Dealing with the Psychological and Spiritual Aspects of Menopause

Finding Hope in the Midlife

Dana E King, Melissa Hunter, Jerri Harris, Harold G Koenig

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317787150
• Edition: 1
• Topic: Medicine
• Subtopic: Nutrition, Dietics & Bariatrics

Turn menopause and midlife into a positive experience Dealing with the Psychological and Spiritual Aspects of Menopause examines the emotional toll of menopause, offering help for the worry, anxiety, stress, and depression women can face during the midlife years. Instead of focusing on estrogen, hormones, and osteoporosis, the book shares up-to-date research findings on the link between spiritual and emotional health. Women from different backgrounds and spiritual traditions will find hope in the healing power of the mind/body/spirit connection as they gain a healthy perspective of the changes taking place and restore balance to their lives. Dealing with the Psychological and Spiritual Aspects of Menopause goes beyond the traditional medical approach to examine ways women can make peace with the changes they face at midlife. This unique book informs, empowers, and enlightens women about the opportunities for personal and spiritual growth during menopause, offering strategies for exercise, meditation, prayer, and counseling. The authors offer a new perspective on menopause that offers hope in the face of the stress, worry, hot flashes, and often-overwhelming responsibilities women face at the midlife. This book demonstrates that women can do more than just "make it through" menopause. The authors show that menopause can become a positive experience for women as they discover new avenues for finding peace and hope to sustain them through the challenges of mid-life—and beyond. Dealing with the Psychological and Spiritual Aspects of Menopause examines alternative aspects of menopause, including:

• dealing with emotional loss on top of physical and psychological changes
  
• moods, attitudes, and depression
  
• the benefits of counseling and group support
  
• exercise as a treatment for anxiety and depression
  
• the work experience
  
• spiritual issues
  
• special challenges of the perimenopausal period
  
• and much more!

Dealing with the Psychological and Spiritual Aspects of Menopause is a vital resource for physicians, counselors, therapists, and psychologists, and especially for the women they treat.

Chapter 1

The Transition to Menopause: The Journey Begins

A woman's experience during the transition to menopause depends on many factors, including general physical and emotional health, diet, levels of physical activity, and social support. Some women may view the transition as the beginning of old age and loss of status in a society that values youth, beauty, and vitality. At first a woman may react to this “change of life” with anger or sadness, focusing on lost opportunities or a life in decline. As time passes women are more likely to feel hope and possibility, viewing this stage of life as an opportunity for growth and a renewed sense of self.

Balancing these physical uncertainties and the emotional and psychological experiences can be a challenge during menopause because so much seems to be happening at the same time. Understanding how the body functions can help ease much of the uncertainty about the physical changes. A number of options are available to relieve symptoms, beginning with a discussion with a health care provider about medications that may help. The emotional and psychological experiences likely will require additional attention.

Sharing experiences with other women can be of great importance in gaining perspective, particularly when sharing with others is combined with reflection on one's own possibilities in moving toward the next third of life. Perhaps the greatest long-term benefit will come from tending to religious or spiritual needs to achieve balance amid all of the physical and emotional changes at perimenopause. For some women this may mean reaffirming relationships at church and making more time to spend with friends. The mind/body/spirit connection is powerful and healing. Combining regular exercise or yoga with prayer or meditation also helps increase feelings of well-being and peace. Other measures that can help are deep-breathing exercises, taking a leisurely bath or having a massage, or walking alone or with a friend in a park or other natural setting. These simple activities help quiet the mind and invite a healthier perspective on all the changes taking place, decrease feelings of anxiety, and help restore spiritual balance.

IS MENOPAUSE A DISEASE?

Throughout her lifetime after puberty a woman is more likely than a man to seek medical care, often related to reproductive issues. In part because she uses health care more often, a woman's health issues are more likely to be medicalized than a man's. Advances in medical treatment have provided great relief, but in the process doctors and their patients have come to expect that many life events are medical conditions that must be treated and cured.

Menopause is not a disease; it is a natural process every woman will experience if she lives into her fifties. Knowing the difference between menopausal symptoms and feelings that are influenced by other health or life circumstances can help maintain perspective on the process. The transition to menopause certainly has a way of getting a woman's attention. Beyond the physical changes, many women find that it can also be a time of reflection, reassessment, and renewal of purpose. More than a transition, menopause can hold the surprising power of transformation and can lead to a more meaningful life. We have included more on how that can happen in later chapters. But first, the following is a brief review of the menopausal process and how other women have dealt with it.

WHEN DOES MENOPAUSE BEGIN?

Menopause begins at different times for different women. It has several stages: premenopause, which includes all reproductive years leading to the transition; perimenopause, when symptoms begin; menopause, medically one year after the final menstrual period; and postmenopause, the years of a woman's life after menopause. The phrase “going through” menopause can be misleading because the process is not a predictable phasing in and out of each stage. Some of the symptoms may occur for at least a year after menopause. Perimenopause can last from 1 to 10 years, the average being 4.8 years. The average age of perimenopause is 47.5, although the range can be from the late thirties to the midfifties. A number of factors influence when perimenopause begins and how long it lasts. For example, women who smoke tend to enter perimenopause up to two years earlier and have a shorter perimenopause than nonsmokers.

