A recent study by researchers at La Trobe University and Monash University in Melbourne, Australia, suggests that working women “need more managerial support [while] going through menopause.” This “Women at Work” study explored the health and wellbeing of working women and women’s satisfaction at work, yet focused on working experiences in or around menopause. The lead researcher, Professor Gavin Jack, reports that “menstrual status did not affect work outcomes” but that “if a woman had one of the major symptoms associated with the menopause — for example weakness or fatigue, disturbed sleep or anxiety, then this did influence how they regarded work.” Jack is further quoted as saying: “What is really important is not the fact of going through the menopause in itself, but the frequency and severity of symptoms which women experience, and how these factors affect their work.”
This study has been described in several news sources over the past few weeks, such as the International Menopause Society, Science Daily, and IrishHealth.com. I have many reactions to this research, both positive and negative.
I’ll present my positive feelings first: I appreciate the fact that researchers are talking about the fact that menopausal women are a large part of the workforce and that menopausal experiences matter for individual women. I also applaud the attention given to the fact that workers are human beings with bodies, and that bodies matter. The idea that employers should recognize that paid workers have bodies and that paid workers may be affected by their bodies is an excellent one. I agree that employers should be educated to be more sensitive to menopause and other bodily experiences that their paid workers might have, and simple adjustments in work policies and work environments can go a long way in making employees happier and more productive (plenty of research has already shown this). Finally, and maybe most importantly, as one article in Science Daily notes, “Not enough attention is paid to the experiences which people go through at different stages of life — the workplace treats this very unevenly.” I couldn’t agree more. Especially when it comes to midlife and aging, we forget that paid workers are still dealing with bodily transitions. We forget the range of chronic illnesses that paid workers might have at midlife and beyond, as well as the many normal health transitions that any midlife or aging individual deals with. Anything from the acquisition of bifocals (and learning to see differently through bifocal lenses) to the hassles of dealing with back pain, neck pain, arthritis, hearing impairments, insomnia, etc., can affect one’s work. Not to mention menopause, prostate conditions, and other aging health concerns that can involve a range of different signs, symptoms, and stages. Starting at midlife, it is also much more common to deal with caregiving for elderly parents, divorces and remarriages, putting kids through college (or putting up with adult kids living at home), deaths of parents and spouses/partners, and other social transitions, and all of these things will impact how a paid worker feels and acts on the job. There is much to pay attention to about paid workers in their 40s, 50s, 60s, and beyond, and I believe that this research is a good start on that. Middle-aged paid workers may be reaching the peaks of their careers and may be excellent at their jobs, but they’re still dealing with a multitude of other life circumstances at the same time. And if they’re not performing well on the job, it may well be because of these very same issues. Paid workers are people, with full lives and physical bodies that they can’t leave at home (no matter how much they try).
Saniya Lee Ghanoui and David Linton
Cross-posted from Public Books
We don’t know where the coy linguistic practice of using-while-not-using so-called offensive words by appending the term “word” after its initial letter and preceded by “the”—as in “the N-word”; “the C-word”; “the F-word”; “the R-word”—came from. The practice functions in spoken and written speech the way the “bleep” does on television. Everyone presumably knows what the word in question is and says it silently to themselves whenever they hear or read the euphemism, but a quaint regard for a Victorian notion of what can be said in “polite company” allows the meaning of the expression to be put into play while not offending anyone. Furthermore, the construction is usually reserved for talking about the word rather than using it in its actual grammatical form. As such, it functions as a meta-phrasing, raising consciousness about the need to be sensitive to the potential that words have to hurt or defame their referents.
This year, Henry Jaglom, the Woody Allen of the West Coast, has cleverly appropriated the practice by applying it to another value-laden, emotionally charged topic: menopause. And while the word “menopause” itself is not as socially verboten as the four words alluded to above, the taboo phenomenon itself is, in some ways, just as culturally vexed and discomforting as the subjects of the other coded expressions.
Jaglom’s decision to name his new film (his 19th feature) The M Word cleverly appropriates the semantic maneuver to several ends. He invites the audience to think about the function of the hyphenation gambit in all its manifestations while at the same time bringing menopause out of its closet for some close scrutiny.
