Table of Contents
| List of Figures | xiii |
| Acknowledgments | xv |
| Introduction: The Journey Begins | 1 |
| Midlife: Redefining Creativity and Home | 3 |
| Why I'm Writing a Menopause Book Now | 5 |
| Blazing a New Trail | 6 |
| Chapter 1 | Menopause Puts Your Life Under a Microscope | 9 |
| "Not Me, My Marriage Is Fine" | 10 |
| The Childbearing Years: Balancing Personal and Professional Lives | 12 |
| Why Marriages Must Change at Midlife | 16 |
| My Personal Fibroid Story: The Final Chapter | 20 |
| Feeling the Joy of Co-creative Partnership | 23 |
| The Forces That Change the Goose Also Change the Gander | 26 |
| Real Menopause Hits | 27 |
| My Marriage Goes Bankrupt | 28 |
| Armadillo Medicine: The Power of Vulnerability | 31 |
| Celebrating the Past While Creating a New Future | 33 |
| Chapter 2 | The Brain Catches Fire at Menopause | 36 |
| Our Cultural Inheritance | 36 |
| Our Brains Catch Fire at Menopause | 38 |
| Learning to Recognize and Heed Our Wake-up Calls | 39 |
| Is It Me or Is It My Hormones? Debunking the Myth of Raging Hormones | 42 |
| The Multiple Roles of Your "Reproductive" Hormones | 48 |
| Embracing the Message Behind Our Menopausal Anger | 53 |
| Emotions, Hormones, and Your Health | 57 |
| How Our Midlife Brains and Bodies Are Set Up to Heal Our Past | 66 |
| Finding a Larger Meaning | 71 |
| Chapter 3 | Coming Home to Yourself: From Dependence to Healthy Autonomy | 76 |
| The Empty-Nest Syndrome | 76 |
| Boomerang Babies | 80 |
| Powerful Feelings, Powerful Healing | 82 |
| Caring for Ourselves, Caring for Others: Finding the Balance | 84 |
| Hitting Pay Dirt: Getting Clear About Money at Midlife | 90 |
| Coming Home to Yourself | 97 |
| Vocational Awakening at Midlife | 99 |
| A Road Map for Navigating Unknown Territory | 102 |
| Chapter 4 | This Can't Be Menopause, Can It? The Physical Foundation of the Change | 105 |
| What Is Happening in Your Body: Hormonal Changes | 106 |
| Perimenopause Is a Normal Process, Not a Disease | 107 |
| The Three Types of Menopause | 110 |
| Perimenopause and Hormonal Levels | 112 |
| Is There a Test I Can Take? | 114 |
| Menopause and Thyroid Function | 118 |
| Menopause and Adrenal Function | 119 |
| What to Expect in Your Transition | 124 |
| Chapter 5 | Hormone Replacement: An Individual Choice | 134 |
| A Brief History of Hormone Replacement | 134 |
| Bioidentical Hormones: Nature's Ideal Design | 138 |
| A Hormone Primer: Essential Information Every Woman Should Know | 142 |
| How to Decide Whether or Not to Take Hormones | 154 |
| A Dusting of Hormones | 169 |
| How Long Should You Stay on Hormones? | 170 |
| Chapter 6 | Foods and Supplements to Support the Change | 172 |
| Basic Principles of Herbal Therapy at Menopause | 174 |
| Menopausal Healing Foods | 178 |
| Traditional Chinese Medicine and Acupuncture for Menopause | 187 |
| Start Somewhere | 190 |
| Chapter 7 | The Menopause Food Plan: A Program to Balance Your Hormones and Prevent Middle-Age Spread | 191 |
| Making Peace (Once Again) with My Weight | 192 |
| Five Steps to Midlife Weight Control | 194 |
| The Elements of Imbalance | 199 |
| The Hormone-Balancing Food Plan | 205 |
| Optimizing Midlife Digestion | 219 |
| The Final Frontier: Accepting Our Bodies | 225 |
| Chapter 8 | Creating Pelvic Health and Power | 227 |
| What Is Yours, What Is Mine, What Is Ours? Reclaiming Our Boundaries | 228 |
| Hormonal Imbalance: Fuel to the Fire | 231 |
| Menstrual Cramps and Pelvic Pain | 231 |
| Heavy Bleeding | 235 |
| Fibroids | 240 |
| An Empowered Approach to Surgery or Invasive Procedures | 247 |
| Strengthen Your Urinary Health and Pelvic Floor Muscles | 254 |
