The Menopause Transition
Introduction: Entering the stage of menopause brings on all kinds of changes and emotions. You may feel a sense of loss since the reproductive years are ending. There will no longer be opportunity to give birth to children. There may be a loss of identity and feeling of usefulness to your family or society. It is normal to grieve. It is normal to feel this way. It’s important to realize that as a child of God you do not lose your meaning and worth. It’s also vital to recognize that menopause is a stage of life to pass through not a disability. This study will look at what happens during perimenopause and menopause; how to cope with this stage of life and God’s purpose for your life. As you begin this study I want to challenge you to begin thinking about God’s perspective on your life. No matter what phase of life you are in – God has a purpose for you, the power to help you through it and to give you joy in the midst of it. Ask yourself these questions: How would God want me to view this stage of life and the changes I may experience? What plan does God have for me in the midst of menopause? What is God teaching me as I take this new journey? Let’s begin now to consider some of the facts of the menopause transition.
The New Stage of Menopause
What happens as women enter the stage of menopause?
“I feel on edge. I can’t sleep or think clearly. My husband is tired of my forgetfulness. Sometimes I just fly off the handle for no reason. I am having trouble with sex. I don’t know what is happening to me? Could this be menopause?”
Nancy, age 52, sat in my office looking frustrated, worn-out and depressed. I have counseled many women with complaints like hers. Women come in with overwhelming symptoms of perimenopause and menopause which impair their emotional, physical, mental and spiritual health.
Surprisingly, a recent BBC news article quoted a Jubilee Report that stated that 76% of post-menopausal women said their health was better, 75% said they had more fun, and 93% said they had more independence and more choice in everything from work to leisure pursuits.
There is light at the end of the tunnel, but if you are currently in perimenopause, odds are you are feeling more like Nancy and are looking for answers to help you cope with this uncertain territory. Informing yourself about what to expect when you begin experiencing menopausal symptoms and how you can more effectively handle this new stage of life is the first step towards feeling better.
Perimenopause, the time our mothers referred to as “the change,” can start as early as 40. The closer a woman gets to 50, the more symptoms she will have. Common symptoms include hot flashes, erratic and often painful periods that may be extremely heavy or too light or skipped altogether, forgetfulness, insomnia, night sweats, headaches, and, given the other symptoms, a hardly surprising tendency to mood changes and depression. This transition period is a unique experience for each woman. Late symptoms consist of vaginal dryness, urinary problems, muscle and joint aches.
“The most notable thing about these symptoms is that they can be very erratic. After months of problems a woman can become symptom-free for six months or more,” said Dr. Paul Lucca, an obstetrician/gynecologist with Advanced Healthcare.
The biological origin
The cause of all these diverse symptoms is the slowing down of the function of the ovaries. “Ninety-eight percent of the time a woman is fine physically but the ovaries are starting to falter in their production of good eggs..” Dr. Lucca said.
As a result, women will begin to have anovulatory cycles in which eggs are not released. This may result in a lighter period, similar to those a woman may have had while taking the birth control pill, or one that is skipped altogether. However, the ovaries are still producing estrogen which causes the lining of the uterus to thicken. Progesterone, released by the egg, causes the uterus to slough off that lining, resulting in a menstrual period. When no egg is released the lining continues to thicken until the next “normal” cycle when a woman’s bleeding can become very heavy. It is advisable to consult your doctor whenever symptoms cause concern such as heavy bleeding.
What women can do for themselves
“Some of the general things women can do during perimenopause include watching what they eat and exercise. These are clichés but clichés become clichés for a reason. Women’s metabolism is slowing down and they start putting on weight. They may have the same diet and exercise program as earlier in life but they begin to gain weight. Watching the diet and doing more exercise not only keeps off weight but it’s also good for the heart and bones,” said Dr. Lucca.
Some doctors recommend hormone replacement therapy (HRT). You should manage your medical care and determine what is best for you. There are some risks with HRT and there are risks associated with use of uncontrolled over-the-counter or ‘natural’ treatments. Inform yourself of the benefits and risks of any treatment you are considering.
What physical changes have you noticed and dealt with?
How have you coped? What has worked and what has not worked for you?
