Menopause

The term climacteric can be applied to both men and women since the word suggests consummation or completion, in this case of one facet of reproductive life. The term menopause can properly be used only of females, since it means the end, or “pause,” of the menses. The popular term male menopause is really an oxymoron. Menopause for a woman is the cessation of monthly menstruation, but it is much more: it is also a life transition that invites a woman to find meaning in life on the basis of something other than her fertility and the monthly patterns that have provided an internal structure (see Menstruation). The male climacteric is a more gentle transition, though it is sometimes associated with marker events such as buying a first sports car or giving up playing football. For the male the period is characterized by the biologic waning of his sexual desire and capacity. Usually the desire exceeds the capacity, and this may lead to painful and destructive attempts to recover sexual prowess with “someone else,” usually younger and more attractive. So the male experience also has both physiological and spiritual implications for the person and his marriage.

Mutual Ministry in Life Transitions

A theology and spirituality of life transitions can equip men and women to assist each other through this significant passage. That is why we have written about these experiences as a husband and wife partnership.

The physical changes associated with pre- , pere- (during) and postmenopause lead women to experience many related psychological dimensions. Married women are afraid they will no longer be attractive to their husbands. Single women, perhaps still hoping until now that they might bear children, receive a profound signal from their bodies that they will not be able to do so. Men are afraid of losing their prowess. In a sexually oriented society in which a woman must look young, thin and beautiful and a man must be macho and virile, both men and women will struggle with their self-image and identity as they approach this midlife transition and enter into maturity. This is especially exacerbated by a society that idolizes youth and physical beauty as projected in the icons of the mass media and advertising. Tragically unlike older, and a few rural, societies, Western society does not normally treasure the wisdom and integrated maturity that can be the special asset of this period in the aging process. In tribal cultures not only men but women gain status as they grow older and are regarded as sexual persons throughout their whole life (Bourgeois-Law, p. 11).

In the Western world the transition for both men and women is surrounded with myths. For the woman there is the myth that since she has lost her ovarian hormones, she is no longer interested in sexual intimacy. But the lack of estrogen does not tell the whole story. Gisèle Bourgeois-Law notes that “adrenal, thyroid and growth hormones are also believed to influence human sexual behavior” (p. 11). The head (brain) is still the major sexual organ! Human sexuality is too complex a matter to be explained by any single physiological factor. Many women enjoy intimate sexual expression even more than in former days, for it allows them and their husbands to express the unitive, and not only the procreative, aspects of sexual love. Sometimes sexual dysfunction in a marriage at this point is blamed on menopause when the actual cause is a psychological dissatisfaction with the marriage relationship as a whole.

For the man passage into middle and late adulthood is a less distinct experience unmarked by a dramatic change in his body or obvious emotional symptoms. With increasing age it takes him longer, and he requires more help to achieve an erection. He may desire or attempt fewer occasions of sexual intercourse—perhaps less than once a week. But this decline, contrary to popular thought, may have social and psychological causes and not merely physical ones (Aitken and Sobrero, p. 262). Some men blame their sexual withering on their physiological “running down” when it may be influenced profoundly by such factors as the loss of work-related identity through retirement. Contrary to what is thought, many men are able to enjoy their marriage relationship more as a whole as they grow older in a way that includes sexual intimacy because of the quality, rather than quantity, of such encounters. Indeed, the occasions for intercourse, while possibly less frequent, may have deeper meaning and beauty because of the investment of the husband’s and wife’s years together. Just as an understanding husband can care for his wife through her more dramatic change of life, so an understanding wife can enhance rather than diminish her husband’s expression of covenant love in their mature years, especially if they talk about it.

Understanding Menopause

Both female menopause and the male climacteric can be thought of as puberty in reverse. In the teens we contend with oily skin, genital moisture and hair growth. In maturity we find ourselves coping with dryness, brittleness, sagginess and hair loss! In the female symptoms can last from as short a time as a few weeks to as long as four years. Some women have no symptoms other than the stopping of their monthly periods. The hypothalamus in the brain has a considerable responsibility for the changes that actually occur. It sends messages to the ovaries to make more estrogen and, at the same time, stimulates the temperature center. This is believed to be the cause of the common hot flashes and night sweats. With the slowing down and eventual cessation of estrogen being produced in the ovaries, some or all of the following symptoms may occur: headaches, sleep disturbance, labile (flat) moods, mental fogging, weight gain, shorter menstrual cycles, spotting and vaginal dryness, this last making intercourse without supplemental lubrication uncomfortable.

