Women have broken so many barriers and crashed higher ceilings than ever before. And then there's menopause. Why is it so hard to talk about it? And what we can do about that?
Maybe it's because this is such new territory for our generation. No, not menopause itself, but living as long as we do with the symptoms. Did you know that life expectancy was only age 49 at the turn of the 20th century, which meant that most women lived only a short time past childbirth? Today the average woman will likely live well into her 80s, some into her 90s and beyond. By the end of this decade, there will be close to 50 million women in this country heading into menopause and dealing with its symptoms with a third of their lifetime still to go. You would think these numbers alone would result in more discussion about it all!
The mystery and secrecy about this stage of life are especially interesting to me, given my work as a clinical psychologist. I am trained to help people speak their mind – to say anything and everything – no topic is off limits. Just saying things out loud together is the first step toward feeling better about almost any symptom.
And yet, even in the privacy of my office, I find I have to prompt women to talk openly about menopause and the possibility that their feelings – like anxiety, confusion, lethargy, depression – may be related to the hormonal changes that come at this stage of life. Why the big cover up? I found the answers while researching my book "Face It," a study based on interviews with hundreds of women who told me what they ‘really' feel and think about this stage of life.
Below is a summary of the most common reactions to the onset of menopause and tips for how to overcome and talk about them. The important thing is recognizing what you really feel, so you can begin addressing this important topic with your doctors, friends and family members.
First, let's make sure we all understand some commonly used terms: Peri-menopause is the natural transition phase during which a woman's body begins to undergo hormonal changes, often occurring gradually over 2-6 years up to the last menstrual period. Symptoms often start with hot flashes and menstrual irregularity. Menopause is when menstruation (or monthly period) stops, occurring usually between ages 45-55 (in Western culture), with the average being about 51. Just as the first menstrual period (menarche) during puberty marked the start of reproductive years, menopause marks the end. Post-menopause is the phase of life marked by completion of menopause. While this used to be a short period of time before the end of life, many women are now living 1/3 of their lives post-menopause. Premature or early menopauseis when a woman stops menstruating, either naturally or as a result of illness, sometime before the ages of 40-45.
While these definitions seem relatively clear cut physically, the fact that so few women talk about this stage of life suggests that psychologically, it is more complicated. Here's why and some tips for what we can do about that:
Shame seems to be the greatest impediment to bringing up the topic of menopause. It's as if the acknowledgement means admission of weakness or defeat. Women today believe they are supposed to be great multi-taskers – juggle children, jobs, homes and hobbies – and take pride in doing it all. For most, the first signs of peri-menopause foreshadow vulnerability and the potential loss of the all-powerful image we have come to associate with being a successful woman today.
Tip: We need to accept that menopause is a natural life transition – not a weakness or disease – so that we can remove the element of shame it evokes. We talk openly (and even celebrate) the onset of menstruation. It's time to find ways to do the same about moving on to this next stage of life. Remember, you are not alone. Once you open this conversation with others, you'll find that millions of women having the same experience.
I've Lost Control
Our menstrual cycle is often one of the few regular, reliable experiences we can count on throughout adulthood. We go through dozens of other transitions and transformations in our lifetime, like moving, new jobs, marriage or children, but our periods ultimately return like clockwork, month after month. That is, until now. When they become irregular, we experience a deep sense of uneasiness and loss of control. On some level we know, at the core of our feminine identity, that something is changing and will never be the same. When the night sweats, hot flashes or sleeplessness arrive out of nowhere, it can feel as if an alien has taken over our bodies. This loss of control is often the most anxiety producing aspect of menopause.
Tip: One of the best ways to regain control is through gathering information. Talking about menopause is an opportunity to educate yourself. Keeping feelings secret creates greater anxiety. Start the conversation with your doctor by asking, "I want to know more about what I'm feeling, why and what I can do about it." If your doctor makes you feel that "it's all in your head," get another referral. Once you feel understood, you may be surprised to find how increased knowledge creates calmness.
It Means I'm Not 'Cool'
While hormones wreck havoc with our thermostats, some women get stuck on the idea that the whole topic isn't 'cool.' They believe simply talking about it is a turnoff and that others – especially men and younger women – have an aversion to hearing about their menopausal symptoms and about aging in general.
Tip: It's time to grow up. The aversion to talking about menopause is created largely by our own fears and attitudes. No doubt, it more fun to chat about vacations, movies or grandkids, but didn't we share our concerns about sex, pregnancies and childbirth when those topics were on our minds? Sure it's wise to raise sensitive topics with people we trust, but if we start the conversation with openness and confidence – maybe even a sense of humor – it will likely be less of a turn off to most everyone.
No, not me!
"Menopause is for old people, right?" Wrong. Unless you think 40s is old, which is often when hormones start to change. Some women convince themselves that menopausal symptoms just don't apply to them. It's almost as if talking about it makes it real, so they remain in disbelief. Besides, some think, "What's the use of talking about it in anyway?" These are woman who believe defying reality, like denying aging altogether, works best for them. Yet, when symptoms can no longer be avoided, they feel like a deer in headlights, paralyzed and unable to take action.
Tip: Actually, working hard to defy or deny reality often makes symptoms worse. Accepting that these symptoms are real and talking openly about them is the first step in coping with menopause -- a fact that is true about almost all aspects of aging. Do you get regular mammograms or bone density tests to ensure proper care? So it is with menopausal symptoms. We need to get comfortable owning – rather than denying – that this stage of life has arrived.
I Fear The Unknown
It's surprising how much anxiety plays a role in keeping menopause a secret. Mostly, it's the fear of becoming asexual, unattractive, invisible and useless. Sometimes it's the fear of becoming our moms and facing the experience that they had of menopause. Women recall mothers who went into hiding and never came out, or aging women who seemed irritable and depressed for the remainder of their lives. Mostly it's the fear of the unknown, of what comes next, without confidence that there are solutions that will bring order to the chaos.
Tip: While we have few role models for how to navigate menopause (our parents' and grandparents' experiences were quite different) currently many women are living full and vital lives well into their 80s and 90s and we can learn from them. Remember, you are among the crusaders for this phase of life and how to make the most of it. Join your sisters with courage, not fear, as you share your new attitudes about aging. You may be surprised at how powerful this new sisterhood can be as we forge new paths together.
Change and Loss Aren't Fun
But both are part of everyone's life. We leave behind childhood as we enter puberty. We let go of adolescence to enter adulthood. And the life cycle continues with transitions and losses all the way to the end. The changes that occur at menopause are real, both to our bodies and minds, and unless we learn to deal with them, we can't move on to make room for new opportunities and experiences.
Tip: Letting go and moving on are basic necessities in the process of aging gracefully. If you find yourself focused only on sadness, then you're probably not talking openly enough about it all. Cry on your friend's shoulder – and your doctor's too. Expressing the sadness is key to helping you let go and move on. Start the conversation by sharing how hard this time of life is so that you can begin making room for what comes next. There's a lot more ahead, years of living full lives. Our goal is to find new ways to enjoy them.
Let's start talking
It's time to stop running from what we feel at menopause. Many women work too hard to hide their hot flashes, sleeplessness and bladder leakage. Or they ignore their lack of libido, vaginal dryness or painful sex. The result? They feel alone, confused, irritable and lost because they are just too uncomfortable sharing what they feel.
It's time to shift our approach. Not only can we benefit from educating ourselves about our physical and emotional symptoms, but we can learn how to manage them by getting the information that's available. We need to overcome our need for this long-standing cover up and let the big secret out.