Straight Talk On Menopause

GUESTS:

Ellen Sarver Dolgen, author of Shmirsky: The Pursuit of Hormone Happiness

Dr. Hilda Hutcherson, an obstetrician and gynecologist in New York

Jane Delgado, CEO of the National Alliance for Hispanic Health

Dani Tucker, Tell Me More's regular parenting contributor

September is Menopause Awareness Month. Menopause affects nearly every woman at some point in her life, yet the issue is difficult to address for many, including physicians and mothers. Tell Me More discusses how menopause affects women physically, mentally and socially, and how women and their families can best manage this time in their lives. (Language Advisory: This segment contains frank and explicit language that may not be suitable for all audiences.)

Copyright © 2011 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

JACKI LYDEN, Host:

I'm Jacki Lyden, and this is TELL ME MORE from NPR News. Michel Martin is away.

We want to talk about something that affects every woman at some point in her life, and yet it's something a surprising number of women often find difficult to talk about.

We're talking about menopause. Mothers seldom open up about it. Doctors may or may not be helpful. And all this not talking can leave us caught off guard if we experience a scene like this.

(SOUNDBITE OF TV SHOW, "THAT '70S SHOW")

DEBRA JO RUPP: (as Kitty Forman) I just can't believe my baby is all grown up and visiting college. I am so freakin' old!

TOPHER GRACE: (as Eric Forman) And menopause makes another unwelcome appearance at the dinner table.

JO RUPP: No, no. It's not unwelcome. It's liberating. It's now, my emotions just spill out.

GRACE: Yeah, Mom. You're sweating all over your pork chop.

LYDEN: Fun, huh? That was a clip from the TV program "That '70s Show."

Whether the conversation's full of laughter or tears - or both, or maybe because baby boomers just aren't the type to go quietly, women going through menopause want to be able to talk more openly about the experience.

That's something we learned when we received more than 1,000 responses to our Facebook call for comments on this issue. And since September is Menopause Awareness Month, we wanted to take this chance to talk with a group of women who've got menopause on their minds. And we just want to advise our listeners that parts of our conversation will be explicit about the sexual effects of menopause, so it may not be suitable for everyone.

CEO: The Pursuit of Hormone Happiness." Dr. Hilda Hutcherson is an obstetrician and gynecologist in New York City. Jane Delgado is the president and CEO of the National Alliance for Hispanic Health. And Dani Tucker is one of our regular Moms contributors.

Welcome to the program.

ELLEN SARVER DOLGEN: Thank you.

JANE DELGADO: Thank you.

HILDA HUTCHERSON: Thank you.

DANI TUCKER: Thank you.

LYDEN: Ellen, let's start with you. First, tell us a little bit about this book. What's a shmirsky, and why do you use that term? And you say that the book is written by E, so explain yourself, if you would, please.

SARVER DOLGEN: OK. Well, a shmirsky is what I call my va-jay-jay. This is a completely made-up name that was given to me by a dear friend and mentor of mine. She had a name for the male counterpart, too. She called it erlick(ph). So we could be at lunch and dinner talking about shmirskies and erlicks, and it sounded like we were talking about a great restaurant or a law firm.

LYDEN: The Pursuit of Hormone Happiness," and I decided I would use E instead of my full name because frankly, the book is a little bit of everyone's story. So E represents everyone and also Ellen, which is the first letter of my first name.

LYDEN: Let me read a little bit from your description of menopause in your book. You write: It's your brain, your body and your life transforming into something you're totally unfamiliar with. You begin to question your sanity, relationships, hormones, genetics, sex drive, age, food, clothes, underwear, everything. Ellen - E, fess up. Is it that bad for everyone?

SARVER DOLGEN: Well, there's no one size fits all. I mean, some women breeze through this and congratulations. You've got great genes. But frankly, most of the women I speak to around the United States have a myriad of symptoms, and we're not prepared.