| Chapter 9 | Sex and Menopause: Myths and Reality | 264 |
| The Anatomy of Desire | 265 |
| Sexuality at Menopause: Our Cultural Inheritance | 267 |
| Menopause Is a Time to Redefine and Update Our Relationships | 274 |
| Hormone Levels Are Only One Part of Libido | 277 |
| Secondary Libidinal Support: Estrogen and Progesterone | 279 |
| Testosterone: The Hormone of Desire? | 281 |
| Aids to Lubrication | 283 |
| Telling the Truth | 287 |
| Nine Steps to Rekindling Libido | 289 |
| Chapter 10 | Nurturing Your Brain: Sleep, Depression, and Memory | 292 |
| Enhancing Midlife Sleep | 296 |
| Depression: An Opportunity for Growth | 304 |
| Memory Loss at Menopause: Is This Alzheimer's? | 314 |
| Estrogen and Alzheimer's | 316 |
| Non-hormonal Ways to Protect Your Brain | 319 |
| Maximizing Midlife Wisdom | 323 |
| Chapter 11 | From Rosebud to Rose Hip: Cultivating Midlife Beauty | 328 |
| Making Peace with Your Changing Skin | 330 |
| Preventing or Treating Wrinkles | 336 |
| Midlife Acne | 347 |
| Rosacea | 351 |
| Hair in the Wrong Places | 354 |
| When Good Skin Care Isn't Enough: Deciding on Cosmetic Procedures | 360 |
| Varicose Veins | 364 |
| Chapter 12 | Standing Tall for Life: Building Healthy Bones | 369 |
| Osteoporosis: The Scope of the Problem | 370 |
| We're Designed for Lifetime Sturdiness | 371 |
| How Healthy Bone Is Made | 372 |
| Are You at Risk for Osteoporosis? | 377 |
| Measuring Bone Density | 381 |
| Bone-Building Program | 385 |
| What About Bone-Building Drugs? | 393 |
| Get Strong | 394 |
| The Sunlight-Bone Health Connection | 403 |
| Shore Up Your Earth Connection with Plant Medicine | 408 |
| Chapter 13 | Creating Breast Health | 409 |
| Our Cultural Inheritance: Nurturing and Self-Sacrifice | 410 |
| The Emotional Anatomy of Breast Cancer | 412 |
| Lifestyle and Breast Health | 417 |
| Eating for Breast Health | 420 |
| Breast Cancer Screening | 423 |
| Putting Breast Cancer Risk in Perspective | 431 |
| The Breast Cancer Gene: Should You Be Tested? | 433 |
| The Effect of HRT on Breast Health | 434 |
| Bioidentical Hormones and Cancer Risk | 437 |
| The Tamoxifen Dilemma | 444 |
| Chapter 14 | Living with Heart, Passion, and Joy: How to Listen to and Love Your Midlife Heart | 449 |
| The Heart Has Its Say at Menopause: My Personal Story | 450 |
| Cardiovascular Disease: When the Flow of Life Is Blocked | 454 |
| Palpitations: Your Heart's Wake-up Call | 456 |
| Gender Bias and Heart Disease: Our Cultural Inheritance | 459 |
| Arteriosclerosis: Reducing Your Risk | 462 |
| Carbohydrates, Sugar, and Heart Health: What Every Woman Should Know | 472 |
| Cardioprotective Supplements | 475 |
| Foods for Heart Health | 480 |
| What About Aspirin? | 482 |
| Get Moving! | 483 |
| Is Estrogen Replacement Necessary to Prevent Heart Disease? | 487 |
| How to Love and Respect Your Midlife Heart | 492 |
| The Heart-Opening Effect of Pets | 493 |
| Epilogue: The Calm After the Storm | 495 |
| Notes | 499 |
| Resources | 538 |
| Index | 567 |
| About the Author | 591 |
Interviews & Essays
Rosacea: Get the Red Out
It is estimated that nearly 14 million Americans have rosacea, a common but little-known inflammatory skin condition characterized by dilation of the blood vessels in the face. Rosacea is often misdiagnosed as acne or discoid or systemic lupus erythematosus (SLE). It usually occurs on the cheeks, nose, central forehead and chin, and can also occur on the upper back and upper chest. If you were to look at the skin of someone with rosacea under a microscope, it would show swelling, dilated blood vessels, and, where red bumps known as papules are present, you would see collections of white blood cells.
