Menopause: Separating myths from truth

By Penelope Morrison Bosarge, RNC, CRNP, MSN

Women’s Health Nurse Practitioner

Teaching Faculty, Graduate Programs

University of Alabama School of Nursing

Birmingham

Regardless of the passage of time, no woman is ever prepared for menopause. One way that health care providers can help their patients successfully navigate the hills and valleys surrounding perimenopause and menopause is to dispel some of the following myths.

Myth: Depression is commonly experienced by perimenopausal and menopausal women.

Truth: Menopausal women ages 45 to 64 actually have a lower incidence of depression than younger women.

Those women who are depressed before menopause are likely to be depressed during menopause. Studies have failed to support the premise that depressed mood is the result of estrogen deficiency. Entering this period being depressed, having a negative self-image, and experiencing feelings of helplessness only adds to the depression and the perception that menopause is the cause.

With the fluctuations of hormones during perimenopause, some women do experience transient or temporary dysphoria or moodiness, but not clinical depression. While this happens only to a few, it likely will pass after menstruation ceases. As a result of vasomotor symptoms, some women experience insomnia, which may result in nervousness, fatigue, and irritability. These sequelae make it difficult to function, which may lead many to presume that the primary symptoms of menopause are psychological.

If women view this period in their lives as unpleasant and out of control, any existing symptomatology, including depressed moods, will be exacerbated. If clinical depression does arise during this time, it is often precipitated by a significant number of life stressors.

When a number of life changes occur in a short period of time, it may have a negative impact on health. The menopausal years are associated with the largest number of life event changes.

Myth: Women can’t prepare for menopause. It is a cross we all must bear at one time or another. There is little to be done to prepare for it.

Truth: The most relevant factors influencing a woman’s quality of life during the menopause transition appear to be her previous emotional and physical health, her social situation, her experience of stressful life events (particularly bereavements and separations), and her beliefs about menopause.

For most women, the time surrounding menopause will be relatively unremarkable, but negative stereotypical beliefs do exist. Health information on menopause may be biased and reflect negative images of the aging woman. Initial findings from the Massachusetts Women’s Health Study, sponsored by the Bethesda, MD-based National Institutes of Health, reveal the majority of women do not seek help concerning natural menopause and their attitudes are overwhelmingly positive or neutral.

Many health care professionals are ill-informed and may consider symptoms as psychological when physiology is not clearly understood. There is confusion between the physiological symptoms experienced and somatic complaints related to the physiological, behavioral, and social changes occurring during the corresponding mid-life years.

Health care providers need to be well-informed of current research findings and data related to the years surrounding the menopause. Once armed with this information, providers need to be ready to share it with their patients. The most important aspect of care for mid-life patients is providing time to talk. Counseling women to maintain a healthy lifestyle should begin at menarche, well before menopause.

The most important component of a wellness program for the mid-life woman is to provide goals for good health. Make the time to discuss such topics as her perception of aging (which will vary with cultural, societal, and personal expectations); the normal aging process and its effects on organ symptoms; life events, both positive and negative; potential changes or challenges; lifestyle changes that can improve psychological well-being; and available resources for support.

Mid-years can be a time of valuable growth and change. Help patients explore such options as returning to school, participating in volunteer events, becoming more physically active, and revising eating habits to include less sugar and more fiber and vitamin-rich foods. Emphasize the importance of regular screening for cancer risks. If women opt for estrogen replacement therapy, monitor their progress through regular visits and follow-up.

One thing is certain: Menopause is going to happen and is beyond our control. It’s important to help patients understand, though, that they can control how they respond to the phenomenon. Explain to them that this is not a disease state but a mere stage in their natural lives, with opportunities for personal growth, productivity, and creativity.

And remind them that changes in body temperature aren’t hot flashes — they are power surges.

Selected references

1. Bosarge PM. Hormone therapy: the woman’s decision. Contemporary Nurse Practitioner 1995; July/August (supplement):3-10.

2. Hunter MS. Predictors of menopausal symptoms; psychological aspects. Baillieres Clinical Endocrinology and Metabolism 1993; 7(1):33-45.

3. McKinlay JB, McKinlay SM, Brambilla D. The relative contributions of endocrine changes and social circumstances to depression in mid-aged women. Unpublished paper available from the New England Research Institute, 42 Pleasant St., Watertown, MD 02172; 1985.

4. McCraw RK. Psychosexual changes associated with the perimenopausal period. Journal of Nurse-Midwifery 1991; 36(1):17-24.

5. Brown PB, Siegal DL, and Older Women’s Book Project. Ourselves Growing Older: Women Aging with Knowledge and Power. New York: Simon and Schuster; 1987.