LYDEN: The Pursuit of Hormone Happiness" for not just a woman, but for the men in their life to read, and also their teenage children to read so they understand what their mother is going through. And the woman can get the help and love and support she deserves.

LYDEN: Dr. Hilda Hutcherson, let's turn to you for a moment. Can you please tell us exactly what menopause is, and when women start to experience it?

HUTCHERSON: There are two things we need to talk about. One is what's called perimenopause, and that's when people get most of their symptoms, and then there's menopause.

The perimenopausal period is that time when your estrogen starts to go down. Your ovaries are not working as well as they used to as you age. And your estrogen starts to decrease. And women will get symptoms related to that decreasing estrogen. And the perimenopausal period can last anywhere from one year to 10 years.

You're considered menopausal - or you've gone through menopause once you haven't had a period for one full year. And many women find that they feel better after that period, although some women will continue to have the same symptoms they had during the perimenopausal period, during that menopausal phase.

LYDEN: Dani, what are some of the symptoms you began experiencing? And who did you talk to about them?

TUCKER: The mood swings, especially, and the hormonal swings and the hot flashes. And I talked to other friends because when Mom went through it, only thing Mom says is, you know, why is it so daggone hot in here? Or, you know, she doesn't really explain to you what's going on, but you just see her go through it. Or you just see it, you know; you just kind of figure it out. But with friends, you know, we want to talk about it. We want to know - you know, is this supposed to be happening? - because you have so many misconceptions.

LYDEN: Hilda, why do you think people are so reticent, that so many women are so reticent? Apparently, Dani and her friends weren't, and some of Ellen's friends were not. But a lot of women are.

HUTCHERSON: It starts with our mothers. Most mothers don't talk to their daughters about menopause. It's always been one of those kinds of taboo subjects. So you get the message that this is something, like sex, that you don't talk about.

LYDEN: Jane Delgado, what have you noticed amongst your family and friends?

DELGADO: I come from a very unusual set of family and friends, and we actually talked about menopause. So I think that my mother said, well, it's just something that happens, and you get through it, and that's it. And as for my friends, the feelings varied widely. And from my patients, you know, how they go through menopause has a lot to do with their attitudes about themselves and their bodies and whether or not they're in a relationship with someone whom they really want to engage in sexual activity with.

LYDEN: Mm-hmm. Why do they say that?

DELGADO: Well, it ranges from menopause made them freer - they didn't have to worry about pregnancy; they didn't get migraines anymore; and hey, no one told them about this side, that their sexual appetite actually went up.

LYDEN: Mm-hmm.

DELGADO: And I think women who have increased sexual appetite during menopause and afterwards are embarrassed to talk about it, because what they usually hear is the other side of the coin. So I think lots of things happen to different people. It's not one size fits all, but there's a whole spectrum of behavior that we have to be open to.

You know, a lot of people say, well, you know, your body is going through changes, and all these things are happening. But it's like at the other end, when we were teenagers and our hormones were first kicking in. Our body went through changes. We had mood swings and things like that, and we adjusted to it. Well, this is another adjustment in our life but this time, it's different.

LYDEN: Empowerment rather than disempowerment.

HUTCHERSON: Exactly. And something that's part of life. It's not something that we should allow people to make fun of as part of our lives.

LYDEN: If you're just joining us, you're listening to TELL ME MORE from NPR News. I'm Jacki Lyden. We're talking about menopause with Jane Delgado, president and CEO of the National Alliance for Hispanic Health; Dani Tucker, who's one of our regular contributors here; Dr. Hilda Hutcherson, she's an OB/GYN in New York City; and Ellen Sarver Dolgen, author of the book "Shmirshky: The Pursuit of Hormone Happiness." And we just want to advise our listeners that parts of our conversation will be explicit about the sexual effects of menopause, so it may not be suitable for everyone.

So we reached out to our listeners on Facebook, ladies, because we really wanted to know what women - and men, too - were thinking about menopause. And as we mentioned, we received over 1,000 comments.

