by Sydney L. Murray

Menopause is in the news as a powerful period in a woman's life, and redefined from period in a woman's life which had been hidden, feared and ultimately endured. Today women are embracing these years as a time of self discovery and growth. Christiane Northrup, M.D. stated in her new book The Wisdom of Menopause, "After working with thousands of women who have gone through this process, as well as experiencing it myself, I can say with great assurance that menopause is an exciting developmental stage­–one that, when participated in consciously, holds enormous promise for transforming and healing our bodies, minds, and spirits at the deepest levels." Recently I had the opportunity to talk to Dr. Northrup.

SLM: Why do you think menopause is so prevalent in the media?

CN: It's because the baby boomers are such a huge population and we can't keep our mouth's quiet. It's five times the population that came before it or after it. And remember we are from the sixties: the sexual revolution, birth control pills, Roe v. Wade. A very powerful and vocal group, (with the motto) don't trust anyone over thirty, and question authority. We helped revolutionize childbirth and now we're going into menopause and we're not going to suffer silently. That's wonderful because that question authority ethos has changed the entire pharmaceutical industry. So that instead of one-dose-fits-all hormones, we now have women who understanding there are herbal medicines that help, there's soy, there's flax, there's the option of hormones. 

SLM: What is menopause?

CN: Menopause medically refers to the final menstrual period and it's average age in the United States is fifty-two. Yet, you don't know you've had your final menstrual period until a year has passed, so there's no way to diagnose menopause per say. What you can do through salivary, or blood testing is begin to document hormonal changes throughout the six to thirteen years leading up to the last menstrual period and that's known as perimenopause. This is where women really begin to experience the effects of fluctuating hormones. The other thing I want women to know is that their ovaries never stop producing hormones-they never shut down, unless they've been removed or unless they've had to cease function because of radiation or chemotherapy. A normal healthy woman will often make enough hormone throughout her entire life to support her health.

SLM: That's good to know, and often not the message women receive.

CN: Yes, and we're taught even in medical school that women do not produce enough estrogen themselves. There are studies that show that many women make enough testosterone for sex drive, enough estradiol, that's a type of normal estrogen to keep their brains and bones healthy. We ignore the healthy women and study women who have had an altered menopause. Even a tubal ligation will change the blood supply to the ovaries a bit. That doesn't mean those things are unhealthy it just means you have to work around them.

SLM: Please expound upon the chapter in your book, 'The Brain Catches Fire at Menopause".

CN: This irritability that younger women experience premenstrually, or what I give as the three wake up calls: PMS, SAD (Seasonal Affective Disorder), which no one probably has in Southern California, and post partum depression. These are the times when your hormonal shifts will lay bare any conflicts which are unresolved in your life. What we like to do is blame the hormonal shift, but it is the hormonal shift which lays bare what is already there. In perimenopause this hormonal shift becomes relentless because it can last for six to twelve years. PMS you have a couple of days or up to a week per month, so you can pretend that everything is fine for the rest of the time. In post partum depression most women are over with it within two months, but there are severe cases which require psychiatric care. In perimenopause there's no escape, you can try Prozac, or you can try every hormone out there, but if your life is not working, your body and your brain are not going to let you ignore it any longer. So if you look at it that way you see the wisdom of nature. You see what an opportunity this is. But if you stay stuck in the: 'it's just my raging hormones' then you are lost, because your choosing to ignore your internal compass.

The real issue is this "grow or die" experience that's going on. And this is evident because you'll begin to get irritated about little things that never bothered you before. Pay attention and use this irritability. What I love about irritability and anger is that they let you know that something is not working in your life, that something is not turning out the way you expected it to; or your needs are not being met. That doesn't mean that someone outside of you is supposed to fix it for you; it means you need to take the reins into your own hands and fix it for yourself. That will prevent you from getting marinated in irritability and anger. Which is a risk factor for cancer and heart disease.

SLM: Tell me about the PBS series you are doing.

CN: Right now I have a show called "The Wisdom of Menopause" and one called "Your Diet, Your Health" and a couple of older shows, called "Women's Bodies, Women's Minds," and "Women's Bodies, Women' Choices."

PBS will be rerunning the "Wisdom of Menopause" which first aired in 1999. That was about six months before my marriage ended. When I look back it's very interesting to see myself saying everything that I knew was absolutely true, but without even knowing how prophetic it was. I remember when I was on the Oprah show in '99 and the show aired pictures of my husband, my kids and myself and we look like the perfect family, and as the pictures run you hear my voice over them. What was startling was my voice-over coming over a picture of my husband and I which said, "It's crucial that we stop pouring our energy into dead-end relationships." It was like god was giving me a sign right then. And the day that show aired a week or so later our marriage was over the very next day.