People with rosacea often experience periods of remission and exacerbation. As with acne, rosacea flare-ups often occur the week before a woman’s period, perhaps because the body is working to rid itself of impurities at that time.
Because of its acne-like effects on personal appearance, rosacea can cause significant psychological and social problems in people who do not know what to do about it. Surveys performed by the National Rosacea Society showed that nearly 70 percent of people with rosacea have lower self-confidence and self-esteem, and 41 percent reported that it had caused them to avoid public contact or cancel social engagements. Among those with severe symptoms, nearly 70 percent said the disorder had adversely affected their professional interactions, and nearly 30 percent said they had even missed work because of their condition. (Source: www.rosacea.org.)
Who Gets Rosacea and Why?Rosacea affects both men and women, but occurs more often in women after the age of thirty and is most commonlydiagnosed in women in their forties and fifties. Rosacea almost always worsens when women are under significant emotional stress. Given our culture, it is not surprising that more women than men get rosacea at mid-life. It is most common in women with fair skin, because fair skin is often more reactive, but rosacea has also been diagnosed in Asian and African American women.
There are several theories behind the cause of rosacea. One theory is that the disease may be a subcomponent of a more generalized vascular disease, as indicated by the tendency of rosacea sufferers to flush. Another theory suggests that changes in normal skin bacteria or infection of the stomach by
Helicobacter pylori may be involved. Various other unproven theories indicate that microscopic skin mites (
Demodex spp.), fungi, malfunction of the connective tissue under the skin, and emotions could all be potential causes. Allergies may also play a role, as allergies can cause flushing, which frequently triggers rosacea symptoms.
Signs and Symptoms of Rosacea
The diagnostic criteria indicative of rosacea include the presence of one or more of the following:
1. Flushing (transient erythema), redness on the cheeks, nose, chin or forehead. This may appear similar to a blush or sunburn. One potential cause is flushing due to the large amount of blood rushing through the vessels quickly. Redness tends to become worse over time and can be accompanied by stinging or burning sensations as well as swelling. Persistent redness (non-transient erythema) occurs later.
2. Telangiectasia, or small, visible blood vessels on the face. These enlarged blood vessels look like thin red lines. They usually appear on the cheeks and nose. They can be hidden by redness, but are visible when the redness disappears.
3. Papules, which look like bumps, and pustules, if they are filled with pus. These are not like the bumps you get from acne, in that they do not contain the blackheads or whiteheads.
4. Watery or irritated eyes. Sometimes rosacea patients report feeling like something is in their eyes. They may feel dry or swollen. People with rosacea tend to get styes. In severe cases, some vision loss can occur. Another quite common symptom is redness of eyelids, often misdiagnosed as an infection and mistakenly treated thus.
5. Rhinophyma, or enlarged nose. Severe cases of rhinophyma cause the nose to swell from excess tissue and knobby bumps. It is more common in men, probably because men do not seek treatment early for their other symptoms. This is what W. C. Fields had. Former president Bill Clinton also suffers from it.
Controlling Rosacea
While the causes are unknown, rosacea can be controlled. Many experts believe that early diagnosis and conventional treatment are key to managing rosacea. While I have seen people with rosacea who fare much better with self-treatments and a holistic approach that includes behavior modification, it is usually a good idea to know what you are dealing with first. That way you can avoid irritating products and other triggers.
For more information about this condition, visit Dr. Christiane Northrup’s
Read an Excerpt
Menopause Puts Your Life Under a Microscope
It is no secret that relationship crises are a common side effect of menopause. Usually this is attributed to the crazy-making effects of the hormonal shifts occurring in a woman's body at this time of transition. What is rarely acknowledged or understood is that as these hormone-driven changes affect the brain, they give a woman a sharper eye for inequity and injustice, and a voice that insists on speaking up about them. In other words, they give her a kind of wisdom -- and the courage to voice it. As the vision-obscuring veil created by the hormones of reproduction begins to lift, a woman's youthful fire and spirit are often rekindled, together with long-sublimated desires and creative drives. Midlife fuels those drives with a volcanic energy that demands an outlet.
