ARCHIE: Edith, if you're gonna have a change of life, you gotta do it right now. I'm gonna give you just 30 seconds. Now come on, CHANGE! EDITH: Can I finish my soup first?
--"All in the Family," 1972
For generations of women of a certain age, Edith Bunker's rejoinder said it all. Husbands might joke or misunderstand, but menopause was something women themselves didn't want to discuss-not with their mothers, their daughters, their doctors or their closest friends. It was like shaving your legs--something you did in private. Even women who wanted to know more about what was happening to their bodies were squeamish about asking questions. After all, it had to do with plumbing, and worse, it carried the unspoken stigma: you're getting old.
Now, The Change itself is undergoing a transition. Suddenly this spring, menopause is the subject of briskly selling books, the buzz of TV talk shows and fodder for support groups, newsletters and posh luncheon gatherings of women who find it intruding on their lives in unsettling ways. Part of the reason is sheer demographics: in the next two decades, nearly 40 million American women will pass through menopause, and by 2020, some 60 million will be at or through the change. A century ago few women lived very long after their ovaries stopped functioning. Today most women have another 30 years-almost one third of their lives-yet to live after the age of 50 and they are determined to make the best of them. Those now at or approaching menopause are also more vocal and more visible than ever before. As Gail Sheehy writes in her new book "The Silent Passage": "In the next few years, the boardrooms of America are going to light up with hot flashes."
But all the brave talk-is exposing a tumult of conflicting emotions. Is menopause a disease that requires medical intervention, or a natural passage that should run its course (page 80). Is it the beginning of inevitable decline--or the start of a great new phase of life? Some women mourn the end of their reproductive years even if they are long past wanting children. Others are delighted to be free of monthly periods and the fear of unwanted pregnancy. Some experts see hormone-replacement therapy as an "elixir of life" that can alleviate unpleasant symptoms and stave off long-term health problems, including heart disease and osteoporosis. Others are wary of the possible cancer risks hormones pose and decry the "medicalization" of menopause. Says feminist Germaine Greer, whose own book "The Change" will be published in America this fall: "All around you, the message is that once you're old, you are worthless and what you better do is get your face fixed and your tits fixed and your ass fixed and so on."
Many women are still unsure of what to think and how much to say about their own menopausal symptoms in a culture that prizes youth so assiduously. "I think women are very often living through a kind of secret hell," says Vanity Fair editor Tina Brown, who published the article that became Sheehy's book last October, and who praises Sheehy's "guts" for revealing her own rocky experiences. Sheehy herself found women reluctant to discuss it-some congresswomen " would rather admit to check bouncing than menopause," she says. "I also noticed that women in their late 30s and early 40s are allergic to this subject. They are so afraid of their own aging." But others say there's nothing to discuss; they've been through it and it was no big deal. Meanwhile, medical experts are concerned that the spate of new books by female activists and authors is potentially dangerous. "It's a shame," says Dr. Wulf Utian, director of the Cleveland Menopause Clinic and founder of the North American Menopause Society, "because so many women are reaching menopause now and are getting information from nonexperts."
But many women argue that getting information from each other is better than the collection of uncertainties--or just plain shrugs-they have gotten from the medical establishment to date. " If you get six menopausal women together, you'll find that their doctors are doing six different things. Our joke is that you might as well go to a veterinarian," says Rep. Patricia Schroeder of Colorado, who has pressed hard for more attention to women's health matters. Most studies on the benefits of hormone-replacement therapy have been funded by the pharmaceutical industry, and most government medical research has ignored women completely. Some time soon the National Institutes of Health will begin reporting the results of a three-year, $10 million study on the toxicity and short-term risks of hormone replacement. It will not deal with whether hormone replacement is good for women's bones or their hearts, how it affects cancer or how it affects them psychologically or cognitively. Those answers should come later, in a massive 14-year Women's Health Initiative involving 150,000 women and focusing on a wide range of women's health concerns in the last third of life. If the answers aren't sufficient, aging baby-boom women are certain to demand more studies. "Remember, this was the generation who demanded that fathers be let into the delivery room, who began monitoring their own pregnancies," says Dr. Florence Haseltine, director of the Center for Population Research at the National Institute of Child Health and Human Research in Bethesda, Md. "We're looking at a very educated patient who isn't going to put up with the current situation."
