Monday, February 18, 2008

Menopause and Letting Go

We have two dogs at our house. Bruce, pictured here sharing his food with a friend, loves playing "fetch" more than anything in the world. He will bring a stick, a ball, a piece of plastic, anything he can find, and lay it at your feet and implore you with his eyes to pick it up and throw it. Once you do, he'll never leave you alone. Playing "fetch" 24 hours a day would be his idea of heaven.

"Fetch" requires several things of a dog. First, they have to chase after and find whatever is being thrown. Next, they have to bring it back to the thrower. Third, they have to let it go so the thrower can throw again.

Now Zeke also loves playing "fetch," but he lacks one of the skills necessary for a good game. He and Bruce will compete in this game, seeing who can get to the stick first. When Zeke gets it first, Bruce becomes very agitated, because he knows the game has ended. Because Zeke hasn't learned how to let go. He chases, fetches, brings it back, and then holds onto it. Letting go is too scary for him. He might lose it to Bruce if he lets go. But because he won't let go, the game and the fun ends.

Letting go is an integral part of life, even in nature. Clouds become so filled with water they have to let go of it. That water feeds the spring-time trees, allowing the leaves to bud and flowers to blossom. The flowers let go of their petals to turn into fruit, the trees let go of the fruit so they can bear more in the future. Then they let go of their leaves so that they can have a period of rest. Letting go is part of the cycle of life.

Our hands are so miraculous. There are a multitude of tasks, way too numerous to mention, that our hands can accomplish. But think what would happen if our hands could pick something up, but couldn't let it go. We would be stuck. When we refuse to let go of things in our lives, we become stuck. The game ends.

Menopause is a time time of letting go. We women get to let go of the cycles of our physical creative powers. This is a time when we also may need to let go of the image we have created about ourselves. Generally, around the time of menopause, our lives as well as our bodies are also changing. "The Change" is often not understated!

This may be the time frame when many of us are also letting go of one of the most important roles we have played, that of mother. Children are leaving the home; they don't need us in the same way anymore; they don't want our advice; their energies are on their studies, their jobs, their relationships, their own new families. We may find ourselves alone more. We may have to redefine ourselves as life shifts around us. We may begin to see, whether we have children or not, that the expectations we had out of life, out of our relationships, or even out of ourselves, are not coming to fruition. We may find ourselves letting go of these long-held expectations.

One of the changes most of us rejoice in is the letting go of the monthly bleeding. Menopause is defined as the time when there has been no menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified. It is the end of fertility, the end of the childbearing years. Unlike men, who produce sperm "on the spot," so to say, women are born with a certain number of eggs in their ovaries. As the eggs begin to "run out," the hormone levels naturally begin to drop, causing the changes present in "perimenopause."

Perimenopause is a period of time before actual menopause, which begins about 6 years before the natural menopause. This is a time when the levels of hormones produced by the aging ovaries fluctuate, leading to irregular menstrual patterns (irregularity in the length of the period, the time between periods, and the level of flow) and hot flashes (a sudden warm feeling with blushing). Other changes associated with the perimenopause and menopause include night sweats, mood swings, vaginal dryness, fluctuations in sexual desire (libido), forgetfulness, trouble sleeping and fatigue. Except for the bleeding, many symptoms can carry over into the menopausal period for a time.

Natural menopause occurs when the ovaries naturally begin decreasing their production of the sex hormones estrogen and progesterone. Induced menopause occurs if the ovaries are surgically removed or damaged by radiation or drugs. Due to the abrupt cutoff of ovarian hormones, induced menopause may cause the sudden onset of hot flashes and other menopause-related symptoms. A "simple" hysterectomy (when the uterus but not the ovaries are removed) before natural menopause should not affect the production of sex hormones and so not cause menopause (unless the nerves or blood supply to the ovaries is damaged during the hysterectomy), though, of course, there will be cessation of bleeding.

In the western world the average age for menopause is now 51. Natural menopause can, however, be in a woman's 30s or 60s. Factors influencing the time of menopause include heredity (genetics) and cigarette smoking. Smokers (and former smokers) reach menopause an average of 2 years before women who have never smoked. High levels of physical and/or emotional stress can also cause menopause to start earlier. High levels of stress may also stop a woman's bleeding cycles even if she is not menopausal, so it is important to test any early cessation of bleeding.

There is no relation between the time of a woman's first period and her age at menopause. The age at menopause is not influenced by a woman's race, height, number of children or use of oral contraceptives.

Usually the symptoms and cessations of periods are adequate to "diagnose" menopause, but if there are questions, usually a blood test measuring the follicle stimulating hormone (FSH) and the luteinizing hormone (LH) is done. These levels become very high when the estrogen and progesterone levels drop.

On the next blog, we will discuss the pros and cons of hormone replacement therapy, both traditional and bio-identical.

"Finding Joy"

Assignment Two: identify the stuck places in your life and determine what is important to let go of in order to move forward. These may be in the areas of health, relationships, spirituality, jobs, home, etc.

Some of the things I've had to let go of:

  • the expectation of having someone always there to take care of me; I've found joy in being independent.

  • the expectations I've placed on some of my children; I am learning how to love at new levels, how to love and respect my children and all of my relationships exactly how they are.

  • the idea of being really thin again; after bearing six children, I appreciate and love my body the way it is and work to maintain it in the best health possible.

  • the belief that my children want my advice on how they raise their children; I've come to the realization that God gave their children to them and not to me for a purpose:-)

  • the belief that I have to sleep 8 hours night in order to function; before I let go of this belief I was tired all of the time. When I chose to let go of it, I found that I can function fine even if my menopausal body doesn't give me 8 hours of uninterrupted sleep.

  • the belief that I have to be spiritually fed by others; I found that my spirituality comes from within, and all life and every event can be an opportunity for spiritual growth.

  • the belief that I need other's approval and love to be good enough and to be happy; I now realize that my worth and my happiness depend solely on me.

Until we meet again,

Dr. Judi

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