I recently saw a couple in my office for a medical visit. The husband insisted on accompanying his wife, who was in her mid-50s, into the exam room because he wanted to make sure she relayed all of her symptoms and all the things that were going on in her life. He immediately commandeered the examination: "First of all, she just isn't interested in having sex with me anymore, and she does everything that she can to avoid being intimate with me." The wife put her head down in embarrassment.
I shifted the conversation to the patient and asked, "Have you noticed any significant changes in your behavior or the way you feel lately?" She launched into a lengthy list of symptoms: depression, severe hot flashes and night sweats, forgetfulness. She also reported waking up three to four times each night and lacking energy. Without a doubt I knew what she was dealing with — menopause.
She finished by saying, "I don't want to have sex because I feel so ugly and unattractive, and also because it hurts so much now." The husband sat there, his mouth open in disbelief. "Wow," he said when he regained his speech. "That's the first time that I've heard any of that."
His wife said, "I thought there was something wrong with me, and I was embarrassed to tell you."
A natural time of life
Sadly, this woman's feelings about what was happening in her life — there's something wrong with me — are shared by too many women. While menopause can come with discomforts and inconveniences, it is not a disease or abnormality. It's a natural time in a woman's life, and most of the things a woman experiences at this time are typical.
Menopause is the point in life when a woman's ovaries begin to significantly decrease production of the hormones estrogen, progesterone and testosterone. Estrogen and progesterone are the two principle female hormones, while testosterone, although commonly thought of as a male hormone, is produced in small amounts in the ovaries and adrenal glands. In women, testosterone plays an important role in sexual desire and energy enhancement.
Menopause is defined as 12 months of going without a menstrual period. The most common symptoms are hot flashes, sweating, increased irritability and mood changes, sleep disturbances, difficulty concentrating and thinning of hair on the head. Vaginal dryness resulting in painful intercourse often occurs later.
Menopause doesn't occur at a specific age, although the average age it begins is just over 51 years. If a woman's ovaries are surgically removed, she enters what is known as surgical menopause.
The effects on relationships
While menopause is natural and normal, husbands and wives are often caught off guard by changes in their marriage relationship. Many husbands become confused by the behavior of their wife during menopause. The first thing men often notice is a decrease in sexual desire by their spouse.
As both partners age, a decrease in the frequency of sexual intimacy is normal, but during menopause some women have a significant loss of desire — or begin to experience so much discomfort with intercourse that they choose to avoid contact. The husband may not understand what's going on and feel rejected or even suspicious that his wife is interested in someone else.
If a couple is already experiencing marital problems, then moodiness, irritability, confusion and sudden outbursts of anger may add another level of difficulty. Counseling may be necessary for both spouses during this crucial time of hormonal change.
Actions and attitudes
Menopause doesn't necessarily spell trouble for a relationship. The key to stabilizing and strengthening the marriage is to embrace this new season of the marriage. Every marriage goes through transitions. You have the opportunity to create some new normal for your relationship.
Communicating through this season of change is extremely important. It's critical for the husband to show deep understanding and compassion for his wife. (He should remember that while he didn't ask for this, neither did she.) The husband needs to avoid blaming and shaming his wife for what is in many ways beyond her control.
He should be curious about her feelings and emotional needs during this transition. Ask questions like, "How are you doing emotionally? How can I best show you love in the midst of menopause? How can I best encourage you through this season?"
Women should likewise extend grace to themselves. The feelings and emotional disruptions they undergo are the result of dramatic hormonal changes.
A woman can often benefit from the care of a qualified medical professional, who can provide information about menopause and treatments for discomforting symptoms. Similarly, the counsel of a licensed therapist or a pastor can be valuable in dealing with relationship issues. Research shows, however, that only about 20 percent of women feel comfortable enough to discuss their symptoms with their health care professional, and many women struggle through this time without the support they need. Setting aside time to talk with other women who are going through menopause can also help.
A well-balanced diet; regular exercise; interacting with others; Bible study and prayer; and taking appropriate vitamin and mineral supplements can also help. (Talk with your health care professional before taking any new supplements, as some can interact with other drugs you may be taking.) Finally, it is of utmost importance that you talk with family members about how you are feeling.
Menopause does not have to be the beginning of a downhill course in life, or of relational difficulties. Nor does it mean the end of your sexual life. Many couples find greater sexual intimacy and fulfillment as they grow closer to each other.W. David Hager, M.D. (FACOG), is a gynecologist who practices in Lexington, Kentucky. Dr. Hager is a member of the Physicians Resource Council of Focus on the Family.