Half of humanity navigates 'the change' but science still can't figure it out

This column is an opinion by Jo Davies, a freelance writer who is working on a collection of short stories about dating in middle-age.For more information about CBC's Opinion section, please see the FAQ.

A 2001 TV commercial spoofed the idea of menopause: A disgruntled middle-aged woman in shorts, T-shirt and winter boots exits her house in a blizzard. She wades through deep snow to an air conditioning unit, rips off the cover and stomps back to the house, whereupon the air conditioner turns on.

Thirty-three-year-old me found it amusing, but not much more. I was just a pup, eons away from hot flashes or any of the other nifty symptoms of the wonder that is "the change."

Two decades later, I'm more familiar than I'd like to be with menopause.

Hot flashes emerge ninja-like at the least opportune times, driving my internal temperature to what feels like 1,000 F in seconds. Added bonuses? Night sweats, insomnia and mood swings the depth and breadth of the Grand Canyon.

Technically, it's just another stage of life, albeit one with more unpleasant surprises than Will Smith at the Oscars.

Practically, menopause can be devastating to a woman's health and well-being, something of which I and my cohort are painfully aware.

Humans are one of only three mammals on this planet known to experience menopause (killer whales and short-finned pilot whales being the other lucky ones), a condition that is deemed to occur when a female has ceased menstruating for 12 months.

The laundry list of side-effects includes: increased risk of heart disease, stroke and osteoporosis; cognitive impairment; irritable bowel; nausea; aching joints; cracking or peeling skin; depression; vaginal atrophy and dryness; lowered libido; memory loss; and sleep disorder.

For decades, menopausal women have been faced with two options: put up with their symptoms or try hormone replacement therapy (HRT).

Many women (especially those of my mother's generation, now in their 80s) opted for the first, confronted as they were with a traditionally paternalistic health-care system that all too often was content to let women believe their symptoms were "all in their head" and could be cured with the purchase of a new hat.

Despite the fact there was a lack of basic understanding about how HRT interacted with a woman's body, it was (and still is) the most widely used intervention for menopausal women.

HRT health risks

Those who opted for HRT in its early days had to trust that it wouldn't do more harm than good. That trust was seemingly misplaced, as it turned out that HRT increased certain women's risk of blood clots in the brain, heart and legs, as well as breast cancer and dementia.

In the early 2000s, HRT was added to the American Cancer Society's list of carcinogens. It is now recommended that women with known risks for cancer not be placed on HRT for control of menopausal symptoms. Non-hormonal strategies are offered first to avoid the potential risks associated with HRT.

I've seen first-hand the damage done by long-term HRT. My mother was on it from the early 1970s until the late 1990s.

By the time she turned 65, she was diagnosed with breast cancer, a disease that was not prevalent in her family. One full mastectomy later, we are left to wonder if things would have been different without HRT.

Presumably, menopause has been around as long as there have been women, yet it wasn't until the mid-19th century that it began to be studied.

Even so, scientists still don't know the definitive purpose of menopause or the best way to treat it. They have yet to determine the chemical signals that stop a woman's body from producing eggs. They still don't know why about a quarter of women have almost no discernible symptoms, while another quarter have hot flashes that are seriously problematic and, in extreme cases, can persist for a decade or more.

Setting aside its physical challenges, menopause can wreak havoc on a woman's mental health. Not only is she faced with sleeplessness and hot flashes: there's also a societal stigma associated with "the change," where menopausal women are deemed less vital, less desirable and less valuable than their younger counterparts. Menopause signals the end of a woman's reproductive capability while men are able to father children virtually until their dying day. This so-called "lack" may lead some women to feel that they are not equally valued.

As for me, I find menopause liberating, now that the symptoms are slowing down. I'm left with the sense that reproductive issues are a thing of my past, and I'm OK with that. I've had my babies and they are all out in the world now and still willing to speak to me. Job done.

What stuns me is that this phenomenon that affects half of the Earth's population is still inadequately understood. I'm betting if menopause affected adult males the whole mystery would have been done and dusted and (safely) medicated up the yingyang decades ago.

Sure am glad we've got erectile dysfunction sorted, though.

Viagra, anyone?

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