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Barbara McCabe never had to worry about her family or her health.
She'd raised two successful sons with her high school sweetheart and husband, Patrick.
She kept active by swimming and walking, or bicycling alongside him on his daily runs.
And she'd always gotten regular physical exams. Each time, everything was perfect.
But once the 57-year-old began to enter menopause, she faced two life-changing events: a breast cancer diagnosis and ankle-replacement surgery. Her hot flashes, heavy menstrual bleeding and insomnia were now a minor inconvenience.
McCabe says she found solace in her husband's unwavering support and her newfound strength from becoming an advocate for her own health.
"Menopause, for a lot of women, is a very hard time because they view the things they're losing in life," said McCabe. "I was dealing with far more pressing issues, and I was really looking forward to spending time with my husband again. Yes, that part of my life was challenging, but you have to keep your whole life in perspective and you have to look at the big picture."
In many cases, perceptions about menopause can mean the difference between a smooth ride and an emotional roller coaster in a woman's life. Though some women may need medication for hot flashes or depression, doctors say lifestyle changes and support from spouses and others is always a good prescription to ease bumps during the transition.
"Menopause is a perfectly natural process," said Pamela Boggs, director of education and development at the North American Menopause Society, in Ohio. "As family members and friends recognize that this is a normal process and learn about the normal, natural symptoms, they will then treat the woman like she's normal and natural rather than a crazy woman."
McCabe says that she and her husband talked often about what she was going through. She also stopped working part time to concentrate on her health - something Patrick encouraged.
In addition, Patrick didn't complain when night sweats or insomnia kept her from going to bed at night, nor did he say anything when she started using nighttime to make personalized greeting cards to send to family and friends.
"He'd only ask whether he should leave the lights on or off before going to bed," McCabe said.
"He has done whatever he needs to do to support me through menopause or whatever else," she said. "When I said for better or worse, I didn't really get the meaning. I mean, you're young, the future is so far ahead, and when I got to menopause, I realized that this is what growing old together entails."
Menopause is the permanent ending of menstruation and a woman's ability to have children that typically occurs when she is about 51. It results from decreased functioning of the ovaries, causing less production of the ovarian hormones, particularly estrogen.
During perimenopause, or the years before its onset, women may experience hot flashes, irritability, depression, difficulty sleeping or changes in their period. These changes usually start while a woman is in her 40s, though it can occur earlier.
Recent studies have shown that estrogen replacement therapy remains safe for short-term relief from menopausal symptoms such as hot flashes, but should not be taken to prevent development of any disease, including breast cancer.
The results have come from the Women's Health Initiative, a government-funded study best known for its landmark finding in 2002 that taking estrogen and progestin after menopause raised the risk of certain cancers, including breast cancer, and heart problems. Taking estrogen without progestin raises the risk of uterine cancer, so estrogen alone is prescribed only for women who have had a hysterectomy.
Estrogen alone has also been shown to slightly increase the risk of Alzheimer's disease and other forms of dementia in postmenopausal women.
"Certainly menopause is a natural biological event, but many women do respond differently and may need intervention by a health care provider to help optimize the quality of their life," Boggs said.
For Jacqueline Irland, menopause symbolized a time to concentrate on her own needs.
"I took a drawing course," she said. "I had no idea if I could draw, but I always wanted to see if I could. I also started to take music lessons, I started walking and I got a new pet."
Irland, who is an obstetrician and gynecologist in Milwaukee, said that she'd always told her patients to look at menopause as a time to make lifestyle changes, including improving their diet and exercise. She encouraged them to drink more water, eat more fiber and take a multivitamin each day.
However, it took a patient asking Irland, 57, about the changes she'd made in her own life to make her listen to herself.
"I was having some of same issues as my patients and I thought, `This is dumb. Why am I not following my own advice?'" she said.
According to a survey of 750 women by the North American Menopause Society, 52 percent of American women ages 45 to 60 view menopause as the beginning of a new and fulfilling stage of life. Also, 79 percent would advise other women to approach menopause with a positive attitude.
Most reported making beneficial lifestyle changes, including eating healthier, giving up cigarettes and learning yoga or other relaxation techniques.
"I tell women that they have to be `menopositive,'" said Marlys Swanson, program coordinator for the Total Health for Midlife Women Program at Froedtert Memorial Lutheran Hospital and the Medical College of Wisconsin. "Menopause is something that all women experience, you have no choice."
At the center, Swanson spends 75 to 90 minutes with each woman to learn about her history and listen to any concerns she may have. She then works with the woman to determine how to incorporate positive lifestyle changes.
For one woman, she suggested wearing a red hat to let her family know she needed space. For another, she encouraged replacing her unhealthy breakfast with fresh fruit at least twice a week.
"Overall, women tend to cheat themselves," she said. "They need to take the time to recharge their own batteries because they're juggling too many balls. If a woman is trying to do everything in the home, then I ask her if there's anyone else who could do something. That person might not do it as well as she does, but at least it'll get done."
Chris Badano, 50, of Milwaukee started menopause about four years ago. She didn't know what to expect and got to the point where her sleeplessness, mood swings, night sweats and depression made her feel isolated.
She visited the Total Health program and joined a menopause discussion group.
"It made me feel very good to know that I wasn't crazy and that I wasn't alone," she said.
Badano said that she has stopped smoking and is eating better and exercising more. She has still not completed menopause.
"I've also started vitamin E and that's made a difference," she said. "But sometimes I think that this is just one of those things that you just have to go through."
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FOR MORE INFORMATION
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