September is National Menopause Awareness Month. This week, Dr. Allen addresses the fears of a 45-year-old woman who is plagued by dread of the menopausal symptoms that afflicted her mother and made her own adolescence miserable —Ed.
Image by ericalaspada via Flickr.
Dear Dr. Pat:
I am 45 years old and terrified of menopause. I am beginning to be short-tempered, and my PMS is worse. I have night sweats with my period now. I still have regular periods, so I know these symptoms could really become unmanageable.
My mother, who smoked (and drank too much on weekends), was always hot-tempered, but when she hit her mid forties, she became a crazy person. I was 15 and no piece of cake myself, with PMS and the usual teenage miseries. I had no help from my mother with any of this. She would berate me and occasionally hit me with a wooden spoon. She became so hard to live with that my father left and got a divorce from her when I was a junior in high school. He told me how guilty he felt because he left me behind, but he tried to help, and he did take care of us financially.
I was able to talk to our school nurse a lot after this, and spent as much time as possible with the families of friends, since I never knew what kind of mood my mother would be in. I survived, though, and left home at 17 to go to college. I did well enough academically, although I did drink a lot and had a great many sexual relationships that I always hoped would become something else. Whenever I was blue or afraid of the future or ashamed of mistakes I made in college, I always wanted a mother to talk to. I was lucky that my roommates’ mothers were kind and had some sense. I developed relationships with these women that exist to this day.
I finally saw a therapist after college, really sorted my stuff out, chose not to drink at all, and became a respected guidance counselor. I love my work and I am very gratified that I have had the chance to mentor hundreds of high school students in my career. I married a wonderful man and have two teenage daughters who are just great. My older daughter has just left for college.
I wanted to start hormone therapy before these symptoms get worse, but my mother and her sister both had breast cancer in their late forties and my mother died from it before she was 50. My doctor told me that hormones are not a good choice for me because of this family history. I am more and more terrified of breast cancer—so terrified that I have not had a mammogram in two years. These fears of becoming just like my mother, treating my husband and children badly, ending up with a divorce and children who don’t want to see me, and then dying of breast cancer are in my head all the time now. I read all the information about menopause management but am stuck. I don’t know where to start to make any change in my life. I vowed that when I married and had children I would not replay my mother’s story over again.
What can I do?
Dr. Pat Responds:
Your story is not an uncommon one. Many women entering the menopausal transition tell me stories of the horrors of their experience as adolescents of their mother’s behavior during her menopause. They want to do everything possible not to repeat this. They are often ressured when we end our session with, “You don’t have to repeat your mother’s menopause”.
You have done such a wonderful job playing the very difficult hand of cards that was dealt you. You learned early to find mentors; the school nurse in high school, then mothers of friends who were kind and loving enough to find the time to include you in their families and to be there for you with some support. You survived college socially in spite of the choices that you sometimes made that were perhaps not the best for you emotionally.
But you are hardly unique in making unfortunate choices in college, so do let the self-judgment of that young woman go now. In fact, you did well academically in spite of little family support. Then you became a guidance counselor, which was a wonderful professional choice for you, giving you the opportunity to guide and mentor young people who might not have other resources. You should be very proud of the lives of the many young people for whom you have made such an impact. You have a good marriage, and so far have enjoyed being a caring mother. History does not have to repeat itself. The lights do not have to dim and that old black-and-white film “Menopausal Madness” does not have to begin, with you suddenly in the starring role, formerly played by your mother.
There are many things that you can do now to get your life back on course. It is so important that you have recognized early that you are having symptoms that could be difficult for you to manage.
• Find mentors again—women who have been through this stage—and find out how they managed.
• Find a good therapist who can help you efficiently change the here-and-now before going back to the past again. Ask the therapist to help you find ways to recognize triggers for anger and anxiety and to develop strategies for control of your emotional response to these.
• Recognize when you are having negative thoughts and notice when you begin to ruminate about what might be, instead of the reality of your life now.
• This is the time for you to withdraw some of that emotional capital you have deposited into your family’s bank account. You have worked to have a good marriage. You have two daughters who have had a loving mother who certainly helped them become the “great girls” they are now. Speak first to your husband about having a family talk. Ask your husband and your daughters to give you more time for self care for the next year. Be specific in your requests.
• Join a meditation class and learn the daily practice of breathing for control of stress, improvement of sleep, and improvement in mindfulness. This practice helps many people recognize and manage ruminating thoughts. Find time between advising students to close the door and empty your mind.
• Begin a daily exercise plan and stick to it. Brain biochemical change occurs with exercise. You will improve your mood, energy, sleep, and overall health with exercise.
• Take a week off to go to a retreat/spa that specializes in meditation, exercise, and healthy vegetarian eating. Do your research carefully. You don’t need an expensive spa that attracts the rich and famous. Do online research to find a place where you can be with other women who are often there for the same issues you want to address. Many of these retreats have lectures and discussions that target the interests of women in midlife.
• Eat carefully. Avoid sugar and large meals. Small, frequent meals will help you with energy as you go through the menopausal transition.
• Find a high-risk breast cancer center and begin a lifelong practice of breast self-exams, breast imaging based on the recommendations of this group, and evaluation of your genetic risk for breast cancer if you and your medical team think that this testing is right for you. You may be at greater risk for breast cancer, but early detection and correct treatment choices are available now that were not available to your mother and aunt. Don’t avoid this because of fear. Avoidance of screening just increases the anxiety.
• You may find that the hormonal impact of your menopausal experience affects your anxiety and negative thinking so significantly that these recommendations for behavior change are not enough. Be prepared to ask your therapist to refer you to a psychopharmacologist who understands which medications can help with hot flashes, sleep, anxiety, and ruminating that may be issues that all of your hard work and willpower may not be able to control.
• Take time to plan the next part of your life. You are entering the midlife transition. Your work as a full-time mother will soon not take up so much of your energy. This is the time for reinvention or evolution in your life. Your relationships and your own life will be richer if you are mindful of where you are in your life’s journey and recognize that you can change the title of your family film to “Menopause: A Time for Change.”