The plot device Jaglom utilizes for this purpose is the “film-within-a-film” construction employed in The Truman Show, The Artist, and Boogie Nights. Here, as in those films, the nature of the medium itself and the way it shapes the behavior of individuals becomes both metaphor and content. In The M Word, a character named Moxie (Tanna Frederick) sets out to make a documentary television series—inspired by her menopausal mother and two aunts—that involves interviewing a variety of women (and one man) about their experiences and views on menopause for a TV documentary called “The M Word,” which is also the title of the (non-documentary) film we, in turn, are watching in the theater. (The film is actually about perimenopause but, as is common in every-day speech, uses the word “menopause” instead. To avoid further confusion and at the risk of perpetuating this mislabeling, we will use the term of the filmmaker’s choice as well.)
Moxie is an actor on a children’s television show at the fictional KZAM network in Los Angeles, where the staff seem to have one thing in common: most of them are menopausal women. The appropriately named Moxie pitches her idea for “The M Word” at a crucial time—her station is bleeding money and a New York–based “suit,” Charlie Moon (Michael Imperioli), is flown in to assess the situation (someone is embezzling funds from the station) and make any necessary employee cuts. And this is where the title’s second meaning comes into play: money. The parallel between the menopausal women and the “menopausal” television station is obvious: both are on their last legs and losing to younger and fresher women/programming. The discussions about money are handled in the same delicate way as menopause; it is something no one wants to talk about but everyone knows what is happening. Moxie, however, brings both M-words out of the closet.
The documentary includes many zany exchanges, as when Moxie asks her mother “What are you feeling right now?” and her mother (Frances Fisher), experiencing a hot flash, fans herself with a head of romaine lettuce and responds, “I’m feeling quite wet.” But it is this type of pep that serves Moxie well when she organizes an impromptu sit-in to save her colleagues’ jobs immediately after Charlie fires a good portion of the staff.
This month an important Sage research journal, Menopause International, “the flagship journal of the British Menopause Society (BMS),” changes its name to Post Reproductive Health. The Co-Editors of this journal are quoted in talking about this name change:
“Women’s healthcare has been changing dramatically over the past decade. No longer do we see menopause management only about the alleviation of menopausal symptomatology, we also deal with an enormous breadth of life-changing medical issues. As Editors of Menopause International, we felt that now is the time for the name and scope of the journal to change; thus moving firmly into a new, exciting and dynamic area. We wish to cover Post Reproductive Health in all its glory – we even hope to include some articles on ageing in men. Our name change is a reflection of this development in scope and focus.”
This name change may seem very insignificant to most people but, for me, a change in name signifies major steps in conceptual thinking, research practice, and (potentially) everyday health care. While I have some problems with the new name (I’ll get to those in a minute), the idea that menopause researchers and practitioners are beginning to see menopause as part of a broader life course transition is phenomenal. It signifies the willingness of many in the business of studying and treating menopause to think more broadly about reproductive aging. It also indicates that many now understand that menopause is not necessarily the “endpoint” of or “final frontier” in one’s reproductive health care needs. Perhaps it also means that we might acknowledge that perimenopausal symptoms are more than single, isolated, “fixable” events and that they may be related to larger, long-term bodily changes. The very idea that “post reproductive health” is important is one that I support and advocate, and I see this as evidence of the realization that there is life after menstruating and having babies. What’s more, the re-branded journal seeks to include research on men’s health too, perhaps signifying that researchers and practitioners acknowledge the sometimes non-gendered aspects of “reproductive” or “post-reproductive” health. Everyone needs health attention, no matter what their life course stage.
What I can still critique about the name change, though, is that the new name of this journal suggests that menopause and other midlife or aging stages are thought of as “post”-reproductive. In my opinion, it is really that we live on a reproductive continuum, that we are never really “post” anything, that prior life stages always continue to affect us and that there are not strict endpoints to the menopausal transition in the way that the word “post-reproductive” might suggest. Reproductive aging as a transition could take as much as 30 years or more, and women report still having signs and symptoms of “menopause” into their 60s and beyond. According to existing research our “late” reproductive years begin in our 30s and don’t end until….what? our 60s? our 70s? The word “post-reproductive” suggests an “end” that maybe doesn’t really exist ever. Here is a link to an article I wrote on this idea of the elusive “end” to menopause, and I think it is important to think about how the word “post” may not be the best way to describe how we live our midlife and older years. We may still have “reproductive” health needs way into our 70s, 80s, and beyond, so how can we think of ourselves as “post” anything?
