by Sydney L. Murray
Menopause is in the news as a powerful period
in a woman's life, and redefined from period in a woman's
life which had been hidden, feared and ultimately endured.
Today women are embracing these years as a time of self
discovery and growth. Christiane Northrup, M.D. stated in
her new book The Wisdom of Menopause, "After
working with thousands of women who have gone through this
process, as well as experiencing it myself, I can say with
great assurance that menopause is an exciting developmental
stage–one that, when participated in consciously,
holds enormous promise for transforming and healing our
bodies, minds, and spirits at the deepest levels."
Recently I had the opportunity to talk to Dr. Northrup.
SLM: Why do you think menopause is so
prevalent in the media?
CN: It's because the baby boomers
are such a huge population and we can't keep our mouth's
quiet. It's five times the population that came before it
or after it. And remember we are from the sixties: the sexual
revolution, birth control pills, Roe v. Wade. A very powerful
and vocal group, (with the motto) don't trust anyone over
thirty, and question authority. We helped revolutionize
childbirth and now we're going into menopause and we're
not going to suffer silently. That's wonderful because that
question authority ethos has changed the entire pharmaceutical
industry. So that instead of one-dose-fits-all hormones,
we now have women who understanding there are herbal medicines
that help, there's soy, there's flax, there's the option
SLM: What is menopause?
CN: Menopause medically refers to the final
menstrual period and it's average age in the United States
is fifty-two. Yet, you don't know you've had your final
menstrual period until a year has passed, so there's no
way to diagnose menopause per say. What you can do through
salivary, or blood testing is begin to document hormonal
changes throughout the six to thirteen years leading up
to the last menstrual period and that's known as perimenopause.
This is where women really begin to experience the effects
of fluctuating hormones. The other thing I want women to
know is that their ovaries never stop producing hormones-they
never shut down, unless they've been removed or unless they've
had to cease function because of radiation or chemotherapy.
A normal healthy woman will often make enough hormone throughout
her entire life to support her health.
SLM: That's good to know, and
often not the message women receive.
CN: Yes, and we're taught even in medical
school that women do not produce enough estrogen themselves.
There are studies that show that many women make enough
testosterone for sex drive, enough estradiol, that's a type
of normal estrogen to keep their brains and bones healthy.
We ignore the healthy women and study women who have had
an altered menopause. Even a tubal ligation will change
the blood supply to the ovaries a bit. That doesn't mean
those things are unhealthy it just means you have to work
SLM: Please expound upon the chapter
in your book, 'The Brain Catches Fire at Menopause".
CN: This irritability that younger women
experience premenstrually, or what I give as the three wake
up calls: PMS, SAD (Seasonal Affective Disorder), which
no one probably has in Southern California, and post partum
depression. These are the times when your hormonal shifts
will lay bare any conflicts which are unresolved in your
life. What we like to do is blame the hormonal shift, but
it is the hormonal shift which lays bare what is already
there. In perimenopause this hormonal shift becomes relentless
because it can last for six to twelve years. PMS you have
a couple of days or up to a week per month, so you can pretend
that everything is fine for the rest of the time. In post
partum depression most women are over with it within two
months, but there are severe cases which require psychiatric
care. In perimenopause there's no escape, you can try Prozac,
or you can try every hormone out there, but if your life
is not working, your body and your brain are not going to
let you ignore it any longer. So if you look at it that
way you see the wisdom of nature. You see what an opportunity
this is. But if you stay stuck in the: 'it's just my raging
hormones' then you are lost, because your choosing to ignore
your internal compass.
The real issue is this "grow
or die" experience that's going on. And this is evident
because you'll begin to get irritated about little things
that never bothered you before. Pay attention and use this
irritability. What I love about irritability and anger is
that they let you know that something is not working in
your life, that something is not turning out the way you
expected it to; or your needs are not being met. That doesn't
mean that someone outside of you is supposed to fix it for
you; it means you need to take the reins into your own hands
and fix it for yourself. That will prevent you from getting
marinated in irritability and anger. Which is a risk factor
for cancer and heart disease.
SLM: Tell me about the PBS series
you are doing.
CN: Right now I have a show called "The
Wisdom of Menopause" and one called "Your Diet,
Your Health" and a couple of older shows, called "Women's
Bodies, Women's Minds," and "Women's Bodies, Women'
PBS will be rerunning the "Wisdom of
Menopause" which first aired in 1999. That was about
six months before my marriage ended. When I look back it's
very interesting to see myself saying everything that I
knew was absolutely true, but without even knowing how prophetic
it was. I remember when I was on the Oprah show in '99 and
the show aired pictures of my husband, my kids and myself
and we look like the perfect family, and as the pictures
run you hear my voice over them. What was startling was
my voice-over coming over a picture of my husband and I
which said, "It's crucial that we stop pouring our
energy into dead-end relationships." It was like god
was giving me a sign right then. And the day that show aired
a week or so later our marriage was over the very next day.
