Menopause 101
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Common Myths, Misconceptions, and Misinformation About Menopause:

The most common misperception is that menopause is "the beginning of the end." The opposite myth is nearly as prevailing- that it just isn't a big deal. Upon hearing about it, many women who are not affected react with nonchalance saying, "I wish I could get out of having my periods!" Yet menopause is about much more than losing your periods. For many women the end of fertility may be welcome, but in some women, the end of childbearing potential can represent a major loss. Many women struggle with the emotional burden of suddenly feeling "old". The confusion of the numerous but sometimes vague physical and emotional symptoms can be overwhelming, especially when many physicians don't consider menopause as the diagnosis; too often women are treated with antidepressants or anxiolytics (anti-anxiety medications) as a panacea. Some women report that when they asked their doctors if their symptoms could be related to menopause, they are simply told to come back when they haven't had a period in a year. Patients fear that they are exaggerating real symptoms; they fear telling their physician, and they fear being misunderstood.

Another myth is that menopause is associated with "empty nest syndrome" and causes depression. Research has shown that the incidence of depression in women actually peaks in the 30's; on the contrary, many women in their 50's experience what Margaret Mead termed "postmenopausal zest". Menopause is a risk factor for depression in certain women: women who have had a previous history of depression (including postpartum depression), women with any other psychiatric illness, women with a family history of menopausal depression, and women with a history of premenstrual dysphoric disorder (PMDD, otherwise known as "PMS"). Depression can also be a symptom of numerous other medical disorders, from heart disease to infectious conditions. Menopausal women with depression should consult their physician, rather than assume it's "normal" to become depressed when one enters menopause. What if your doctor's diagnosis is depression? Remember- it is treatable.

Don't assume that your doctor thinks you have depression if s/he recommends an antidepressant (e.g. Prozac, Zoloft, Effexor, Paxil) to treat your menopausal symptoms such as hot flashes and mood swings. As we'll discuss later, these medicines have been shown to be an effective alternative therapy to HRT from menopausal or perimenopausal symptoms in some women whether or not they also have depression.

The most dangerous myth is that menopause is just a "natural" phase of life and doesn't have any serious consequences. This simply is not true. Losing estrogen puts women at increased risk for osteoporosis, heart disease, colon cancer, Alzheimer's disease, tooth loss, impaired vision, vaginal and urethral atrophy, Parkinson's disease, and diabetes. The longer women are without the protection of their own estrogen, the greater their risk for the serious health consequences from these conditions. Likewise, just because menopause is "natural" doesn't mean there aren't interventions we can use to improve our quality of life- many of the consequences of menopause can be successfully treated and managed. The good news about menopause is that with prompt intervention and proper management, many of the long-term consequences can be prevented, reduced in frequency, or delayed.

Another way to view this issue of "it's natural, why interfere?" is that all diseases and medical disorders are natural too, yet we "interfere". For example, diabetes is caused by a shortage or lack of insulin; we replace insulin to treat it. While menopause itself is certainly not a disease or a disorder, its consequences are. They are either caused by or exacerbated by a lack of estrogen; we can replace estrogen in many patients in order to treat them. Of course, hormone replacement therapy (HRT) has its own list of consequences and side effects, so the decision to chose this therapy should not be made lightly. The good news is that there are many alternatives depending on a woman's individual circumstances, risks and symptoms.