What is Menopause?
Menopause begins a new phase in a woman’s life when she stops having periods, often some time in her 50s. Menopause is a natural biological event in which the menses stop when the function of the ovaries begins to cease. Menopause does not occur overnight, it is a gradual process. A woman is in menopause when she has had no menstrual periods (menses) for 12 months and has no other medical reason for her menses to stop.
What makes menopause so difficult? The decrease in estrogen also affects serotonin- a brain (neurochemical) chemical – which causes women to feel good, energetic and to focus more clearly. This is called the “serotonin-estrogen” dance. Less estrogen=less serotonin. When serotonin decreases women begin to feel “blue” or experience depressive-like symptoms.
The following are physical signs and symptoms associated with menopause. Let me assure that these symptoms are not experienced by all women going through menopause and are not experienced to the same degree.
-Hot flashes – sudden waves of heat that can start in the waist or chest and work their way to the neck and face and sometimes the rest of the body. They are more common in the evening and during hot weather. They can hit as often as every 90 minutes. Each one can last from 15 seconds to 30 minutes – five minutes is average. Seventy-five to eighty percent of women going through menopause experience hot flashes, some more bothered by them than others.
-Sometimes heart palpitations accompany hot flashes.
-Irregular periods – this varies and can include:
-Periods that get shorter and lighter for two or more years.
-Periods that stop for a few months and then start up again and are more widely spaced.
-Periods that bring heavy bleeding and/or the passage of many or large blood clots. This can lead to anemia.
-Vaginal dryness – this results from hormone changes. The vaginal wall also becomes thinner. -These problems can make sexual intercourse painful or uncomfortable and can lead to irritation and increased risk for infection.
-Loss of bladder tone which can result in stress incontinence (leaking urine when you cough, sneeze, laugh or exercise).
-Skin and hair changes. Skin is more likely to wrinkle. Growth of facial hair, but thinning of hair in the temple region.
-Muscles lose some strength and tone.
-Bones become more brittle, increasing the risk for osteoporosis.
-Risk for a heart attack increases when estrogen levels drop.
Emotional changes associated with menopause:
-Lack of concentration, difficulty with memory.
-Tension, anxiety, depression.
-Insomnia which may result from hot flashes that interrupt sleep.
These symptoms can seem unbearable. Women are fortunate to live today in a world which provides much guidance and many resources for understanding and managing menopause.
Questions for Thought:
What has been your understanding of menopause? What symptoms have you been experiencing?
How has perimenopause or menopause affected your lifestyle, energy level and/or mood?
What has been your perspective about this stage of life from a spiritual standpoint?
What would God want you to do and to be during this stage of life?
Coping with Perimenopause and Menopause
I encourage women to take better care of themselves in every aspect of life: physically, mentally, emotionally and spiritually. In perimenopause the body goes through substantial changes and requires additional resources to complete the process. Taking extra good care of yourself during this time pays dividends.
Physical Wellness: Because hormone levels are decreasing, there will be fluctuations in the symptoms women experience. Vaginal bleeding and hot flashes come and go. There is no set time when these symptoms will stop. Some women experience these symptoms for over a decade of their lives.
Hormone or Estrogen replacement therapy taken orally or applied topically may be prescribed by a doctor in order to help alleviate symptoms of hot flashes and vaginal dryness. Whether you choose hormone replacement therapy or not it is important to manage your own treatment and research the best kinds of medical or natural interventions for your situation. Recent research discouraged the use of the combined hormone replacement therapy (estrogen and progesterone). This is something you should discuss with your doctor. Vaginal dryness can be alleviated by using estrogen cream or K-Y jelly prior to sexual intercourse.
Lifestyle changes should include quitting cigarette smoking, curtailing alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D. Such changes are beneficial for increasing physical wellness and preventing complications such as osteoporosis and heart disease.
Emotional and Mental Wellness: When you are experiencing the symptoms of hormone loss, from time to time you will feel blue. Hormonal changes can increase emotional fragility and lower your confidence. Combined with a lack of sleep menopause can cause irritability, confusion, sadness, angry outbursts, tears and disrupt relationships.