Women enter the menopausal years with assumptions that have been shaped by society and their own expectations. How a woman views menopause depends in large part on understanding the process as much as on individual circumstances and conditions.

HORMONAL CHANGES

Hormonal changes during perimenopause affect most of the tissue and organs in a woman's body. Reproductive organs, breasts, connective tissue in joints, skin, the urinary tract, liver, the cardiovascular system, and the central nervous system all have estrogen receptors. Fluctuations in hormones during perimenopause cause changes throughout the body that may or may not be noticeable for several years. Ovary function begins to decline in the midthirties, continues to decline at a faster rate in the forties, and stops in the late forties to early fifties.

The most common signs of the transition are hot flashes, night sweats, irregular menstrual periods, and vaginal dryness. Sleep disturbances are related mostly to hot flashes and night sweats. Interruptions in sleep can make fatigue, irritability, mood swings, and forgetfulness much worse. Vaginal dryness, urinary tract problems such as infections or incontinence, irritability, and mood swings can contribute to less interest in sex. Sexual interest is also influenced by the relationship a woman has with her partner as well as her own self-image as she experiences these changes in her body.

Changes in sexual function during perimenopause are not all related to the transition to menopause. Sexual health during midlife also is related to previous sexual health, attitudes, and experiences, as well as to general health. Women who have been sexually active before perimenopause tend to have fewer problems with vaginal dryness and atrophy, which are two of the major causes of sexual discomfort. Motivation and mood are important factors in whether a woman is interested in sex, and both may be affected during fluctuations in hormonal patterns. Having a regular sexual partner also influences a woman's interest and sexual health. In addition, during midlife both men and women may experience chronic disease such as diabetes, hypertension, and heart or breathing problems. These diseases and the side effects of medicines used to treat them also can affect motivation and mood.

Lillian's Story

Lillian had been having hot flashes, but they were not really bothering her too much. She thought she was handling the situation pretty well. Then night sweats became more bothersome, soaking her pajamas and sheets. That's when she decided to see her doctor.

I thought I could handle the changes, but when my night sweats were disturbing my husband's sleep, too, I felt I'd better do something about it. On my first visit for menopausal symptoms my doctor decided I wasn't menopausal. I don't know why, except he seemed to think I didn't “look” menopausal. Anyway, about six months later I tried again. This time he tested for hormone levels and told me I was in perimenopause. You know, after all that, I don't think it was the hot flashes that concerned me most. It was the vaginal dryness. It certainly affected my interest. I don't think I ever mentioned that to either my husband or my doctor. Looking back, I think I was embarrassed about it and must have thought it was a sign of getting old. I guess I'm just surprised at myself for falling for that old stereotype of the “menopausal woman.” I didn't realize how powerful that image was in shaping my beliefs about myself, and mostly about my value as a person.

Part of society still regards midlife for a woman, and the aging process itself, as the beginning of the end—the end of sexual function and the end of life. It should be no surprise that many women feel powerless and disregarded at menopause. It is without doubt a time of change in roles and relationships in a woman's life, at home and at work, with children, partners, and parents, and in health related to chronic diseases. Yet, for many women, the end of the reproductive phase of their lives also can be positive. One obvious benefit is that once they are past perimenopause they are no longer bothered with the inconvenience, cramps, or premenstrual syndrome (PMS) that many women experience with monthly periods. Many women also enjoy an active sex life without having to worry about getting pregnant.

Cultural stereotypes of the aging woman are powerful influences on attitudes about perimenopausal symptoms. If hot flashes occur at work, some women may feel embarrassed and distracted, thinking their visible responses might compromise not only the quality of their work but also their regard by co-workers. Studies have linked low self-esteem with depression and feelings of helplessness in people who have chronic health problems. Although the transition to menopause is not a disease, it certainly is chronic, and for a disturbingly unspecified period of time. The added stress of not knowing when the next hot flash will occur increases distress. In bed, a woman may feel not only her own discomfort but the discomfort of her partner as well. For many women dealing with these shared symptoms can add to self-doubt and negative feelings. A positive self-image helps maintain a balanced perspective. Of course, a healthy sense of humor helps too.

No scientific studies support the assumption that the transition to menopause causes such mental health problems as clinical depression, anxiety, or erratic behavior. Hormonal changes do contribute to mood swings. That these changes occur most notably during perimenopause has led to the assumption that fluctuating hormones are responsible for mental health problems. In fact, many other stresses a woman experiences at midlife can have a profound effect on mental health, and may be responsible for the rise in mood disorders that occurs during menopause. A depressed mood during perimenopause, as opposed to major or clinical depression, is intricately related to the status of older women in society, how women are treated at home and at work, and to other stress factors during midlife.