In the meantime, women are left with a host of old wives' tales and misconceptions about menopause. " You grow a beard, Dorothy," said Sophia in an episode of "The Golden Girls." "Believe me. I woke up one morning, I looked like Arafat. " What little women have heard, sotto voce, from mothers and grandmothers, often leaves them unnecessarily frightened, experts say. " We're living with the myths of a generation ago," says June Reinisch, director of The Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University.
A great many women seem to go through menopause with few, if any, complaints. But some report debilitating symptoms from hot flashes to night sweats, sleeplessness, irritability, mood swings, short-term memory loss, migraine headaches, vaginal dryness, urinary incontinence and weight gain. Most such problems can be traced to the drop-off in the female hormones estrogen or progesterone, both of which govern the ovarian cycle. But every woman starts with a different level of hormones and loses them at different rates. The unpredictability is one of the most unsettling aspects. " Women never know what their body is going to do to them when," says Jennifer A. Knopf, director of the Sex and Marital Therapy Program at Northwestern University.
That loss of control is profoundly disturbing, particularly to a generation of women who have dieted, jogged and taken charge of many aspects of their lives. And hearing that other women have negotiated menopause with few problems is cold comfort to those encountering severe symptoms. "My mother used to complain about the flashes," says Ruth Tompkins, a 54-year-old administrative assistant to a New Jersey developer. " I'd think, 'How bad could it be?' Let me tell you. When it started, and I found myself walking down the street in the middle of winter with my coat off, just pouring sweat, I started to call her every day to say, 'I'm sorry, Mom.' That's how bad it can be." Haseltine says she wakes up repeatedly in the night, drenched in sweat. " Your heart's pounding so hard that it wakes you up from a deep sleep. You throw off the covers, but because you're covered with sweat, you start shivering. Then you can't get back to sleep and get up in the morning exhausted." All in all, she says, her symptoms were so bad she considered them "a national emergency."
The first symptoms aren't always the telltale hot flashes or menstrual changes. Sometimes they are more subtle shifts in cognitive functions that can leave women doubting their competence, their confidence and their very sanity. Judy Askew became forgetful and noticed joint pains, insomnia and migraine headaches when she was 47. She thought they were due to her high-stress job as an editor at a fast-paced management-consulting firm. She had no idea it was menopause-but she did know she "could not put on hose and heels and go downtown every day." (Now 51, she switched to a lower-stress job, takes more care with her diet and publishes a newsletter called Menopause News from her home in San Francisco.)
Lonnie Barbach, 45, a clinical psychologist in Mill Valley, Calif., had a similar experience when she went through menopause in her early 40s. At first she found she was irritable and grouchy all the time. "I went from doctor to doctor and none of them realized it was menopause," she says. She discovered that few doctors are "skilled in the intricacies of menopause, and the obstetrician who was great at delivering babies may not be ready to help you with the complexities of menopause."
There is evidence that women who diet excessively to stay thin have a harder time with menopause. Part of that is biological: since estrogen is stored in fat cells, women who are a bit Rubenesque retain more of it than those still struggling into a size 6 as they turn 50. But it is often hard to separate physiological changes from the varying emotions women bring to menopause, which can in turn affect how menopause makes them feel. Santa Fe art-gallery director Anne Schleider, 54, went through menopause eight years ago and concedes that her reaction was closely tied to her self-esteem-each hot flash seemed to be blinking "old-old." "I used to be noticed a lot when I was younger," she says. "At a point around 50, it started to slow down and then it stopped." She surmises that "the prettier a woman is in her youth, the more insecure she is. When the looks start to go, she's not left with much."
Rita Rifkin felt that acutely. "As I grew up, I thought all I was was a body and a face," says the former TV actress, whose credits include "Starsky and Hutch" and "The Rockford Files." She went through early menopause four years ago, at 40. A gynecologist discovered a sharp drop in her hormone levels and she learned that her mother had undergone menopause in her 30s. Still, Rifkin says, " I was totally in denial." She says she went into "a state of hopelessness ... I spent two years going absolutely nuts." Like many women, Rifkin found a silver lining to her change of life-partly with the aid of hormone therapy and partly by redefining herself. "I thought that everything had to be perfect on the outside," she says. "But I'm finding out now that grabbing every second you can and living life to its fullest-that's the real woman part. About a week ago I said to myself-and I never thought I would say this-'This is going to be the best time'."
