It recently occurred to me that many women are sharing their experience of menopause.  It seems to be a therapeutic issue that’s coming up more and more.  Part of the reason I am writing this article is to let you know you are not alone. 

     As I listened to Ellen (not her real name), struggling with the symptoms of menopause, as so many women do, it became clear to me how profoundly she was distressed. “I don’t understand what’s happened to me,” she said teary-eyed.  “I have the perfect life.  I’ve been married for 25 years to a wonderful man.  I have great kids and they are doing well in life.  Something is wrong.  One moment I am happy, relaxed, and calm; the next moment I am so tense I could scream or jump out of my skin.  I usually apologize but there’s always so much pressure inside of me to say what I’m feeling.  It’s like my emotions take on a life of their own.  My poor husband John has no idea what’s happening to me and neither do I!” 

     She went on to say, “I frequently feel depressed but I don’t know why.  I often dwell on the past and question my parenting.  I feel so guilty about the mistakes I made when the children were growing up.  I wonder if I’ve irreparably damaged my children.”   

     “I also miss being a mom.  All three of my children live away from home now and are doing well but I am lonely.  It not only feels like the “empty nest syndrome,” it feels like the bottom has fallen out of the nest.” 

     “I miss being needed.  I tried to return to work as a teacher, but it just wasn’t as fulfilling.  I could go back to college but I’m just not sure what I would want to do…”

     “Then I get to my spiritual life.  It’s dry and lacks spiritual vibrancy.  I just don’t feel connected to God the way I used to.  Where has He gone…or where have I gone?  I pray but I feel like my prayers don’t go beyond the ceiling.  I feel like God doesn’t hear me.  There are no answers.”

     She continued, “And God, being a father, what does He know about menopause?  It’s not like He’s been through this!  I know it’s not rational but I wonder what He was thinking when He created this phase.  I’m having trouble trusting Him.”

     “The physical symptoms are so annoying.  I have hot flashes, I can never sleep the whole night through, and fatigue overwhelms me at times.  My joints can ache, I get killer headaches, I have to urinate frequently, and it feels like there are bugs crawling on my skin.  My period is so unpredictable – some months I have it and some months I don’t.”

     Ellen sighed.  “Then there are all of the sexual issues.  Where do I even begin?  Sometimes I feel like being sexually intimate, more times I don’t feel like it.  My best friend said that’s why they call it “MEN – o- PAUSE.”  I think it’s funny but it’s all too true.  So much of the time, I just want to be left alone.  A lot of it is because I don’t feel like having sex.  There’s also vaginal dryness.  The result is that it’s painful to have sex!    My breasts are tender more often than they used to be.  Previously they were most tender the week before my period. Now they are tender not only the week before my period – if I have it – but also in the middle of the month.  John says it’s never safe to touch me!”

     “When I went to my gynecologist appointment she initially recommended Hormone Replacement Therapy.  When she found out that there was breast cancer in my family she was reluctant to suggest I try it.” 

     “On my own, I tried some herbal replacements. Since there is lack of research in terms of side effects, long terms effects, and interactions with other medications, I don’t feel comfortable using them. When I tried them they didn’t seem to make much difference.  It was recommended to take them for a long period of time but I didn’t feel safe doing that. If their reaction is similar to HRT (in terms of being susceptible to breast cancer) then that’s another reason I do not want to take them.”

     As I listened to Ellen, it became apparent to me that she was overwhelmed and confused by all the mental and physical changes that result from menopause.  We discussed menopause.  I gave her information to read to educate herself about this stage of life.  She needed to understand the hormonal changes her body was undergoing and the ramifications of those changes.  I recommended that she schedule a follow up visit with her gynecologist to discuss more in-depth the HRT and other possible alternatives.

     I encouraged her to write down specific questions for the doctor so she could get answers to all her questions.  This was imperative because so many women forget their questions once they actually see their doctor - or the doctor may be in a hurry. Not wanting to cause any problems, the woman tries to be “a good patient.”  She does not want to “bother” the doctor with her questions, which “probably aren’t so important anyway…”  I needed to impress upon Ellen that it would be good for her to partner with her doctor and that she advocate for herself.  I told her that her health is her responsibility and this may require assertiveness on her part. 

     Some of Ellen’s reluctance to be sexually intimate stemmed from painful intercourse. Ellen studied the physiology of the reproductive system to understand what was occurring in her body.  She learned that decreased estrogen to the vaginal walls caused the lack of lubrication.  She tried some over the counter lubricants to see if that would help.  When that did not help her, she spoke with her doctor and decided to try an estrogen based lubricant, which the doctor prescribed.

     Understanding that a slower sexual response is normal for this stage of life enabled Ellen and John to relax, thereby becoming more responsive.  It removed the pressure from their sexual encounters, allowing them to once again enjoy their relationship instead of feeling that they were not performing adequately or satisfactorily.

    Although initially skeptical, Ellen’s husband, John, agreed to come in for a visit to address the marital tensions that were caused by menopause.  He was eager to understand what he might be able to do to help in this situation.   We discussed techniques that would relieve tension for each of them.  We talked about how he might become more sensitive to her needs.  For example, if she needs space, allow her that. John asked, “But how do I know?”  I suggested that he just ask her, thus preventing mixed signals.  I also helped him to understand that it was counterproductive to take her symptoms personally.  Menopause was not about him, it was about her:  her changing hormones, changing body, changing moods.  I impressed upon him that it was not his fault, and that he wasn’t doing anything wrong to create this.  Once he understood these things (and it did take a little time), John felt a huge wave of relief.   As his understanding of the role he was playing improved, he became more supportive, and their communication improved as well.

     There were also times Ellen came into counseling very “weepy.” When those times occurred, I allowed her to cry, encouraged her to cry, to get it out, and that it really was safe to cry in my office.  This alleviated the need to cry so much at home. 

     Ellen and I prayed together.  We worked on her relationship with the Lord. She came to believe not only in her head but also in her heart that God really does understand every stage of life (since He created them!), including menopause.  She was reassured to learn – once again – that just because God does not feel close does not mean that He is removed.  Over time she found out that He is just as close as He has ever been.

     Ellen found out that there’s a part of menopause that has to be tolerated and gone through.  The acceptance of this reduced her symptoms.  She came to understand several things:   She is not the only woman trying to get through this phase of life; she’s not crazy because she feels the way she is feeling. It’s normal for her to go through these questions and changes during this stage.  John came to understand that he needed to become more supportive, less argumentative, and that he needed to stop taking her erratic behavior personally.  He understood that this really was about her, not him.

     Ellen and John continue to adjust to this new stage of life.  They work to communicate clearly in their lives, knowing that there will be bumps along the way but that the bumps are to be expected and are probably “normal” during menopause when so many things are changing.

     Hopefully, as you read this, if you are one of the many women who struggle with the same issues as Ellen, you will not feel alone.  Be comforted with the knowledge that many women struggle with these issues.  Also be comforted because there are answers.  Just know that it may require patience and persistence as you try various possibilities and solutions.

     In addition, it’s not necessary for you to go through this alone.  Find someone in your life whom you trust and can confide in.  It may be a support group, a women’s ministry leader at church, a doctor, a close friend, or an older woman who has already gone through this process and can mentor you.

     You can manage the menopause madness!

Mary