Lenore Pomerance : Menopause Counseling

Public Statement
Scientific Workshop Menopausal Hormone Therapy
National Conference Center, NIH, Bethesda, MD.
October 23-24, 2002

Lenore M. Pomerance, MSW, LICSW
Psychotherapist, Menopause Educator
2000 P St. NW. Suite 720
Washington, D.C. 20036
202-333-2434
www.menopausecounseling.com

The raging debate about the health risks and benefits of hormone therapy comes out of the medical model in which menopause is treated as a disease. In the more holistic Complementary and Alternative Medicine (CAM) model, menopause is seen as a natural condition. Under the holistic model medications and lifestyle changes are given equal weight in treating menopausal symptoms. I believe treating women holistically relieves the pressure on the physician to solve all problems of menopausal mid-life women, and offers women the services of health practitioners with expertise in mental health, nutrition, and physical therapy.

Under the medical model, the medical aspects of menopause become the dominating focus for diagnosing and treating, what is, in fact, one of the many mid-life events that a woman is experiencing. Treatment under the medical model centers on medication. Replacing diminishing hormones has become an appealing solution, not just for hot flashes and vaginal dryness, but also as a broader, more vague panacea for decreased libido, dry and wrinkled skin, and an overall decrease in joie de vivre. Hormone treatment has also rapidly expanded to include more long-term conditions of aging, primarily heart disease and osteoporosis. Consequently, healthy women, many of whom have had no adverse menopausal symptoms, were urged to take hormone therapy.

In fact, for most women, The Menopause , the end of their reproductive cycle, is not a negative event. Studies have shown that if women have overall life satisfaction, menopause is not experienced as stressful. If mid-life women are in crisis, it may be because of the following:

facing the end of child rearing which may have been the most image-defining activity of the past fifteen years.
finding themselves in financial straits without a high enough paying job.
feeling burnt out in their chosen career but thinking they are too old to start another.
seeing the horizon on their life span for the first time and feeling yearnings about how much time is left to do all the things dreamed about when younger.
experiencing emptiness in her long-term relationship now that child reading has receded as the primary focus of the couple.

Depression and/or anxiety around these and other issues bring many women into therapy or counseling, usually by themselves, sometimes with their partners. In these cases, the woman and her partner can deal with menopause issues in the context of the emotional and physical health of the couple. For example, decreased libido may have more to do with deteriorating communications than with waning hormone levels.

Responding to the medical model, amid conflicting medical opinion, women are once again faced with a very personal choice, similar to the one made about birth control when they were fertile. Then, it was weighing the risks and benefits of birth control pills, IUDs, foams, creams, diaphragms, rhythm , and tubal ligations. If a woman s partner was not involved with her and her doctor in weighing the risks and benefits of birth control he is not likely to be involved in her hormone replacement decisions.

The medical model puts increasing pressure on physicians to ensure as risk-free a hormone choice as possible and to be available to assuage their patients anxiety about the outcomes of their choices. In a fifteen-to-thirty minute office visit, a physician can barely do an adequate physical exam much less address the anxieties of hormone treatment which are embedded in her other mid-life issues. For example, neither the doctor nor patient might feel comfortable with frank discussions about sexual issues. Nor is there time or inclination to discuss life disappointments or stressful life events.

A holistic approach views menopause as a natural condition that all women will experience if they live long enough. It includes assessing all the bio-psycho-social quality of life issues facing them at mid-life including:

health status and overall physical well-being;
family relationships: significant other, parents, siblings, children, grandchildren and extended family;
friends and important social support networks including community, religious, and physical activity institutions;
financial stability: stable and safe housing and neighborhood, adequate income;
satisfying work or career where she is valued and adequately paid.

Treatment under the holistic model gives equal weight to medication when necessary, mental health interventions, complementary practices, and lifestyle changes. Lifestyle changes for a mid-life woman experiencing distress at menopause encompass diet, exercise, and reducing stress. Physicians urge lifestyle changes on their patients but are without the means to make them happen. Physicians have a hard enough time getting patients to comply with medication regimes much less enforce a weight reduction plan, smoking cessation, or exercise routines.

To achieve optimal health, an integrated system addresses total body health. A number of dietary, lifestyle, and supplementation practices have been shown to improve and relieve women from the common problems related to the various stages of menopause. Examples are:

Mental health interventions: individual, couple, and/or group counseling help a woman and/or her partner recognize the relevant issues causing distress and provide a supportive, confidential setting to prioritize and work on them. Group work in particular helps a woman share her feelings, and learn from others while enforcing necessary lifestyle changes.
Chiropractic and acupuncture: a number of small clinical studies have shown that the combination of chiropractic manipulation and soft tissue therapy is an effective symptom management intervention, primarily regarding back pain, abdominal cramping, and headaches.
Nutrition, dietary supplementation, and exercise: there are specific dietary recommendations aimed at reducing menopause symptoms. Exercise enhances healthy eating habits, improves mood and reduces anxiety and depression.

The healthcare community must use the considerable knowledge and tools that we have for treating aging women in the healthiest, safest, and most respectful way possible.