Introduction Throughout life we are faced with many pathways. It is the paths we choose that affect how we live and the way we feel. Some women see midlife as a crossroads -- a time of change and potential. This can be a truly exhilarating time for women who embrace possibilities and maintain their health. It can be a time of profound growth and creative endeavor -- a time to strengthen social bonds and tap into inner wisdom.
The menopause transition is a unique experience for each woman. Many women cruise through it with few problems. But the transition can throw up some real physiological "speed bumps." The erratic nature of fluctuating hormones during this time can make life difficult and for some women extremely trying. These are the women who walk through our doors. They often complain of difficulty sleeping, troubling hot flashes, mood swings, worsening PMS, concerns about memory, and difficulty managing menopausal symptoms within the context of their busy lives. They may experience feelings of isolation. Concerns about sexuality and other changes may be affecting their interpersonal relationships. Often, sharing their stories and talking about the transition with other women makes a big difference. As they learn more, they soon find that they have more control over how they feel than they had originally thought possible.
If you notice that hormonal fluctuations are affecting the way you feel or slowing you down, you are not alone! And you are not alone if you are apprehensive about which path to take when it comes to medical care. Debates over hormone use have left many women unsure of what to do and whom to trust.
In Mind Over Menopause, we hope to help you sort through your many health care options. Most importantly, we hope to convince you that you are your best guide. You hold the power when it comes to knowing your body, understanding your symptoms, and determining your needs. And you'd be surprised at how much power you have in managing the midlife transition.
What we have found, based on thirty-five years of research and patient care, is that we all possess an innate ability to heal and overcome adversity in both a physical and an emotional sense. The years around menopause are a great time to reassess your health care; tend to your physical, emotional, and spiritual needs; and look toward the future. Our goal is to provide helpful advice about how you can make changes, starting today, which will help you manage the symptoms of menopause and improve your long-term health.
The strategies we describe, "tools" as we like to call them, are the same ones that we offer to patients in our Mind Over Menopause Program at the Mind/Body Medical Institute. The basic program lasts for ten weeks, during which time participants attend weekly two-and-a-half-hour sessions. The first program was developed in 1991 by Alice Domar, Ph.D., and was refined and enhanced by Eileen O'Connell, Ph.D., R.N., C.S., in 1997. Under the guidance of Leslee Kagan, M.S., N.P., it has continued to grow -- helping many women make significant changes in their lives and ease or eliminate their symptoms.
One of our groups was evaluated in a pilot study in 1999, and the results were presented to the North American Menopause Society -- a scientific, nonprofit organization devoted to promoting women's health during midlife and beyond. When the participants were tested after the program concluded, they were found to have experienced substantial improvements in their quality of life. Their hot flashes were reduced in intensity and number, they experienced marked reductions in psychological distress, including depression, and they felt more prepared to manage their "stressors." They were also more comfortable talking about issues and found great support in empathizing with other women. As a result, they felt less isolated and more connected.
In addition to these improvements, these women had been successful in adopting a variety of health-promoting behaviors. Months after their participation, they were still exercising more, eating better, and experiencing enhanced personal relationships and spiritual growth. All told, the pilot study demonstrated that this is a healthy, self-care approach to menopause, one that could not be accomplished by a prescription alone!
We believe you too can benefit from the many tools we teach.
In this book, you will find a step-by-step guide to managing menopause that combines the latest information about stress management, nutrition, exercise, and other health care decisions, including an approach to medications. This book builds on advice offered in earlier books by Dr. Herbert Benson, particularly The Relaxation Response and The Wellness Book. It also builds on the work done by Alice D. Domar, Ph.D., who applied these teachings to women's health issues and passed her knowledge on to readers in her books Self-Nurture and Healing Mind, Healthy Woman. Mind Over Menopause is just one of several clinical programs that are offered at the Mind/Body Medical Institute. We also have programs to help people deal with heart disease, infertility, insomnia, cancer, HIV, chronic pain, and general stress-related symptoms. Founded in 1988 at Beth Israel Deaconess Medical Center, the Mind/Body Medical Institute is a nonprofit organization dedicated to advancing scientific research, public education, and professional training in the field of mind/body medicine. This field helps people tap their own natural capacity to heal in a way that complements other traditional medical approaches. At the Mind/Body Medical Institute, we employ an interdisciplinary team of exercise physiologists, advanced practice nurses, dietitians, psychologists, and physicians who together have developed the strategies you will find in this book. Thousands of people have already completed our mind/body programs, and made significant changes in their lives. We hope you can use the tools and knowledge in this book as you embark on your journey.
A variety of health professionals may play important roles in the care of menopausal women. These providers range from physicians to nurse practitioners, from psychologists to nutritionists. For this reason, we've used the term clinician throughout the book to refer to those individuals providing clinical care to menopausal women.
Note: Patients' names have been changed throughout to preserve confidentiality.
Copyright © 2004 by the President and Fellows of Harvard College
Chapter One: Redefining "The Change"
Imagine hovering at the edge of a lake. You know the water is going to be cold, but you ease in (or maybe you plunge in headfirst!). At first it's unbearable, but as you work your muscles, the discomfort goes away and you enjoy the swim. For many women, menopause is like this. The transition can be difficult and there may be apprehension, but when all is said and done, it's not as bad as expected. They may even walk away feeling invigorated and full of life.
Millions of women worldwide report the years after menopause as a time of increased confidence and feelings of empowerment. As Margaret Mead, one of the world's foremost anthropologists, observed, "There is no more creative force in the world than the menopausal woman with zest."
And, that creative force is growing exponentially. The aging of the "baby boomers" means that an unprecedented number of women are reaching menopause now. In the United States, there are approximately 42 million women over the age of fifty. From 1990 to 2030, some 1.2 billion women worldwide will go through the years of "the change." As millions of women look for meaning and seek answers, menopause is truly being redefined. It is long overdue.
Menopause and Beyond
A century ago, most women did not live much beyond the age of menopause. But today, a woman who is healthy at menopause can expect to live another thirty or forty years. That's more than a third of your life! And unlike past generations, women now speak openly about menopause. The increase in communication has come at an important time. Today women are faced with more choices about their health care than ever before. Making good choices regarding lifestyle and health care can help you fill your postmenopausal years with happiness and health.
Menopausal symptoms, heart disease, and osteoporosis are all major concerns for women at midlife because all are linked to declining levels of the hormone estrogen. One of the biggest decisions in the past -- and probably the most confusing -- has been whether or not to take hormones. Yet research is proving estrogen is only part of a much larger and complex equation, still not entirely understood.
What is becoming increasingly evident is that the way we feel, how we handle symptoms, and our risk for disease are dramatically linked to our lifestyles. The advice we offer in this book is the same that we provide to participants in our mind/body program for menopause called Mind Over Menopause. The framework for all of our programs is based on the philosophy that your attitudes, health care choices, and lifestyle behaviors can significantly affect your overall well-being. Some women enter our programs simply seeking information to help them make decisions. Some express sadness at the loss of their youth and are looking for ways to change their perceptions of getting older. Others want the tools to manage menopause symptoms. And still others seek support from women facing similar life-stage issues.
The techniques and advice we offer in this book are designed to give you the power to manage menopause symptoms while reducing your long-term risk for disease. They have been backed by scientific research, and women in our programs have found them to make a profound difference in the quality of their lives. Our patients report a decrease in intensity of hot flashes, improved sleep, a significant decrease in tension and anxiety, and a decrease in depression. In addition, they are successful at making long-lasting chang...