With this said, however, I still am very happy to see the current name change of the journal, Post Reproductive Health, because I believe it signifies a very important change in the right direction, and I hope to see many more moves like this as we contemplate what midlife and aging health really is.
I owe you an apology.
Remember when you were perimenopausal (or as we called it, “going through menopause”)? Remember when you experienced hot flashes? And remember when you did, how we, your loving family, either 1) ignored 2) trivialized or 3) mocked you? Your hot flashes were a constant source of humor around our house and I recall you joining the fun.
But I am betting that while you were yukking it up, you felt lonely and misunderstood. I think you were just ‘being a good sport’ because what choice did you have?
You deserved better.
I admit that until recently, until I began hotflashing myself, I forgot about your transition and how we responded to it. But now that I am living with my own body thermostat on the fritz, I get it.
Now that I am consumed by cycles of heat and chill with no warning, I am having a major A HA ! moment. Now that I find myself waking in the night, my pillow wet, my face wetter, my sleep disrupted, I am time traveling to our sunny kitchen on 2nd Street—you: flapping your blouse, face flushed. Me: rolling my eyes.
I feel badly that I did not appreciate that this process is HARD. I feel badly that I made fun of you, thinking you just a silly old woman whining about something meaningless.
In short, I was a total brat.
Sure. I did not have models for compassionate support. It seems that the discourse of peri/menopausel has two nodes 1) joking 2) patholgizing—another distorted binary that fails to capture the complexity of human experience.
I know that today, struggling through my own perimenopause, I need some simple understanding. I am normal. This is normal. AND this normal reproductive transition can suck to high heaven.
While, we don’t need to stop the clocks or call the midwife, I would like some acknowledgement (minus the sexist aging jokes, please) that doesn’t make me (or my body) the butt of a joke.
You deserved better when it was your time, Mom, and I am so sorry you didn’t get it.
According to a recent piece in The Times, a reputable English newspaper, symptoms are demeaning AND feminine. More specifically, the article reports on the prostate cancer experiences of Sir Michael Parkinson, or “Parky,” a famous British talkshow host. Parkinson reveals his harrowing experience of getting prostate cancer treatment and its “grueling” side-effects. While the treatments worked, they apparently produced menopause-like symptoms (hot flushes and weight gain) that reminded him of “how women feel when they are going through menopause.” Parkinson is quoted directly as saying, “In a sense you become a woman. I’m getting fitted for a bra next week!” The reporter goes on to say “he’s joking but he’s also deadly serious.” The “menopausal” symptoms that Parkinson had during his prostate cancer treatments are also described as “demeaning” in the same paragraph.
Parkinson is a major public figure in the UK, with significant media influence. I’m certain that this article was read by many as a result, and it makes me wonder about the far-reaching impact of the negative characterizations made about both women and bodily symptoms in this article. When I read this article, I find the equation of symptoms and femininity problematic, for lots of health conditions that produce bodily changes and sensations are not only experienced by women. Experiencing a hot flush or hot flash, while often attributed to menopause, is not menopause-specific all of the time. You can have hot flushes from exercising hard, from the flu, from medications that treat a range of diseases, or when you’re embarrassed. You can have weight gain at midlife (or any time of life for that matter) for a variety of reasons unrelated to menopause. Both the equation of women with symptoms and the definitions of symptoms as negative and “demeaning” show exactly how little progress we have made in eradicating gendered ideologies that harm us. Women are equated with their bodies and seen as lesser than men because of this equation. Men are supposed to be able to rise above their bodily functions, signs, and symptoms and live the life of the mind. Thus, when men experience a symptom they must rid themselves of it because, oh, the horror, they might be “like women” if they have to pay attention to their bodies at all. Research studies show quite often that women are ignored by doctors when they report a long list of symptoms and are not given the treatments they need to ease those symptoms as much as men are, because doctors learn to assume that women are just overreacting. Symptoms are not real if reported by women, studies suggest. Yet, when men experience symptoms and report them they are treated for them more often, especially when they report things such as pain. I interviewed a woman once who told me that “symptoms are always negative” and I wonder if that is partially because of the equation of symptoms with femininity and women’s bodies.
