Menopause itself usually occurs around age 50. By the year 2000, about two million American women a year will reach that turning point. And 25 years from now, America will experience something that has never happened before: It will have as many postmenopausal women as it has women in their child-bearing years.
The huge numbers alone hold promise of a sort of menopausal golden age. Some experts foresee a time when the terms menopause and change of life will finally be spoken without embarrassment or snickers, and a time when doctors and drug companies will roll out many new or newly studied products to treat every brittle bone, night sweat and hot flash.
The stigma may finally disappear.
"When our mothers went through it, we were in the era of the crazy old lady . . . you were sort of expected to act batty," said writer Gail Sheehy, 52, currently working on a menopause piece for Vanity Fair. By contrast, the well-educated, more outspoken boomer women "will kick up some dust" and demand more information, more studies, Sheehy said. "Five years from now there will be menopause documentaries every weekend."
Already, new books - among them Ourselves, Growing Older and Managing Your Menopause - are appearing in stores. New osteoporosis drugs are being tested, vaginal creams and lubricants with exotic names such as Replens and Astroglide are being marketed, and a host of new devices - refrigerated blankets for night sweats? - are in the idea stage.
In the public sector, the federal government has launched long-term studies to untangle complicated questions about menopause and hormonal treatment.
No less an august body than the U.S. Congress took on menopause last month at a special hearing on the state of research attended by top directors of the National Institutes of Health.
"Finally (we) see menopause coming out of the closet and becoming a legitimate health concern rather than a joke," testified U.S. Rep. Patricia Schroeder (D., Colo.).
But for all the new interest, there is still so little known about the event that comes to every single female on the planet - unless she dies first - that it is not yet clear what connection menopause has to osteoporosis, heart disease and the other ailments of a woman's advancing age.
A big debate, in fact, is over whether menopause - defined as the end of menstrual periods and the few years following that - should be considered a problem at all.
Because it occurs when a woman's ovaries cease functioning and her estrogen and progesterone levels drop, doctors are inclined to treat menopause as a hormone deficiency disorder requiring correction. Feminists, on the other hand, frequently regard it as a natural life event that women can handle quite well by themselves.
"Instead of women being able to talk among themselves and learn about menopause, unfortunately it has become a disease, number one, which it is not, and also something to market, something to sell," complains Diana Laskin Siegal, co-author of the 1987 book Ourselves, Growing Older, produced by women associated with the same feminist health collective that introduced the revolutionary Our Bodies, Ourselves in 1973.
New Brunswick, N.J., gynecologist Gloria Bachmann, a menopause expert, disagrees.
"The major effect of menopause is loss of estrogen, and for many women this is devastating," Bachmann said. "It affects not only their emotions, it affects their quality of life. Hot flashes, night sweats, insomnia, mood changes, depression. . . . Many women begin to have atrophy of the skin, atrophy of the vagina. Many women begin to lose bone (mass), so they are at a risk for fractures and all the body changes that occur with shrinkage (of the spine). They are at risk for cardiovascular problems. . . . I think the bottom line for many women is that the loss of estrogen is a great health risk."
For the many doctors who encourage treatment of menopausal symptoms, estrogen replacement therapy (ERT) is the approach of choice.
Estrogen, in use since the 1940s, allays menopause's vaginal dryness and its annoying hot flashes - the sudden, intense bouts of heat and sweating linked to dropping estrogen levels. It also protects against the brittle-bone disease called osteoporosis, and may also protect aging women from heart disease. Between 5 million and 9 million U.S. women are on some form of estrogen therapy, and the number grows larger each year.
But research into the therapy is still so new that it has raised more questions than answers. Among the big ones:
Does ERT lead to a rise in breast cancer, as many studies have indicated?
Does adding progesterone to the therapy do more harm than good? Doctors began prescribing this hormone along with estrogen when it was learned that the use of estrogen alone was causing an outbreak of uterine cancer in
menopausal women who had not had hysterectomies. But studies indicate that progesterone may blunt any of estrogen's heart-disease benefits and might even introduce heart risks of its own.
There is also a critical new question confronting baby boomer women that no previous generation has faced: Will years of taking birth control pills containing estrogen increase any of the risks of going on ERT?
"I think that is the time bomb that none of us had any idea what it would do," said Sonja M. McKinlay, a menopause expert who heads the New England Research Institute in Watertown, Mass. "You're really looking at a double burden (of added estrogen), a lifetime burden almost. This is a black hole right now with no idea what the effects of long-term oral contraceptive use are."
One thing many boomer women can expect to feel as they reach menopause is confused.
