Symptoms of menopause
A doctor's list to make you sweat!

A whole array of symptoms of menopause has been described by doctors. The list is so long that many people see menopause as a medical condition, rather than a normal part of life development. When a normal life process is dominated by doctors, it becomes "medicalised".

Doctors write scientific articles about symptoms of menopause, attend specialist conferences and prescribe medication to make us feel better. So we tend to accept it as right and proper that they should define and control our discomforts as we traverse middle age.

By calling all our middle age discomforts "symptoms of menopause" and putting them in a nice tidy list, it somehow helps us all feel that we know what's going on.

Even if it does turn perfectly healthy women into permanent patients…


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Symptoms of menopause – a tidy list

One of the most accepted categorisations of so-called symptoms of menopause is the Greene Climacteric Scale. This scale was first published in 1998 and has recently been republished.

According to the Greene Climacteric Scale, menopause symptoms can be divided into 3 main groups:

1.Vasomotor symptoms – this means hot flushes (hot flashes) and night sweats.

2.Somatic symptoms – somatic means related to the body. Included under this heading are sensations like pressure or tightness in either head or body, muscle and joint pains, numbness or tingling anywhere, headaches, dizziness or feeling faint, difficulties breathing and loss of feeling in hands and/or feet.

3. Psychological symptoms - which can divided into:

anxiety feelings

depressive feelings.

Anxiety related symptoms might include: tension or nervousness, panic attacks, heart palpitations, insomnia and difficulty in concentrating.

Symptoms of depression might include a general sense of unhappiness, loss of interest in life, irritability, crying spells and tiredness or lack of energy.


What about the menopause and sex?

It's interesting that in the original Greene Climacteric Scale of symptoms of menopause there was no mention of anything related to sex, sexual difficulty or discomfort. In the final scale another item was added – almost as an afterthought: "loss of interest in sex."

But still there is no mention of vaginal dryness – a symptom that may affect up to a third of middle aged women and which the evidence shows probably is related to the end of menstruation.


By the way...

It's worth noticing the name of the scale - it's the Greene "CLIMACTERIC" scale and not the Greene "MENOPAUSE" or "PERIMENOPAUSE" scale; So at least for menopause expert, Dr Greene, the word climacteric is not dead.

You will also notice that there is very little in Dr Greene's list of symptoms of menopause that is the sole property of middle-aged women …


The malicious myth of menopause deficiency disease

The idea of those (nowadays hopefully few) doctors who see every menopausal woman as a patient, is that these symptoms cluster together to create a medical syndrome that requires treatment.

To add fuel to the fire and to back up the idea of a medical syndrome, there is a theory of causation: the theory is that these symptoms of menopause are "caused" by a deficiency of oestrogen.

This whole line of thinking about menopause as a deficiency disease can be traced back to the 1960s when a certain "menopause expert", Dr Robert Wilson published a book called "Feminine Forever."

"The unpalatable truth must be faced that all postmenopausal women are castrates."

Robert A. Wilson and Thelma A. Wilson. 1963

In this book Dr Wilson, made the case that all menopausal women are victims of a menopause disease. Wilson claimed that the cause of this disease was oestrogen deficiency and that it led to women becoming gradually de-feminised as the symptoms of menopause took hold.

According to Dr Wilson, this menopause disease was a terrible path of destruction and decay from which every poor woman on the planet could only be rescued by taking hormone therapy – FOR EVER!


Normal is normal and depends on stage of life

It maybe uncommon nowadays to hear doctors talk about menopause as a deficiency "disease", but the idea that the pre-menopausal state is normal and that the post-menopausal state is hormone deficient and by implication abnormal remains remarkably persistent.

Let's not forget:

It is NORMAL for a post-menopausal woman to have a low level of oestrogen compared with the relatively high level in younger women.

Evolution surely had a good reason for making it so...

Medical thinking about menopause has come a long way since the days of Dr Robert Wilson and his big idea that all post-menopausal women are castrates. But some of these attitudes still remain. The huge debate about the rights and wrongs of hormone therapy owes some of its firing fuel to the continued presence of these attitudes in the medical unconscious.

Scientific evidence shows that only two and a half symptoms are definitely linked to the hormone changes of menopause. These are hot flushes, vaginal dryness and some insomnia. For all those other symptoms on the list the scientific evidence is very flimsy that they are even linked with menopause, never mind caused by it.


Medical enlightenment

The medical profession is often blamed for taking control of natural processes and making them their own. This may seem reasonable criticism when it comes to menopause.

But doctors come from a very broad church and there are many voices in the congregation. And there are some encouraging signs of opening minds out there.

The experts on the US National Institute of Health Expert Panel outlined a long list of research that needs to be done so that we can all understand menopause better.

Here are some of their suggestions:

  • Nearly all studies to date focus on white women. We need to know more about how ethnicity and race affect the menopause.
  • We need to know why some women sail through menopause without turning a hair and others suffer troublesome symptoms. What is it about the ones who don’t suffer – do they have a different lifestyle or are their attitudes to their bodies, their symptoms and aging different in some way?
  • What happens in the long term to normal women who never take any menopause-related medication? Do they get symptoms? And if they do, how and when do they resolve?

But the most important recommendation from the experts was that:

It's time to return this natural process to where it belongs…

…here it is from the horse’s mouth:

"Menopause is 'medicalized' in contemporary US society. There is great need to develop and disseminate information that emphasizes menopause as a normal, healthy phase of women’s lives and promotes its demedicalization."

NIH State-of-the-Science Panel. US National Institutes of Health, 2005


Bibliography

Greene JG. Constructing a standard climacteric scale. Maturitas 1998; 29: 25-31. Reprinted Maturitas 2008.

Wilson RA, Wilson TA. The Fate of the Nontreated Postmenopausal Woman: A plea for the maintenance of adequate estrogen from puberty to the grave. J American Geriatrics Soc 1963;11:347-62.


Published February 2010. Updated 6/8/2012


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