The Wisdom of Menopause: Creating Physical and Emotional Health During the Change Paperback - 2006

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Chapter One


Menopause Puts Your Life Under a Microscope

It is no secret that relationship crises are a common side effect of menopause. Usually this is attributed to the crazy-making effects of the hormonal shifts occurring in a woman's body at this time of transition. What is rarely acknowledged or understood is that as these hormone-driven changes affect the brain, they give a woman a sharper eye for inequity and injustice, and a voice that insists on speaking up about them. In other words, they give her a kind of wisdom--and the courage to voice it. As the vision-obscuring veil created by the hormones of reproduction begins to lift, a woman's youthful fire and spirit are often rekindled, together with long-sublimated desires and creative drives. Midlife fuels those drives with a volcanic energy that demands an outlet.

If it does not find an outlet--if the woman remains silent for the sake of keeping the peace at home and/or work, or if she holds herself back from pursuing her creative urges--the result is equivalent to plugging the vent on a pressure cooker: Something has to give. Very often what gives is the woman's health, and the result will be one or more of the "big three" diseases of postmenopausal women: heart disease, depression, and breast cancer. On the other hand, for those of us who choose to honor the body's wisdom and to express what lies within us, it's a good idea to get ready for some boat rocking, which may put long-established relationships in upheaval. Marriage is not immune to this effect.

"Not Me, My Marriage Is Fine"

Every marriage, even a very good one, must undergo change in order to keep up with the hormone-driven rewiring of a woman's brain during the years leading up to and including menopause. Not all marriages are able to survive these changes. Mine wasn't, and nobody was more surprised about that than I. If this makes you want to hide your head in the sand, believe me, I do understand. But for the sake of being true to yourself and protecting your emotional and physical health in the second half of your life--likely a full forty years or more--then I submit to you that forging ahead and taking a good hard look at all aspects of your relationship (including some previously untouchable corners of your marriage) may be the only choice that will work in your best interest in the long run, physically, emotionally, and spiritually.

From the standpoint of physical health, for example, there is plenty of evidence to suggest that the increase in life-threatening illnesses after midlife, which cannot be accounted for by aging alone, is partly rooted in the stresses and unresolved relationship problems that simmered beneath the surface during the childbearing years of a woman's life, then bubbled up and boiled over at perimenopause, only to be damped down in the name of maintaining the status quo. The health of your significant other is also at stake. Remaining in a relationship that was tailor-made for a couple of twenty-somethings without making the necessary adjustments for who you both have become at midlife can be just as big a health risk for him as it is for you.

This is not to say that your only options are divorce or heart attack. Rather, in order to bring your relationship into alignment with your rewired brain, you and your significant other must be willing to take the time, and spend the energy, to resolve old issues and set new ground rules for the years that lie ahead. If you can do this, then your relationship will help you to thrive in the second half of your life. If one or both of you cannot or will not, then both health and happiness may be at risk if you stay together.


Preparing for Transformation

At midlife, more psychic energy becomes available to us than at any time since adolescence. If we strive to work in active partnership with that organic energy, trusting it to help us uncover the unconscious and self-destructive beliefs about ourselves that have held us back from what we could become, then we will find that we have access to everything we need to reinvent ourselves as healthier, more resilient women, ready to move joyfully into the second half of our lives.

This process of transformation can only succeed, however, if we become proactive in two ways. First, we must be willing to take full responsibility for our share of the problems in our lives. It takes great courage to admit our own contributions to the things that have gone wrong for us and to stop seeing ourselves simply as victims of someone or something outside of ourselves. After all, the person in the victim role tends to get all the sympathy and to assume the high road morally, which is appealing; none of us wants to feel like the bad guy. But even though taking the victim role may seem a good choice in the short run, this stance is ultimately devoid of any power to help us change, heal, grow, and move on.

The second requirement for transformation is more difficult by far: We must be willing to feel the pain of loss and grieve for those parts of our lives that we are leaving behind. And that includes our fantasies of how our lives could have been different if only. Facing up to such loss is rarely easy, and that is why so many of us resist change in general and at midlife in particular. A part of us rationalizes, "Why rock the boat? I'm halfway finished with my life. Wouldn't it just be easier to accept what I have rather than risk the unknown?"

The end of any significant relationship, or any major phase of our lives, even one that has made us unhappy or held us back from our full growth and fulfillment, feels like a death--pure and simple. To move past it, we have to feel the sadness of that loss and grieve fully for what might have been and now will never be.

And then we must pick ourselves up and move toward the unknown. All our deepest fears are likely to surface as we find ourselves facing the uncertainty of the future. During my own perimenopausal life changes, I would learn this in spades--much to my surprise.

By the time I was approaching menopause, I had worked with scores of women who had gone through midlife "cleansings"; I had guided and counseled them as their children left home, their parents got sick, their marriages ended, their husbands fell ill or died, they themselves became ill, their jobs ended--in short, as they went through all the storms and crises of midlife. But I never thought I would face a crisis in my marriage. I had always felt somewhat smug, secure in my belief that I was married to the man of my dreams, the one with whom I would stay "till death do us part."


Delirious Happiness and Shaking Knees

I will always remember the happiness of meeting and marrying my husband, a decision we made merely three months after we met. He was my surgical intern when I was a medical student at Dartmouth. He looked like a Greek god, and I was deeply flattered by his attention, especially since I wasn't at all sure I had what it took to attract such a handsome man with such an Ivy League, country club background. Something deep within me was moved by him beyond all reason, beyond anything I'd ever felt before with any other boyfriend. For the first five years of our marriage my knees shook whenever I saw him. There wasn't a force on this planet that could have talked me out of marrying him. I remember wanting to shout my love from the tops of tall buildings--an exuberance of feeling that was very uncharacteristic of the quiet, studious valedictorian of the Ellicottville Central School class of 1967.

