by Jaine O’Neill

Menopause? Hormone replacement?

Those words were not what I had expected to hear in 1990 as I was about to celebrate my 40th birthday.

It didn’t seem to me that I was experiencing any menopause symptoms, other than maybe the missed period for the past year. I had, in fact, experienced erratic periods for many years, so I was somewhat used to it by now.

The more I thought about it, perhaps I had been undergoing some changes. There was difficulty cooling off after a morning shower. I wasn’t particularly bothered by the cold winter we had just had. And I had noticed a change in my ability to concentrate. But all these symptoms were subtle. I even rationalized my struggle to concentrate was probably a case of burn-out — I had been in school for six years, finishing a master’s in social work at NYU on top of completing my bachelor’s degree.

Yet there was the word. “Menopause.” It suddenly forced me to address some realities in my life that I didn’t think I’d be addressing so soon.

One was whether to take hormone therapy. I had always put off taking medication unless absolutely necessary. Concerned that HRT might not really be the panacea it was touted to be, I was hesitant.

I also recalled my mother’s experience with menopause. She seemed to weather that phase of her life just fine without HRT. She had tried it but stopped due to side effects. At 89 years old, she is still quite active.

I began to think seriously about the pros and cons of beginning HRT. I have a history of scoliosis, which was first diagnosed when I was 10. Three years before I was offered HRT, I started experiencing severe pain in my hip. The first doctor recommended that I have surgery within three to six months. I went for a second, then a third, then a 10th opinion …

The advice was always the same: I would need surgery at some point. One of the surgeons I saw at the Minneapolis Spine Center said that he couldn’t promise to help me feel better. What he could do was stop the scoliosis from progressing.

Fortunately, the results of a bone density test around the time menopause was first confirmed showed that my bones were strong. However, the concern then became how to keep them strong. That was the deciding factor when it came to starting HRT. I felt that if and when I have the surgery to correct the curve and stabilize my spine, I’d want my bones to be strong and I’d want to be as healthy as possible.

Several years later, reports about the use of HRT were released indicating that the risks may outweigh the benefits. I decided that it was time to stop taking hormones and just continue with calcium and vitamin D, along with other supplements and exercise that my endocrinologist had recommended. (Now with the recent news about the decrease in the number of cases of breast cancer linked with the reduction in the number of women on hormone therapy, I am even more relieved that I stopped. Sorry it wasn’t sooner, but better late than never!)

I was not able to tolerate Fosamax. Even calcium was difficult to tolerate so I tried different forms, ultimately settling on liquid calcium.

While HRT, scoliosis and maintaining healthy bones have been just a few of the challenges I have had to deal with, I imagine there will be more. That is just part of life. When I think back to how I experienced menopause, there were certainly moments early on when it felt overwhelming. Shifting my focus from what I had no control over, such as the onset of menopause, to what I did and do have control over, such as integrating a health regime that maintains and enhances my quality of life, has been helpful.

Building a support team is something I feel very strongly about. Not only do you want to have a good team of medical specialists who are on top of things and sensitive to your needs, but it is also important to have a good personal support system, whether it is your family or friends or both. It is also helpful to do some research on your own so that you can make educated decisions when doctors present you with their recommendations. 

My work as a therapist has also been invaluable to me. I still have moments of feeling overwhelmed. So I take a deep breath and acknowledge how I am feeling — whether it is anger, frustration, anxiety, etc. Acknowledging the worst part of how we feel is actually quite freeing. It then makes it easier to act on the things that will help us to make the best choices we possibly can.

While menopause is associated with a particular phase of life, it is sometimes experienced as the end of the previous phase — the time for starting a family and/or a career. Some find themselves mourning a road not taken.

But many of my friends and clients seem to embrace this new phase in their lives. They look forward to the next chapter with excitement and curiosity. Fertility, now, becomes more about giving birth to other aspects of themselves — to their own creativity, ideas and interests.

Menopause is just a part of who we are, but it does not define us.

Jaine O’Neill, LCSW, is in private practice in New York City.

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