New Study Downplays the Effects of Menopause

A major new study of the health of midlife women has found that the health consequences of menopause are “vastly overrated.”

“Basically, the menopause is a small ripple in a woman’s life,” said Sonja M. McKinlay, who, with her husband, fellow epidemiologist John B. McKinlay, conducted the five-year survey of 2,500 Massachusetts women between the ages of 45 and 55.

The McKinlays’ research shatters certain widely held preconceptions by contending that not only does menopause not cause depression, but that it also plays very little role in the general health of women.

Family Primary Cause of Stress

The research found further that most women in this age group named family as the primary cause of stress and described work as a relief from that stress.

Among the widows in the midlife age group, the McKinlays’ study attributed most health problems to economic factors, such as decline in income and health care coverage. Depression was described by some newly widowed women, but overall the McKinlays found that widowhood had no real impact on the mental health of women at midlife.

But it was their findings about menopause that seemed most strongly to fly in the face of conventional wisdom.

“Menopause has been erroneously described as the cause of all the health problems of (midlife) women,” Sonja McKinlay, an associate professor of community health at Brown University, said in an interview at her office in the Boston suburb of Watertown.

“For the majority of women,” she said, menopause “is not the major negative event it has been typified as. That is basic mythology.”

In fact, she continued, “a lot of women have expressed relief” at the arrival of menopause because it released them from fears of conception.

“Only about 2% to 3% (of the women surveyed) were actually expressing regret,” she said.

But in a telephone interview from his office at the UCLA Medical School, Dr. Howard Judd, a professor of obstetrics and gynecology who is head of the school’s division of reproductive endocrinology, cautioned that even a five-year longitudinal study may provide insufficient data for assessing the long-term health consequences of menopause.

“If you want to look at the impact of the loss of ovarian function on the health of older women,” Judd said, “then you cannot look for five years.

“The long-term consequences are really the key issues.” Among these problems, Judd cited vaginal atrophy and associated urinary disorders, osteoporosis and, “potentially,” heart disease.

But John B. McKinlay stressed that one of the qualities that makes the new study distinctive might also make its conclusions surprising for some physicians.

“Just about all the studies that have been done to date have been done on patients,” women who have sought medical advice from physicians, McKinlay said.

McKinlay, on leave from his position as a professor of sociology at Boston University, called the perspective of doctors “very understandable” because “they base their knowledge on what they see, and what they see is a very selected group of people.

“Because they see sick women, the think that all women are sick,” he said.

Lack of Information

“I don’t like to engage in physician-bashing,” Sonja McKinlay emphasized. “Physicians have been operating from as much misinformation and lack of information as women in general. This study provides important information for practicing physicians in terms of what they are looking at with midlife women.”

Rita Jacobs, a sociologist and gerontologist at the Wellesley College Center for Research on Women who is familiar with the McKinlays’ work, observed that “doctors have been in the habit of attributing every illness that a woman has either to being premenopausal, menopausal or postmenopausal.”

But, Jacobs admonished, “I think it is important not to overlook the fact that there are some women for whom menopause is difficult. We don’t want to minimize that.”

One subgroup that the McKinlays encountered was women who undergo surgical menopause--hysterectomies where both ovaries are also removed. Although these women tended often to report that they were depressed after the menopause, they also turned out to be “higher users of medical services beforehand,” Sonja McKinlay said, and “more likely to be depressed before they get the surgery as well.”

The McKinlays’ study, based on a randomly selected population of women chosen from street listings and voter records in 38 Massachusetts communities, was funded by a series of grants from the National Institute on Aging, a branch of the National Institutes of Health. Its initial sample looked at more than 8,000 women, from which the subsample of 2,500 premenopausal women was selected. These women, who experienced menopause during the five-year study, were interviewed on seven occasions.

About 70% of the women sampled worked full- or part-time, with many returning to work after their children left home or after their husbands died, retired or became infirm.

Work as a ‘Buffer’

Regardless of the type of job, Sonja McKinlay said, “Work serves a real buffer function. It allows these women to take some relief from their nurturing role.”

For 39% of the women interviewed, children were the primary source of stress. Elderly parents or in-laws were cited as the main cause of stress by 24% of the McKinlays’ sample, and 22% mentioned other relatives. The husband or partner caused stress for 11% of the women, while 4% blamed friends or co-workers.

Children Return Home

One phenomenon the McKinlays documented and discovered to be a major source of stress for midlife women was the growing trend of older children returning to the home for economic reasons. The return of these children turned out to be “more of a source of stress than their leaving,” Sonja McKinlay said. She called the fabled “empty-nest syndrome,” in which women supposedly wallow after their last child leaves home, “a figment of Freud’s imagination.”

As for the apparent palliative quality of work in these women’s lives, John McKinlay said, “I think the quick and dirty explanation is that there is so much discomfort and problem in women’s lives that work is quite a relief.”

Women in the middle years “are having an incredibly tough time of it,” he went on. A second study by the McKinlays on the frail elderly confirmed the vital role of women in caring for older people, McKinlay said. A full 25% of the women in the midlife study said they were providing care on a regular weekly basis for an elderly relative.

“There is a big gender bias in this society,” he said. “It is the daughters and the daughters-in-law who are expected to care for the elderly. The women in this society care not only for their own parents, but also for their husband’s parents.”

As a consequence, he said, “what we’re talking about is women in the middle in every sense: in the middle of the years, and in the middle of the (family) sandwich.”

The McKinlays said they would continue to follow their survey group as they approach retirement, examining the effect of retirement on their health as well as their often-complex family roles.