I am certain that it was difficult for Parkinson to undergo treatments for his prostate cancer. I also know that hot flushes and weight gain are never comfortable for people, especially when they seem uncontrollable. BUT, when we go on to support the characterization of symptoms as “what women feel” and then in the next breath say that those symptoms are “demeaning,” we head right into reifying gender ideologies that harm every single one of us. Men should be able to notice changes in their bodies without feeling “feminine.” We should recognize bodily symptoms as part of both health and illness that everyone experiences. And women should not have to be defined only by the fact that they go through certain reproductive transitions that include symptoms. I know Parkinson is perhaps from a generation that might still be holding tightly to gender ideologies that do not make much sense for the contemporary world, but I hold the reporter responsible for some of the characterizations made in this article, too. It is 2014, and aren’t we supposed to be more progressive than this? Because you experience a hot flush you should be fitted for a bra? In the YouTube video that appears along with this post, Parkinson himself admits “men are silly about their health.” I’ll say. But comments reported in the recent Times article go way past being silly.
A few years ago, in response to an article of mine on menopause, an editor encouraged me to think of women’s reproductive lives as “recursive”. Little did he know how much his comment would affect my thinking about women’s lives and life in general. Recursiveness is a common sense concept, but something we don’t often think about. But, especially in light of the “new” year and the sense that we all hold that we are beginning 2014 as if we have a clean slate, I decided to blog here about recursiveness. This is very relevant for anyone thinking about menstruation and menopause, which is why I write about it here.
If you look up the word “recursive” in a dictionary, you find this as one of several definitions:
“of, relating to, or constituting a procedure that can repeat itself indefinitely…”
— re•cur•sive•ly adverb
— re•cur•sive•ness noun
If you think about reproductive events like menstruation, menopause, pregnancy, childbirth or anything else, we often think of them one at a time, almost in isolation. But, they’re not isolated at all and many of them have a tendency to repeat because of the cyclical nature of all life processes. In addition, reproductive events are tied to each other in meaning and we think of them only in relation to what comes before and they only mean things in relation to what other events meant to us in the past or what situations we are dealing with in the present. Thus, potentially when two menstrual periods or other reproductive events occur, we might tend to think of them similarly, approach them similarly, and/or compare them even when they could be very different, because the first experience colors the second and beyond. To think that we might approach each reproductive event as it comes as something new and unrelated to past events or experiences is almost silly, for the past always colors our perceptions of things even if it shouldn’t. Likewise, if we think of 2014 as a brand “new” chunk of time that represents a blank slate, we are also fooling ourselves (perhaps we do so knowingly though). We can make different decisions or act somewhat differently if we’d like, but we approach 2014 with our past in mind and potentially may repeat our attitudes and behaviors in the future automatically. Even if we live different experiences in the new year and very purposely separate ourselves from past attitudes and behaviors, we might think of our new attitudes and experiences in relation to other past experiences, making attitudes and behaviors recursive in meaning at least (even if our newer experiences are not the same as in the past).
I have written here about similar themes in the past, and I do really like thinking about the recursiveness of our experiences. My brother is a forester and farmer and always talks about nature’s cycles and tendency towards repetition, but I think we can think about recursiveness in much broader terms than that too. Recursiveness is a powerful idea and it makes a lot make sense in the world. It doesn’t mean we can’t experience things differently over time. Thinking about transitions like menopause makes us realize that things (like menstruation or fertility) are definitely not the same over time and maybe stop repeating and cycling. But, in our minds, we might expect things to repeat indefinitely (and therefore emotionally wrestle with the physiological changes we experience because we don’t expect change). Previous experiences might repeat in the identities we continue to hold dear or in the ways in which we think about reproductive transitions or any other changes in our lives, even when the experiences themselves change.
As we approach this new year, I propose we acknowledge recursiveness as a real thing.
Happy new year, everyone.
This holiday season consider giving the women in your life the gift of body literacy. The books, resources and services compiled below support understanding and appreciation of our bodies.