I knew too much to stay in this relationship.
My biggest compliment is when women come
up to me and say, 'I always knew what you were saying was
true, I just never saw it in writing and I've never heard
it from a medical doctor.' Once women open up to their own
inner voice there is no going back. Think about 40-45 million
baby boomer women waking up and supporting not only their
own intuitive message, but that of their families and their
kids, then we will see the world change.
SLM: Do men experience anything like
CN: I believe they absolutely do. I have
a friend who refers to it as "testapause." I don't
like that term because I don't want what's been told to
women, the misinformation that their ovaries are going to
shut down and have that told to men. Because they don't,
there's a huge variation. You can find men who are seventy
who have testosterone or DHEA levels that are the same as
a forty year old male it just depends on their level of
What men go through and there is no question
(about this) is mid-life crisis. And it usually involves
something about their work. Either they're downsized at
their place of work or they have to start a new career at
age forty eight or fifty. This can be very devastating for
a man. And often men will act out sexually, or buy a new
car, or become very agitated about the economy.
I read this article about how
women were choosing not to get married until they meet the
right guy. I can tell you that having done it, having tried
to make someone feel better about his career, to keep the
marriage and the relationship going, that it is almost as
natural to women to help their men feel good about themselves,
as milk coming into their breast after they've had a baby.
Yet what is evolving today is
our sexual roles. I had just listened to Dr. Joyce Brothers
on the Today Show where she said, "We've heard of the
seven and the fifteen year itch in a marriage, and now we
have the twenty-five year ditch."
People realize that they are still viable,
they look decent, they have a lot of life left. I believe
menopause is a time where this huge upsurge of energy or
spirit wells up within you, kind of like sap in a tree.
Watch people who are fueled by
inspiration from within. And then watch others who are staying
in a marriage for security or in a job to get their benefits.
The: 'If I just stay ten more years here, I can retire to
Key West.' But they're going to die before they get their
benefits. I know this feeling, because in my own marriage
I was thinking, 'Am I going to be able to continue here?'
There was a big part of me that said, 'I'm half way there
and it's worked pretty well up until this point, why mess
with it? But if you can take the risk to move out of a relationship
which doesn't serve you it's better to work through it.
SLM: Do you feel most MDs are
up to date on the most current information on menopause
CN: I keep up with my own field through
the eyes of the medical profession. They're very up to date
on medicalized ways to soothe the symptoms of menopause
and they also know you can't give the same dose of hormones
to every woman. That's a huge change. If you look at the
estrodiol patches there are now four or five doses. So individualized
hormone prescribing has become mainstream. That concept
wasn't in place when I first came out with "Women's
Bodies, Women's Wisdom." In 1994 everyone was getting
the same dose. It was like a herd, a herd of cows. You go
in and vaccinate them with the same dose. That was horrifying
But these are two sources the
medical profession receives information: Continuing education
and pharmaceutical companies. The soy reps don't visit your
office, the multivitamin reps don't visit the office, the
Pilates instructors don't visit the office, so it's a cultural
thing, within the culture of medicine. And having earned
my stripes in those trenches I understand it and I have
great compassion for it.
On the other hand I despise the arrogance
where the Chief of OBGYN of one of the major East Coast
hospitals can come visit my hospital, and go over all the
evidence on estrogen and heart disease, estrogen and Alzheimer's
and tell us the truth which is that we don't have the data
telling us that estrogen prevents these conditions. To be
honest and say, I have watched people spend twenty-five
years convinced that estrogen was going to prevent heart
disease and then when the studies aren't panning out that
way, literally not be able to speak.
So here this MD is at the end of his talk
with about five minutes left and he's going to conclude
with the alternatives (to ERT). So he describes soy and
various other remedies like black cohosh and states that
the overwhelming evidence is that they don't work. So here's
a guy that's honest but who has this huge blind spot about
alternatives to ERT and which he knows very little about.
Now I wouldn't mind if he said, 'Some women have done really
well with these, but I don't know enough about them.' So
with all of the authority vested in him, he said, 'These
don't work.' So then a group of 50 OBGYN doctors repeat
this information as this happens again and again all over
the United States.
A women then goes to her natural food store
where she tries a menopausal herbal combination of black
cohosh, red raspberry, nettle or red clover and her hot
flashes go away, and her vaginal moisture comes back. And
her doctor might have said to her, 'These herbs don't work
and they might be dangerous.' And as Lionus Pauling said,
'What we're not up on, we're down on.' That's human nature,
so what I did in my book (The Wisdom of Menopause) is take
the finest research I could find, that backed up the experience
that I had seen with thousands of women. I watched women,
I listened to women. They said, 'I'm taking these herbs
and I feel great!' I'd examine them and everything was great.
