Menopause 101: new-school strategies for navigating the change

Girl, I was so hot, I took my own temperature, and I couldn't believe it was normal," says one woman.

"And I stuck my entire head in the freezer trying to cool off," says another woman. What are these women talking about? Our fore-mothers called it "The Change." The medical term is menopause, and it is an important and unavoidable transition for all women on life's journey.

By age 60, experts say, nearly all women will have experienced it, although in the U.S. the average age of onset is 51. Menopause comes from the Latin words meno, meaning "month," and pausus, meaning "cessation," say Dr. Marilyn Hughes Gaston and Gayle K. Porter, Psy.D, authors of the book Prime Time, The African American Woman's Guide to Midlife Health and Wellness (Ballantine Books, revised edition 2003).

It literally means the end of menstruation and the time when the ovaries either severely decrease or stop producing estrogen. The estrogen decline can begin in the 30s, before most women are even aware it is happening. Black women often believe they will go through menopause later because they started having periods early, but that has not been verified in recent studies. "But for those women who smoke, we do know that menopause tends to start one year earlier, and we find that if your mother or grandmother tended to go through menopause earlier, perhaps at age 45, 46, you are likely to go through it earlier as well. It's a transition," says Dr. M. Natalie Achong. "It's not like one day you wake up and you're menopausal. It's defined clinically as not having had a period for 12 cycles--for most women that means a year."

"This is not a disease," says Dr. Gaston. "It's not abnormal. This is a normal process--women have gone through this for eons."

Experts say 15 to 20 percent of women have mild symptoms or no symptoms at all. In some cultures, particularly Asian cultures, women rarely report problems during menopause. "We need to help women get ready for the changes," says Dr. Porter. "If they prepare, they are less apt to experience some of the really negative and debilitating emotional responses."

Sharlie A. Stevens, 54, of Youngstown, Ohio, says menopause, for her, was a small thing to deal with. "I'm a very positive person and I just decided to deal with it," says the recent General Motors retiree. "I'm secure in who I am; this is just a process, another phase of life." The first sign that she was going through menopause was the fact that she was often emotional. "I cried a lot and the least little thing would bring tears," she says. Exercising three times a week has helped her cope, and she says now that the hot flashes and other symptoms have subsided.

Although most women experience menopause naturally, some women start menopause abruptly and suddenly after surgical removal of the uterus and/or ovaries. Women who experience menopause after surgery tend to have more severe menopausal symptoms, including depression, experts say. Carolyn Scott Brown of Seattle had a hysterectomy at age 44 and plunged into immediate menopause, suffering severe insomnia and other symptoms. She calls herself a "menopause rebel" and has been open about the process. With Dr. Barbara S. Levy, she has written the book The Black Women's Guide to Menopause: Doing Menopause with Heart and Soul (Sourcebooks, Inc., 2003) because there was little support for Black women. "Menopause was an emotional and spiritual wake-up call for me," she says. "It took me to a place where I had to resolve some old issues, how happy I am with the person I am today, with the work that I'm doing with my purpose in life." She says Black women have historically not wanted to talk about menopause for two reasons: "They feel there is a stigma attached to menopause that it makes you old; and they feel it detracts from their sexuality."

The issue of sexuality in midlife is complex, but experts agree that menopause is not the end of a woman's sexuality. "If a woman enjoyed a healthy sex life in her 20s and 30s, she's likely to continue with that, "says Dr. Achong, a Yale University-trained, National Medical Association physician.

For some women, freedom from pregnancy can invigorate intimacy. "Some women feel so free that they say sex is better than it's ever been," Dr. Gaston says. "This is an area where we can build on our strengths as Black people because we have much reverence for older women and we know a lot of very attractive, vibrant women who are over 60. Our sexuality is not tied up in having an anorexic-looking body." Dr. Porter says: "You can look at 60 [as being] a healthy, attractive vibrant person, and now you've got a mind and some experience that you didn't have at 20."

This is one reason, experts say, they emphasize a holistic strategy to navigating menopause--one that includes the total package of mind, body and spirit.