A Change in Attitude on Menopause

Menopause--once a mysterious part of the female cycle that was seldom discussed among women and never mentioned in mixed company--is becoming one of the buzzwords of the ‘90s, a hot topic for how-to books, TV talk shows and group therapy sessions.

Psychologists give the aging baby-boom generation, which, as one local therapist says, “hasn’t done anything quiet yet,” credit for bringing the “M” word out of the closet.

In the next two decades, an estimated 40 million American women will be experiencing “the change of life.” These are the women who insisted that fathers be allowed in delivery rooms and that PMS be treated seriously, and they’re expected to be increasingly vocal about the kind of support they need as they make their way to what author Gail Sheehy calls a “second adulthood.”

In her latest book, “The Silent Passage,” Sheehy contends that women have been reluctant in the past to talk openly about menopause because of “shame, fear, misinformation” and--most of all--”the stigma of aging in a youth-obsessed society.”

Anne Price, a 56-year-old Laguna Beach psychotherapist, sees a growing number of women liberating themselves from that stigma: “In our increasing consciousness, we as women are more prone to celebrate who we are at all stages of our life and not feel pressured by societal definitions to try to retain youth or be something that we truly are not.”

Price and other Orange County therapists agree that Sheehy’s book--along with the prominent media attention menopause has been receiving nationally--has helped give women the courage to discuss their symptoms frankly with friends and loved ones as well as health professionals.

Some are even able to joke about those embarrassing, untimely hot flashes, or at least to see them as a natural part of menopause instead of a reason to go into hiding. (Candor will prevail during an upcoming episode of ABC’s “Room for Two,” when the TV talk-show star played by Linda Lavin will have a hot flash on the air as she’s co-hosting a telethon with Dick Cavett.)

This eagerness to bring a once-taboo subject out in the open has led to a proliferation of seminars and support groups for women across the country. In Orange County, where many hospitals are offering lectures on the benefits and risks of hormone replacement therapy, menopause support groups meet regularly at the Community Counseling Center in Huntington Beach, South Coast Medical Centerin Laguna Beach, Westminster Counseling Center and Anne Price’s office in Laguna Beach among other locations.

Women are also gathering at retreats and “pajama parties” to share information and help each other cope with the most unsettling symptoms of a passage that everyone experiences differently.

Although the average age at which women reach menopause is 51, symptoms can start as early as the mid-30s, according to Dr. Leigh Erin Connealy, who gives lectures on menopause at the South Coast Women’s Medical Group in Newport Beach.

Medical experts say that although some women breeze through menopause, most have physical and emotional difficulties that come and go over a period of years, and 10% to 15% suffer severe symptoms that significantly disrupt their lives.

Price, who will soon be starting a therapy group in Anaheim, says many women are reaching out to others who are going through menopause because they are not getting the support they need at home.

“Women in our culture have typically been the ones who are regarded as the nurturing one in a pair,” Price explains. “A lot of men are just not ready to take on the nurturing role when the woman truly needs that more than anything else.”

Connealy says that a number of the women she is treating with hormone replacement therapy have told her their husbands were impatient with such symptoms as depression, fatigue, weight gain and reduced sex drive. The message some women are getting from men, according to Connealy, is, “If you don’t snap out of this soon, I’m outta here.”

The physician adds: “Most men don’t have a clue how a woman goes through her menstrual cycle, much less how she goes through menopause. They don’t want to hear about it.”

Ruth Luban, a Laguna Beach therapist who will soon be offering menopause educational programs and support groups, suggests that some men retreat because they don’t want to be reminded that they, too, are aging. She explains: “Menopause brings up all the issues of loss of physical youthfulness and energy and sexual attractiveness. When women hit menopause and men have midlife issues they haven’t dealt with, they tend to turn away and not be as sympathetic as their wives need them to be.”

Price notes that some men also have a difficult time with the ways in which menopause upsets the predictable patterns that evolve in a long-term relationship. For example, couples may suddenly find themselves out of sync because of the dramatic mood swings some women experience during menopause or because she’s emerging from her midlife transition with a sense of freedom and eagerness to start something new while his career is winding down.

There may also be power struggles between partners if a woman who has made menopause a time for personal growth becomes more independent and assertive, and her husband feels threatened.

To survive this high-stress period in their marriage, couples must have “a lot of mutual respect for each other’s needs--and they’ve got to talk,” Price says.

