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 "I
am convinced that when women enter menopause and seek a doctor,
they are in truth pursuing an ineffable, illusory and transcendent
strength. This inevitable and irrevocable stage in a woman's life
deprives her of her final claims to youth. And in a culture that prizes
youth, sex appeal, and virility over age, wisdom, and grace, women in
menopause find themselves socially devalued. It is little wonder that
the newly menopausal woman not yet aware of the power of wisdom quests
for a doctor who can reverse the aging process. For centuries cultures
have invested doctors, healers, and medicine men with higher powers.
Women in menopause yearn for a miracle.From the start, the pursuit for the miraculous has been my intuitive explanation for the frustrated state in which many of my patients approach me. On the one hand, there are those who are overwhelmed by an urgency to know and understand the details of their condition. They present me with lists, articles, books, studies and facts. They want the best and the latest in medical data and technology. On the other hand, there are those who resolutely deny their condition. They are the ones who at age fifty-two demand a pregnancy test when their periods stop. Although both types of women deploy different strategies, they are trying to control the same unknown biological enemy. I had originally thought these tactics were aimed at an idealized form of younger self. I now see the situation as more complex. That, in fact, what women really want is to resist old age. They wrestle to halt its progress by attempting to control the menace that is menopause. With the burgeoning technical knowledge of menopause available, doctors are being encouraged in treating these patients. Yet many doctors are tentative. They know there is something far larger at stake. Something not taught in medical schools. Patients have common physical symptoms that can be recognized. But these symptoms only account for part of the condition. Since a patient's conflicted search for self-worth and identity is intrinsic to the menopause, then the variety of symptoms that a doctor might confront are limitless. While a doctor can impart certain knowledge, in actuality he or she can only understand menopause as well as the patient knows herself. To look at this another way, a patient's search for magic is a joint mission. Both doctors and patients must have faith in the real power of medicine which lies in the hope that the unexpected is always possible. This is what I mean by magic. The myths of menopause are a jumble of misconception and transferred suffering. We must dispel the notion of hormone replacement therapy as Ponce de Leon's dream of youth come true. To think of treatment in terms of turning back the clock fosters the negative connotation of menopause as a destructive experience and an end rather than a beginning. To say that menopause ultimately is a positive experience is not to minimize the pain of the experience. I do see it as a blessing, though, a wake up call for the woman who has never found herself. It is a biological luxury unafforded to men that should be taken advantage of. In Anatole Broyard's book Intoxicated by My Illness, he reminds us that in an earlier, more holistic age, doctors advised patients to go abroad for their health. Illness was an authorization to make discoveries, fulfill desires and flirt with fantasies. Likewise, I advise menopausal women to go abroad for their health, to indulge themselves in their own identities and cultivate their personal flair as counterstyle to despair. To revise themselves as they have always longed to be seen. It is a time to right grievances, resolve relationships, and realize dreams. Menopause is an occasion for narrative. As an episode in a women's life, menopause has a beginning, a middle, and an end. Women must be encouraged to structure this event as a story in order to rationalize, contextualize, and integrate it into the epic of their lives. In this way, women begin to exercise intellectual control over the physical and emotional phenomena of menopause. Freud called this process 'the talking cure'. Indeed, its therapeutic effect comes from the catharsis of communicating a shared human experience. This is the essential and galvanic role of the doctor. She must act as a good listener in order to generate the patient's sense of self-worth. The doctor must impart to the menopausal woman an impression of respect and optimism toward her arrival at this new phase of life. Once the doctor assumes the role of an interactive audience rather than an embodiment of authority, the patient feels empowered by the potential for mutual enlightenment. She becomes self-reliant and more confident, knowing that the doctor welcomes her input and effort to initiate her own treatment. There is no better way for a woman to seize control of her menopause and reassume the business of living her life. By organizing or directing patients to a support group, the doctor can forge a spirit of camaraderie among menopausal women. And the doctor should consider her office a haven for women in need of security and understanding. It is in this sort of comfortable environment that the woman can begin to open up, can begin to reveal her true self, shedding layers like worn clothes, that she might bare herself to the potential magic. Finally, the most daunting of all obstacles which patients and doctors must surmount in their collaborative search for magic, is a menopausal woman's sense of loss of sexual desirability. A misconception persists that she invariably suffers from a decreased libido. THIS IS SIMPLY NOT TRUE. There are many older women who maintain a healthy sex drive. Princess Metternich of Austria was once reputedly asked at what age a woman ceased to feel sexual desire. 'I do not know', she replied. 'I am only sixty-five.' Some women who profess new feelings of sexual apathy may be confusing them with unattractiveness. For this reason I remind my patients that menstruation does not equal sexiness. A woman's style and appeal come more from her composure and sense of self-worth. Her recent independence from periods and contraceptives is license to enjoy new-found sexual freedom. There is a story by Colette titled In the Flower of Age. It is a love story between a young man and an older woman. One line has always stuck with me. 'She's amazing', the young man thinks. 'Even I would never imagine she was sixty-two years old'. Whether at twenty-two or sixty-two, woman is the subject of a drama that is her own beautiful life. Events take place. She experiences them with her body, her emotions, her mind, and her soul. Rightfully, she expects to effect decisions made about her health. She wants doctors who will listen and respond to her insights and judgment, who care about her special needs as both woman and individual, and doctors who respect the process of self discovery. Back |