I knew too much to stay in this relationship.

My biggest compliment is when women come up to me and say, 'I always knew what you were saying was true, I just never saw it in writing and I've never heard it from a medical doctor.' Once women open up to their own inner voice there is no going back. Think about 40-45 million baby boomer women waking up and supporting not only their own intuitive message, but that of their families and their kids, then we will see the world change.

SLM: Do men experience anything like menopause?

CN: I believe they absolutely do. I have a friend who refers to it as "testapause." I don't like that term because I don't want what's been told to women, the misinformation that their ovaries are going to shut down and have that told to men. Because they don't, there's a huge variation. You can find men who are seventy who have testosterone or DHEA levels that are the same as a forty year old male it just depends on their level of health.

What men go through and there is no question (about this) is mid-life crisis. And it usually involves something about their work. Either they're downsized at their place of work or they have to start a new career at age forty eight or fifty. This can be very devastating for a man. And often men will act out sexually, or buy a new car, or become very agitated about the economy.

I read this article about how women were choosing not to get married until they meet the right guy. I can tell you that having done it, having tried to make someone feel better about his career, to keep the marriage and the relationship going, that it is almost as natural to women to help their men feel good about themselves, as milk coming into their breast after they've had a baby.

Yet what is evolving today is our sexual roles. I had just listened to Dr. Joyce Brothers on the Today Show where she said, "We've heard of the seven and the fifteen year itch in a marriage, and now we have the twenty-five year ditch."

People realize that they are still viable, they look decent, they have a lot of life left. I believe menopause is a time where this huge upsurge of energy or spirit wells up within you, kind of like sap in a tree.

Watch people who are fueled by inspiration from within. And then watch others who are staying in a marriage for security or in a job to get their benefits. The: 'If I just stay ten more years here, I can retire to Key West.' But they're going to die before they get their benefits. I know this feeling, because in my own marriage I was thinking, 'Am I going to be able to continue here?' There was a big part of me that said, 'I'm half way there and it's worked pretty well up until this point, why mess with it? But if you can take the risk to move out of a relationship which doesn't serve you it's better to work through it.

SLM: Do you feel most MDs are up to date on the most current information on menopause and perimenopause?

CN: I keep up with my own field through the eyes of the medical profession. They're very up to date on medicalized ways to soothe the symptoms of menopause and they also know you can't give the same dose of hormones to every woman. That's a huge change. If you look at the estrodiol patches there are now four or five doses. So individualized hormone prescribing has become mainstream. That concept wasn't in place when I first came out with "Women's Bodies, Women's Wisdom." In 1994 everyone was getting the same dose. It was like a herd, a herd of cows. You go in and vaccinate them with the same dose. That was horrifying to me.

But these are two sources the medical profession receives information: Continuing education and pharmaceutical companies. The soy reps don't visit your office, the multivitamin reps don't visit the office, the Pilates instructors don't visit the office, so it's a cultural thing, within the culture of medicine. And having earned my stripes in those trenches I understand it and I have great compassion for it.

On the other hand I despise the arrogance where the Chief of OBGYN of one of the major East Coast hospitals can come visit my hospital, and go over all the evidence on estrogen and heart disease, estrogen and Alzheimer's and tell us the truth which is that we don't have the data telling us that estrogen prevents these conditions. To be honest and say, I have watched people spend twenty-five years convinced that estrogen was going to prevent heart disease and then when the studies aren't panning out that way, literally not be able to speak.

So here this MD is at the end of his talk with about five minutes left and he's going to conclude with the alternatives (to ERT). So he describes soy and various other remedies like black cohosh and states that the overwhelming evidence is that they don't work. So here's a guy that's honest but who has this huge blind spot about alternatives to ERT and which he knows very little about. Now I wouldn't mind if he said, 'Some women have done really well with these, but I don't know enough about them.' So with all of the authority vested in him, he said, 'These don't work.' So then a group of 50 OBGYN doctors repeat this information as this happens again and again all over the United States.

