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Life after the menopause

An American doctor takes a determined look at the bright side of getting older, reports Christine Doyle

IF asked to guess what the words "bracing, exciting and health-enhancing" describe, many women might suppose they came from a travel brochure - perhaps for a breezy spa resort with a lively casino.

Travel of a sort is involved. Dr Christiane Northrup uses the phrase to describe the "high-speed journey of transformation" that more and more women today take in mid-life when they realise their child-bearing days are over, and ahead lies the challenge of the menopause. "Jump aboard the fast-moving train," she advises in The Wisdom of Menopause, published here this month. The alternative, she implies, is to potter along, frustrated and unreconstructed.

Not everyone will take to Northrup's over-enthusiastic prose. However, in America, her book is a bestseller, only weeks after publication, helped along by an Oprah Winfrey television show on the menopause.

Northrup's theme is how women can effect a reconciliation between mind, body and spirit in the post-menopausal years. "We need a way to look at the menopause that allows us to be positive, to see it as a time to renew ourselves in a way not possible since adolescence. But many women fear it. They fear the finality of not being able to have a baby and they fear they will become unattractive or that the men in their lives will drop them for a 25-year-old."

She is adamant that older women should trust their own attractiveness, in spite of the present youth culture. Older role models, ranging from actress Sigourney Weaver, 51, to writer and cook Jane Asher, 55, who have a "sexier" image, are leading the way, she thinks. Already, young American black women are less fearful of the menopause because they have sexy and outrageously confident older role models such as 61-year-old Tina Turner.

More recently, says Northrup, women from all walks of life are disproving the image of the older woman as a decrepit crone. As the post-menopausal years may actually be longer that the child-bearing ones, that must be good news.

Northrup does not see the menopause solely as physical hormonal shifts to be smoothed over with a dose of hormone replacement therapy and some expensive nips and tucks. It is a time when children are on the verge of leaving home, and women who have always juggled work outside and in the home begin to wonder what happened to untapped creative abilities they may have left behind. Others, who have devoted their energies entirely to child-raising, become interested in starting a late career or setting up a business.

Some, such as Northrup herself, take a long look at their marital relationships. She is defensive on this subject, as some American critics have assumed she advocates walking away from married life "to gain personal fulfilment". Her marriage to an orthopaedic surgeon grew increasingly shaky and finally broke up. "He always remained rooted in the medical establishment and I was the one who made substantial concessions in the early days to my career. But I was lucky later on in that my work [founding a pioneering holistic Women to Women health care centre] helped me along beautifully."

Her ideal, she insists, is to be married to the same person for the rest of her life. "But if that means battling with depression and stress it is not responsible either to one's children or to oneself."

Leaving her marriage was, she admits, an extraordinarily difficult act. "My daughters, then aged 16 and 18, were extremely vulnerable, but I believe they are unlikely to repeat the uneven relationship pattern of my marriage."

Northrup advises women to regard the peri-menopause and its aftermath as a chance to stand back and analyse how to make the best of what lies ahead. But the first step in her seven-point plan is to deal with the troublesome physical symptoms that can rumble on for several years before the menstrual cycle finally stops for good.

"Don't throw up your hands in panic," she advises. "This is a time to relax rather than agonise. Chief executives can become artists, learn golf or landscape their gardens. Those who stay at home can try their hand at running businesses or charities.

"The menopause is a turning point and presents women with a choice."

Diet

This is a priority, says Dr Christiane Northrup. Metabolism slows by as much as 15 per cent during the peri-menopause and the body becomes better at storing fat, usually around the waistline.

Ten to 20 extra pounds could put the heart at risk, or tip mildly high blood pressure into a danger zone. Extra mid-life pressure on hips and knees is also a fast route to arthritis and the Zimmer frame. Being overweight and having a high intake of processed starchy and sugary foods are prime causes of adult diabetes - one of the fastest-growing health problems.

One in four people are able to eat whatever they like and remain slim, but the rest of us, especially women during the peri-menopause, are genetically more susceptible to weight gain and diabetes.

"Balance and discipline are crucial," says Northrup, who advocates avoiding carbohydrates with a high glycaemic (blood sugar) index. "Eat more fruit, vegetables and grains and steer clear of biscuits, sweets, pastries, ice cream and most processed foods. Remember that alcohol contains sugar and can trigger insulin surges."

This diet will also reduce troublesome cramps, heavy bleeding, bloating and mood swings among other peri-menopausal symptoms. Women - Northrup included - often find that whole grains, especially wheat, rye or oat, exacerbate symptoms and leave them feeling groggy and bloated. "Looking back, I can see that gluten sensitivity from eating too much bread has been a problem with me for years," says Northrup. "At the peri-menopause, my body finally said 'Enough'."

Other tips include focusing on portion size. Cup both hands in front of you. That is about your stomach capacity - eat no more at any meal and always eat some protein.

Hormone replacement

With the best of mainstream hormone replacement therapy and the alternatives or a combination of both, there are plenty of ways to reduce hot flushes, mood swings, irritability, insomnia, a dry vagina and dry skin.

Northrup thinks women should discuss what is best with their doctor. "No one wants to deteriorate and if a little 'dusting' of hormones prevents that, I am all for it."

Even so, the whole subject, she says, is in a state of flux, with many new studies and fresh information about all kinds of hormone substitutes. For example, doubt is being thrown on the claimed benefits of HRT for the heart after the menopause, according to the latest research, funded by the American government.

The current medical fashion for designer oestrogens also worries her: these drugs are believed to stimulate the good effects of oestrogen and bypass the bad ones such as increased risk of breast cancer, but she wonders if eventually they will prove a double-edged sword.

She is a fan of natural progesterone cream to rub into the skin, though most British doctors are sceptical. It is particularly useful during peri-menopausal hormonal swings, according to Northrup. It can convert to oestrogen if that is deficient, and similarly to testosterone. But, she concludes: "There is something to help everyone and it is foolish to suffer unduly."

Strength

Increase lean body mass with weight training or anything that puts force on the bones. Biking, walking and yoga are all good. The stronger you are, the less likely you are to lose lean muscle when slimming. One of the ironies of mid-life weight loss is that fat levels may not alter significantly and may even increase, while unexercised muscle is lost.

Strong muscles also increase confidence and the mental energy to face new challenges. Without them, says Northrup, "you can see women talk themselves out of their vitality. There is no biological reason for women to lose their strength as they get older."

The brain

Keep using it. The brain makes new connections throughout our lives. Relatively new research also shows that cells in the hippocampus, the part of the brain linked with memory, increase throughout life. "The old saying that it is all downhill after the age of 25 is not true. Some forgetfulness occurs with age, but the more the brain is used, the more the connections between brain cells increase."

Sex

A good sexual relationship does wonders for the zest for life. And, as recent research shows, many women say their sex life improves and increases once fear of pregnancy recedes.

"I think men and women in this culture have been brainwashed into thinking that once fertility is past, sexuality decreases. I believe that women now in their forties and fifties will change this idea for younger women," says Northrup. Like the brain, all organs work best when used regularly.

Relationships

Keep up your old friendships - and make new ones. It is about noticing and fostering mutually beneficial relationships, says Northrup. "We have all the scientific research on how to make the best of ourselves, but good friendships and relationshse that allows us to be positive, to see it as a time to renew ourselves in a way not possible since adolescence."

-- Anonymous, April 23, 2001