Chapter 1 - The menopause: A signal for the future

Abstract

The menopause is overly laden with negative symbolism. Many of the behavioral complaints at the time of menopause can be explained by psychologic and sociocultural influences. Important interactions among biology, psychology, and culture do not occur, but it is time to stress the normalcy of this life event. Menopausal women do not suffer from a hormone deficiency disease. Hormone replacement therapy should be viewed as specific treatment for symptoms in the short term. Therapy remains effective for treating women with vasomotor symptoms and vaginal atrophy and selected women with osteoporosis. The benefits and risks of hormone therapy should be balanced in each individual. Part of the reason for the negative stereotypical views of menopause is that the initial characterization of menopause was derived from women with physical and psychologic difficulties. The variability in menopausal reactions makes the cross-sectional study design particularly unsuitable. More and larger longitudinal studies are needed to document what is normal and the variations around normal. It is important to educate women and clinicians about the normal events of this time. This physiologic event brings clinicians and patients together, providing the opportunity to enroll patients in a preventive health care program. Contrary to popular opinion, menopause is not a signal of impending decline, but rather a wonderful phenomenon that can signal the start of something positive, such as a good health program. Rather than being a lightning rod for social and personal problems, menopause can be a signal for the future.