A women then goes to her natural food store where she tries a menopausal herbal combination of black cohosh, red raspberry, nettle or red clover and her hot flashes go away, and her vaginal moisture comes back. And her doctor might have said to her, 'These herbs don't work and they might be dangerous.' And as Lionus Pauling said, 'What we're not up on, we're down on.' That's human nature, so what I did in my book (The Wisdom of Menopause) is take the finest research I could find, that backed up the experience that I had seen with thousands of women. I watched women, I listened to women. They said, 'I'm taking these herbs and I feel great!' I'd examine them and everything was great. There were women who were desperate to avoid hormone replacement and yet the herbs didn't do the trick. Then there are the women with breast cancer who can't take estrogen so they might have difficulty with intercourse. They could be given estriol, a type of estrogen which works locally and could thicken the whole vaginal tissue and get rid of urinary symptoms. There's no reason not to give it and because doctors aren't aware of it these women suffer.

The other thing that I have seen with thousands of women who take soy powders or eat a lot of soy to get their level of isoflavones up to 100-180 milligrams a day, that their hair, nails, skin, are the best they've ever been. Their PMS goes away, their period lengthens up and their breasts instead of having that thick dense tissue that mammograms can't read through, are healthier and the mammograms get much better, and all of that is from soy. But it has to be a high enough dose--you're not going to get it from eating a little edamame or a couple of soy nuts, it's got to be higher dose and it should be whole soy.

But I do think women need to know the down side of Premarin and Provara which I'm certainly very clear about in my book (The Wisdom of Menopause). But when it comes to humans we use horse estrogen and it makes no sense aside from the fact it is historical. And whether the horses are treated ethically or not, and I've spoken to veterinarians who assure me they are not. But even if that weren't the issue, there is concern because Premarin is not native to humans. I think it's very important for women to know that Premarin was the first oral estrogen that was available in 1949. And when the pharmaceuticals first started producing it they didn't have the laboratory expertise to take soybeans and yams and make human beta-17 estrodiol which is the exact match of what is in humans. Now we do, but Premarin early on got this market share, and then Robert Wilson wrote this book Feminine Forever and the rest is history, it's just sales and marketing.

Now we have the Women's Health Initiative which you and I are paying for with our tax dollars using the wrong estrogen to determine if every woman needs estrogen replacement. It's a big boondoggle, and that's because the pharmaceutical companies provided the Premarin and Provara. Premarin in its metabolic breakdown or the metabolites of Premarin are stronger than the original mother compound, so the daughter compounds are stronger. That means that your estrogen sensitive tissues, which in perimenopause, are being bombarded by estrogen dominance-which is too much of your own body's estrogen without enough progesterone. Then you add Premarin and what's lingering keeps stimulating the breast tissue and may keep stimulating the ovaries and the uterine lining. Researchers have demonstrated this and the studies are in here," she said pointing to her book.

We know that the metabolites of Premarin cause damage to the DNA of breast cells. So then you make the women who could really use estrogen terrified that if they use estrogen they're going to get breast cancer. But you could use the other estrogens which break down into the weaker and weaker daughter compounds, and they are estriol, estrodiol and estrone. If they would use one of these, or a combination of the three, at the lowest possible dose I think the risk would be minuscule. Also birth control pills are another synthetic hormone and many women in perimenopause are put on them, and the ovaries are on automatic pilot till they get Premarin and Provera. And Prempro is just Premarin and Provera in a new package with a new name for the same old stuff. And it's the number one selling hormone replacement.

Provera, a synthetic progestin, has a profoundly adverse affect on blood vessels in the coronary arteries. So this is probably worse than taking no hormones at all.

Every woman has a choice. You could try Prometrium which is a capsule of natural progesterone, or you can go to a Formula Pharmacy, and have them make up something just for you using bioidentical progesterone. Then there is no undue risk with the heart. This is critical and again, the studies are in this book (The Wisdom of Menopause). Women need to know this to make an informed choice. Yet there still will be women who will take whatever their doctor prescribes for them.

Now is the time for myself, as for so many other women of the baby boom generation, to be pioneers in re-creating the second half of our lives on our own terms. As we do so, we must keep in mind that physical and emotional health is our natural state, even during this time of transition. Have no regrets, whatever you decide. Take advantage of the clarity of vision that is the gift of menopause, and use that gift to let the second half of your life be truly your own.

SLM: What has been your menopausal experience?

CN: Mine has been really interesting because it was jump started through taking GnRH agonist known as Cinerol and it puts you into menopause artificially. I had just one goal: to shrink the size of a fibroid. It's not right for everyone but by this time my fibroid was as big as a soccer ball. And with this drug it had shrunk down to the size of a grapefruit by the time I had surgery. I didn't want a scar that went all the way across my lower abdomen. Today, with uterine artery embolization, I might have gone in and had a shot in the femoral artery and done it that way. So I've been on this drug and it does this fast forward of my body, so that for six months after surgery I had hot flashes that were so bad I had cracking on the sides of my mouth.