While estrogen therapy may be recommended to help elevate mood, women should also incorporate natural methods of elevating mood such as: lowering stress and increasing recreational and exercise programs. I encourage women to consider a new venture, pursuing education or career goals. Try learning a useful pursuit such as photography, writing or computer technology. Start participating in meaningful recreational and social activities. Begin hiking, biking, bird-watching, join a book club, start a new hobby. Add some more fun to your schedule.
Spiritual Wellness will bring the greatest stability when women enter this new stage of life. Take time to read scripture, the Psalms and pray. Focusing on the spiritual aspect of your life will bring the hope and faith which can alleviate depression and anxiety caused by menopause. Memorizing scripture can change your attitude about life.
Self-Care Tips to reduce the discomfort of hot flashes::
Wear lightweight clothes made of natural fibers.
Limit or avoid beverages that contain caffeine or alcohol.
Avoid rich and spicy foods and heavy meals.
Have cool drinks, especially water, when you feel a hot flash coming on and before and after exercising. Avoid hot drinks.
Keep cool. Open a window. Lower the thermostat when the heat is on. Use air conditioning and/or fans. Carry a small fan with you (hand or battery operated).
Try to relax when you get a hot flash. Getting stressed out over one only makes it worse.
Use relaxation techniques such as meditating on scriptures, prayer.
Take 400 international units of vitamin E daily, but consult your doctor first.
If you suffer from night sweats, (hot flashes that occur as you sleep):
Wear loose fitting cotton nightwear. Have changes of nightwear ready.
Sleep with only a top sheet, not blankets and keep the room cool.
To deal with vaginal dryness and painful intercourse:
Don’t use deodorant soaps or scented products in the vaginal area.
Use a water soluble lubricant such as K-Y Jelly, Replens, etc. to facilitate penetration during intercourse. Avoid oils or petroleum-based products. They encourage infection.
Ask your doctor about intravaginal estrogen cream.
Remain sexually active with your spouse. Having sex often may lessen the chance of having the vagina constrict, help keep natural lubrication and maintain pelvic muscle tone.
Avoid using antihistamines unless truly necessary. They dry mucus membranes in the body.
To deal with emotional symptoms:
Exercise regularly. This will help maintain your body’s hormonal balance and preserve bone strength.
Talk to other women who have gone through or are going through menopause. You can help each other cope with emotional symptoms.
Avoid stressful situations as much as possible.
Use relaxation techniques such as meditating on scripture and prayer and listening to soft music.
Eat a healthy diet. Check with your doctor about taking vitamin/mineral supplements.
What are some goals that could help you better manage the symptoms you are dealing with? Write these goals down.
How can you take better care of yourself and move forward in this new phase of life by applying the self-care tips?
How are you growing spiritually? What is God teaching you? What scriptures have brought you hope and encouragement?
Consult with your physician about medical interventions if you would like further help during this time of your life. When you apply some of these tips – you, too, may find that the menopause transition is more tolerable and the happier stage of life other women report it to be.
Committing Your Life to God
As you pass through this stage of life – be assured that God has a plan and purpose for you.
God’s Word declares these core purposes for your life:
to be reconciled to God by trusting in Christ as Lord and Savior;
to love God with your whole heart, mind, soul and strength;
to be a witness of the gospel and Christ’s love to the whole world;
to live a godly life – fully devoted to Christ.
Read about Faith and how knowing God personally can help bring you hope and power for living!
Identify the purposes of the Christian life? What does each purpose mean to you?
When did you fully commit your life to Christ? What difference did His presence and power make in your life?
How has menopause – paused you spiritually?
What can you do this week to focus more on Christ?
How can you reach out to others with the love of Christ?
Don’t let menopause – pause your life! No matter what trial you face in life – living for God’s purpose and for Christ will give you fulfillment and satisfaction in the midst of it. The symptoms of menopause are only ‘light and momentary troubles’. You can move forward and continue to live fully for Christ. In passing through menopause – you can discover a new depth in your relationship with Christ and a new purpose for living. Take time to readThe Purpose Driven Life by Rick Warren for a deeper understanding of the significance God places on your life!
