Dr Christine Ahern
Aboriginal Health
Women's Health
Antenatal Diagnosis of Congenital Abnormality
Emotional aspects of menopause
Endoscopic Surgery in Gynaecology
Obstetric Emergencies - Antepartum
Obstetric Emergencies - Intrapartum
Obstetric Emergenies - Postpartum
Preventable Causes of Congenital Abnormalities
The Principles of Antenatal Care
Table of Contents |
Menopause is most often viewed by society and the medical profession as a physical phenomenon and directly attributed to ovarian failure.
However, many women experience emotional and spiritual challenges - a female mid-life crisis - which may or may not be due to changing hormone levels, but which needs to be addressed just as urgently. As with any crisis situation, ongoing support, good listening, and validation of that particular person and their experience are necessary to ensure survival through this period of turmoil. When such changes coincide with dramatic physical symptoms, the situation can be most challenging for the practitioner.
Some particular emotional issues which may need to be addressed include:
Unresolved grief
It is not unusual for women to experience a re-awakening of a grief they had believed long since resolved. Frequently this may involve the death of a child, sibling or parents, or previous death of, or separation from a spouse. Some women will understand immediately what is happening to them, others are mystified by their own strong feelings.Anger, sadness, guilt and depression
The common accompaniments of grief need to be accepted, explored and worked through. Although such issues are time consuming and therefore frustrating for the busy GP when presenting unexpectedly, working to resolve them can be extremely rewarding.Anger, particularly if it appears unjustified or totally out of all proportion, can present in most interesting ways - even at times being directed at the caring and totally unsuspecting practitioner.
Feelings of worthlessness also are experienced quite commonly at menopause, and can be overwhelming.
If specialised counseling necessitating referral seems appropriate, a gentle and diplomatic approach may be required. E.g. "We all need some one to talk to at times," or "Sometimes the people we are close to are not the best people to help us with these problems," or "Counsellors are experts at dealing with feelings. They often help you see solutions to problems that the rest of us miss."
Remember to let the patient know it is okay to change counselors if they are uncomfortable with the initial referral.
Empty nest syndrome
With children leaving home, many women feel they lose their primary role (even working mothers often identify most strongly with their maternal component). A perception of losing this role may feed right into those feelings of worthlessness as mentioned previously. The reality is that a certain letting go of children and a renegotiating of the relationship is required, although this process has often started long before, and will continue long after, the child leaves home. Most women will adapt and find a new role very quickly.The emergence of an independent new woman in a former homemaker can strain the relationship if the partner finds it difficult to adapt, or has previously been the centre of attention, and has now lost this position. Seeing the partner may be appropriate at this point.
Sexual changes
Loss of libido, discomfort with intercourse due to vaginal changes, and poor communication can also contribute to disharmony in a relationship, often with a sexual focus. It is important to explore all possible causes. The problems are often part of an ongoing situation which has been highlighted due to the couple's experience of menopause. Physical problems may be eased with remedies such as HRT, vaginal creams and rarely, I believe, testosterone.Contributory male factors such as impotence, P.E. and loss of libido will be more difficult to address as men find it excruciatingly difficult to discuss such issues, even in confidence.
Counseling
Any remaining problems can often be successfully dealt with through individual or couple counseling. Successful resolution sometimes will necessitate separation and it remains a challenge for all concerned to find the positives in such an outcome. Because separation is an ongoing process, not a one-off event, it will require ongoing support from the doctor.Always remember when dealing with sexual dysfunction to consider the possibility of a past history of sexual abuse. I have known women in their seventies to confide such secrets to their doctors for the first time. If the disclosure is treated with a non-judgmental acceptance and appropriate compassion, the relief to the woman may be immense, and no further action may be needed. Of course, referral to a sexual assault counsellor may sometimes be appropriate.
Confronting our own attitudes
Menopause is indeed a time of change. The challenge for all women is to accept and deal with the less positive aspects, while continuing to grow towards a new and glorious image of themselves.Society has conditioned women to view their worth in mostly physical terms. As practitioners, we may need to confront our own attitudes towards aging and older women in particular, and if we struggle to see their beauty, ask ourselves why.
Christine Ahern
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