He, however, was considerably less eager to display his feelings. I couldn't help but notice during the years we were both immersed in our surgical training that my husband seemed uncomfortable relating to me when we were at work, and often appeared cold and distant when I'd try to show affection in that setting. This puzzled and hurt me, since I was always proud to introduce him to my patients when we happened to see each other outside of the operating room. But I told myself that this was because of the way he had been raised, and that with enough love and attention from me, he would become more responsive, more emotionally available.


The Childbearing Years: Balancing Personal and Professional Lives

My husband's life didn't change much when we had our two daughters. Mine, however, became a struggle--one that millions of women will recognize from their own experience--as I tried to find satisfying and effective ways to mother my children, remain the doctor I wanted to be, and at the same time be a good wife to my husband. Nonetheless, these were happy years, for both of us adored our daughters from the beginning and enjoyed the many activities we shared with them--the weekend walks, the family vacations, the simple daily contact with two beautiful, developing young beings.

I did sometimes resent the disparity between what I contributed to the upkeep of our family life and what my husband did. Once, when the children were still young, I asked him if he'd consider working fewer hours so that I wouldn't have to give up delivering babies, an aspect of my practice that I dearly loved. He replied, "You've never seen a part-time orthopedic surgeon, have you?" I admitted that I hadn't, but suggested that this didn't mean it couldn't happen with a little imagination on his part. It was not to be, however. It was I who, like so many other women, became the master shape-shifter, adjusting my own needs to those of everyone else in the family.

In the early years of our family life, I was also becoming increasingly aware that the inequities that bothered me in my marriage were a reflection of inequities that existed in the culture around us. I saw many people like my husband and me--people who had started their marriages on equal grounds financially and educationally, even people who, like us, did the same work--and always, once the children arrived, it was the wife who made the sacrifices in leisure time, professional accomplishment, and personal fulfillment.


Change Yourself, Change the World

During those often exhausting years, I began to put into action some of the ideas I'd been developing about women's health--while always being careful not to say much about those ideas at home, where I knew they would not be welcomed by my husband. Inspired by my own experiences as well as those of my patients, and buoyed by the conviction that my ideas could make a difference in people's lives, in 1985 I joined three other women in the venture of establishing a health care center we called Women to Women. The idea of a health center run by women for women was virtually unheard of at that time. Our central mission was to help women appreciate the unity of mind, body, and spirit, to enable them to see the connection between their emotional health and their physical well-being. I wanted to empower women, to give them a safe place in which to tell their personal stories so that they could discover new, more health-enhancing ways of living their lives.

I knew that sometimes this would involve challenging the status quo, because the inequities of the culture take a terrible toll on women's bodies as well as their spirits. But as I practiced this new, holistic form of medicine, which was quite revolutionary for its day, I realized that the fact that I had a normal, happy family life, as well as a husband with conventional medical ideas who practiced in the same community, provided a kind of cover for me. It made me appear "safe" at a time when my ideas were considered unproven at best, dangerous at worst.

My three partners in Women to Women and I bought an old Victorian house that we could convert into a center for our new practice. We all agreed that we wanted to keep our husbands out of our new venture, lest their participation undermine our enthusiastic but still tender confidence in ourselves as businesswomen.

Of course, in my case, at least, that didn't necessarily mean that I didn't want my husband's support. I clearly remember a day at the beginning of the building and site renovation. Two bulldozers sat on the lawn, workers were everywhere, and the existing building had been torn apart. At that moment the whole project suddenly became real for me, and I realized that my colleagues and I were now responsible for paying for all of this. This was an overwhelming thought. When I came home that evening, I uncharacteristically reached out to my husband for help in calming my fears. "I'm scared," I told him. "I'm not sure I can do this." He replied, "I hate it when you're disempowered like this." I quickly realized that I'd been foolish to expect anything from him.

His response to my uncharacteristic and risky moment of emotional vulnerability simply reinforced the coping style I'd developed in childhood, a stoicism that was a necessity in a household where emotional neediness was frowned upon and we were told to "keep a stiff upper lip." Another favorite saying in my family was "Don't ask for a lighter pack, ask for a stronger back." So, as usual, I pulled myself up by my own bootstraps, dug into my inner resources, and pretended that I wasn't afraid.

As it turned out, Women to Women became a great success. Our work struck a resonant chord with our patients, and the center grew steadily by word of mouth. As excited as I was about what I was doing, I could never interest my husband in any of the ideas about alternative medicine that were at the core of my new clinical practice. We did, however, have enough other areas of mutual interest that I didn't think his attitude toward my work mattered. In fact, I was rather proud of myself for being able to sustain a loving relationship with a card-carrying member of the American Medical Association.


Marrying My Mother

Looking back, I see that in marrying my husband I had made a secret and mostly unconscious vow that I would do whatever it took to make this marriage work and be the woman I thought he wanted--as long as I could also pursue the work that I loved. Unbeknownst to me, I was re-creating with my husband many aspects of the unfinished business I had carried over from my relationship with my mother, a fact that would only begin to dawn on me some twenty-two years later, as I entered perimenopause.

Media reviews

"Northrup writes from experience and, more important, from her professional expertise as a physician who has treated many women and researched menopause. The specific medical advice on sleep, diet, breast health and the empowerment motif will bring insight, comfort and confidence to women embarked on 'the change.'"—Publishers Weekly


From the Hardcover edition.