Gifts for teenagers:
* To hold a Wondrous Vulva Puppet is to experience a loving representation of the female body. Dorrie Lane’s vulva puppets are used around the world to spark conversations about our bodies and our sexuality. To quote a testimonial on the website: “The sensual curves, velvety feel and beauty of these puppets seems to disarm people in a way that opens the door to real discussion about women’s sexuality.”
* Toni Weschler, widely known for her best-selling book on fertility awareness Taking Charge of Your Fertility, has also written a book for teenagers. Cycle Savvy: The Smart Teen’s Guide to the Mysteries of Her Body makes the perfect gift for your daughter or younger sister, neice or cousin. This book can transform a young teenager’s experience and understanding of her body as it teaches her the practical benefits of charting her menstrual cycles. Available in paperback and Kindle editions.
Gifts for those who want to learn fertility awareness:
* Justisse Method: Fertility Awareness and Body Literacy A User’s Guide by Justisse founder Geraldine Matus is a helpful gift for anyone wanting to learn about fertility awareness based methods (FABM) of birth control. It is “a primer for body literacy, and a guide for instructing women how to observe, chart and interpret their menstrual cycle events.”
For someone who wants to learn fertility awareness to prevent or achieve pregnancy, or to fix menstrual problems, finding a certified practitioner is getting easier. Technology can connect women with skilled instructors who may live thousands of miles away. Check out the practitioners below online and on Facebook.
* * * * * *
I invite other certified instructors who work locally to leave their contact information in comments.
Gifts for women in midlife
* For women who are in the perimenopausal transition – which can last from six to 10 years for most women, ending one year after the final menstrual period – give the gift of information. Connect friends and family with the website of the Centre for Menstrual Cycle and Ovulation Research where they’ll find many free resources that offer explanations and treatment suggestions for the symptoms they may experience throughout this transition including night sweats, hot flushes, heavy and/or longer flow, migraines, and sore, swollen breasts.
* To those who love fiction, consider giving Estrogen’s Storm Season, a fictionalized account of eight women’s journey through perimenopause written by CeMCOR’s Scientific Director, endocrinologist Dr. Jerilynn Prior:
They are as different as women can be—yet they share the mysterious experiences of perimenopause, night sweats, flooding periods or mood swings. We follow these women as they consult Dr. Madrona, learn the surprising hormonal changes explaining their symptoms, get better or worse, and try or refuse therapies. As each woman lives through her particular challenge, we begin to see how we, too, can survive perimenopause!
Proceeds from book sales support ongoing research.
From menarche to menopause, it is never too early or too late to acquire body literacy. I invite readers to share other gift ideas that promote menstrual cycle comfort and support body literacy.
Does menopause cause an increase in health problems ranging from heart disease to bone disease to psychological depression? One issue is that many of these claims have been criticized as being overblown both by professionals within the medical community and by critics outside it. Another issue is that when problems are linked to menopause, the suggested solution has often been estrogen supplements (postmenopausal hormone therapy)—since after menopause a woman’s body produces far less estrogen—rather than seeking more complex causes, solutions, and mechanisms.
For example, although heart disease has many causes, during the 1990s many professionals recommended hormone therapy as being uniquely effective at preventing heart disease. At one time, a middle-aged woman who was depressed ran the risk of a professional assuming that she was suffering from a hormone imbalance without a careful evaluation of her distress.
While there is more attention today to looking at what causes problems and the best way to solve them, there is still a fundamental lack of understanding of basic processes. Even if menopause is linked to a problem, that doesn’t in itself tell us the mechanism by which this happens, or the best way of solving the problem. Suppose, for example, it had turned out that research established (it hasn’t, but suppose it had) that a woman’s risk of heart disease increases because of menopause. If this was because changes in estrogen levels result in changes in a woman’s metabolism, then lifestyle changes might solve the problem by revving up her metabolism even though a hormonal change caused it. Further, some other cause might be present. Perhaps some women who feel old or are busy become less physically active at midlife. Or perhaps some women who are depressed start eating more dessert. Or perhaps (as seems to be the case) heart disease risk simply increases as people get older.
For a wide variety of problems related to menopause, it would be great if more research looked at basic causes, complex mechanisms, and individual differences.
I’ve been thinking a lot about the messages that women do or don’t get at menopause.
