Challenges, Choices, and the Change of Life

It's not just the hot flashes that heat up your life at menopause.

Best-selling author and women's health adviser Christiane Northrup, M.D., talks to senior producer Anne A. Simpkinson about the profound changes--physical, emotional, and spiritual--that the process leading to menopause brings.

It might be a good idea to start the conversation by having you distinguish between perimenopause and menopause.
Perimenopause is the process which lasts anywhere from four to 13 years that leads up to actual menopause, the final menstrual period. And so really, all of what I'm talking about takes place in those years before--and possibly for a year or two after--the final menopause.

You take a mind-body approach to perimenopause, strongly tying physiological changes to emotional and psychological ones. The excerpt from your book that we're using lays out your thinking about how hormonal changes can rewire the brain.
Yes, they do.

But your argument is that hormonal changes are not responsible for the intense feelings that women might feel, that they only uncover emotional issues.
If you go through perimenopause, and you begin to have a difficult time emotionally, you need to look at your diet, exercise, and alcohol intake; you will also need to look at what's going on emotionally. The vast majority of the time, you will find that there's some pattern in your life that needs transforming, or at least updating. Midlife is a time of life when you can either tap in to who you really are--your creative spirit--or you can begin a long decline. You see people all the time who begin to fade at 50. Many others hit their stride and become more powerful than they've ever been. It all depends on how you play it, what choices you make, and what your heredity is like, and so on. I don't want to make the mistake of thinking this is all about a hormonal change. But our hormones definitely uncover emotional issues.

Don't you think that when you talk about physical discomfort and unresolved issues that women run the risk of blaming themselves? Won't many women say, "If I had only dealt with my issues prior to this, I wouldn't be suffering."
I think we women will always [laugh] blame ourselves. There are moments when I say to myself, "What were you thinking for 24 years?" Self-blame is a pattern to expect. But you can say to yourself, "All right, I can wallow in blame, I can feel guilt, or I can say, 'Hmm, I'm not responsible for it, I'm responsible to it. How do I go about changing this circumstance?'"

On prime-time television, do you see any women in this menopausal time with real strength, power, sexiness, beauty? It's like there's a backlash. As the perimenopausal baby boomers get more and more powerful, more and more wealthy, it's like the powers-that-be are doing everything possible to keep us invisible. So Sean Connery stars in a movie with a love interest who is 25 years old.

We have endless opportunities to feel like the culture is doing us a bad turn. Our response has to be: "OK, that's true--so what are we going to do about it? Are we going to feel like washed-up fifth wheels, or are we going to tap into the power that's really there?" That's a choice.

In your book, you wrote: "The most significant way of contributing to your own good health is through the quality of our thought process." Is this what you're talking about?
That's exactly what I'm talking about. Whatever you're thinking in a given moment is what's determining your emotions to a very large extent. When you begin to get a handle on the fact that you can change your thought patterns, choose other ways of being, and when you make that a habit, then you have a lot more power in your life.

It's not being a Pollyanna. It's not saying, "Oh well, this degradation of midlife women doesn't exist." It's saying, "OK, let me be a force to change all that."

Your suggestion in the book to use writing to work with feelings seems like it would be useful. You used it yourself, didn't you?
Yes, I did it in a formal way for seven years with proprioceptive writing. I lit a candle, put on an adagio movement from Bach, sat down, and began to write. I would say, "What do I mean by..." My particular thing is seeing that I'm worthy. I remember that went on for a year, "What do I mean by 'I'm worthy'?" I would write and write and write, and always come out at the end with a new insight.

I learned that thoughts have direction, and that they're usually going towards more feelings--if you get out of the way. It wasn't therapy per se, but it certainly acted like it.

You also, in your book, talk about creativity, about how "the change" can stimulate women to innovate, to create.
When I was on "Oprah," they had the most wonderful "Remembering Your Spirit" segment. They found a woman in the Midwest, one of the salt-of-the-earth women, who on camera is talking about how menopause was a bigger rite of passage for her than having children, getting married, or having her first menstrual period.

