Managing Menopause

Something was terribly wrong. I was dealing with the usual chaos that went with my managerial job, but it wasn't even noon—and I was exhausted. In fact, for the past couple weeks, I hadn't been sleeping well, I cried at the drop of a hat, and everyone and everything got on my nerves. I felt hot all the time. At restaurants, I had to ask for two menus—one to read and one with which to fan myself! I'd become forgetful, and my soft skin had turned into sandpaper. What was going on?

I hurried over to photocopy something for a colleague, but when I pressed "print," a flashing light signaled a paper jam left by the previous user. Impatiently I tore open the door in front of the machine, twisted knobs, pulled out trays, fiddled, and yanked. Nothing. Disgusted, I slammed the door shut, gave the machine an unladylike kick, and burst into tears.

A secretary in an adjacent office came running into the copy room, wondering what was going on. There I stood, blubbering like a baby.

"Are you all right?" she asked.

"Do I look all right?" I snapped. "I'm fighting with a piece of stupid machinery and it's winning!"

She froze in her tracks like a deer caught in the headlights, then spoke with exaggerated calmness. "Uh … okay … why don't you give me what you need copied, and I'll try to fix it."

I beat an embarrassed retreat to my office and picked up my phone. Although I wasn't due for my routine exam and mammogram for a couple months, I made an appointment to see my gynecologist over the lunch hour. I felt as though I were living inside a body suddenly gone berserk!

My visit to the doctor, along with subsequent blood tests, confirmed that at the age of forty-nine, I was in perimenopause, the transition phase between regular menstrual periods and no periods at all. Doctors say this stage can last about two years, during which time periods can be longer or shorter, lighter or heavier, closer together or farther apart. Erratic bleeding is common. It's often the first sign of "the change," as my grandmother called it.

I was totally unprepared for menopause. So I started combing magazine articles and books written by doctors, sociologists, and others, trying to understand this passage in my life. I was surprised at what I found:

—Until the turn of this century, a woman's average life expectancy was forty-eight years. Society never addressed menopause because many women didn't routinely live long enough to go through it. Today there are an estimated forty-three million women in the perimenopause, menopause, and the postmenopause stages of life.

—Studies indicate 10 to 15 percent of women have no problem with menopause. Another 10 to 15 percent have only minimal problems. The rest—roughly 70 percent—may have a tougher time. Keep in mind the bigger picture, however—menopause does end, and many women report a heartening postmenopausal zest for life.

—Estrogen replacement therapy (ERT) is the most common treatment for menopausal symptoms, but it's controversial. Most doctors have no problem prescribing estrogen to get women through the acute phase of menopause, assuming there are no glaring individual risk factors. For most, estrogen controls hot flashes, stabilizes mood swings and emotions, keeps skin supple, relieves vaginal dryness, and may enhance sex drive. More importantly, estrogen offers protection against more serious conditions such as heart disease and osteoporosis.

So what's not to like about ERT? Estrogen may increase the risk of uterine or breast cancer. Since the risk of breast cancer increases in all women as they age (regardless of whether they're taking estrogen), there's debate over just how big the link is. The potential risk of uterine cancer, however, does appear to be more directly linked to estrogen.

The dilemma is whether to take estrogen and risk breast or uterine cancer, or avoid estrogen and risk osteoporosis and/or a heart attack. Researchers at the Gallup organization found 46 percent of women worry about getting breast cancer but only 4 percent worry about heart disease. Yet heart disease is the number-one killer of women in the U.S. And a woman's chances of dying from heart disease are double that of dying from cancer of any kind. Those facts seem to tip the scale in favor of ERT.

The key concern doesn't appear to be whether a woman takes estrogen during menopause (assuming she's not high risk) but whether she remains on estrogen after menopause to protect herself from heart disease and osteoporosis. According to a published report by the Centers for Disease Control, a woman who uses estrogen pills for fifteen years has a 30 percent greater risk of developing breast cancer.

The final decision about if, when, and how long a woman uses estrogen should be made after she sits down with her doctor and discusses her personal medical history and the severity of her menopausal symptoms. Together they can establish a personal risk/benefit profile that takes into account factors such as the effects of smoking, weight and body size, diet, and family history.

If you choose ERT, expect your doctor to place you on the lowest dose possible to achieve benefit, to have regular physical exams while you're taking it, and to be asked to be alert for rare but potential signs of trouble such as abnormal vaginal bleeding, pain in your calves or chest, severe headaches, breast lumps, or severe depression.

The estrogen question illustrates a central truth about dealing with menopause. You've got to get involved. Here's how to take a more active approach:

Select a doctor you're comfortable with. A 1993 study by the North American Menopause Society found 80 percent of women recognized menopausal symptoms, but only one in three talked to a physician about them. A concerned physician can be a welcome partner as you traverse this uncharted season of your life. Find someone who takes your needs seriously and shows compassion.

Talk with those you love about what you're going through. Your spouse and children may have as much difficulty in coping with your menopause as you do. And they may be uncertain as to what to say or do because they see you're obviously distressed.

I loved to play the card game Hearts with my husband and daughter, and I usually won more games than I lost. However, I began noticing I couldn't keep track of what cards had been played—an important factor in winning. I was regularly getting trounced!

One night, I sat at the kitchen table, cards in my hand, tears rolling down my face. Humiliated, I said, "I can't do this. I can't get my brain to focus. I just can't remember the rules." There were hugs all around and my husband suggested we play Scrabble, a game I could handle until "the memory thing" straightened out. It wasn't until later I learned short-term memory loss is often a symptom of estrogen deprivation—a crisis largely resolved once the imbalance was corrected.

Stop beating yourself up. Learn to laugh over some of the crazier moments. My family has a whole repertoire of Mom & Menopause stories—like the time I was cleaning up after dinner and placed the leftovers in the linen closet. ("Uh, Mom, are you sure you want the cottage cheese next to the bath towels?")

Don't expect to handle menopause perfectly because you've never been menopausal before. It's okay. Besides, about the time you get the hang of it, it'll start to wane, or you'll start to look at it with different eyes. A greeting card sums it up perfectly: "I'm not having hot flashes, I'm having power surges!"

Address menopause—but don't obsess. It's easy to become preoccupied with what you're going through to the exclusion of everything else. Ask the people closest to you for a reality check. I worried that my sex drive was gone for good. It wasn't—but my husband's reassurance and support made a difference during my season of insecurity.

Have you lost your emotional balance? If you don't have the support of a spouse or close friends, consider counseling or finding a support group.

In the meantime, take good care of your body. Physical exercise and healthy eating habits can help minimize menopausal symptoms. Make time for activities that nurture your spirit.

Ecclesiastes 3:1 says, "There is a time for everything, and a season for every activity under heaven." Menopause is a season, not a disease. It's not fatal. In fact, it's a good time to take stock. In the same way that a harsh winter is always followed by spring and new life, menopause can be a precursor to a fresh beginning to the rest of your life. Take time to reflect on what you did right the first two-thirds of your life—and dare to dream about your next twenty-five or so years!

Verla Wallace is an author, speaker, and spiritual life coach. You may contact her through her blog, Pilgrim on the Loose, at www.pilgrimontheloose.com, or at verla@verlawallace.com.