Myths and realities of the menopause

Menopause is a reproductive milestone in a woman's life around which many different myths have developed. We reviewed three sets of myths that middle-aged premenopausal women hold and evaluated those myths according to scientific data from our own work and that of others. First, middle-aged women expect to experience depression, irritability, and vasomotor symptoms during the menopause. It appears that the vast majority of postmenopausal women do not experience depression, but do experience vasomotor symptoms that are uncomfortable and may have secondary effects on psychological well being, especially during the perimenopause. Second, middle-aged women believe that holding negative expectations about the menopause affects the quality of the menopausal experience. Indeed, that appears to be the case, perhaps because myths can function as self-fulfilling prophecy. The third myth is that there are no important changes that occur during the menopause. That is incorrect. Estrogen deficiency during the menopause sets the stage for substantial changes in risk for CHD, which becomes clinically apparent later in life. We discussed how estrogen deficiency may influence both lipids and lipoprotein levels and the magnitude of neuroendocrine and cardiovascular respond to mental stress. That latter pathway is of particular interest because middle-aged women may be exposed more often to interpersonal stress and may respond more emotionally to it, relative to men, suggesting a potential interactive effect of the decline in reproductive hormones and co-occurring social and psychological changes during the menopausal period. This discussion of the myths and realities of the menopause has deliberately not been exhaustive.(ABSTRACT TRUNCATED AT 250 WORDS)