"And so are the doctors who treat them," Rep. Schroeder, a women's health advocate, said in a recent interview. "Every woman who goes to a doctor can get a different answer. There are no standards. . . . It's amazing how many women we've heard from with drawers full of stuff. Doctors say, 'Take this, take that.' . . . They go somewhere else and get something else. You begin to think, 'That's nuts!' "
Generations ago, menopausal women didn't face such confusion; on the other hand, medicine didn't offer them much more than a pat on the hand.
One 1908 gynecology text, the standard of its day, advised that for women entering menopause, "fresh air, exercise, attention to the bowels and kidneys and favorable surroundings are of utmost importance. . . . If the nervous symptoms are well-marked, it is often the wisest plan to send the patient to some sanitarium or health resort, where she can receive constant attention and be free from (an) atmosphere of anxiety and petty cares."
Sex after menopause? It was simply assumed that a woman was through with all that.
"What did grandma do when vaginal dryness occurred at age 55 or so? She probably stopped sleeping with grandpa," said Bill Bologna of Columbia Laboratories Inc., a Miami company that in 1989 introduced a new, long-acting vaginal moisturizer called Replens.
"Women of 55 today don't want it that way; they want to continue as they did when they were 35 or 40," added Bologna, who predicts that the aging boomer women will ultimately help push Replens to $100 million in annual sales.
(Similar rosy forecasts are being made for the vaginal lubricant Astroglide, developed by a former NASA chemist and produced by a North Hollywood, Calif., company called Astro-Lube Inc. Astroglide has been greeted by jokes that its name "sounds like everything from a Disneyland ride on down," said company president Charles Boynton. "It is a strange name, but people don't forget it.")
The idea that menopause was a condition to be managed and treated took hold in America in 1966 with the popular book Feminine Forever by Robert A. Wilson. To Wilson, a doctor, menopause meant "the death of womanhood" and femininity, a "tragedy that often destroys (a woman's) character along with her health."
But by taking the "cure" - estrogen - Wilson wrote, "the bodily changes typical of middle age can be reversed, and sexual functions can be restored, along with a fully feminine appearance. . . . Every woman alive today has the option of remaining feminine forever."
The notion of menopause as a destroyer of femininity has for the most part faded away. Today, medical experts focus almost entirely on menopause's long- term impact on health, a critical issue for a generation of women who can look forward to spending one-third of their adult lives postmenopausally.
"Today, a healthy woman in her 50s has got well over 30 adult years to expect," said Cleveland doctor Wulf Utian, author of Managing Your Menopause and founder, in 1989, of the North American Menopause Society. "If she has fractures in her 60s, then that will seriously impact her independence and her quality of life."
Soon, boomer women can expect the introduction of several menopause treatments, including etidronates and bisphosphenates - drugs that have shown great promise in halting, and perhaps preventing, the dangerous bone loss associated with postmenopausal osteoporosis, which causes fractures in one of every two women.
In the next three to five years, says Nelson Watts of Emory University School of Medicine in Atlanta, a typical menopausal woman might expect to get routine bone-loss screenings and then be able to turn to a variety of options - estrogen or one of the new drugs - for treatment.
With new drugs and a growing medical focus on menopause, the stigma of the condition may begin to disappear. Already, many experts suggest that the fatigue, irritability and depression long associated with the change of life may have less to do directly with dropping hormone levels than with loss of sleep.
About 75 percent to 80 percent of all menopausal women experience hot flashes, and when these occur at night, the women waken again and again to kick their covers off.
Before long, a non-drug solution to that problem may be on the way. Utian said he had been contacted by one company with an interest in producing a ''refrigerator blanket" to keep menopausal women cool at night.
For some women, the end of menopause's stigma won't come too soon.
Philadelphia nurse Virginia Thompson, 43, recalls dabbing her sweating upper lip surreptitiously when she began experiencing hot flashes at age 39.
"You don't want people to think, 'Oh, God, here is this woman hot-flashing in front of me!' "
But she thinks the day is coming soon when menopause no longer means "that dried-up woman, that over-the-hill non-person."
Menopause, she says, "is going to become very au courant."
Philadelphia artist, writer and teacher Susan Rodriguez, who began having
menopausal symptoms three years ago at age 44, believes that a woman in menopause is still widely regarded as someone "with gray hair and flat breasts wearing orthopedic equipment and finding her way to a walker supply outlet."
"We don't see a woman in menopause as someone who, quote-unquote, looks and behaves like a young woman," Rodriguez said. "That is what bothers me about it. . . . (But) let's recognize the 'M' word for what it is. It really is only a drop in hormone levels.
"We're just as terrific as we ever were."
