MENOPAUSE: THE "WHAT ABOUT ME? SYNDROME

Less privileged women assume that menopause is just another burden of being a woman and simply bear it, though not grinning. But the class differences are glaring. The population tapped for the rare studies has been almost exclusively white, well educated, and motivated to take care of its health preventively. The vast majority of women in lower socioeconomic groups have no idea of the long-term health issues related to "the Change." They are so accustomed to bleeding and having cramps and premenstrual tension that when they hit menopause they just shrug and say, "Here we go againmale doctors treating me like I don't matter a damn."

That was Kate McNally's first reaction. A secretarial assistant in local government in a medium-size Long Island town, she is now fifty-five. All her life Kate has been a great coper, having had four children close together and launched them all as young adults of whom she can be proud. Her reward? "The most frustrating phase I've ever been through in my lifeit's horrendous! I've never felt so helpless. Nobody understands menopause. And nobody knows what to do about it."

Kate went to her gynecologist complaining of heavy bleeding. After a questionable Pap smear, a cone biopsy was done, followed by a D&C. She was put on estrogen and told to have a mammogram. The results weren't conveyed to her for two months. A lump had been found. Of course, at first she blamed the hormones. But the great majority of breast tumors, including hers, are slow-growing. Her disease had probably been developing, undetected, for several years. The irony is, many women do not bother with a mammogram until they consult a doctor about indications of menopause. If a tumor is found, the culprit may look like hormones, but is probably the result of more careful medical surveillance.

After two lumpectomies, Kate is off estrogen forever and bedeviled by menopausal symptoms no one can tell her how to relieve. "I feel betrayed," she says softly. "I've always put others before myself. By this age I have more money to work with and more leisure time with the kids gone. I should have the energy to do the things I've always wanted." I asked what things she had looked forward to.

"Getting a decent night's sleep." This modest expectation is betrayed by the dull film over her blue eyes. "You go for years with little babies waking you up all night. Then the teen years when you can't sleep for worrying because they're out in your car. And now I'm the one awake all night!" She laughs hard. Her husband seems wonderfully supportive, and Kate is determined to cope with this stage as she has with other trials in the past. But after months of sleep deprivation, no wonder Kate, like so many menopausal women, says she feels frustrated.

Her sister, Bindy, is only forty-two and very attractive, with long, curly red hair and a sugar-doughnut figure wrapped in shorts and a T-shirt, but already she is wrestling with the emotional preamble to menopause. "I used to be the no-worry type. Just leave the house, go to the beachnothing ever bothered me," she says. "I lost my temper but once in a blue moon." Now she's a virtual powder keg. When her son didn't come to the table until his dinner was cold, she jumped up in such a childish rage she knocked over a chair. "Everybody looked at me as if I had three heads."

She told her girlfriend later, "They measured the chemicals in my brain with a blood test. They said chemicals were out of balance and that indicated I was in menopause."

"That explains why you're so moody," sympathized her friend.

"Moody! I'm not moody!" Bindy remembers shrieking. "How can you say that? You're my best friend!"

These powerful hormones do, in fact, cross the blood-brain bridge. Sensors in the brain that control emotions pick up a signal when there is an erratic production of either estrogen or progesterone. In a person whose nervous system is finely tuned, these sensors overreact, triggering brain-chemistry changes and emotional symptoms. Veteran gynecologists affirm that some women can have physical symptoms from even slight changes in the amount of estrogen produced.

Every morning, as a waitress in a busy coffee shop, Bindy has to stroke hundreds of people who haven't had coffee yet. "The doctor told me to stop smoking, cut down on cholesterol, and avoid stress. Hah, avoid stress! How?"

She knows she is being grouchy and impossible. "But I can't control it. And I'm afraid if I take this estrogen, then I'll have lumps like my sister."

Women like Kate and Bindy are often caught in the middle between caring for aging, fragile parents and dealing with the lingering financial dependence of children. Many experience the "What about me?" syndrome. They are not accustomed to nurturing themselves. But even as they are encouraged by books like this to pamper themselves through this transition, Western society is making more demands on them today than ever. Most middle-aged Americans today still have living parents, a change in family dynamics with no precedent in history. With many more people in the U.S. and Europe living into their eighties and nineties, and fewer children per family, geriatric researchers warn that almost every woman is going to have to take care of an aging parent or parent-in-law.

That will put more and more women on "the daughter track," possibly for a decade or more, just as they are emerging from the "mommy track." Traditionally/it has been middle-aged women who are depended upon to do the work of unpaid caregiving for the disabled elderly at home. But women now also fill nearly half the paid positions outside the home. At just the stage when they expect to enter the most focused and productive period of their working lives, with their children grown and gone, they may not be able to carry the new double burden of elder-caregiving and full-time career. Many will have to switch to part-time jobs, forfeit promotions, or quit their jobs altogether, unless they demand reforms in public policy and decent eldercare. The cruel choice for a growing number of menopausal-aged women will be: Do I take care of my mother in her old age, or provide for independence in my own old age?

No wonder, just beneath the calm, composed surface of many middle-aged women, one finds bag lady fears.

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Womens health