When Robert A Wilson, MD, a Brooklyn-based OB-GYN, argued that estrogen therapy allowed menopausal women to remain feminine forever, he had a certain idea of feminine in mind!
Feminine Forever was the title of Wilson’s influential book, published in 1966, which convinced women and their doctors that menopause was a curable “hormone deficiency disease.” In the book, Wilson made grandiose promises of the multiple benefits of supplemental estrogen – promises that we now know are false. He also outlined how menopause had impacted his patients, including one particular woman whose husband first came to Wilson begging for a cure for his wife because, in the husband’s words:
“She is driving me nuts. She won’t fix meals. She lets me get no sleep. She picks on me all the time. She makes up lies about me. She hits the bottle all day. And we used to be happily married.” (p. 81)
For Wilson, it was the woman’s hormone deficiencies that made her unfeminine and fail at being a good wife, not perhaps the emergence of a midlife awakening, the type of which may occur when you are married to a macho man of the 1960s (or 21st century). Did I mention that her husband placed a gun on Wilson's desk and threatened to kill his wife if the doctor didn't cure her?
Wilson claimed that estrogen therapy saved the day! The change – a collapse in her femininity – was halted; the woman returned to take care of her husband and avoided a violent death.
Today, your doctor probably won’t list avoidance of murder as a benefit of HRT, as Wilson did – although there are certainly doctors who still share other disproven ideas that he promoted, such as the idea that estrogen therapy will offer you long-term protection from heart attacks and cancer.
In addition, your doctor can no longer prescribe HRT for life, as if menopause is a life-threatening chronic illness, as Wilson and the rest of the medical community used to do for decades. And yet modern medicine still relates to menopause as if it were a hormone deficiency disease, even if doctors no longer label it as such.
By my mid-40s, I was already aware that many of my perimenopause symptoms, including extended PMS, migraines and night sweats, intensified each month between ovulation and menstruation – which is what classically happens in perimenopause. I shared what I was experiencing with my doctor but she promptly dismissed the possibility that my symptoms could be connected to midlife change because at 45, I was “too young!”
My experience of being confronted with a doctor who clearly lacked knowledge of women’s life cycles is incredibly common. Other women have shared that even in their 50s, when they’ve gone to their doctor seeking symptom relief, they’ve been told that they are not yet in menopause because based on the tests done on their hormones, the lab computer said so!
Women’s knowledge of their own bodies is being ignored, because menopause has been reduced to a diagnosis based on whether a woman can be a candidate for the medical “fix” for menopause, namely HRT. If a woman doesn’t meet the medical criteria to receive HRT because of her age, or because on the day and time when a woman’s hormones were tested, they didn’t match the required menopausal levels as defined by medicine, a woman may be told that she is not menopausal even when she’s certain she is!
Menopause should not be defined by what the lab computer churns out and not by the warped theories of women’s health that have lingered on from the last century. Yet menopause has been drawn into the system of disease management that focuses on what’s going on downstream in the patient – the lab results and a collection of symptoms – and then offers long term medication as a fix.
For women who are experiencing multiple symptoms at midlife, whether they are a candidate for HRT or not, they are often offered a cocktail of medications – one for anxiety, one for insomnia, one for eczema, one for migraines, and so on. This is the logical equivalent of discovering that a number of streams that all flow from the same river are polluted, and attempting to clean each one of the streams daily, rather than taking a trip upstream to the river that feeds into the streams, to discover what the source of the pollution is, in order to deal with it there.
Happily in the medical world, there are doctors who are challenging this practice. I was not surprised to read in Dr. Rangan Chatterjee’s fascinating book, How To Make Disease Disappear, that when Dr Chatterjee takes an upstream view of his patients’ health and addresses issues of stress, diet and gut health, sleep, sunlight, toxins and physical activity, he’s not only able to cure what in the West we usually regard as life-long chronic conditions, such as Type II Diabetes, high blood pressure, depression and dementia, but he’s also able to offer women relief for menopause symptoms.
Dr Chatterjee realized that by offering medication to suppress symptoms, he wasn’t tackling what causes the symptoms to begin with, but by looking at what was out of balance in patients’ lives, he could guide them back to good health and reverse diagnoses of disease.
In the case of menopause, we don’t need a diagnosis based on hormone levels because firstly such a diagnosis is inaccurate – our hormones are fluctuating! – and secondly, as I have argued before in this blog, our fluctuating hormone levels do not create our symptoms, they create the sensitive time for symptoms to arise when our lives are out of balance.
I have encountered numerous accounts of women reaching a meaningful reduction in their perimenopause and menopause symptoms by cleaning up their diet, exercising, taking better care of themselves and offering themselves more compassion during these sensitive years. And in my work, I have seen the most significant reduction of symptoms through understanding how our experiences in life are created, and in particular by addressing how and why stress, anxiety and low moods can spike during perimenopause and menopause, and why, even when our hormones are in flux, they don't have to.
As Chatterjee also explains in this TEDx talk, in order to cure his patients who had been diagnosed with chronic conditions, he had to look beyond what he was taught at medical school, and instead shine light on patterns of modern living that so many of us have fallen into. Chatterjee helps his patients avoid long-term medication by, for example, reducing stress at work, limiting the consumption of processed foods, increasing sunlight and movement in their day, and encouraging other life-style behaviours that challenge what has become the norm in Western societies.
To understand how to help women in menopause, doctors also need to look beyond what they learned in medical school, which was invariably impacted by the false science of Wilson’s time. The structures of our societies have not evolved with women’s life-cycles in mind, and certainly do not support women through the sensitive years of midlife change. Our multiple perimenopause and menopause symptoms, which are very particular to a modern Western woman’s experience of midlife change, offer testament not to how women are destined to malfunction at midlife, but to how far we have fallen out of line with ways of living that can support our health.
Menopause is not a disease and yet when we treat it as if it is, we don’t serve women. This is becoming more obvious in this day and age when menopausal women are only allowed to take HRT for a limited number of years (due to the proven health risks of prolonged use). Women who had hoped that HRT would cure their symptoms are faced with a new reality once they have to come off HRT – all their menopause symptoms return. HRT does not cure symptoms, it suppresses them and it allows us to forget what is actually out of balance in our lives.
The purpose of perimenopause and menopause is not to allow us to feel like we are falling apart and losing the woman we once were. It is a transition period to prepare us for our wiser woman role. We are supposed to awaken, learn and discover that which will keep us and those around us healthy for decades to come. Treat this transition period as one of disease, and treat symptoms as evidence of malfunction rather than a wake-up call, and you will miss one of life’s greatest lessons.
Now, why would you want to do that, when your wiser woman role awaits you?
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