Studies of other cultures have found that the more women are revered in aging, the less trouble they seem to have with menopause-physically or psychologically. UC, San Francisco, anthropologist Yewoubdar Beyene, a native of Ethiopia, studied women in Mayan villages and found they actually looked forward to menopause, since it brought freedom from years of continuous childbearing. She drew blank stares when she asked about hot flashes. "People thought I was out of my mind going around asking these questions," she says, though she concedes Mayan women's bodies may adjust better to disruptions in their estrogen cycles after bearing so many children. Beyene also studied peasant women on the Greek island of Evia, who had roughly the same number of children as U.S. women, and found that they did suffer hot flashes. But they had few negative feelings about menopause--perhaps because the culture doesn't stress youth. Overall, she concludes, " Menopause is part of being a woman, but the menopausal experience is shaped by culture."
Culture sends conflicting messages about sex and aging-and many women approaching menopause rank fears about their libido high among their concerns. There, too, every woman reacts differently. Some do become less sexually active after menopause, but that may be due to vaginal dryness that makes intercourse painful and is easily corrected, either with hormones or lubricating creams. A few women find they are simply less interested-and that doesn't bother them. But others say they want and enjoy sex more than ever once they no longer have to worry about pregnancy. Former NOW president Karen DeCrow, 54, currently practicing law in New York, says her sex life is terrific, largely because she is calmer about it: "When a 20-year-old woman has sex with a man, she worries about how she looks, does she do it right? Should she look messy? Should she look neat? By the time you're 50, you're more relaxed. I would definitely say sex is better. Everything in life is better."
In her studies, University of Chicago behavioral scientist Bernice Neugarten found that 65 percent of women said menopause did nothing to cramp their sexuality; 17 percent said it left them with less sexual desire and 17 percent reported improved sex. Richard Carroll, a University of Chicago psychologist, says that 65 percent of women in their 70s are still sexually active. Reinisch at the Kinsey Institute also notes that with each passing generation, the numbers of women who find postmenopausal life sexually invigorating keeps growing.
All this is great fodder for the many support groups springing up to discuss menopause. In San Francisco, the Red Hot Mamas meet once a month to discuss such matters as the smells and tastes of vaginal lubricating creams. "I can't imagine talking to a doctor that way," says Susan RoAne, 46, who adds that members of the group "consider ourselves our own primary-care physicians." Judy Askew runs a hot-flash hot line (1-800-241-MENO) where she gets distress calls as well as subscription inquiries. Shirley Krohn, 54, started holding what she calls "pajama parties" at her Walnut Creek, Calif., home for women friends to discuss menopause--partly as a way to come to terms with her own wrenching, and drenching, experience. Once a hard-driving manager, she suffered severe emotional symptoms and thought she was having a nervous breakdown when she started going through menopause six years ago. She would lock herself in her office. " I was absolutely petrified to let, anyone know I was going through menopause," she says. She quit her job, found a hormone regime that suited her, started seeing a psychologist and made "a deliberate decision to share what was going on." Now she also wonders if it would have been better to talk openly with her male colleagues at her last job. " Maybe I didn't have enough trust that they would have compassion," Krohn muses.
Should women be upfront about their symptoms at work? The debate has scarcely begun. "There's no earthly reason to feel embarrassed-if you had a bad cold, you wouldn't be embarrassed if you had to sneeze," says Robin Morgan, 51, editor in chief of Ms. magazine. She likes to tell of attending a business meeting with a group of male colleagues when she suddenly felt heat rush to her face. She opened her purse, pulled out a fan and said airily, "Ah, I just had a flash." Other professional women would never be so bold. Nadine Haag, 48, a human-resources manager who attends Krohn's group, says that after 25 years of insisting to male managers that she can handle any pressure and any task, it would be tough to admit she couldn't handle her emotions today. "Men are already mystified by us," she says. "They're going to think, 'What are we going to do with her now?' " But Seattle psychotherapist Cristi Lien says that if corporate boardrooms are indeed going to light up with hot flashes, executives are going to have to accept it. "Hopefully, most of those men are at home with a woman who, if she isn't going through it, will be," she says.
