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Q: I’m not in menopause yet but I’m 47 so I know it is not far off. You read so much these days about treating menopause but it seems to me that it is a natural event, not a disease. Why should menopause need to be treated?

A: It doesn’t always. Menopause is a transition and, like other transitions in our lives, can be easy or difficult. Transitions are life changes and are physical, mental and spiritual. At each new stage there are new health considerations. Think of puberty, the first major transition of which we have conscious understanding. Some of the events of puberty, like acne, menstrual cramps, and moodiness, are “normal.” When these are mild, need nothing done about them but if they are more intense medical help is a good idea. This does not mean that puberty is a disease. We give infants iron in their formulas and immunizations without thinking that there is anything abnormal about being a baby. Rather it is because we recognize the special needs for health maintenance at each stage of human life.

Actually, I think we need to stop thinking of health care as just for disease. This outmoded concept is still around. Medicine is also for preserving health and, very important, for making life better, so-called quality of life. When a transition is difficult, medicine has a role to play in easing the difficulty. One of the reasons for the growth of alternative medicine is that much of it is intended to enhance life rather than cure disease. “Adaptogens” such panax ginseng or eleutherococcus are not given for any particular disease but are intended to enhance the body’s ability to deal with challenges.

Much of what is written about menopause is confusing because it fails to recognize a point I often stress: menopause is different for every women who is going through it. Questions such as, “Does menopause need to be treated?” “Do alternative treatments help menopause?” “Is HRT good or bad?” do not have a single answer but an answer for each woman. To debate them as generalities is unproductive; more useful is to weigh the pros and cons of each for your own life. [What's Happening? What Do I Do? A Guide To Menopause]

What I suggest for menopause is to think about your feelings and your body. How do you feel? Are you having hot flashes, skin sensitivity or other discomforts? Are they disruptive or can you take them is stride? Have you tried alternative treatments such as soy and black cohosh? Also consider the long term health factors benefited by HRT: bones, brain and probably the heart. Do you have any risk factors for these. How would HRT compare with other ways of reducing these risks? Also consider your take on the confusing breast cancer controversy. Thinking through these questions will enable you to make the right decision for yourself regarding conventional and alternative treatment.

Any transition has a spiritual aspect. Menopause is a particularly important one and a good occasion for reflection, for prayer and meditation. What form these take also is highly individual, because based on a person’s own spiritual traditions and values. Whatever form spirituality takes, great benefit comes from reconnecting to sources of meaning.

I never recommend just one treatment for menopause because there is no one best treatment for all women. Since menopause is so variable, it is fortunate that there are many options. This makes for harder but better decisions. The most important thing about menopause treatment is that it be tailored to your body and your needs and that you find a physician who is willing to work with you on this basis.

The experience of menopause and ways of dealing with it are discussed further in the menopause section.

Geoffrey Redmond, MD

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