OPTIMIZE YOUR HEALTH
Integrated Medicine for Menopause

Menopause & the Maturing Woman
By Dr. Stephanie Buehler

Menopause is a time not only of physical change, but emotional and relational change as well. Increased depression and anxiety are possible at menopause, but generally occur in women who have already experienced episodes of depression or prone to anxiety disorders such as generalized anxiety and panic disorder. Although it is critical to recognize and treat such problems, other changes occur that are more positive. Many women come into my office at menopause and declare, “This is my time.” But what do they mean? Generally, menopause signals the end of one’s reproductive years. Although one may still have teens at home, the role of mother is essentially closing. Now there is time to focus on one’s self. More than that, though, women at this age often report that they feel more assertive and less concerned with what others may think about their actions.

Please allow me to diverge for a moment into a bit of what some might call psychobabble. Carl Jung, a protégé of Freud, developed the idea of archetypes, which are basic, human, unconscious patterns of behavior. We may seek to fulfill these archetypes, sometimes as a spiritual calling (the healer, the teacher, the judge), or we may struggle internally because of various blocks to their fulfillment. In our Western culture, maturing women may have come of age during the reign of feminists like Gloria Steinem, but for the most part women do not have the same opportunities as men to express power. Instead, potent female archetypes are subsumed, or pushed down, in favor of more acceptable roles such as mother. But menopause signals an end to some of the conventions that women find necessary. Now, with reproduction ending, Jung would say other aspects of the self seek expression.

How do women at menopause say they express these aspects of the self? Women of all sorts tell me that they are less likely to put up with nonsense and to cut to the chase. Mortality is staring one in the face — there is no time to waste! Women may return to work, paid or volunteer, not just to earn money but to establish an identity; women who have been working may intensify their careers. At menopause, women have a sense of having lived, perhaps by experiencing the ups and downs of various relationships, raising children, or tending to the needs of an aging parent. They have all most certainly faced the death of a loved one, and they may have experienced chronic pain or illness in themselves. With a sense that life is impermanent and fleeting, many women at menopause grab onto life with gusto. If one’s body cannot produce life any longer, one can still affirm life by diving in and expressing one’s existence, not with a whimper, but with a defiant dance of feminine energy.

Jung explained this transformation in another way. He stated that in youth and adolescence, we tend to see a world of opposites, and to experience these opposites within ourselves. For example, teens see themselves as omnipotent when in fact they are still quite dependent. As we grow older, we have more experience in understanding that there are more shades of gray, and we resolve many of the struggles of opposites within ourselves. We become more comfortable within our own skins. Think about this, too: As we age, men and women become more and more alike, demonstrating the fact that the differences between us are no longer so very important. Of course, our hormonal changes also erode the differences between the sexes. But the psychological changes are profound.

All that being said, depression can and does sometimes occur because of the effects of hormonal changes. Although hormonal changes may create conditions for the expression of depression and anxiety, they do not occur routinely in menopausal women. There is the possibility of the “domino effect,” in which women who experience nocturnal hot flashes find they do not sleep well. Their fatigue may be a factor in subsequent depression. A whole person evaluation is necessary to understand why a woman at menopausal age may be depressed. Is her mate supportive? Is she stressed because of care-giving an aging parent, an ill mate, or growing offspring — or some combination of the three? Are there goals she did not achieve, such as having children, marrying, or having a career? Are there other physical concerns that she has not addressed — not just annoying symptoms such as hot flashes, but other concerns such as headaches? Is she being treated appropriately with medication and psychotherapy, or just taking a pill in the hope that all her circumstances will change?

Anxiety is another problem that some women have at menopause. Many women have experienced anxiety all along but deny that it is so, especially women who demand much of themselves. With hormonal changes, there may be symptoms that make women feel a lack of control. A woman who is already anxious might find her anxiety is heightened and might even develop panic disorder. Again, a whole person evaluation can help determine the cause and best intervention. From a psychological standpoint, a course of medication in some cases may be helpful in the short term, while learning management techniques that can help in the long term. Many people find that by learning appropriate skills, anti-anxiety medication can be eliminated altogether. Both depression and anxiety are not “all in your head,” and you need not struggle while putting up a brave front. (In fact, you probably aren’t fooling anyone!) Medical and psychological treatments are not only available, but treating these mental conditions can be critical to optimizing your physical well-being. (See the February issue of the newsletter for more on how depression affects your physical well-being.)

Menopause need not be psychologically difficult. It can be a time of asserting one’s identity as one’s true self. It can be a celebration of the acquisition of wisdom, of having already survived many of life’s vicissitudes. This is not to candy coat difficulties, but to suggest that you can reframe the end of reproduction as the beginning of a new phase of life devoted to the resumption of your own intellectual and emotional growth. What better time to take up a cause, increase volunteer work, renew friendships, join a book club, intensify one’s career, write a book, or plant a garden? When my own mother reached menopause she painted furiously, took up tai chi, and convinced my father it was time to travel. When she died a few years ago she looked back at that time as her glory days. I intend these years to be the same for me. Might they be so for you!

—May 2006

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