Blog of the Society for Menstrual Cycle Research

Male Menopause, Andropause and now “Manopause”?

August 22nd, 2014 by Heather Dillaway

August 18, 2014 cover of TIME magazine

By now, everyone has probably seen this week’s TIME cover story. The magazine’s August 18th cover photo showed a topless, seemingly frumpy, middle-aged man worried about his loss of testosterone and (therefore) manhood under the title, “Manopause?! Aging, Insecurity and the $2 Billion Testosterone Industry”. The cover story details the booming testosterone (“Low-T”) industry in the U.S., describing the reasons why middle-aged men might go to the growing number of Low-T clinics for treatment. While the article draws some interesting parallels to the hormone therapy industries that have targeted women and highlights some of the important risks and unknowns about Low-T treatments, there are some interesting gaps and missteps in the article that are worth detailing.

First, if we are going to talk about a male menopause, can we please pick one term? This author of this article refers to male menopause, andropause, and then titles his article “manopause.” So, which is it? Having all of these terms floating around is just confusing. As we know from research on women’s menopause, having more than one term or having vague terms for a health condition just leads to confusion. This article adds to the confusion over terminology.

Second, the article is titled “Manopause” but really has little to do with this supposed testosterone “deficiency” condition. The article is mostly about the growing Low-T industry and men’s search to remain youthful. It is more about potential treatments for testosterone deficiency than anything else. Anyone looking for information on what “manopause” is would be misled by the title and would not find any answers in this article. At most, readers learn that men who are worried about aging might have low testosterone. Readers will not gather comprehensive information about manopause, andropause, male menopause, or male aging.

Third, this article only addresses research on testosterone “deficiency” in a cursory manner. Readers looking for actual evidence of decreasing testosterone in midlife or the need for Low-T treatment should make sure to consult scientific studies of such things. Since this is TIME magazine, this is not a source of any real information on these subjects. As another commenter reports, the author’s reference to “foggy science” is also misplaced; while we do not have complete answers, there are real studies to be found on this subject.

Fourth, there are comparisons made to women’s menopause, hormone therapy for women, and how women handle their midlife transitions in this article. While it makes sense to compare endocrinological changes in women’s and men’s bodies and burgeoning hormone replacement industries for midlife women and men, comparisons about how women and men “handle” their midlife transitions are a bit misplaced and subjective here. The author states that “women handle their [bodily] betrayal more matter-of-factly – a nip, a tuck, a tint, maybe, but not a Vegas condo”. The author argues that, “judging by the demographic profile of sports-car buyers,” men don’t deal well with testosterone deficiency and bodily change. As someone who has studied women’s bodies and women’s menopause for almost 20 years, I think this comparison masks the variation in how women or men might experience these transitions and reifies gender dichotomies that help no one in the long run. Women DO have trouble with bodily change at times. And the majority of men still forgo Low-T treatments. The author would have done better if he had steered away from these gendered generalizations about how individuals “handle” midlife.

A commenter at HealthNewsReview.Org asks, Does Manopause Really Warrant one of TIME’s 52 Covers This Year? This is a great question. The power of pharmaceutical industries in this country means that topics like this get more press than is probably warranted (especially in light of all of the topics that could have had this front page, such as Ebola, Ferguson, Parkinson’s or ALS disease, foreign conflicts, etc.). Some scholars argue that we are experiencing the “pharmaceuticalization” of society, which puts industries like the Low-T industry front and center and makes us think in terms of “deficiency”, “disease”, and “replacement”. Pharmaceuticalization reinforces ideas about the importance of youthfulness and unchanging bodies and makes the onset of midlife problematic in general. We are actively urged to fight bodily change (here termed bodily “betrayal”) despite how normal it is.

Lately I’ve also seen a lot of press on men and masculinity. NPR has been running an “All Things Considered” series on boys and men this summer, detailing the hardships and unique experiences that boys and men have. I also read that a group of middle aged men recently got together to create a play called “Four Play” to combat the hype around Menopause: The Musical – to make sure that men have their stage too. In Detroit this summer we’ve also been tangoing with groups of Men’s Rights Activists who feel that feminists are taking over the world. To me, the “Manopause” cover of TIME magazine falls right in line with other recent attention to “men’s issues”. To me, this is all a backlash against attention given to women’s issues. In some cases I don’t even think it’s a conscious or calculated backlash but it still presents as one.

Overall, I’m indifferent about this TIME story. I don’t think it warrants the cover photo or the cover story but it is interesting to find out about a growing testosterone industry. Nonetheless the hype around the story concerns me because I keep thinking about what’s lurking behind the hype. For instance, we have to think about the gendered dynamics behind these stories and media portrayals, for gender forms an important backdrop here and can hinder the pursuit of real knowledge about these midlife transitions. Gender ideologies are what make testosterone (and estrogen) important in the first place. In addition, I do think we need to settle on one term for male menopause/andropause/manopause and why it might be important for us to think about. Finally, we really need to think about what pharmaceuticalization means for all of us.

