“Oo-Wee,” my three year old nephew said as he lifted his shirt up and down in front of the large fan. We all laughed including Grandmom because it was not difficult to figure out who he was imitating. Grandmom, who was going through “the change of life,” would often watch Hunter while his mom was busy with her other four children.
As I enter my mid forties, working part-time in both the ministry and as a family physician in a fast pace urgent care center, I often get questions regarding this “change of life” or “The big M.” As I stare this oncoming stage of life right in the eyes, I have choices to make… fear or faith. I thank God that I have several spiritual mentors who are traveling this road in a godly way. Although menopause is different for each woman, another advantage I have is a medical perspective which takes away some of the fear of the unknown. My hope is that this article may dispel some of the menopause myths and encourage women to have a godly perspective.
Menopause is a natural, inevitable, biological cessation of menstrual periods. Technically, menopause is defined as the absence of periods for twelve months. It is the other end of puberty – the end of a woman’s potential childbearing years. The age of onset varies as early as 30 and rarely as late as 60, but the average age is 51. It is a time where not only our bodies are changing, but also our perspectives need to change for our spiritual maturity.
Peri-menopause is the time leading up to menopause where the ovaries gradually stop functioning, resulting in a decrease in estrogen, progesterone, as well as testosterone. This time frame typically lasts three to six years, but may span for a decade. Certain surgeries (e.g. hysterectomies) as well as some medical treatments (e.g. radiation therapy, chemotherapy) can hasten this process and create a rapid onset of menopause. Symptoms of abrupt menopause can be more severe. Symptoms certainly vary among different women, but there are some that are more common.
During the peri-menopausal phase, periods can become shorter or longer, heavier or lighter and with more or less time between periods. The North American Menopause Society (NAMS) recommends seeing your doctor if periods last more than a week, are excessively heavy or come very close together. Although unusual during this phase, it is still possible to get pregnant (trust me…I have had to give news of pregnancy to a couple of very shocked women).
Hot flashes (or flushes) are the most common symptom. These are usually brief, 3 seconds to 10 minutes, 4 minutes being the average length of time, where a woman may feel: a pressure in her head that progresses into a flush; redness, warmth, and sweating of the face, neck, shoulders and upper chest; fast or pounding heartbeat; sweating followed by a slight chill; and sweating at night which can cause sleep disorders. Sleep deprivation can lead to a myriad of other symptoms (exacerbation of mood swings, irritability and other health concerns). Symptoms can vary from very mild and brief to more significant and disabling. There are a few pharmacological (prescription medications) and homeopathic (“natural”) treatments than can help with the more significant symptoms.
There are a many symptoms that have been attributed to the peri-menopausal phase, but there is no direct evidence in the medical literature that supports a direct relationship to menopause, except perhaps vaginal dryness, some urinary incontinence and thinning of the hair. We know from post-partum depression and PMS that hormones play a role in mood; however, studies have been unable to prove a direct correlation of mood swings to menopause. Sleep deprivation caused by night sweats may be the source of irritability, mood swings and forgetfulness in some women. Also, it is unclear if weight gain may be caused by a natural slowing of metabolism with aging or more specifically by menopause. Several recent medical studies have made a correlation between sleep deprivation and obesity. Good sleep hygiene and plenty of rest are paramount in doing well through this phase, even if it means consulting your physician to treat disruptive hot flashes or using sleep aid medications. Light clothes, no heavy bedding, avoidance of spicy foods, fans, damp cloth by the bedside… all are are helpful tips that can assist in making this journey more favorable.
Lifestyle changes are recommended for all women starting this new phase in life. Exercise alone will assist in deeper, more productive sleep and may prevent unnecessary weight gain. Exercise and diet alone will definitely affect how we travel through this stage of life. As estrogen decreases during this phase, women lose the protective effect this hormone has on both bones and the heart. Thus, they become more at risk for bone fractures and heart attacks. Aerobic exercise may not only assist in maintaining healthy weight, but it increases our good cholesterol, lowers blood pressure even without weight loss and can reduce heart attacks, strokes and diabetes. Certain exercises strengthen bones, preventing osteoporosis. There also have been a few studies that suggest that exercise decreases depression and anxiety. Some evidence suggests that it assists in reduction of hot flashes and even increase libido. The NAMS goes even further claiming that “Exercise may cause the same magnitude of change as that induced by estrogen.” (I am convicted…time to get a move on…) Furthermore, getting physicals, checking for diabetes and high cholesterol, screening for cancers (e.g. colonoscopies, mammograms) and bone densities are all part of taking care of the one body entrusted to us. Menopause serves as a reminder to take a closer look at our lifestyle.
There are many pharmacological treatments that can assist in alleviating symptoms of menopause and peri-menopause. Traditionally, pharmacological hormone replacements include oral, transdermal patches, and vaginal creams. These prescribed treatments still play an important role in preventing hot flashes, osteoporosis, vaginal dryness, as well as some forms of urinary incontinence. Low dose birth control pills are sometimes prescribed during the peri-menopausal phase. The Food and Drug administration recommends the lowest amount of hormone for the shortest period of time necessary in order to decrease potential harmful health risks. This same recommendation also applies to non-synthetic, bioidentical hormones and the “natural” remedies that have oestrogenic effects (plant based “estrogen” in soy, red clover, flaxseed and alfalfa….)
