Abstract
This handsome, bound publication is one of a series of monographs on Clinical Practice which aims to provide contemporary perspectives and factual materials and information for the treating practitioner on a range of topics. This series is designed specifically for quick access to presentations by experts in the field who provide comprehensive overviews. This book deals with menopause from a wide range of disciplinary perspectives that include biomedicine, endocrinology, epidemiology, cross-cultural, psychopharmacology and hormone therapies, psychoeducation and supports groups, psychology and psychiatry. This last approach tends, unfortunately, to dominate sections that simultaneously admit to low psychiatric disturbances occasioned by menopause transition. Yet, from the editorial introduction and the first chapter, reference is made to psychiatric problems (p.ix) and the approach for clinicians in psychiatry and other mental health professions. This perspective is not surprising given the authors are two leading women psychiatrists, yet, simultaneously it is disappointing that the normality of menopause is couched at the outset in a somewhat slanted and negative way.
The book is comprised of 12 chapters of around 19 pages each, well and clearly written almost entirely by medical experts, with a reference list at the end. The chapters cover an introduction by the authors, four chapters on mental health aspects and treatments which include a chapter on psychological treatments, one each on physiology and symptoms, sexuality or cross-cultural issues, three on treatments that include medical management, hormone therapies and psychopharmacology, and one on the older woman beyond menopause. Only the second chapter is provided by non-medical experts.
Chapter one, the introduction, is the shortest chapter consisting of eight pages and sets out to describe the phenomenon and identify the controversies and issues. There is a disappointing use of negative language which refers to menopause as ‘ovarian failure…deficiency of oestrogen and serotonin’ rather than depletion or reduction. Thus, while the authors try to present different sides of the research, debates about the ‘menopause question’, the persistent use of such negative terminology betrays entrenched proclivities and biases.
Chapters two and five present clear and factual reporting of research on age at menopause, the range of reported complaints women present with, and changes to sexual functioning. The later chapter provides an excellent evaluation of biological, psychological and endocrinological changes in relation to ageing, natural and surgical menopause and observes the present state of uncertainty surrounding the association between sexuality and menopause as a marker of reproductive ability change and ageing. While basic reproductive abilities are irreversible and universal, other sexual activities, with or without a partner in terms of attitudes and interest, remain unaffected by the menopause transition, yet only or mainly the partnered activities involving intercourse seem to attract attention by medical research and clinical practice.
Chapter four on cross-cultural issues written by a nurse focuses exclusively on studies from the Mayan, Greek and Japanese cultures which, while of interest, cannot be said to provide a broad or comprehensive coverage. Still, attention is accorded to diet and exercise, social relativity and the importance of consideration of culture within developed multicultural societies like North America.
Chapters six, seven and eleven cover medical and drug managements of menopausal symptoms. The chapter on hormone replacement therapy (7) gives a balanced account of the known risks and benefits and considers these from both short-term and long-term perspectives. These chapters should prove of special interest to the practising clinician.
Chapters three, eight and nine examine a wide range of aspects pertaining to mental health and well-being, distress, disorder and psychiatric illness. While no psychiatric illness is now regarded as triggered by menopause per se, the notions of social disadvantage and individual vulnerability are regarded as important underpinnings that will lead to risk or protective factors during women's menopausal transition. Chapter ten evaluates the application of psychoeducational programs applied to address anxieties and depressed moods, low self-esteem and inadequate coping by vulnerable women. The chapter gives particular attention to psychodynamic therapy and self help support groups which help women to ‘normalise’ their experiences and demystify the changes. Both approaches suggest providing some benefits, although outcome evaluations are still limited.
The last chapter by two sociologists explores vulnerability and hardiness in women as they pass menopause and move into older age. This chapter focuses on the normal good health, activity and independence experienced by most women compared to the negative views and findings that many of the foregoing chapters present. Stereotypic views and beliefs about older women are examined and the ways that health professionals relate to older women patients are critiqued. The health promoting movement is commented on and due accord is given to the women's own knowledge and awareness of their changing bodies and their selves.
This book provides a very useful addition to any clinician's shelf for a quick and straightforward overview of the many issues that mid-aged and older women will present and for which they will seek answers. The overly negative focus needs to be borne in mind but it still provides important information on the health changes and risks for which the menopause transition is a marker.