The major dilemma is whether to look at menopause as a natural process to be left to take its course or as a disease to be treated by alleviating troublesome symptoms. The question of what is normal or abnormal is therefore raised for each woman, and this turns out to be not merely a medical question but a theological one. Calling a natural process a disease can be problematic when one wants a healthy attitude to growing old graciously. But there is also a sociological factor in this matter for women today. We are living longer than previous generations. Many women in developing countries do not live beyond menopause. But where they live this long, the desire to stay young is almost universal.

Today estrogen replacement is the elixir of youth to make this somewhat turbulent period more comfortable and to slow down the aging process. But there are risks. Estrogen is powerful stuff. Receptors from the brain to the bones and liver are affected by its presence, not just the reproductive organs. It poses as a wonder drug, but taking what doctors call hormone replacement therapy (HRT) is a complicated matter. When our thyroid gland is deficient, we take thyroxin. When our pancreas is deficient in producing insulin, as in the case of diabetes, we take additional insulin without question. Why not take a replacement when our ovaries stop producing estrogen? Each woman, in consultation with physicians, must decide for herself whether the advantages outweigh the risks. Significantly, of the 22 million women in North America who have been given a prescription for estrogen, as few as 20 to 30 percent get the prescription filled, and only 10 percent continue past a year to receive the long-term benefits.

On the pro side of taking HRT are the following. First, there is the relief of menopausal symptoms: hot flashes, night sweats and vaginal dryness. Second, heart disease is prevented by making the blood vessels pliable, thereby lessening the chances of blockages and improving the ratio of good cholesterol (HDL) over bad cholesterol (LDL). Third, estrogen prevents osteoporosis through retarding the thinning of bones, which make postmenopausal women vulnerable to fractures. Fourth, it reduces the risk of colon cancer, some studies suggesting by as much as 55 percent. Fifth, it slows mental deterioration and improves the memory, reducing the onset of Alzheimer’s disease in around 30 to 60 percent of people (Elias). Finally, hormone replacement preserves skin elasticity and helps maintain collagen, which keeps tissues moist and plump.

On the con side is the increase in the possibility of cancer of the female reproductive organs: breast, ovaries and uterus. Dosages, however, are now greatly reduced compared with twenty years ago, and the risks are less onerous. Women who have had hysterectomies (uterus removal) and their ovaries removed are at much less risk. In general it is worth bearing in mind that eight times as many women die of heart attacks as die of breast cancer (Wallis, p. 34). Other less-serious side effects experienced by a small percentage of women are monthly bleeding even until age sixty, abnormal blood clots, benign fibroid tumors, gallstones and increased weight, especially in the thighs.

Given how recently this option has been available and how many questions remain unanswered, it is not surprising that some women feel they are like guinea pigs when it comes to HRT. There are natural alternatives: eating a diet rich in calcium and low in fat, consuming foods containing estrogen (soybeans, Mexican yams and tofu), using multivitamins including vitamin E supplements, exercising (both aerobics for heart and weight-bearing exercises for osteoporosis) and stopping smoking. But many women are thankful to be able to take estrogen. I am one of them, inasmuch as I have had an hysterectomy with ovaries removed, have a family history of heart disease, have no history of breast cancer and have the possibility of developing osteoporosis.

The psychological dimensions of menopause are related to both the physiological changes noted above and expectations generated by society. Like puberty, it is a time of emotional turmoil. Most women experience an emotional relinquishment of fertility, especially singles who have never born a child. At the same time many women desire sexual intimacy more and wonder if their desire is normal, especially if their husband appears to be winding down. The fear of aging and a degradation of self-image are undoubtedly influenced by society in which, as in the West, a postmenopausal woman feels she has lost status. There is, however, an interesting contrast in Japanese society, in which women age with the anticipation of being venerated as they pass through menopause and become respected elders (Hall, p. 11; Lock, p. 1270). All of this suggests that there is more than a clinical disease involved here. Bourgeois-Law concludes in this way: “When dysfunction and dissatisfaction are identified, an approach including empathy, respect and encouragement can restore what has been lost” (p. 14).

Understanding the Passages in a Man’s Life

As mentioned above, the male experience of the climacteric may be a more gradual transition. One of the most significant transitions occurs between 40 and 45, when early adulthood is terminated and middle adulthood is entered. Much good work can be done during this 40 to 45 transition (what Jung called the “noon” of life) and the transition that follows later between 60 and 65 (the “afternoon and evening”): developing a greater capacity for intimacy, getting in touch with our feminine side and becoming more of a mentor than a doer. At the same time men are experiencing the loss of youthful energies and are confronted with the certainty of their own inevitable death. As Daniel Levinson notes, “To experience the dangers and the possibilities of this period is, however, to open a Pandora’s box of unconscious fantasies and anxieties” (p. 26). Thus many men, trying to recycle the missed opportunities of an earlier stage and becoming disoriented by their fantasies, abruptly change careers. They buy sports cars and a new wardrobe. And tragically some, like the menopausal priests in Malachi’s day, divorce the wife of their youth for someone who can “turn them on” (Malachi 2:14-16).