Self-Worth Issues during Memopause
Women typically suffer from low self-esteem. They seek to increase self-worth through the approval of others or from achieving goals. Raising children, building a career and/or fulfilling the role of a wife can become the basis for a woman’s identity. Unfortunately, when menopause comes along – the physical changes and roles are affected greatly. Children generally move out of the home. Energy and sexual libido decrease. Lower estrogen levels may cause some depression and unhappiness about self and life.
Thus, women need to build their self-esteem and especially build it on the love and forgiveness of Christ. Christ provides an unchanging basis for self-worth. He gives real purpose and value to His children. No matter what occurs in life – Jesus loves you unconditionally, can use you and fulfill His purpose in you. Believing these truths can radically change how you view yourself during menopause. Trusting in God’s purpose and Word and experiencing His love will change your motivation and ability for dealing with this stage of life.
Dignity and Self-Respect
You need to determine that because you are a person of dignity, made in the image of God – that you have great value. When you question your dignity and worth – you will feel like a failure and not be motivated to deal with the difficulties of menopause.
What is dignity? According to the dictionary dignity is the quality of being worthy of being esteemed or respected. Dignity = self-regard, self-respect and self-esteem.
“What should move us to action is human dignity: the inalienable dignity of the oppressed, but also the dignity of each of us. We lose dignity if we tolerate the intolerable.” Anonymous
The well-known psychologist Abraham Maslow, who charted out a hierarchy of human needs, put self-esteem above basic survival needs such as food, shelter and clothing.
It’s important to note that safety needs are basic to human survival and foundational to your belonging and esteem needs. When these needs are unmet – your life will be in disorder.
When you feel you are a person of worth – you will place high regard on your life and how you are treated.
Also, you must come to the realization that how others treat you does not determine the truth about who you are. You need to realize that you are a person of worth and value despite what anyone thinks, does or says and despite any goals you may or may not have accomplished.
Read Search for Significance by Robert McGee. This book will help you base your self-worth on truth versus the opinions of others or false beliefs. Take the following inventory to measure your self-esteem:
DIRECTIONS: For the statements below, circle the rating which is most true of your level of exhibiting these behaviors in your life. Use the following rating scale:
1 = never
2 = rarely
3 = sometimes
4 = frequently
5 = almost always
1 2 3 4 5 ( 1) I seek approval and affirmation from others, and I am afraid of criticism.
1 2 3 4 5 ( 2) I guess at what normal behavior is, and I usually feel as if I am different from other people.
1 2 3 4 5 ( 3) I isolate myself from and am afraid of people in authority roles.
1 2 3 4 5 ( 4) I am not able to appreciate my own accomplishments and good deeds.
1 2 3 4 5 ( 5) I tend to have difficulty following a project through from beginning to end.
1 2 3 4 5 ( 6) I get frightened or stressed when I am in the company of an angry person.
1 2 3 4 5 ( 7) In order to avoid a conflict, I find it easier to lie than tell the truth.
1 2 3 4 5 ( 8) I have problems with my own compulsive behavior, e.g., drinking, drug use, gambling, overeating, smoking, use of sex, shopping, etc.
1 2 3 4 5 ( 9) I judge myself without mercy. I am my own worst critic, and I am harder on myself than I am on others.
1 2 3 4 5 (10) I feel more alive in the midst of a crisis, and I am uneasy when my life is going smoothly; I am continually anticipating problems.
1 2 3 4 5 (11) I have difficulty having fun. I don’t seem to know how to play for fun and relaxation.
1 2 3 4 5 (12) I am attracted to others whom I perceive to have been victims, and I develop close relationships with them. In this way I confuse love with pity, and I love people I can pity and rescue.
1 2 3 4 5 (13) I need perfection in my life at home and work, and I expect perfection from others in my life.
1 2 3 4 5 (14) I seek out novelty, excitement, and the challenge of newness in my life with little concern given to the consequences of such action.
1 2 3 4 5 (15) I take myself very seriously, and I view all of my relationships just as seriously.
1 2 3 4 5 (16) I have problems developing and maintaining intimate relationships.
