The climacteric is generally used to describe the 15-year period
during which menstruation eventually ceases. Around this fulcrum will
be a number of physical and psychological symptoms.
In much
the same way that there is rarely a precise beginning to menstruation -
many young girls have light spotting and erratic bleeding for years -
and there is rarely a precise beginning to labour - many women
experience niggly symptoms on and off for days or weeks - there is no
precise beginning to menopause. By calling this period 'perimenopause'
(the time before menopause), practitioners have a name to hang these
symptoms on. But there is little evidence that this is helpful to
women. What is more, there is evidence to show that the major stresses
in the lives of menopausal women, which can so often translate into
feelings of depression and unpredictable mood swings, are most often
caused by family or factors other than menopause (Arch Gen Psychiatr,
1994; 41: 959). For instance, around 25 per cent of menopausal women
are caring for an elderly relative, which can certainly be stressful
(Am J Epidemiol, 1987; 125: 110).
Not surprisingly, in one
study, women's overall health status, emotional and physical,
objectively and subjectively - not income and education - were the
significant factors in how well women adjusted to the menopause (J
Health Behav Educ Promot, 1995; 19: 22-31). But by making perimenopause
sound like a medical diagnosis, doctors are causing women to focus more
deeply on perceived health problems.
This may explain the
increasing acceptance of HRT. In one study of the adaptation to
menopause, the only differences between the HRT users and non-HRT users
was the expression of 'hope' (Eur Menopause J, 1997; 4: 91-4). Although
non-HRT users were shown to have fewer expectations, less desire for
new experiences and were generally less active, this was not taken as
an indication of a depressive mood, but more of a mood of acceptance.
In contrast, HRT users were more likely to be lonely and unhappy. They
were also more likely to be unmarried. For this group, HRT, often
referred to as a 'youth potion', represented hope for the future.