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Last week I posted "The 2nd 'Talk' Women Aren't Having About Their Bodies." I wrote it to encourage readers to share their menopause experiences and work together with the World Health Organization to bring change to the way our culture views this normal—yet still stigmatized—phase in women's lives.
Readers were extremely responsive, sharing dozens of heartwarming stories about their menopausal struggles—a sign I took of their eagerness to join "The 2nd Talk." Hot flashes and night sweats? Women described them as the most annoying symptoms, often using humor as their best defense. Insomnia? They talked openly about their sleeplessness—who doesn't struggle with sleep at some point?—seeking doctors and drugs to deal with it. Irritability and mood swings were more difficult to share. A number of women said they felt out of control, doubtful that things would ever return to normal and worried that others—even peers—would view them as crazy or think they were "losing it."
But the most difficult symptoms to talk about were vaginal dryness, lack of libido, and bladder leakage. Not many women wrote about these menopausal issues and if they did, it was with embarrassment and shame. Some said they felt judged and misunderstood, convinced that there were few who empathized with what they were going through—not their mates, friends, or even their doctors. Some described "not feeling like themselves" for many years and isolated in their struggle.
Why is that? With huge numbers of women (50 million in North America alone!) currently facing menopause, you would think there would be more clarity about it all. But confusion and fear continue to fuel women's concerns. We have come so far in so many ways; isn't it time to be upfront and open about this phase of life?
In my last post, I described four commonly held myths about menopause. Below are five more misleading assumptions and the truth behind them. Let's continue the "2nd talk" so that we can confront this challenging time together.
1. Depression is inevitable.
Before assuming that menopause necessarily leads to depression, it's helpful to clarify this catch-all diagnostic phrase. There is "clinical depression," which is a psychological disorder that typically requires treatment. There are "depressive symptoms," which are reactions we have following losses—like loss of a job, death of a loved one, or divorce. These are usually short-term and may not require professional help. Then there is what we refer to as a depressed mood, a period of sadness or feeling blue.
Probably none of these categories exactly describes what the majority of menopausal women feel, and does not apply to all women across the board. While many do experience mood swings—moments of happiness followed by unexpected tearfulness, contentment that turns quickly into irritability—these are most often reactions to the fluctuating levels of ovarian hormones.
Truth: Mood swings due to menopause are not the same thing as clinical depression. If your mood swings extend into a lengthy period of lethargy, sadness, and an ongoing lack of interest in life, it's possible that clinical depression may be setting in and requires attention by a professional.
2. Menopause means I'm losing my mind.
Some menopausal women worry that their memories are going and that these lapses foreshadow the onset of dementia or Alzheimer's disease. Yet it's very unlikely that hormonal changes lead to long-term memory loss. While there is some evidence that fluctuating estrogen may influence the part of the brain that affects sleep, moods, and memory, it's more likely that this stressful time robs women of their ability to concentrate and absorb and recall information. The "fog" that women report may result more from the difficulty in taking in new data and less about permanent loss of memory.
Remember too, that women in their 40s and 50s are often pulled in multiple directions—with children that still need them, demanding careers, and aging parents. Add to that the physical changes that menopause brings, and the result is a lack of focus and a heightened awareness of cognitive losses.
Truth: You are neither losing your mind nor necessarily heading toward dementia. Your fluctuating hormones and stressful life may be temporarily interfering with your otherwise intact, but active mind.
3. All women gain weight during menopause.
Increased weight is a global and socio-demographic phenomenon, not just a menopausal one. There are other factors involved that impact weight gain as we age, including a family history of obesity, diabetes, use of psychotropic drugs, poor education, and low economic position. Keep in mind that aging men put on pounds, too. Probably the most significant factor contributing to weight gain is the decrease in the level of activity that comes with age.
While it's very likely that loss of estrogen can favor the accumulation of abdominal fat (that annoying redistribution of weight reported by some menopausal women), the simple addition of pounds does not appear to be affected by hormonal changes alone.
Truth: Menopause itself is not completely to blame for weight gain in women. It's more complicated than that!
4. Menopause means a decline in sexual activity.
Menopause does lead to a decrease in estrogen, which can lead to a thinning of the vaginal wall, a lack of lubrication, and pain during intercourse. But estrogen loss does not directly lead to a lack of sexual interest. There are other factors at play. More likely, the culprit is the decline of testosterone, the hormone that is known to contribute to sexual arousal, which reaches its height in women in their 20s. Testosterone begins to decline years before peri-menopause and is solely age-related, not menopause related. Not only is it difficult to pinpoint the loss of sexual interest to menopause alone, but the effect of declining testosterone on women's libido also remains controversial.
In addition, there is a difference between sexual activity and interest. While physical changes may impact the sexual experience, some postmenopausal women report an increased interest. For some, it is the lack of pregnancy concerns. For others, it's the freedom from child-rearing responsibilities that fosters intimacy with their partners that is more relaxed and enjoyable.
Truth: Reduced sexual desire in women as they age usually has multiple causes. The stress of family and work, reduced energy, poor health, low self-esteem, and relationship problems are very likely strong contributing factors and can occur at any age. So, while menopause marks the end of a woman's reproductive cycle, it does not signal the end of her sexuality.
5. Hormone replacement therapy is dangerous.
A little over a decade ago, using medication containing female hormones to replace the ones depleted during menopause was considered the treatment of choice to relieve symptoms. At that time, we were told that hormone replacement therapy (HRT) had potential benefits against heart disease and may even prevent cognitive losses.
But in 2002, The Women's Health Initiative conducted a study that showed greater risks than benefits, with statistically significant increases in rates of breast cancer and strokes among the sample studied. Doctors abruptly stopped prescribing HRT and alternatives were suggested (bio-identical hormones became popular, as did other homeopathic treatment methods), but many women suffered through their symptoms until they resolved on their own.
However, the original HRT study has recently come under question and new clinical trials using a younger population suggest that HRT may be a good choice for certain women. According to new research, the risks and benefits depend on the age when medication is started and whether you take systemic hormone therapy or low-dose vaginal preparations of estrogen. Studies continue to be under review, but this new research holds strong potential for future treatment possibilities.
Truth: Before we assume all hormone replacement therapy is dangerous, or that it is unsuitable for all women, it's important that you consult a doctor who is an expert in this field and up to date on the latest research. It turns out that our age, onset, and type of menopause may play a significant role in determining the best course of treatment. Not all women, nor their symptoms, should be treated in the same way. Talk with your friends. Talk to your doctor. Don't suffer alone.
Like other myths worth shattering, the ones about menopause are too. World Menopause Day was just a reminder that it's time to start talking about this natural phase of life and find out that it isn't all that we feared it would be.
Share your menopausal story in the comment section so that we can learn from one another.
Follow Vivian Diller, Ph.D., on Twitter: www.twitter.com/DrVDiller