1 2 3 4 5 (17) I feel guilty when I stand up for myself or take care of my needs first, instead of giving in or taking care of others’ needs first.
1 2 3 4 5 (18) I seek and/or attract people who have compulsive behaviors (e.g., alcohol, drugs, gambling, food, shopping, sex, smoking, overworking, or seeking excitement.)
1 2 3 4 5 (19) I feel responsible for others and find it easier to have concern for others than for myself.
1 2 3 4 5 (20) I am loyal to people for whom I care, even in the face of evidence that the loyalty is undeserved.
1 2 3 4 5 (21) I cling to and will do anything to hold on to relationships because I am afraid of being alone and fearful of being abandoned.
1 2 3 4 5 (22) I am impulsive and act too quickly, before considering alternative actions or possible consequences.
1 2 3 4 5 (23) I have difficulty in being able to feel or to express feelings; I feel out of touch with my feelings.
1 2 3 4 5 (24) I mistrust my feelings and the feelings expressed by others.
1 2 3 4 5 (25) I isolate myself from other people, and I am initially shy and withdrawn in new social settings.
1 2 3 4 5 (26) I feel that I am being taken advantage of by individuals and society in general; I often feel victimized.
1 2 3 4 5 (27) I can be overresponsible much of the time, but I can be extremely irresponsible at other times.
1 2 3 4 5 (28) I feel confused and angry at myself and not in control of my environment or my life when the stresses are great.
1 2 3 4 5 (29) I spend a lot of time and energy rectifying or cleaning up my messes and the negative consequences of ill–thought–out or impulsive actions for which I am responsible.
1 2 3 4 5 (30) I deny that my current problems stem from my past life. I deny that I have stuffed–in feelings from the past which are impeding my current life.
____ TOTAL SCORE
SCORING AND INTERPRETATION Add the ratings circled. This score indicates the degree to which you are affected by low self–esteem.
0–30 Not affected by low self–esteem.
31–45 Traces of low self–esteem. Take preventive action to reduce its impact on your life.
46–61 Presence of mild low self–esteem in your life. Take steps to treat this.
62–90 Presence of moderate low self–esteem. Take steps to treat this as soon as possible.
91–120 Presence of severe low self–esteem. Take steps to treat this immediately.
121–150 Presence of profound low self–esteem. Take immediate step to treat this and seek out professional help to assist you in this process.
Consult with your physician about medical interventions if you would like further help during this time of transition.
Dealing with Low Self-Esteem During Menopause
In the Search for Significance, Robert McGee, writes that there are false beliefs behind low self-worth:When I fail at something, I feel lousy about myself.
When others don’t approve of me, I can’t seem to get over it.
Sometimes it feels like I’ll never measure up.
I’m so hopeless.
These beliefs are contrary to scripture and will prevent your self-worth from growing. You must challenge these beliefs with the truths of scripture. Jesus Christ proclaims the following facts about who you are as His child, as His servant and as His friend. When you are a Christian – someone who has trusted fully in Jesus Christ as Lord and Savior and repented from sin – you have a brand new identity in Christ! Do you believe what Jesus says about you or the false beliefs underneath low self-esteem?Here are scriptures which describe your relationship with God and your identity as a Christian:
John 1:12 Yet to all who received him, to those who believed in his name, he gave the right to become children of God.
John 15:5 “I am the vine; you are the branches. If a man remains in me and I in him, he will bear much fruit; apart from me you can do nothing.”
John 14:13-21 And I will do whatever you ask in my name, so that the Son may bring glory to the Father. You may ask me for anything in my name, and I will do it. And I will ask the Father, and he will give you another Counselor to be with you forever- the Spirit of truth. The world cannot accept him, because it neither sees him nor knows him. But you know him, for he lives with you and will be in you. I will not leave you as orphans; I will come to you. Before long, the world will not see me anymore, but you will see me. Because I live, you also will live. On that day you will realize that I am in my Father, and you are in me, and I am in you. Whoever has my commands and obeys them, he is the one who loves me. He who loves me will be loved by my Father, and I too will love him and show myself to him.”
Acts 10:43 “All the prophets testify about him that everyone who believes in him receives forgiveness of sins through his name.”
