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THE STRESS RISKS INVOLVED IN MENOPAUSE: INDIVIDUAL DIFFERENCES

As in all aspects of the Female Stress Syndrome, individual differences are important determinants of symptoms. L. Speroff, R. H. Glass, and N. G. Kase have summarized the influences on the average woman's menopausal pattern.

Rate of hormonal changes. Usually, menopausal changes begin a few years before menstruation actually ceases, and the body has time to make a natural transition by approximately forty-eight, the national mean age for menopausal women. If this is the case, brief hot flashes and amenorrhea (cessation of menstruation) may be the only symptoms of menopause. Most women who experience hot flashes have them for about a year, although some women report ten years of these vascular changes. If, however, the hormone feedback to the hypothalamus is withdrawn suddenly, as with a total hysterectomy including removal of the ovaries, menopausal symptoms may be more severe and numerous. "Instant menopause" can produce instant symptoms: fatigue, insomnia, heart palpitations, back pain, and moodiness. In addition, any surgery can produce anxiety; surgical removal of reproductive organs can result in a profound sense of loss as well. Since messages of anxiety and loss can affect hormonal functioning through the complex hypothalamus connection, both "instant" and natural menopause symptoms will be aggravated by stress. Amount of hormone depletion. Estrogen levels gradually drop as the ovaries become less active. Since the changes in the vaginal wall and the autonomic nervous system are related to estrogen depletion, symptoms of menopause such as dyspareunia (pain during intercourse), diminished vaginal lubrication, and hot flashes will be more severe among women who have greater estrogen depletion. Although estrogen-progesterone-replacement therapy may relieve these symptoms, the elevated risk for certain medical conditions means that it is not always recommended. Water-soluble jellies can relieve vaginal dryness with less risk, and a fan and a sense of humor may help make hot flashes bearable.

Physical fitness. Although menopause has genetic parameters, nurture also has an influence.

Hormonal changes can lower resistance to infection by changing the acid/ alkaline balance

in the vagina and urethra; nutrition and exercise can help to restore resistance. Changes in

calcium and fat metabolism are part of menopause; exercise and nutrition can help to compensate for some of the effects of these changes.

In fact, as nutrition and vitamin awareness has improved over the years, the average age of

menopause onset has been set back and menstruation onset has been set forward!

The meaning of aging. As with all mind-body syndromes, menopause has an autonomic nervous system component, a hormonal component, and a cerebral cortex (brain) component, with the hypothalamus as the information-processing and control center. If the thought of aging is distressful, this message will go from the brain to the hypothalamus to the autonomic and hormonal systems; and the General Adaptation Syndrome will gear up for a long-term stress situation. With menopausal changes also affecting these mechanisms, a woman may experience a multiplication of the symptoms of both stress and menopause. If, in addition, the symptoms themselves make her more anxious, we see a vicious cycle in which more autonomic changes

lead to more hot flashes, and so on. Many times of body change are times of stress, because we may feel our sense of control threatened. The changes associated with menopause, as with menstruation and pregnancy, are preprogrammed; we can make them better or worse, but we can't turn them off! This may increase anxiety and make many women feel helpless or victimized by their bodies.

Marilyn had always exercised, dieted, and maintained a youthful style of dress. She felt that her appearance and health were in her own hands and that her self-discipline was the secret of her "staying power." Although she thought that she had accepted the inevitability of menopause, she found that when menopausal changes began, her sense of control was threatened. She looked for, and of course found, every new wrinkle and age spot that appeared. She could no longer predict the rate of her body's changes, and her stress level rose. Feeling that she was fighting a losing battle, she lost her interest in dieting, exercise, and dressing attractively. She became increasingly depressed; soon Female Stress Syndrome symptoms, which she blamed on menopause, developed.

Does Marilyn's story sound familiar? Although the menopausal symptoms themselves may not be under full control, other areas of functioning are. Unlike Marilyn, women who maintain control of their weight, their exercise, and their time can help themselves reduce that feeling of being overwhelmed by inevitable physical changes.

Depression and stress are not exclusive to changes in body state such as menstruation, pregnancy, and menopause. In fact, often these feelings coincide with body changes only because both come at the same time of life, not because one has been caused by the other. For example, a husband's retirement, a daughter's failing marriage, or the loss of one's own parent may trigger a depression mistakenly labeled "menopausal melancholia." The loss of one's office friends or autonomy may coincide with the postpartum period. To understand the Female Stress Syndrome fully, we must look in the next chapter at stresses not associated with preprogrammed body changes, and at the body changes that go along with these stresses.

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