Here's one listener, Kathryn Burlingham from Portland, Oregon, talking about what she experienced.

KATHRYN BURLINGHAM: I had about three months of incredibly high hormonal surges that were really terrifying in their effects. I was actually talking to my doctor, and I think she had been told it's just perimenopause; it's not a big deal. So she just kind of laughed and waved her hand and wasn't really paying attention to the severity of what I was experiencing.

LYDEN: Let me turn to you, Hilda. Now, you are an OB/GYN.

HUTCHERSON: Yeah.

LYDEN: But do you think that a lot of doctors are prepared to answer these questions?

HUTCHERSON: Well, we're all taught about menopause but often, doctors don't feel comfortable talking about it. And it's very time-consuming, to be honest, and some doctors don't want to give the time or don't have the time to give to a woman, to really explain what's going on with her body. And I usually tell women that if you're not getting the answers that you need and deserve from one doctor, you should always look for someone who has more interest or expertise in perimenopause and menopause.

LYDEN: Ellen, you have really waded into this with your book. I mean, you found that women would talk to each other, but often really felt confused about where to turn.

SARVER DOLGEN: That was one of the reasons that gave me so much passion to pursue this, because when I reached out to the sisterhood, most of the women I talked to were confused as I was, and really didn't even understand that there are approximately 34 symptoms of perimenopause and menopause. For me, it started with memory loss in my 40s. And, of course, I didn't even think about menopause. I thought I was way too young and frankly, you know, I thought one day I'd wake up at about the age of 65 and my period would be gone. I thought that was menopause. So it really propelled me to create a symptoms chart, actually, to help women understand what the symptoms are so you don't think you're losing your mind, because I get email after email from women, and at the bottom of it, it says: Am I in menopause, or am I losing my mind?

LYDEN: Dani, you're kind of nodding your head here.

TUCKER: Oh, she hit it on the nose because that's what me and my girlfriends were going through - I mean, again, the misconception. We thought - because our mothers didn't talk about it - that, you know, it was something that happened for five days. You turn 60, you didn't get a period, OK, woo.

(SOUNDBITE OF LAUGHTER)

TUCKER: You know, you stuck your head in the freezer for a minute and, you know, you yelled at your husband or whatever. But like her - I mean, then, you know, we're in our 40s, I can't remember anything. Your kids are like, all right. What is wrong with you, you know?

(SOUNDBITE OF LAUGHTER)

TUCKER: I mean just, you know, is this a sock on the step? Oh, I'd go off. And I'm like...

(SOUNDBITE OF LAUGHTER)

TUCKER: ...oh, my God. Did I just go off over a sock? So we started to - just what she said. We started to talk to each other about it, found out that we were all going through the same thing. And then we heard the premenopause or the perimenopause. And, you know, you're looking at your mom, like, why didn't you say something? Just say something. You know, and we were determined that were going to talk about it. And what we have agreed to do is to continue to talk, and then share and not be, you know, like our moms. And credit to them, they weren't raised to talk about a lot of things because their mamas didn't talk to them about it. So hopefully, each generation gets better.

LYDEN: Ellen, you also said that a lot of women sort of don't want to admit that anything's wrong, and they say they're fine, because to be less than fine would be somehow admitting failure.

SARVER DOLGEN: Yeah. I mean, first, I have to say that I do think that my children thought I needed an exorcism. I really was not myself. And although I tried to be fine - because women are caregivers, and we kind of don't know how to take care of ourselves as well as we take care of everybody else, so we just try to pull it all together.

I do have to say, I kind of understand now why my mother never talked to me about menopause, when I realize that my grandmother - her mother - was actually institutionalized because they thought she was going through a depression when she went through menopause. One of the symptoms of hormonal changes can be anxiety, depression. And in those days, women were hospitalized for that and, in fact, some women were given shock therapy. So I get why my mom was not going to talk about it. She did not want to go through that.

LYDEN: Psychologically, Jane, do you see this generation of women in a different place?

