society. May 2003. Menopause Basics. Cleveland:
            Author.
The Society of Obstertricians and Gynaecologists of Canada. December 2002
            Hormone Replacement Therapy And You. Ottawa: Author.