But I wasn't yet in menopause, because I still had my periods, so the drug effect wasn't wearing off. Then two months before the separation (with her husband) the hot flashes were getting worse and worse so that in the middle of the winter I'm taking off all of my clothes and the cracks around my mouth are getting worse. I'm going to an acupuncturist who's telling me I'm out of yin, she said with a wry grin. And I'm taking herbs and soy protein with their isoflavones and I kept waiting for the drug effect to wear off and the ovaries to kick in.

Literally within a week of my marriage ending the hot flashes left. Then I had normal periods for a full year like clockwork, every 28-30 days, then the following year, my periods were regular until August or September of last year (2000), I had a period that lasted for 20 days. Which was exactly how my mother's last period was because I was with her on a camping trip when she had it, and my dad had just died. Think of this parallel: My dad had died playing tennis with her of a ruptured cerebral aneurysm, when she was in her final year before menopause. I got divorced in the final year before my menopause. She had a period that was so heavy she had to tear her nightgown apart in the tent we were in and make pads out of it. I had this incredibly heavy period and have had nothing since. I had a couple migraine headaches, but with high dose soy I've had no symptoms of dryness or urinary infections. My skin is wonderful. Right now I take soy and flaxseed. and get plenty of exercise. And if I have some hot flashes they are very mild if I don't eat any sugar.

The bottom line is that if you do not get in touch with your spirit now, then that's it for you. And I'll tell you what I mean by that. I'm walking around Rodeo Drive yesterday. A gorgeous, gorgeous place and every bit of it is about how it looks: externals. It's about external, surface perfection-outer perfection. Well, the only perfection you can ever count on to last is your connection with your own soul. Which is eternal and which is always there for you and always beautiful and it's why at age 75 my mother can say to me, 'In many ways I feel no different from when I was twenty.' Because the soul is eternal and immortal and it's always there for you So you get some sagging skin, so what? If we still are pumping all of our juice into looking twenty-five, thinking that's who we should be, and how we should be, then, god help us, because, god is the only thing that will. And I think that's why menopause is so difficult for women who have the benefit of going through life as genetic celebrities. They've told me, 'I walk into a room and heads don't turn anymore.' Well the beauty of never having heads turn, is that you don't miss it.

But if you have this internal dialogue that says, 'I'm something no matter what!' then if you're 80 and you can laugh at yourself, then you've got it. And this essence keeps rejuvenating yourself until you're ready to go and recycle."

Menopause has been a personal and physical renaissance for me because I feel so much stronger, my body feels better. I do Pilates so I know how to be strong. I saw a beautiful woman here in the workout room (we're at the Beverley Hills Regent Hotel) today and I wanted to ask her, 'Would you please open yourself up?' (as she opened her chest and expanded her body upward.) You can be still be very strong and be hunched over, and that's not good and it doesn't need to happen.

SLM: What are you going to do with the second half of your life?

CN: I would love to do a television series where we have women telling their stories and do it intergenerationally so that we have young women, women from an older perspective and women in the middle, and hear each of their voices simultaneously.

Also, I have another book that I've been working on since 1997, about mothers and daughters. Its about the health of the mother and her beliefs about her body, which often confuse her daughter. With my own mother for example, to have her last period almost at the same age as myself, with both of us after the loss of our husbands is amazing. There is this legacy and when you understand your own legacy you can bring it to the next level.

I don't think that's necessarily a goal that we should have, but what we should do is glean the wisdom of the stage we're in, just like a plant. What season are you in? And what is the wisdom and the beauty of that season? So the mother-daughter book I'll be writing in the next year. I would also like to do some more television work. And my two daughters are almost launched. The (youngest) one is going to college in the fall. So this book tour is the first time in the last 20 years where I'm not worried about getting back home because my kids need me. They need me, but I don't have to be there in the same way, and that is so liberating. I feel that I'm on the verge of a life where I didn't have to look at someone's school schedule.

Northrup's book is the story of her life and her experience with menopause. She told me that she wouldn't write a book on menopause until she had gone through it herself. This book is full of helpful information and well researched studies which allow women to make educated choices about their lives and their health during perimenopause and menopause.

The Wisdom of Menopause, Creating Physical and Emotional Health and Healing During the Change by Christiane Northrup, M.D. $27.95 Bantam Books, www.drnorthrup.com.