Add to this the physiological changes in a man’s body, and you have a recipe for self-inflicted trauma. Alternatively, you have also an invitation to a deeper spirituality and reevaluation of the meaning of a man’s life. While the male climacteric is progressive and diffuse, it is characterized by the need for more prolonged and direct stimulation to achieve an erection and ejaculation. Sometimes men unkindly blame this on their aging wives when it is within the sphere of their own biology. Some commonly used medications, such as antihypertensives and antidepressants, may reduce sexual interest and capacity. In this, as with the woman’s experience, it is all too easy to epitomize what is “normal” when each person is unique. Once again communication with one’s spouse and friends, empathy and appropriate help can make this time of transition one of the most fruitful periods of a man’s life relationally and spiritually.

Theological Reflection

So how are we to think Christianly about this matter? When I (Paul) first read Levinson’s book on this, I realized that I was a textbook case with all the right marker events, but then I realized that this scheme does not explain my life at all! My life is ultimately explained by the initiative, providence and acceptance of God. In the same way I (Gail) cannot explain my life by consulting a medical text. We are both mysteries, uniquely fashioned by God and brought together as husband and wife to support and love each other through all of life’s transitions, especially when there is not complete synchronism of our experiences. As one author said, “We need withering and senescence lest we deceive ourselves into imagining that everything we desire could be given through more of the same kind of life. . . . We need withering if we are to cultivate within ourselves the deepest rhythm of love—the mystery of self-giving and self-sacrifice that is God’s love” (Meilaender, pp. 18-19).

Each season has its own challenge, sometimes more for one partner than the other. If, early in one’s marriage, the male was more ready for sexual intimacy, especially during pregnancies and menstrual periods—a difference that invited personal and spiritual growth, understanding and true love—we are entering into a period when these differences may be somewhat reversed. Love listens, understands, waits and supplies what is needed. We testify together that this is the richest time of our married life.

We cannot believe that a sequence of changes programmed in our bodies by our gracious Creator is wrong or evil. Scripture does not deal directly with female menopause and the male climacteric, but it does provide a redemptive perspective. It proposes that God is with us always at each stage of life and that he is with us for good. It offers, as the Puritans understood so well, a way to live fully now by preparing to die and be resurrected—a heavenly mindedness that allows us to flourish now without idolizing, for example, youth. Further, Scripture tells the stories of people who found God in these moments of their lives: Sarah, who knew again “pleasure” (Genesis 18:12) in her old age; Anna, the widow praying night and day in the temple; Simeon, the righteous old man—these last two finding in the Christ child the true climax of their lives (Luke 2:25-38).

Living our lives under the initiative, providential care and acceptance of God equips us to see these life transitions as privileged moments. In these moments we can reaffirm the centrality of love as the mark of true personal maturity; we can recover our identities on the basis of who we love rather than what we are able to do; we can prepare ourselves to die and be resurrected by relinquishing our youth and middle age. As with all crises, this one is both danger and opportunity. Scripture invites us to seize the latter and in doing so to be found contented in God himself.

» See also: Aging

» See also: Body

» See also: Death

» See also: Marriage

» See also: Menstruation

» See also: Parenting

» See also: Retirement

» See also: Sexuality

References and Resources

G. S. Aitken and A. J. Sobrero, Dr. Hannah and Abraham Stone’s “A Marriage Manual,” 7th ed. (New York: Simon & Schuster, 1965); J. Balswick, Men at the Crossroads: Beyond Traditional Roles and Modern Options (Downers Grove, Ill.: InterVarsity Press, 1992); G. Bourgeois-Law, “Menopause and Sexuality,” Contemporary OB/GYN, August 1995, 10-14; M. Elias, in USA Today, 20 November 1995, Life sec., 1D; D. P. H. Hall, “Dodging Time,” Contemporary Ob/Gyn, June 1995, 8-16; D. J. Levinson, The Seasons of a Man’s Life (New York: Knopf, 1978); M. Lock, “Medicine and Culture: Contested Meanings of the Menopause,” Lancet 337 (1991)1270; G. Meilaender, “Mortality: The Measure of Our Days,” First Things 10 (February 1991) 14-21; C. Wallis, “The Estrogen Dilemma,” Time, 26 June 1995, 32-39.

—Gail C. and R. Paul Stevens