Eph 1:7 “In him we have redemption through his blood, the forgiveness of sins, in accordance with the riches of God’s grace .”
Col 1:13-14 “For he has rescued us from the dominion of darkness and brought us into the kingdom of the Son he loves, in whom we have redemption, the forgiveness of sins.” (NIV)What are the truths about your identity from these verses?
That you are a Child of the God of the universe because you have trusted in Jesus Christ as your Lord and Savior.
That Christ lives in you and you live in Christ.
That when you allow Jesus to have control of your life, you will produce valuable workswhich glorify God.
That Jesus will hear your prayers and answer them.
That the Father and the Son love you.
That you have forgiveness and eternal life because of your relationship with and faith in Christ.What more validation can a person want than to have the approval, love, forgiveness and inheritance of our Lord Jesus Christ?
This must take pre-eminence in your life. Jesus Christ is the way, the TRUTH, and the life. What He says is true, not what anyone else says or does, not any thoughts you have which contradict scripture.
When you grow in this understanding of who you are in Christ, you can let go of wrong thinking or any rejection from others. You can rise above the ‘blues’ of depression and menopause and say with the Psalmist, “Why are you so downcast O my soul? Why so disturbed within me? For I will yet praise Him – my Savior and my Lord.” Psa. 42:5
You will be determined to follow God’s will and trust Him for your life despite the trials of menopause.
When you believe that you are valuable in God’s sight – you will start acting like it. You will assert yourself and set boundaries so people will treat you with the dignity a person made in God’s image deserves.
Maybe you have been looking for your identity in the approval of others and/or in your performance and role at work or at home. Now is the time to transition from finding out who you are in what you do — to finding out who you are in Christ!
Here are some facts about your who you are in Christ from Scriptures:
1. You are now a child of God and part of God’s family: John 1:12
2. You are a new creation in Christ — the old has gone — the new has come! 2 Corinthians 5:17
3. You have been justified by faith in Christ and have peace with God….thus, you no longer have to work to try to make yourself right before God. Romans 5:1
4. You have been completely forgiven through faith in Christ and His death and resurrection: Ephesians 1:7
5. You are completely loved by God in Christ: Romans 5:8; John 17:23; John 3:16
6. You are “in Christ”: John 17:21; Colossians 3:3
7. You are on your way to heaven: John 3:16, 36.
8. Nothing can separate you from the love of Christ: Romans 8:35-39
9. The Holy Spirit now indwells you forever: John 14:16; Ephesians 1:14
10. You have a new purpose in life — to live for Christ and to know and share His love with others: Philippians 1:21, 3:13-14; Colossians 2:6-7;
Matt 5:14-16 “You are the light of the world. A city on a hill cannot be hidden. (15) Neither do people light a lamp and put it under a bowl. Instead they put it on its stand, and it gives light to everyone in the house. (16) In the same way, let your light shine before men, that they may see your good deeds and praise your Father in heaven.” NIV
In other words, concentrate now on living fully for Christ. In living fully for Christ you will find strength and hope for living; new meaning for your life and a new identity; an eternal perspective when you feel troubled by the changes menopause causes in your life. Your faith can bring you hope about the circumstances and people around you; a joy even when life disappoints you because Jesus loves you and will carry you through.
1. Which category did your self-esteem fit into? How did your self-esteem measure prior to entering the stage of menopause?
2. What does the Bible teach about your identity in Christ? How should this affect you when you are confronted with menopause or any difficulty in life? What false beliefs do you struggle with?
3. Reflect on the following statement and verses: You have a new purpose in life — to live for Christ and to know and share His love with others: Philippians 1:21, 3:13-14; Colossians 2:6-7; Matt 5:14-16. Have you considered what God’s plan is for you in this stage of life? What ministry could you invest yourself in? How are you using your spiritual gifts?
Though you feel troubled by the symptoms of menopause – scriptures challenge you to serve others. How can God empower you to use your spiritual gifts and live more fully for Him? Jesus said in Mark 10:45 “For even the Son of Man did not come to be served, but to serve, and to give his life as a ransom for many.” (NIV)
© copyright 2007 by Lynette Hoy, NCC, LCPC