Prof James Simon Clinical Professor, George Washington University
Menopause is Strange
Menopause is strange. It is clearly a normal, physiologic phenomenon. If a woman lives long enough, it will happen. As such, many would argue menopause does not need to be treated. But the oestrogen insufficiency/deficiency state associated with menopause IS, in fact, a biologically detrimental health burden. We often forget that menopause is rare on this planet earth. I would argue it has only been well-documented in humans. Remember, nearly all other animals die long before their menopause, and in those which are long-lived, death typically comes shortly thereafter. Mother Nature valued reproduction above all else, and postmenopausal women who by their biology cannot reproduce are the exception in the entire animal kingdom.
We should and do assign great societal and social value to menopausal and aging women (beyond the youth orientation of “Madison Avenue”), the so-called grandmother hypothesis is prima facie evidence of that. The grandmother hypothesis posits that the help of grandmothers enables mothers to have more children. So, women who had the genetic makeup for longer healthier lives would ultimately have more grandchildren carrying on their longevity genes.
It is therefore incumbent upon women to view menopause as both a normal physiologic phenomenon not requiring treatment, but also a time to reflect on how best to optimize health going forward. Around the time of the last menstrual period, for the sake of argument…age 50… or even a few years before, women should be carefully evaluating their:
1) weight and their diet,
2) sleep and adequacy of rest,
3) interpersonal relationships,
4) emotional stress and anxiety, and
5) the adequacy of their physical activity.
Into this mix, each woman should make a conscience, evidence-based, personal determination of whether menopausal hormone therapy will improve any, some, or all the aforementioned. The ultimate goal being improved longevity and quality-of-life.