Twenty years ago, many male physicians thought the hot flashes of menopause took place in their patients' heads. Fact was, they didn't think about menopause much at all.
"The symptoms sound pretty vague: irritability, sleep disturbances, sweating, flushing," says epidemiologist Trudy Bush, associate professor of obstetrics and gynecology at Johns Hopkins Medical School. "Since men never experience any of this themselves, they were apt to take the attitude: 'You know, women get funny around this age.' "
Few questioned this wisdom -- least of all the post-menopausal women who were often too humiliated by the end of their childbearing years even to discuss their discomfort with friends.
No more, says journalist Gail Sheehy, whose new book "The Silent Passage: Menopause" (Random House, $16) is claiming such mass media arenas as "The Oprah Winfrey Show." Ms. Sheehy predicts a blossoming of knowledge as the up-close and personal baby boomers enter their 40s and 50s.
During the next decade, the population of women between 45 and 54 will jump from 13 million to 19 million. These women will demand more information about the physical changes and risks of menopause, Ms. Sheehy says. They will demand more research into the hormonal replacement therapy that most physicians consider the best way to prevent heart disease and bone loss in post-menopausal women.
And they will demand better PR.
Indeed, Ms. Sheehy suspects the vitality of the baby boomers will erase society's perception of menopausal women as second-class females.
"I think menopause has been painted with an ugly image that may hurt menopausal women psychologically as much as anything," says a 51-year-old Baltimore social worker who has gone through menopause. "Mention menopause and everyone still comes up with a negative image of some hump-backed, broken-down person: That's why I don't want my name used. One of the greatest benefits of better information would be to change attitudes."
Researchers say there is a lot of ignorance about menopause, which is officially reached when menstruation has stopped entirely for a year.
For instance, there's confusion about age: Although the average age for the onset of menopause is 51, some of its earliest symptoms, such as changes in menstruation, can begin as early as the late 30s. It seems related to such factors as family history, smoking -- heavy smokers have an earlier menopause -- and size: Thin women tend to reach menopause earlier.
Although physicians used to consider menopause something of
an overnight phenomenon, it is a gradual transition which often takes years. Some researchers believe women's ovaries begin producing less estrogen, the female reproductive hormone, in their 30s.
Ms. Sheehy says most women are unaware of the uncomfortable range of possible menopausal symptoms. As she describes them in her book:
"At the dignified apex of one's adulthood, to have to worry about being hit with surprise periods, hot flashes, night sweats, insomnia, incontinence, sudden bouts of waistline bloat, heart palpitations, crying for no reason, temper outbursts, migraines, itchy, crawly skin, memory lapses -- 'My God, what's going on?' "
"We know that puberty causes profound changes in a woman's body and a man's body. And no one has an issue that puberty is a tough time socially," says Dr. Bush. "Women have just as profound changes in our internal hormonal milieu at menopause."
Ms. Sheehy finds the subject of hormone replacement therapy raises particular concern and frustration.
It is now widely acknowledged that estrogen is the best prevention for heart disease, the primary killer of women over 50, and osteoporosis. However, many health professionals disagree on the best form of hormone therapy to use, on its risks and on length of treatment. It is not recommended for women who have had cancer or such conditions as heart, liver and gall bladder disease.
The most commonly prescribed form of treatment uses both estrogen, a female hormone produced in the ovaries, and progestin, a synthetic hormone similar to the natural female hormone progesterone. Researchers believe that progestin protects the endometrium -- the lining of the uterus -- against the increased rate of cancer estrogen may pose to women on hormone therapy. (Although it has been widely used since the 1980s, progestin has never been officially approved by the U.S. Food and Drug Administration.)
Estrogen replacement therapy is considered the best way to slow bone loss for women at risk of developing osteoporosis, a post-menopausal condition in which the bones become fragile and weak by losing calcium. In addition, estrogen can help stop the hot flashes, urinary incontinence, low sex drive and vaginal dryness which often accompany menopause.
Although several large studies have shown that women on hormone therapy live longer than those without it, long-term use of estrogen has also been linked to higher rates of breast cancer, Ms. Sheehy says.