She was drawn to fabric when she was a little kid, but she put it aside to have her family. Then, during menopause, she began to ask her family for more support for getting her needs met. Everyone said OK. She opened a quilting shop, and it's very successful. She's become this businesswoman, but she's doing it with the quilts and fabric she's always loved, She said that it's one of her proudest moments to pass on this legacy--being a good businesswoman and an artist--to her daughter. What about your own creativity?
It feels as though my work with women's health is becoming deeper, and I feel as though there's more grace about it; I'm more relaxed. I'm not so concerned about what my colleagues think. When I began to have these insights [about women's health] in my mid-30s, I felt terrified because I knew what I was saying went against the grain. But there is a freedom now, a spaciousness to be who I am.

Do you find, as a physician, that when you bring these matters up--matters of the soul--they're well received by colleagues?
The colleagues I'm in touch with absolutely resonate with this. I can tell you, though, that in the context of the average practice of a very busy physician, it might be difficult to bring these aspects up. But today, there are articles on how to pray with patients. There are courses on spirituality and medicine that are popping up in many medical schools. Both patients and doctors are hungry for this dimension of life. I think that the only danger is if one were to push his or her beliefs onto another.

So basically what you're saying is that it would be wise for physicians to explore the spirituality or the religious beliefs of their patients.
I think so, because I can remember times when I would be sitting with a patient and they would tell me amazing stories about dreams they had. One woman had an extraordinary spiritual experience going to visit the grave of her daughter, who had been killed at the age of 12. She met her daughter, who told her, "It's OK, I'm OK." The experience transformed the woman's life. She sat in my exam room and said, "I have never told this to anyone else before. I was sure they would think I was crazy."

My own sister was killed in a car accident when she was 23. My mother found herself in the driveway of a woman who had a spiritualist church in Buffalo, New York. My mother said it was as if her car just went there of its own accord, drove her to the woman's house, where the woman starts to channel someone named Dr. Andre who tells her all about what was going on in the car when my sister was killed. It was extraordinarily helpful to all of us. Did we make it up? Was this minister a charlatan? I don't think so, because she knew things that were too accurate.

I also work with Dr. Mona Lisa Schultz, who is a neuropsychiatrist and the preferred provider for Blue Cross/Blue Shield for the entire state of Maine for head injury and mental retardation. She also happens to be a medical intuitive, and so knowing only someone's name and age--they can be anywhere in the world--she can do a reading on their body and what's going on with their health. Her accuracy is astounding. So, I work within that reality all the time.

You start your book with your personal story. That had to be a very conscious decision not to just talk about the physiology of menopause or even the psychology of it. Why did you begin with your own story?
I have listened to women's stories for over 20 years, and whenever I read a book or listen to a patient or a speaker, it is the story that moves me. I've noticed that in our culture, women are encouraged not to tell the whole story. What we tell is the pieces that we think are socially acceptable.

I always thought that I was so respectable. I'm in this town in New England, and life was perfect. I had two smart daughters and the good-looking husband--we looked good. But I had this feeling, this profound feeling, that a lot of our health gets stymied by trying to look good instead of just telling the truth.

I've always found throughout my career that when I told a truth about my own life, it helped other people, and it helped them far more than if I just gave a physiological explanation. But of course, keeping a professional boundary is important as well. In this particular case [writing the book], I thought there was an objectivity to a very personal and very painful story that could open the hearts of others and help them in a way that maintaining silence simply wouldn't.

Medical texts are full of data and statistics, and that's all helpful, but each of us has to relate those things to our own story.

My own story--looking back on it and putting the pieces together--is one of: "Oh my God, I found my voice when I went on this GnRH [gonadotropin releasing factor] drug. The FSH [follicle-stimulating hormone] and LH [luteinizing hormone] start to pulse at a higher rate, and I can no longer keep the peace and hold my tongue. I can't do it anymore. Then, I find, once I actually go through menopause, that any lack of partnership is intolerable. A new energy comes in. I knew it was related to menopause because I've been in relation with my body and my self for years, completely embracing my menstrual cycles and falling in love with what happens premenstrually--what everyone else calls PMS and is taking Prozac for--and I'm looking forward to every month because it's a time of such profound connection with my unconscious and with my soul. Now, I realize, this connection is present all the time.

I think we can only know something through our own experience. Medical texts are full of data and statistics, and that's all helpful, but each of us has to relate those things to our own story.

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