DELGADO: Most definitely. You know, we've done work on looking at the views of Hispanic mothers who only spoke Spanish, and things like sexually transmitted diseases, and we found that this generation now is very different than the past. So the good news is, we are working to inform each other. The reason that my book "The Latina Guide" did so well was because women like to talk to each other. And we're doing that more and more, and we have more venues do that.

So I have great hope for the future. And I also have hope that menopause is not just a woman's problem. It's also a man's problem, too. They go through it, also. But because of us, it's such an observable event in terms of our period, it's something which people make a lot more noise about. But men go through their mood swings and all sorts of changes, too, and we sort of accept that. I think that we need to understand that they go through changes, we go through changes, and it's all part of life. And how can we make it better for everybody?

LYDEN: Mm-hmm.

DELGADO: That's the challenge.

LYDEN: Dr. Hutcherson - we haven't even talked, Hilda, about hormone-replacement therapy. That was a big deal, and understandably so, very recently - whether to do it or not.

HUTCHERSON: Yeah. Many women have chosen not to take hormone-replacement therapy because of the Women's Health Initiative study that showed a slight increase in breast cancer, as well as heart attack and stroke, in women who took hormone- replacement therapy. And the day after the study results came out, I received hundreds of calls from women, saying they didn't want to take hormones. It's now starting to turn a little bit the other way, in that women are saying: I am miserable this way. I don't want to feel crazy. I want to get sleep. And they're choosing to take hormones again.

And so what I say to women is, it's a quality-of-life issue. If you're miserable and your family wants to divorce you and you don't feel good about that, it's OK to take hormones.

LYDEN: Well, Dani, you think the guys are still with us on this one today?

TUCKER: Oh, no. They've change the channel.

(SOUNDBITE OF LAUGHTER)

SARVER DOLGEN: Well, you know what? Guys really do care, though, because they really suffer when the women in their life doesn't feel good. So I get a lot of emails from men. I think they really are interested in helping the women they love. They might be listening.

TUCKER: Yeah, I think they're interested. I just don't think they're - you know, I think they're interested, but hearing us talk about it is something different.

(SOUNDBITE OF LAUGHTER)

TUCKER: You know, the guys I know, they leave the room. They go OK, you know what? That's just not for us. TMI. Everything is TMI.

(SOUNDBITE OF LAUGHTER)

TUCKER: You know, too much information. Too much information. They just want us to fix it, and they just want it to be right, you know.

(SOUNDBITE OF LAUGHTER)

DELGADO: Well, I think your partner - whether it's male or female, your partner - it's having a loving relationship and being able to talk through the issues. And if it's just someone has vaginal dryness, there are also products that are lubricants that someone can use, that will also help the situation. And part of menopause - because men also have problems, too...

(SOUNDBITE OF LAUGHTER)

DELGADO: ...as we know, you know, is having a loving relationship. I have to be honest and say some women have said to me: Well, thank God. Now I can have a reason for not having sex - you know, because they're not in a loving relationship. So it's a very complicated, very individualized. And it's not a one pill fits all or a one size fits all - as we all know about that, for many things. So it takes work, and a loving relationship is at the heart of it.

LYDEN: I really want to thank everybody for speaking with us today. We have Dr. Hilda Hutcherson, an OB/GYN who joined us from NPR in New York. Ellen Sarver Dolgen is the author of "Shmirshky: The Pursuit of Hormone Happiness," and she joined us on KSON in San Diego. And with us here in Washington, D.C., Dani Tucker, one of our regular contributors, and Jane Delgado, president and CEO of the National Alliance for Hispanic Health. Thank you all so very much.

TUCKER: Thank you.

DELGADO: Thank you.

HUTCHERSON: Thank you.

SARVER DOLGEN: Thank you.

LYDEN: And that's our program for today. I'm Jacki Lyden, and you've been listening to TELL ME MORE, from NPR News. Let's talk more tomorrow.

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