CHAPTER 18: Rethinking Menopause

Introduction Menopause is associated with many health issues. – Intertwined with personal, societal, and biomedical appraisals of midlife, femininity, and aging The experience of menopause is biopsychosocial.

Definitions Menopause refers to the final menstrual period. Perimenopause refers to the transitional time surrounding the end of menstruation. Premenopause precedes perimenopause. Postmenopause is the time following the final menstrual period.

Biology of Perimenopause/Menopause Physiology – Involves feedback relationships among ovarian, pituitary, and hypothalamic hormones, as well as other chemicals and brain structures

Biology of Perimenopause/Menopause Biomedical Model – Menopause is natural, healthy, and overly medicalized. Alternative Perspectives – Evolutionary theories

Perimenopause/Menopause and Life Stage Need for positive personal definitions of what it means to be menopausal – It is a Period of introspection and developmental change No cultural consensus about what it means to be a midlife or mature woman – In United States, cultural attitudes toward older women have been negative.

Perimenopause/Menopause and Life Stage Loss of fertility may be an important issue for women who have delayed childbearing. Women’s ideas and experiences of sexuality may change during menopause.

Normal Course of Perimenopause/Menopause Average age of menopause is 51 in Western cultures. Menopause is the end of fertility. – There is a typical sequence to changes in menstrual flow, but not all women progress through each stage in the same way.

Signs and Symptoms Hot flashes – Transient feelings of heat, sometimes accompanied by visible reddening or sweating Cross-cultural and social class variations – Great variations among social class, racial, and cultural groups

Coping With Distress Facilitated by a positive self-concept and sense of mastery Proactive health-promoting behaviors (e.g., diet, exercise, supplements) Cognitive-behavioral and other psychological approaches

Postmenopausal Hormone Therapy Complex issue of use of hormone therapy (HT) – HT vs. hormone replacement therapy (HRT) – Method of managing of symptoms? – Increase in breast cancer risk? – Decrease in coronary heart disease (CHD) risk?

Conclusion Menopause is associated with a wide range of health issues, including: – Understanding normal course of aging – Coping with uncomfortable physical symptoms – Forming a self-concept as a menopausal woman

Conclusion Key Points: – Menopause differs among women. – Women should not expect a predictable course. – Women should not expect that they will be unable to cope with distress if it occurs. – Cultural stereotypes have encouraged negative views of menopause and midlife. – A woman’s own definition of her life stage is key.