Because of this, I decided to come up with a list of things that women would love to hear at menopause (or perimenopause, if we are talking about when women experience the majority of their signs and symptoms).
I’ve divided my list into things that they might want to hear that are true, and things that they might want to hear but might not be true yet (but should be). I’d love to hear reader comments on this division and any ideas about what I’ve forgotten that should be on my lists!
Things Menopausal Women Would Love to Hear That ARE True:
1. It’s okay to be glad to be done with menstruation, the threat of pregnancy, the burdens of contraception, etc. It’s also okay to use the menopausal transition to question whether you really wanted kids, whether you had the number of kids you wanted, and whether you’ve been satisfied with your reproductive life in general. It’s normal to have all of these thoughts and feelings.
2. You’re entering the best, most free part of your life! But, it’s okay if it doesn’t feel like that yet.
3. Menopause does not mean you are old. In fact, potentially you are only half way through your life.
4. You are not alone. Lots of people have the experiences you do. You are normal!
5. I understand what you’re going through. (Or, alternatively, I don’t completely understand what you’re going through but I’m willing to listen.)
6. It’s okay to be confused and frustrated at this time of life, or in any other time of life!
7. You’ve had an entire lifetime of reproductive experiences, and this is simply one more. How you feel about menopause is probably related to how you’ve felt about other reproductive experiences over time, however. It might be helpful to reflect back on all of the reproductive experiences you’ve had to sort out how you feel about menopause.
8. Talk to other women you know. Talking about menopause helps everybody.
9. Menopause and midlife can be as significant or insignificant as you’d like them to be. For some women, these transitions mean very important things but, for others, they mean little. Whatever it means to you is okay.
10. Researchers are working hard to understand this reproductive transition more fully.
Things Menopausal Women Would Love to Hear But Might NOT Be True:
1. This is guaranteed to be your last menstrual period. You are done! (Or, a related one: You’ve already had the worst signs and symptoms. It gets better from here on out!
2. Signs and symptoms of menopause will be predictable and will not interrupt your life.
3. No one will think negatively of you or differently about you if you tell them you’re menopausal.
4. There are no major side effects to hormone therapies or any other medical treatments you might be considering.
5. Doctors will be able to help you, and will understand your signs and symptoms, if you need relief.
6. Leaky bodies are no problem! No one will care if your body does what it wants whenever it wants.
7. Partners, children, coworkers, and others will completely understand what you’re going through.
8. Middle-aged women are respected in this society, and it is truly a benefit to be at this life stage.
9. There is a clear beginning and a clear end to this transition.
10. Clinical researchers are researching the parts of menopause that you care about.
In my opinion, things that menopausal women would love to hear but might not be true speak to many of our societal norms and biases. Menopausal women are in a tough spot when it comes to norms about bodies, aging, gender, etc. Items on this second list also speak to menopausal women’s difficulties in accessing quality health care or getting safe relief from symptoms when needed. The latter list also notes the potential disconnects between research findings and women’s true needs during this transition. The first list represents what we should probably tell women and represents the kinds of supportive comments they might want to hear while going through perimenopause in particular.
The North American Menopause Society held its annual meeting Oct. 9 to 12. An article posted a few days earlier stated that hot flashes would be “extensively discussed” at the meeting because “temperature control is such a preoccupation for menopause.” There would be 13 presentations on low-dose paroxetine mesylate (brand name Brisdelle), “the first nonhormonal treatment for hot flashes to be approved by the US Food and Drug Administration.” A link was provided to an article about the FDA approval.
The article is titled “Brisdelle okayed as first nonhormonal Rx for hot flashes.” However, the content of the article states: “The first nonhormonal drug for hot flashes associated with menopause was approved by the US Food and Drug Administration (FDA) today despite an agency advisory committee having rejected it as too much risk for minimal benefit. …The FDA’s Advisory Committee for Reproductive Health Drugs voted 10 to 4 against recommending approval. …The FDA is not obliged to follow the advice of its advisory committees, but …it usually does.”
With regard to risks, the same article states: “Critics said the drug’s minimal superiority to a placebo did not outweigh the risk for suicide ideation and osteoporosis, 2 adverse events associated with paroxetine. …The drug’s label features a boxed warning about the increased risk for suicidality. The label also warns clinicians that paroxetine mesylate can reduce the effectiveness of the breast cancer drug tamoxifen if taken together, increase the risk for bleeding, and comes with the risk for serotonin syndrome.”