By the time a woman reaches her middle forties or fifties significant changes are occurring in many parts of her life. She may be facing the uncertainties of changing relations with family and friends. She may be trying to come to terms with the emotional, financial, and social aspects of divorce or the death of her partner. She may be caring for young children or adolescents living at home or returning home as young adults. She may be taking care of parents or in-laws, or dealing with the death or life-threatening illnesses of parents or friends. She may also be struggling with her own illnesses or changing expectations of career or education. Although men experience many of these life situations, women still tend to bear the major responsibility for the care of others. Given all these possibilites, it is not surprising that midlife women have physical and emotional symptoms, and sometimes feel overwhelmed.

SYMPTOMS

Researchers in North America and Europe have found that the symptoms women expect to have during perimenopause are based largely on cultural stereotypes and not necessarily on what most women experience. Women who have had problems with periods (PMS) may be more likely to have perimenopausal symptoms and respond to those in similar ways, both physically and emotionally, than those without menstrual problems. It is interesting that fewer symptoms are reported in societies in which women can look forward to gaining social, religious, or political power after menopause. Different responses to perimenopause in other cultures also may be associated with diet, number of pregnancies, use of contraceptives, and physical activity.

Differences among women may be accounted for in part by the types and quality of studies done and which types of women were included in the studies. Early studies were conducted in Western cultures among white women of at least high school education who had talked with a medical professional about symptoms that were particularly bothersome or disruptive for them. However, among women surveyed in the Massachusetts Women's Health Study, only one-third of the women had actually talked with a physician about their symptoms (Leidy et al., 2000). Common medical beliefs about the menopausal woman clearly have been influenced by the experiences of those who have felt bad enough to seek medical care for their symptoms. Even so, interviews with large groups of women throughout the United States do show that many women experience fatigue, headache, irritability, and forgetfulness. However, the range and degree of symptoms are broad. For some women they are just an inconvenience. For others, they can be disabling.

Only 45 percent of women have hot flashes, and only 16.4 percent have night sweats. Irregular menstrual periods during the transition to menopause seem to be a problem for most women, and nearly as many feel a lack of energy. Periods can be longer or shorter, lighter or heavier, or just unpredictable. Some women also have stiff joints, difficulty concentrating, bloated stomach, decreased sexual drive, breast tenderness, and excessive bleeding.

Relief for hot flashes, sleep disturbances, and sexual discomforts can make a big difference in quality of life and self-image. Hot meals or drinks, hot weather or room temperature, or even too many blankets on the bed can make hot flashes worse. Wearing layers of clothing that can be removed if needed and using a fan both day and night can help. Staying away from too many sweets, high-fat meals, alcohol, and coffee, tea, or other drinks with caffeine can improve sleep. Exercising regularly also improves sleep. For discomfort during sexual intercourse, lubricating vaginal cream is helpful. Doing Kegel exercises regularly increases control if urine leakage is a problem during sex.

INTERPRETING MENOPAUSAL EXPERIENCES

By the year 2020, about 40 million women in America will be experiencing menopause. Yet it has been only a relatively short period of time that many physicians have paid attention to the individual changes associated with perimenopause. Despite more recent public attention about this natural life process, women who have perimenopausal symptoms still may be referred from specialist to specialist in search of treatment for what may seem to be elusive medical problems. Because each woman experiences perimenopause in her own way, it is possible that neither the woman nor her physician recognizes the symptoms. As a result many women may be either undertreated or overtreated for individual symptoms for months or even years. It can be frustrating and even frightening when physicians cannot find a cause, much less a “cure,” for the symptoms. The added stress of not knowing what is happening can make symptoms worse.

One of the problems with diagnosing stages of menopause is that the signs and symptoms of perimenopause are not the same for every woman. There are hundreds of variations, and those differences alone defy the one-size-fits-all approach to treating menopause. Even more confounding to medical science, not to mention to women themselves, is that the way a woman feels about the changes at midlife is unique to her own emotional, psychological, and cultural experiences. Some women seem to breeze through the menopause years with only minor interruption to their lives. Others may feel nearly devastated by the experience. What causes such vast differences in an experience that is, biologically, a natural transition in a woman's life?

Menopause, just as other life phases, always embodies the whole of our life experiences. Each woman brings to midlife an interplay of biological function, responses to personal circumstances, and individual emotions. Some women feel completely out of control and victimized by their bodies. Others may prefer to think of menopause as a kind of dance, and marvel at the rituals and rhythms inherent in the process. Most women fit somewhere in the middle—sometimes feeling out of control and sometimes marveling at the wonder of it all.

Just as each woman experiences menopause in her own way, each also differs in the way she defines illness or seeks medical care for health problems. Women i...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• About the Authors
• Table of Contents
• Authors' Note
• Foreword
• Preface
• Acknowledgments
• Introduction
• Chapter 1. The Transition to Menopause: The Journey Begins
• Chapter 2. Closing and Opening Doors: Dealing with a Journey of Personal Loss
• Chapter 3. Mood and the Mind in Menopause
• Chapter 4. Counseling and Group Support
• Chapter 5. Exercise: Moving Along the Menopause Journey
• Chapter 6. Menopause and the Workplace
• Chapter 7. Spiritual Issues Facing Women at Midlife
• Chapter 8. Last Word
• Resources
• Selected Bibliography
• Index