In truth, the bedroom is almost as uncharted as the boardroom as far as menopause discussions go. Many women fear that raising the subject will interject the specter of age into their relationships, and prefer to pretend their mates don't notice what's happening. Even supportive, sympathetic husbands aren't sure how to raise the topic. Sheehy says most men bring somewhat selfish concerns to their wife's mood swings and other symptoms: "They focus on what they're going to lose--peace in the house and maybe a regular sex life." But she says her own husband (magazine editor Clay Felker) was extraordinarily supportive: "He asked what I was feeling like and he listened and he tried to find something in his experience that would match it, but he couldn't. He was also very encouraging about saying, 'Don't try to demand as much of yourself as you always have. You don't have to be a world-beater every year of your life'." On speaking tours, Sheehy says she gives men a similar prescription when they wonder what to say to their wives: "Listen ... and if you ask 'What's the matter?' and she says 'Nothing!' ask her again and say, 'On a scale of one to 10, how do you feel today?' If she says 'Three and a half,' try to find it in your heart to say in some way, 'I really love you,' because it's a very important time."
Part of the marital conundrum is that men are undergoing their own midlife passage and husbands and wives may be at wildly conflicting stages. A few years later the positions may reverse. Many men shift to a lower, more family-oriented gear in their 50s, says Northwestern University psychologist David Gutmann. " You see the opposite taking place in older women. They're getting a new dose of energy and vitality and self-assertiveness."
Anthropologist Margaret Mead often referred to the "post-menopausal zest" women feel once they are through the unsettling transition phase. There are legions of women who hit their professional strides or forged new careers in their 50s, from Eleanor Roosevelt to Margaret Thatcher to Golda Meir. Even women who suffered terrible symptoms during menopause say they emerged on the other side with a new sense of purpose and vigor. Here, too, it's unclear whether that energy and enthusiasm comes from the physiological freedom from producing enough hormones to sustain pregnancy, or from a more psychological kind of freedom. "Because our culture has dismissed older women, you're released. There are no more expectations," says Caroline Bird, a prolific author at 77. "You can do anything the hell you want, and that realization is pretty heady."
Germaine Greer, who abandoned hormonal therapy because of bad side effects, describes her transition through menopause as almost like dying and going to heaven: "It came to me as a great surprise that on the other side of all that turmoil, there is the most wonderful moment in one's whole life-really, the most golden, the most extraordinary, luminous instant that will last forever." She also posits that it's men who are the most upset by menopause. "It was the men who decided that women who didn't want them anymore must be dead. Women didn't say that. Women were getting on with business, reading, thinking, gardening, painting, whatever." Men are profoundly uncomfortable with this notion, Greer adds. "They say, 'But what about us?' I say, 'I'm not thinking about you. I'm not interested in you, you bore me.' They say, 'But we're in pain and we're suffering.' I say, 'Someone else will take care of you. Go to Robert Bly, please. Don't waste my time. I know it's sad to be rulers of the universe. But spare me. We spend our whole lives worrying about you, and the great thing about menopause is that we can at last say, We don't worry about you anymore. You'll be fine. Bye-bye'."
In Sheehy's world the women are different. " Most of the women I've interviewed find that men play a rather pleasant role in their lives and would like to continue that association, thank you very much," she says. She also takes exception to the idea that women are concerned about aging and sexuality just to please men, not for themselves. "I do think your life beyond menopause will be different, and better, but not because you don't need men or you don't care how you look, but because it is a bridge from youth to a second adulthood," she says. Greer's manifesto, Sheehy adds, " is an interesting hat trick, but I don't think it really appeals to women who want to have full, rich lives."
What makes for a rich, full life is as different for every woman as her individual hormone levels, her family medical history and how she chooses to spend her time. Each has to decide for herself whether the benefits of counteracting menopause with hormones are worth the still-unknown risks, just as each must decide whether the fight to stay young-looking is worth all the trouble it takes and at what point she will accept her aging self. But in many ways, there has never been a better time to undergo menopause. As controversial as they are, medical options do exist, and American society offers more opportunities than ever for women to find happiness and purpose apart from being a reproductive vessel. As society's long obsession with youth slowly gives way with the aging population, that passage will become even easier.