There were women who were desperate to avoid hormone replacement
and yet the herbs didn't do the trick. Then there are the
women with breast cancer who can't take estrogen so they
might have difficulty with intercourse. They could be given
estriol, a type of estrogen which works locally and could
thicken the whole vaginal tissue and get rid of urinary
symptoms. There's no reason not to give it and because doctors
aren't aware of it these women suffer.
The other thing that I have seen
with thousands of women who take soy powders or eat a lot
of soy to get their level of isoflavones up to 100-180 milligrams
a day, that their hair, nails, skin, are the best they've
ever been. Their PMS goes away, their period lengthens up
and their breasts instead of having that thick dense tissue
that mammograms can't read through, are healthier and the
mammograms get much better, and all of that is from soy.
But it has to be a high enough dose--you're not going to
get it from eating a little edamame or a couple of soy nuts,
it's got to be higher dose and it should be whole soy.
But I do think women need to know the down
side of Premarin and Provara which I'm certainly very clear
about in my book (The Wisdom of Menopause). But when it
comes to humans we use horse estrogen and it makes no sense
aside from the fact it is historical. And whether the horses
are treated ethically or not, and I've spoken to veterinarians
who assure me they are not. But even if that weren't the
issue, there is concern because Premarin is not native to
humans. I think it's very important for women to know that
Premarin was the first oral estrogen that was available
in 1949. And when the pharmaceuticals first started producing
it they didn't have the laboratory expertise to take soybeans
and yams and make human beta-17 estrodiol which is the exact
match of what is in humans. Now we do, but Premarin early
on got this market share, and then Robert Wilson wrote this
book Feminine Forever and the rest is history, it's
just sales and marketing.
Now we have the Women's Health
Initiative which you and I are paying for with our tax dollars
using the wrong estrogen to determine if every woman needs
estrogen replacement. It's a big boondoggle, and that's
because the pharmaceutical companies provided the Premarin
and Provara. Premarin in its metabolic breakdown or the
metabolites of Premarin are stronger than the original mother
compound, so the daughter compounds are stronger. That means
that your estrogen sensitive tissues, which in perimenopause,
are being bombarded by estrogen dominance-which is too much
of your own body's estrogen without enough progesterone.
Then you add Premarin and what's lingering keeps stimulating
the breast tissue and may keep stimulating the ovaries and
the uterine lining. Researchers have demonstrated this and
the studies are in here," she said pointing to her
We know that the metabolites of
Premarin cause damage to the DNA of breast cells. So then
you make the women who could really use estrogen terrified
that if they use estrogen they're going to get breast cancer.
But you could use the other estrogens which break down into
the weaker and weaker daughter compounds, and they are estriol,
estrodiol and estrone. If they would use one of these, or
a combination of the three, at the lowest possible dose
I think the risk would be minuscule. Also birth control
pills are another synthetic hormone and many women in perimenopause
are put on them, and the ovaries are on automatic pilot
till they get Premarin and Provera. And Prempro is just
Premarin and Provera in a new package with a new name for
the same old stuff. And it's the number one selling hormone
Provera, a synthetic progestin,
has a profoundly adverse affect on blood vessels in the
coronary arteries. So this is probably worse than taking
no hormones at all.
Every woman has a choice. You could try
Prometrium which is a capsule of natural progesterone, or
you can go to a Formula Pharmacy, and have them make up
something just for you using bioidentical progesterone.
Then there is no undue risk with the heart. This is critical
and again, the studies are in this book (The Wisdom of Menopause).
Women need to know this to make an informed choice. Yet
there still will be women who will take whatever their doctor
prescribes for them.
Now is the time for myself, as
for so many other women of the baby boom generation, to
be pioneers in re-creating the second half of our lives
on our own terms. As we do so, we must keep in mind that
physical and emotional health is our natural state, even
during this time of transition. Have no regrets, whatever
you decide. Take advantage of the clarity of vision that
is the gift of menopause, and use that gift to let the second
half of your life be truly your own.
SLM: What has been your menopausal
CN: Mine has been really interesting because
it was jump started through taking GnRH agonist known as
Cinerol and it puts you into menopause artificially. I had
just one goal: to shrink the size of a fibroid. It's not
right for everyone but by this time my fibroid was as big
as a soccer ball. And with this drug it had shrunk down
to the size of a grapefruit by the time I had surgery. I
didn't want a scar that went all the way across my lower
abdomen. Today, with uterine artery embolization, I might
have gone in and had a shot in the femoral artery and done
it that way. So I've been on this drug and it does this
fast forward of my body, so that for six months after surgery
I had hot flashes that were so bad I had cracking on the
sides of my mouth.
