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.