Risks might be worth it if they are unlikely and there is a large benefit. In testing paroxetine did better than placebo, so it was accurate to state that the medication had an effect. However, the absolute advantage of the medication compared to placebo was small. For example, at week 4 of the study, 60% of the women taking the medication reported relief but so did 48% of the women taking a placebo; at 12 weeks, 47.5% vs. 36.3%.
Some clinicians with patients with severe hot flashes, and some women themselves, have had the experience that serotonin reuptake inhibitors (the class of drugs that includes Brisdelle) have worked. The article on the FDA approval speculates on why the medication was approved: “In a news release, the agency seemed to explain why it overrode the recommendation of its advisory committee when it came to paroxetine mesylate. ‘There are a significant number of women who suffer from hot flashes associated with menopause and who cannot or do not want to use hormonal treatments,’ said Hylton Joffe, MD, director of the Division of Bone, Reproductive and Urologic Products in the FDA’s Center for Drug Evaluation and Research.”
For women with severe hot flashes, an effective treatment is needed. Yet, surely, a treatment with potential side effects should pass a high bar before being FDA approved.
What is a holistic approach to health? To me, this is something different than using bio-identical hormones, practicing yoga, or seeking help from an acupuncturist. Sometimes, practitioners using complementary/alternative or integrative-medicine methods have as entrenched a disease model of the reproductive system as anyone else. For example, some practitioners talk about “treating” menopause itself, especially about treating “hormone imbalances” caused by the “shutdown” of the ovaries, accepting a theory that menopause is a disease or intrinsically unhealthy. A similar idea may be applied to normal changes through the menstrual cycle or premenstrual changes that are distressing.
To me, a holistic or integrative approach involves attitudes or understandings about what health is. Feeling healthy is the baseline against which dis-ease or disease contrasts. Sometimes disease results from just-one-thing (like a hormone imbalance), but, more typically, many factors are involved. For example, menopause isn’t unhealthy in and of itself, but sometimes unhealthy or distressing complications of menopause develop based on many factors. For example, treatments for menopause-related, premenstrual, or other reproductive issues often involve lifestyle changes (in diet, activity, etc.) in addition to whatever other approaches are used.
Here is a copy of a handout I use to provide an introductory overview of holistic health:
What Is Holistic Health?
Paula S. Derry, Ph.D.
Health is more than not having any diseases.
The World Health Organization defines health as “complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Feeling healthy is an actual experience.
This may include a feeling of well-being; feeling solid, whole, at home in our bodies; feeling like we can move forward to accomplish our personal aims and goals, feeling physically strong and energetic, etc.
We feel healthy in the here-and-now.
Health involves being able to maintain our balance in the face of adversity.
Being able to cope, being resilient, being adaptable, asking for help when it is needed, etc.
Health involves the whole person and a balance among all our parts.
Physical health, mental well-being, and spiritual needs are all interconnected and play a role in overall health.
There is a natural vital energy in all living things.
Health also involves our relationship to all that is around us.
For example, relationships with other people and the physical environment. Some would put spiritual experience here.
Understanding illness involves understanding the whole person.
A person recovering from illness is restored spiritually, psychologically, and physically.
Maintaining health may mean getting help from a health professional or healer; engaging in activities for the purpose of preventing illnesses (like a diet to prevent diabetes); or having a satisfying lifestyle that is healthy and as a side-product maintains health (like if you practice yoga because you enjoy it, and it ends up helping to reduce stress).
What are basic needs, and what is a healthy lifestyle? It’s individual, but can include:
Activity (including exercise)
With regard to illness:
The body wants to heal itself.
Sometimes it needs a push in the right direction or other help restoring the ability to heal.
Holistic practitioners help the body regain its ability to heal itself. Sometimes this is not what is needed or enough, as when cancer or other illnesses require different kinds of help.
Some important parts of healing:
Restoring conditions so the body can heal itself; restoring balance to the body/mind/spirit; using the natural vital energy to help the body heal itself; attending to lifestyle; the relationship between a practitioner/giver and the client is important. Some methods: herbs, acupuncture, touch, breathing, talk, etc.