If it does not find an outlet -- if the woman remains silent for the sake of keeping the peace at home and/or work, or if she holds herself back from pursuing her creative urges -- the result is equivalent to plugging the vent on a pressure cooker: Something has to give. Very often what gives is the woman's health, and the result will be one or more of the "big three" diseases of postmenopausal women: heart disease, depression, and breast cancer. On the other hand, for those of us who choose to honor the body's wisdom and to express what lies within us, it's a good idea to get ready for some boat rocking, which may put long-established relationships in upheaval. Marriage is not immune to this effect.
"Not Me, My Marriage Is Fine"
Every marriage, even a very good one, must undergo change in order to keep up with the hormone-driven rewiring of a woman's brain during the years leading up to and including menopause. Not all marriages are able to survive these changes. Mine wasn't, and nobody was more surprised about that than I.
If this makes you want to hide your head in the sand, believe me, I do understand. But for the sake of being true to yourself and protecting your emotional and physical health in the second half of your life (likely a full forty years or more) then I submit to you that forging ahead and taking a good hard look at all aspects of your relationship (including some previously untouchable corners of your marriage) may be the only choice that will work in your best interest in the long run, physically, emotionally, and spiritually.
From the standpoint of physical health, for example, there is plenty of evidence to suggest that the increase in life-threatening illnesses after midlife, which cannot be accounted for by aging alone, is partly rooted in the stresses and unresolved relationship problems that simmered beneath the surface during the childbearing years of a woman's life, then bubbled up and boiled over at perimenopause, only to be damped down in the name of maintaining the status quo. The health of your significant other is also at stake. Remaining in a relationship that was tailor-made for a couple of twenty-somethings without making the necessary adjustments for who you both have become at midlife can be just as big a health risk for him as it is for you.
This is not to say that your only options are divorce or heart attack. Rather, in order to bring your relationship into alignment with your rewired brain, you and your significant other must be willing to take the time, and spend the energy, to resolve old issues and set new ground rules for the years that lie ahead. If you can do this, then your relationship will help you to thrive in the second half of your life. If one or both of you cannot or will not, then both health and happiness may be at risk if you stay together.
Preparing for Transformation
At midlife, more psychic energy becomes available to us than at any time since adolescence. If we strive to work in active partnership with that organic energy, trusting it to help us uncover the unconscious and self-destructive beliefs about ourselves that have held us back from what we could become, then we will find that we have access to everything we need to reinvent ourselves as healthier, more resilient women, ready to move joyfully into the second half of our lives.
This process of transformation can only succeed, however, if we become proactive in two ways. First, we must be willing to take full responsibility for our share of the problems in our lives. It takes great courage to admit our own contributions to the things that have gone wrong for us and to stop seeing ourselves simply as victims of someone or something outside of ourselves. After all, the person in the victim role tends to get all the sympathy and to assume the high road morally, which is appealing; none of us wants to feel like the bad guy. But even though taking the victim role may seem a good choice in the short run, this stance is ultimately devoid of any power to help us change, heal, grow, and move on.
The second requirement for transformation is more difficult by far: We must be willing to feel the pain of loss and grieve for those parts of our lives that we are leaving behind. And that includes our fantasies of how our lives could have been different if only. Facing up to such loss is rarely easy, and that is why so many of us resist change in general and at midlife in particular. A part of us rationalizes, "Why rock the boat? I'm halfway finished with my life. Wouldn't it just be easier to accept what I have rather than risk the unknown?"
The end of any significant relationship, or any major phase of our lives, even one that has made us unhappy or held us back from our full growth and fulfillment, feels like a death -- pure and simple. To move past it, we have to feel the sadness of that loss and grieve fully for what might have been and now will never be.
And then we must pick ourselves up and move toward the unknown. All our deepest fears are likely to surface as we find ourselves facing the uncertainty of the future. During my own perimenopausal life changes, I would learn this in spades -- much to my surprise.
By the time I was approaching menopause, I had worked with scores of women who had gone through midlife "cleansings"; I had guided and counseled them as their children left home, their parents got sick, their marriages ended, their husbands fell ill or died, they themselves became ill, their jobs ended -- in short, as they went through all the storms and crises of midlife.
But I never thought I would face a crisis in my marriage. I had always felt somewhat smug, secure in my belief that I was married to the man of my dreams, the one with whom I would stay "till death do us part."
Copyright © 2001 by Christiane Northrup.