Menopause and Marriage

Many of us grow up believing love conquers all. We may see relationship disasters all around us—among our friends, family and all over the media—yet we tend to believe our own will be the exception.

In truth, sustaining long-term relationships is hugely challenging in today's culture. Did you know that the overall divorce rate is still hovering close to 50% – and for those over 55, it is actually rising? Fewer couples are willing to remain in dysfunctional marriages if it means living for years with frustration and unhappiness. Remember, "til death do us part" can last a very long time these days. In addition, fewer are tying the knot in the first place. How do we understand this cultural trend and how can we avoid falling victims to it?

First, let's recognize that the institution of marriage has dramatically changed over the past fifty years. Religious and societal pressures no longer provide couples the kind of adhesive power they did in the past. Marriage, while once the only path toward living with a mate and creating a family, is now just one of the ways couples attain these goals. And, with the stigma of divorce significantly lessened, maintaining a long-term relationship is much more challenging than most of us realize.

Given the fragility of the bonds that keep couples together, it's important to address the issues that cause friction. And menopause—perhaps surprising to many–is one of them. While rarely discussed, we cannot underestimate the impact that menopause and its symptoms have on women, their mates and their relationships.

Close to 50 million women in North America are currently facing menopause, most experiencing at least five related symptoms. Yet few are talking openly about it—not to their friends, family or doctors. Some women deny its impact altogether. Others view it as a weakness, a shameful secret to be kept from others. Some symptoms, like lack of libido or vaginal dryness, can be misinterpreted by spouses and viewed as rejection or disinterest. Other changes are more difficult for children to understand, like mood swings and forgetfulness, which can be unnerving to kids relying on mothers as their unwavering constant. We discuss concerns over everything from finances to careers and in-laws, but when it comes to the struggles brought on by menopause, we tend to suffer in silence. It's time to confront this stage of life and talk about it as we do other relationship issues.

A 43-year-old patient, who I'll call Steve, came to me for help saying he didn't understand what was happening to his wife. Together for twenty years, with three children and one grandchild, he reported feeling as if a switch had been flicked in his marriage when his youngest left for college. "I don't understand Mary anymore. She kept our family going; working, caring for our house and the kids. Now she has little interest in talking to me-or anyone really-and when she does, she's so irritable. She gets headaches, can't sleep. And forget sex. Is this an empty-nest thing or what? I'm not sure I can take it anymore." I asked him if she had started menopause and he said, "How would I know, she doesn't talk to me? And, I'm not even sure what that would look like anyway." Therein lies part of the problem.

One of the most difficult issues for loved ones is being left in the dark. Family and friends who are sensitive find themselves walking on pins and needles, not sure what to expect. Those less sensitive get annoyed and impatient. In truth, the symptoms of menopause are so idiosyncratic and so misunderstood, that we have a hard time even explaining what we are going through.

Take Steve. I asked to meet his wife after realizing that his marriage was in jeopardy. As I suspected, she was in the midst of a pretty serious depression following the onset of menopause. She said, just as her husband described, that she felt like a something had been seriously altered when she turned 42. "Aren't I too young to be in menopause?" she asked me. "My mother went through her 'change of life' in her 50s, got depressed and never fully recovered. She died of cancer ten years later." Mary said she was afraid to tell anyone about her fading periods, thinking they would view her as old. "Besides," she said, "I felt so angry and mean, even a little crazy. I didn't dare share my thoughts with anyone." So she withdrew from her husband, friends and even her kids. "I wanted to protect them from me, but I felt so alone."

Over time, I helped them both understand what was going on physically and emotionally, and explained that it is not uncommon for hormonal changes to begin at age 40, even earlier. I told Steve that menopause was a natural process, not an illness, that all women experience a slowing and ultimately a shutdown in their reproductive cycle and that this process can create symptoms like Mary's.

I emphasized the importance of learning to cope with these changes as a couple-much the way they coped with life style changes when they got married or when their children were born. I reminded them that it was likely that they would have a third of their lives ahead of them with Mary as a menopausal woman, so it was best to learn how to deal with it.

I also explained that that symptoms can vary from woman to woman and Mary's experience would not necessarily be similar to her mother's. Although hers were fairly typical—moodiness, headaches, loss of energy and libido—hiding them probably added to their intensity and to the distance that had been growing between them. Almost immediately after their first session together, Steve and Mary's intimacy improved. I referred Mary to a menopausal specialist to see if she needed additional medical treatment for her physical symptoms. But the couple left my office feeling closer than they had in many months.

With long-term relationships so fragile in today's culture, it's important to pay attention to all the potential impediments that may get in the way of maintaining them. Isn't it time for you to talk about your menopausal symptoms with your mate, and your children too? Why suffer alone? Menopause does not have to be a sad solo act, but a duet you can do with others. You might be surprised how understanding and supportive the people who care for you can be. Start talking. It's a good beginning.

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