Waiting

August 20th, 2014 by Heather Dillaway

re-blogging re:Cycling

In celebration of our fifth anniversary, we are republishing some of our favorite posts. This post by Heather Dillaway originally appeared October 28, 2010.

I’ve been thinking a lot lately about the words we use when we’re talking about menstruation or reproductive experiences more generally. I’ve been noticing lately that we use the word “waiting” quite a bit. I have a friend who is “still waiting” for her menstrual cycle to be “normal” again after her second child, and several other friends who are either “waiting” to figure out whether they will get pregnant, “waiting” to be done with their pregnancies, or “waiting” before they can have their last and final kid. I just had my basement waterproofed and one of the basement repairmen told me that his wife had been “waiting” ten months to get a menstrual period and that they were worried about her (this is information he volunteered after I told him I studied women’s health). I started thinking more about how the menopausal women I interview always talk about “waiting” to figure out whether they are really “at menopause,” or “waiting” to figure out if this is really their last menstrual period. Or how so many girls/young women who are sexually active are “waiting” to get their periods so that they can be relieved to know they are not pregnant. Or how women with painful periods, endometriosis, or migraines are waiting until those days are over each month. What does all of this reproductive waiting (waiting for menstruation, waiting for menstruation to be over, waiting for pregnancy, waiting for birth, waiting for menopause) mean?

In all of these instances of reproductive waiting, waiting seems a negative connotation and that seems to stem from the fact that we do not feel in control or in charge of this reproductive time. When I think of the other situations in which I might use the word “waiting”, the same holds true. I tell my kids to “wait their turn” and they don’t like it. And none of us really like waiting in line. Fast food restaurants, frozen dinners, and ATM machines are all in existence because we don’t have time or don’t like to wait. Phrases that we use like “worth the wait” also connote negativity about waiting. So, I finally looked up the actual definition of waiting. Depending on which online dictionary you visit, definitions of “waiting” include: “pause, interval, or delay,” “the act of remaining inactive or stationary,” or “the act of remaining inactive in one place while expecting something.” While some of these definitions do not automatically lend themselves to negativity, waiting is defined mostly as a passive activity that we are forced to participate in, perhaps against our will.


All of this makes me think further about whether women really dislike the waiting or the time that comes with menstruation or other reproductive experiences, and whether women really feel out of control as they engage in their experiences. Is this just a word we use or are we really impatient about menstruation and reproduction? When I think about alternative words that are sometimes used, like “tracking,” other words seem much more agentic in that they put women back in control of their cycles and other reproductive experiences. So, is it just the word “waiting” that has the negative connotation or is that word signifying some larger impatience that we have about reproduction these days? I have a colleague who writes about the “inconveniences” of reproduction and how, in so many ways, we try to avoid the reproductive waiting or reproductive uncertainties we face. For instance, instead of waiting to see when a baby is born, we might plan a c-section so that we can know when we’ll get that baby. Or, now we’re told that if we’re “waiting” more than 6 months to get pregnant that we should probably start taking fertility drugs to shorten our wait or get rid of some of that uncertainty. Or now we can find out that we’re pregnant a couple weeks after conception instead of waiting to see whether we menstruate a few weeks later. We attempt to cut out some of those reproductive waits these days. Menstrual suppression is at least partially popular because then women won’t have to be surprised by their periods or wait to know what bad day their period might fall on.


I think perhaps we do need to be more conscious of the words we use to describe our own and others’ reproductive events. Is “waiting” the correct word to use? Is “tracking” a better word to use because of the agency/active control it implies? Is “experiencing” a broader, less value-laden word to use? What do we really mean when we use these words?

Save the Date! The Next Great Menstrual Health Con

June 16th, 2014 by Chris Bobel

We Bring Our Bodies to Work

May 23rd, 2014 by Heather Dillaway

“Woman Working,” courtesy of Open Clip Art

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).

The M Word—In Multiplex

May 21st, 2014 by Saniya Lee Ghanoui

Saniya Lee Ghanoui and David Linton

Cross-posted from Public Books

Tanna Frederick, Eliza Roberts, and Frances Fisher in The M Word.

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 ShowThe 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.

What’s In A Name?

March 27th, 2014 by Heather Dillaway

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.

A Letter to My Mom: I am Sorry I Was A Brat

February 17th, 2014 by Chris Bobel

Photo courtesy someecards.com

Dear Mom,

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.

Love, Chrisi

Symptoms are Demeaning….and Feminine?

January 31st, 2014 by Heather Dillaway

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.

Recursiveness

January 3rd, 2014 by Heather Dillaway

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.

Cause and Effect

November 11th, 2013 by Paula Derry

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.

What Menopausal Women Want to Hear

November 7th, 2013 by Heather Dillaway

 

Photo Courtesy of Heather Dillaway

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.

Brisdelle for Hot Flashes

October 14th, 2013 by Paula Derry

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.

Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.