But I wasn't yet in menopause,
because I still had my periods, so the drug effect wasn't
wearing off. Then two months before the separation (with
her husband) the hot flashes were getting worse and worse
so that in the middle of the winter I'm taking off all of
my clothes and the cracks around my mouth are getting worse.
I'm going to an acupuncturist who's telling me I'm out of
yin, she said with a wry grin. And I'm taking herbs and
soy protein with their isoflavones and I kept waiting for
the drug effect to wear off and the ovaries to kick in.
Literally within a week of my
marriage ending the hot flashes left. Then I had normal
periods for a full year like clockwork, every 28-30 days,
then the following year, my periods were regular until August
or September of last year (2000), I had a period that lasted
for 20 days. Which was exactly how my mother's last period
was because I was with her on a camping trip when she had
it, and my dad had just died. Think of this parallel: My
dad had died playing tennis with her of a ruptured cerebral
aneurysm, when she was in her final year before menopause.
I got divorced in the final year before my menopause. She
had a period that was so heavy she had to tear her nightgown
apart in the tent we were in and make pads out of it. I
had this incredibly heavy period and have had nothing since.
I had a couple migraine headaches, but with high dose soy
I've had no symptoms of dryness or urinary infections. My
skin is wonderful. Right now I take soy and flaxseed. and
get plenty of exercise. And if I have some hot flashes they
are very mild if I don't eat any sugar.
The bottom line is that if you
do not get in touch with your spirit now, then that's it
for you. And I'll tell you what I mean by that. I'm walking
around Rodeo Drive yesterday. A gorgeous, gorgeous place
and every bit of it is about how it looks: externals. It's
about external, surface perfection-outer perfection. Well,
the only perfection you can ever count on to last is your
connection with your own soul. Which is eternal and which
is always there for you and always beautiful and it's why
at age 75 my mother can say to me, 'In many ways I feel
no different from when I was twenty.' Because the soul is
eternal and immortal and it's always there for you So you
get some sagging skin, so what? If we still are pumping
all of our juice into looking twenty-five, thinking that's
who we should be, and how we should be, then, god help us,
because, god is the only thing that will. And I think that's
why menopause is so difficult for women who have the benefit
of going through life as genetic celebrities. They've told
me, 'I walk into a room and heads don't turn anymore.' Well
the beauty of never having heads turn, is that you don't
But if you have this internal dialogue that
says, 'I'm something no matter what!' then if you're 80
and you can laugh at yourself, then you've got it. And this
essence keeps rejuvenating yourself until you're ready to
go and recycle."
Menopause has been a personal
and physical renaissance for me because I feel so much stronger,
my body feels better. I do Pilates so I know how to be strong.
I saw a beautiful woman here in the workout room (we're
at the Beverley Hills Regent Hotel) today and I wanted to
ask her, 'Would you please open yourself up?' (as she opened
her chest and expanded her body upward.) You can be still
be very strong and be hunched over, and that's not good
and it doesn't need to happen.
SLM: What are you going to
do with the second half of your life?
CN: I would love to do a television series
where we have women telling their stories and do it intergenerationally
so that we have young women, women from an older perspective
and women in the middle, and hear each of their voices simultaneously.
Also, I have another book that I've been
working on since 1997, about mothers and daughters. Its
about the health of the mother and her beliefs about her
body, which often confuse her daughter. With my own mother
for example, to have her last period almost at the same
age as myself, with both of us after the loss of our husbands
is amazing. There is this legacy and when you understand
your own legacy you can bring it to the next level.
I don't think that's necessarily a goal
that we should have, but what we should do is glean the
wisdom of the stage we're in, just like a plant. What season
are you in? And what is the wisdom and the beauty of that
season? So the mother-daughter book I'll be writing in the
next year. I would also like to do some more television
work. And my two daughters are almost launched. The (youngest)
one is going to college in the fall. So this book tour is
the first time in the last 20 years where I'm not worried
about getting back home because my kids need me. They need
me, but I don't have to be there in the same way, and that
is so liberating. I feel that I'm on the verge of a life
where I didn't have to look at someone's school schedule.
Northrup's book is the story of
her life and her experience with menopause. She told me
that she wouldn't write a book on menopause until she had
gone through it herself. This book is full of helpful information
and well researched studies which allow women to make educated
choices about their lives and their health during perimenopause
The Wisdom of Menopause,
Creating Physical and Emotional Health and Healing During
the Change by Christiane Northrup, M.D. $27.95 Bantam