Thursday 22 August 2019

Banishing the myths about Menopause

For most women, the menopause is not psychologically stressful
For most women, the menopause is not psychologically stressful

'When a woman sees her womanly attribute disappearing before her very eyes, she is bound to get a little depressed and irritable. Having outlived their ovaries, they may have outlived their usefulness as human beings. The remaining years may be just marking time until they follow their glands into oblivion" - (Everything You Always Wanted To Know About Sex But Were Afraid To Ask by David Rubin, 1969.

Hardly surprising then, that the menopause, with its inevitability and hopelessness, struck terror into the hearts of women. Then there were the denigrating adjectives to describe women at this time of life as volatile, mad, spinsters. Apart from the possible misogyny in these words, we know that the lives of women can be significantly enriched with the passing of the menopause.

There is no longer the inconvenience of menstruation as you holiday, perhaps one month sailing in the Galapagos or trekking in Nepal. The most obvious freedom is no longer having to worry about the possibility of pregnancy. Yes, there may be some weight gain, but by exercising you can lose it. The menopause occurs most commonly around the age of 50 and with the female life expectancy now standing at 83 (an increase of 33 years since 1900), we can expect many fulfilling years into the future.

For most women, the menopause is not psychologically stressful and only about 10pc are reported to regret it. Several studies have asked women which events in their lives were the most stressful and cessation of menstruation was bottom of the list. In some cultures, it is seen as enhancing the person's status as an elder.

The perennial question posed to me by my patients is whether their depression is connected to the menopause. And even women in their 30s inquire if their symptoms are an indicator of an early menopause.

Emile Kraeplin, one of the scientists who first described schizophrenia, believed that depression and the menopause were interconnected. He called it involutional melancholia and claimed that it ran a chronic course. While the myth regarding the menopause and depression persists, it does not stand up to close scrutiny.

If depression was closely linked to the menopause, then its prevalence should be highest in the 45-55 age group. Instead, study after study shows that depression is most common in those under the age of 45.

Studies examining the symptom profile of those who become depressed for the first time during the menopause with those in other age groups suffering from depression, report no difference. And first episodes of depression were no more common in the 45-55 age cohort than in any other. As psychiatrist Ian Brockingtom says in his book Motherhood and Mental Illness "… it would be a mistake to attribute any slight increase in depression, at the time of the climacteric, to the biological event or the end of the childbearing era. Social, cultural and family changes and adverse events such as marital breakdown and the departure of children, are more important than physiological changes in causing mental illness in menopausal women". Parent-child conflict has been identified as among the most serious stressor in middle-aged women.

The menopause usually has a gradual onset, but if the ovaries are removed surgically then its onset is sudden. Even in this group, there is little evidence of an increase in the prevalence of psychiatric illness. That is not to say that women who are childless will not experience regret at the passing of the possibility of motherhood. But regret is not a psychiatric illness and by the time the menopause is reached, many will have adjusted and found fulfilment in other areas of life.

What about a male menopause or an "andropause" as some refer to it? A few years ago the New England Journal of Medicine, the world's most prestigious periodical in medicine, published a scientific paper that examined the relationship between hormones and sexual function in males. The media breathlessly hailed this as evidence of a male menopause. What they failed to report was that combination of erectile dysfunction and low libido (called late onset hypogonadism) were present in fewer than 2pc of 3,400 males interviewed. The researchers warned that the diagnosis should only be made when these core sexual symptoms were present. Unlike the female menopause, which is inevitable, the entity called the male menopause was rare and the researchers identified a less dramatic change in hormones than in females. So the male menopause remains a myth.

Some years ago, former TD Pat Rabbite infamously described another male TD as a 'menopausal Paris Hilton'! These words betrayed many of the stereotypes that the word evokes - irrationality, tempestuousness etc. Now, anthropology suggests that the preoccupation with the menopause in the Western world stems from its focus on flawless beauty and youth and that the Western stereotypes are absent in other cultures. Other commentators suggest that the preoccupation represents a medicalisation of what nature has designed for us.

Whatever the explanation, one thing is certain: it is not associated with any significant increase in mental illness andw life hereafter will, in all probability, be more enriching than heretofore. So, banish the myths.

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