Karen Jordahl, a therapist who leads menopause support groups at the Community Counseling Center in Huntington Beach, says the couples who struggle most when a woman reaches menopause are those who lack good communication. For them, she adds, “menopause can be an opportunity to find more intimacy, more sharing and more understanding.”

That’s what Sara, a 50-year-old Orange County resident, has been trying to achieve in her marriage since she began going through menopause two years ago. But her husband’s terse advice--”get help”--wasn’t what she needed when she told him how miserable she felt. “What I really wanted was comforting,” she says.

At first, Sara attributed her menopausal symptoms to stress. Although her periods had become erratic, she thought her fatigue, lack of motivation, headaches, mood swings, insomnia and memory lapses were signs that she’d been working too hard.

“At my worst, I felt like I was fading away, becoming invisible,” she recalls. “Sometimes I thought, ‘I’m going to be 50, but I may as well die because I can’t do anything.’ ”

At one point when Sara’s emotions were particularly volatile, her grown son jokingly called her a “menopausal hag.” That hurt, she admits, but what disturbed her most was her husband’s failure to come to her defense.

“I felt alone in my misery,” she says.

Sara finally regained her equilibrium after a doctor started her on estrogen therapy. (Estrogen treatment remains controversial because of studies suggesting it raises a woman’s breast cancer risk; health experts say each woman should discuss her own medical history with her physician to determine whether the benefits outweigh the risks.)

Today, Sara still has moderate mood swings, some joint pain and occasional periods with uncomfortable symptoms of PMS, but the “hellish” days when she felt like she was losing herself appear to be over. She celebrated her 50th birthday with a sense that she was “coming of age.”

“I’m looking ahead to very productive career years,” she says, adding that she also plans to work hard at resolving the communication problems that menopause exposed in her marriage.

Diane, a 45-year-old, divorced Huntington Beach resident, has found a man who gives her the kind of support Sara devoutly wishes her husband could have offered when she needed him most. Diane’s “significant other” listens patiently when she needs to talk--and doesn’t feel rejected when she asks for some time to herself.

“It takes a real understanding man to go through this with a woman and really share it,” says Diane, who received little compassion from the man she was dating when she experienced her initial menopausal symptoms at age 41.

She became “real fuzzy-headed” and then started having hot flashes and bouts of depression with long crying spells, all of which made her feel like a “totally different person.”

Diane, who is feeling back in control of her life now that she’s on estrogen therapy, says her depression forced her to pay more attention to her own needs instead of always looking out for others.

“This has been a real growth experience. I’m coming out of it a lot different than I was, and that’s good. I know who I am and what I want. I feel like I could do anything I put my mind to.”

Menopause has also been a time of self-discovery for Jane, a 50-year-old Fullerton resident whose life went into a tailspin when she began going through “the change” at age 45.

While struggling with middle-of-the-night panic attacks, memory loss and unpredictable crying jags, Jane was unable to keep up with the demands of her high-level university fund-raising position. She ended up taking a low-stress, part-time job and going to a therapist because “I was feeling crazy.” The counselor reassured her that her symptoms were related to menopause and referred her to a physician who put her on hormone replacement therapy.

Jane says she and her husband have grown closer since menopause shook up their marriage of nearly 30 years.

For a while, they were going to bed at different times to avoid sex, each thinking the other was to blame. But when they began to talk, they realized they were both at fault. Jane says her sex drive had dropped because she was experiencing pain during intercourse and lacked a sense of overall well-being, and her husband had felt rejected. Once they stopped blaming each other and started communicating, they were able to take steps to recapture a satisfying sex life.

Jane says it took a lot of prodding to get her husband to read the educational materials she brought home to help him understand what she was going through, but he gradually became more supportive--and even began to share his own concerns about aging as they confronted her midlife transition together.

Jane cautions women against expecting too much from their husbands, however. “My husband isn’t going to sit and cry with me, and I’m not sure he needs to,” she says, noting that women can go to support groups for that kind of empathy. “It’s just nice to have him there and know he cares.”

She’s also grateful that he doesn’t seem to be threatened by the signs that she is emerging from her midlife passage with what anthropologist Margaret Mead called postmenopausal zest. “I’m so excited about the years to come,” Jane says. “I have a whole world out there that I haven’t explored. Five years ago, I felt I had missed my chance. Now I feel it’s out there waiting.”