Because of recent research questioning the role of hormonal replacement in increased heart attacks, as well as in a possible increase in breast cancer, more people are turning to non-hormonal treatments. There have been several non-hormonal prescriptions, as well as alternative, homeopathic remedies that have been used for menopausal symptoms. “Natural” or homeopathic remedies are not without potential drug interactions or harmful health risks. Because they are not regulated through the FDA, manufacturers of “natural” medications are not obligated to prove their product safety, purity, potency and efficacy. Despite scant medical research and poor study designs, especially regarding the “natural” remedies, a look at the research may assist in avoiding ineffective treatments. To date, there is some evidence that clonidine (a blood pressure medication), some antidepressants like paroxetine and venlafaxine, gapapentin (traditionally a seizure and pain medication), and the “natural” remedy black cohosh may be beneficial in the treatment of hot flashes or flushes in certain women. There is no current evidence that supports the use of acupuncture, fluoxetine (another antidepressant), red clover, phytoestrogens, ginseng, evening primrose oil, dong quai or vitamin E. Regardless of pharmacological or homeopathic treatments, risks and benefits have to be weighed when choosing medical treatments.
Taking care of our bodies is important, but spiritual fitness has value for all things (1st Timothy 4:7-8). My spiritual perspective going into this phase of life will certainly affect how menopause plays itself. Will I give into my fears or will I mature spiritually as I believe God intends us to do? How will I deal with potential sleep deprivation? How will menopause affect my physical intimacy with my husband? On a less serious note, how will my deodorant hold up after sweating (I come in close proximity to many people in fellowship at church and as a physician)? With or without children, married, single, divorced or widowed, we each face a whole realm of unique emotions and fears that menopause can surface. Regardless of where we are when we enter this stage of life, God sets in place some Biblical principles that will assist us in maturing spiritually.
We all love new beginnings…the New Year, a birthday…any excuse to look forward after reflecting and learning from the past (Philippians 3:12-15). Menopause is an important new beginning. Despite our western culture’s worship of youth, God reminds us of both the respect and responsibility that comes from aging. Gray hair is the crown of splendor (Proverbs 16:31, Proverbs 20:29). Older women are to be treated as mothers and expected to teach the younger women (1st Timothy 5:2 and Titus 2:3). There are inspiring narratives in the Bible of women glorifying God into their mature age. Naomi, a grieving widow who lost both her sons, teaches a young woman to love God and His people. Naomi helps Ruth not only to turn from her paganism towards God, but to become the grandmother of King David, a man who takes after God’s own heart (Acts 13:22) and in the lineage of Jesus Christ (Ruth). Sarah and Elizabeth had babies in their old age…and I am concerned about sleep deprivation in my 40’s and 50’s? How can we not be in awe of the prophetess and widow Anna who never left the temple, but worshiped day and night, fasting and praying into her eighties (Luke 2:36-38). These women lived victorious, productive and faithful lives. With the right perspective, we can all have these fruitful lives as God has intended.
Just as our puberty was designed by our sovereign and loving God, so is our menopause. God commands us to be grateful in all circumstances…yes, even late at night fanning ourselves trying to get back to sleep (1st Thessalonians 5:18). Sin is always sin, and that does not change in menopause. Sin includes fits of rage – out loud or just in our heads, complaining, ingratitude, selfishness, worry, anxiety, lack of joy etc. We need to stay humble and confess our sins so we can be healed (James 5:16). The Bible is timeless and its principles apply to all stages of life, even as our roles and struggles may change. Rather than traveling this road alone, recognizing our fellowship of support and seeking advice will allow us to be victorious (Proverbs 24:6). As many of us have strained to pray more and fight for godliness during our time of the month, so too can we learn to fight to be godly during these years. By now, prayerfully we have a repertoire of scriptures in our armory to combat our mood swings. We have perhaps learned to pour out our hearts to a God who loves us. Let us continue to seek out truth in our emotions as we journal this journey. Even if our relationship with our God is new, menopause is a great opportunity to start our walk with Christ with a mature perspective. We have a savior who sympathizes with our weaknesses (Hebrews 4:15). We can grow to become more like our savior in our compassion and sympathy as we forge through any physical or emotional challenges. Menopause is an opportunity to glorify our God. As the apostle Paul learned to boast and even delight in his weaknesses (2nd Corinthians12:5-10), we too can learn to enjoy our weaknesses, even laugh at our weaknesses. “A cheerful heart is good medicine, but a crushed spirit dries up the bones.” (Proverbs 17:22)
“Rejoice in the Lord always. I will say it again: Rejoice! Let your gentleness be evident to all. The Lord is near. Do not be anxious about anything, but in prayer and petition, with thanksgiving, present your requests to God. And the peace of God, wich transcends all understanding, will guard your hearts and your minds in Christ Jesus.” Philippians 4:4-7
Menopause is a natural turning point, not a disease, in a woman’s life. It can produce a big impact on both our physical and spiritual wellbeing, depending on our perspective. Although it can bring physical and emotional upheaval, it can also be the start of a rewarding phase of a woman’s life. Our example and teaching will direct future generations whether we invite that responsibility or not. There are many Ruths , Marys and even Davids awaiting encouragement and direction, many young men and women who need spiritual mothers and grandmothers. Giving into fear or faithfully anticipating this new beginning will determine whether there is dread or celebration. Let us confront and reframe any fears we may have and come out faithful and victorious. Let us choose faith, sisters, and let’s celebrate a new beginning.
