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.