Sex education has changed a lot over the years. You may recall the plastic model of the female reproductive organs that graced the teacher's desk. At some point in the course, the teacher would send the model around the room, so everyone could get a closer look. The girls would pass the model around, eyeing it casually and handing it to the next student — nothing to see here, folks! The sexual revolution was just unfolding, and young girls were learning to regard their bodies and sexuality in whole new ways.

In a time of growing sexual freedom, baby boomers learned be cool and nonchalant about sexuality — and they certainly weren't caught up in issues their mothers and grandmothers thought of “female problems.” They laughed at old euphemisms for menstruation, such as “falling off the roof” or “getting the curse.” In an age of feminism, these women learned to toss aside old concepts of feminine weakness and fragility and recognize themselves as strong, capable, freethinking, sexual creatures.

But now, as they approach menopause, many women in this post-feminist age are considering their femaleness from another perspective. At some point, every woman begins to contemplate certain facts about this time of transition, and to acknowledge some of the following basic truths:

• Some physical aspects of the aging process are unique to women.

• The body and mind of a fifty-year-old woman is different from that of a twenty-five-year-old woman.

• Menopause marks a physical change in a woman's body, and every woman's reaction to that physical change will be different.

Beyond these simple, basic truths, however, most people hold a number of ideas and attitudes toward menopause and aging — some true and some false. So how do you think about menopause? Do you dread it? Are you looking forward to the freedom of moving beyond menstruation and into a life free of unwanted pregnancy? Or do you equate fertility with femininity, and worry that menopause will leave you dried up and dreary? Are you hopeful that with the right diet, treatment plan, and nutritional supplements you can get back the body you had at twenty-five? Or at least keep the one you have at forty-five? Do you know the woman you are, and can you accept the woman you are becoming?

Your attitude toward menopause and the aging process will determine the answers to many of these questions. And the first step in understanding how you feel about menopause is to examine the source of those feelings and ideas. The common wisdom of menopause — the information and misinformation that fuels society's beliefs — plays an important role in determining what people believe. So, take a moment to review some of the beliefs that make up the common wisdom of menopause, so you can understand the truths — and untruths — they hold.

Myth #1: Menopausal Women Lose Interest in Sex

The lack-of-libido mythology about women in menopause is part of the common wisdom shared by both men and women — and it's simply not true. Masters and Johnson conducted a study that demonstrated no link between estrogen levels and libido. A number of studies have shown that only a small percentage of postmenopausal women report a lack of interest in sex, and over half of all women studied report no decrease in sexual interest at all after menopause. In fact, the American Association of Retired Persons (AARP) Modern Maturity Sexual Survey, conducted in 1999 and repeated in 2004, showed over half of men and women age forty-five and older say they're satisfied with their sex lives, and many say they enjoy sex “now more than ever.” In the 2004 survey, women reported that when their male partners used medication for erectile dysfunction, the men's increased satisfaction enhanced the women's satisfaction as well.

So where did this myth come from? The truth is that women suffering from severe estrogen depletion can experience some discomfort during sex due to drier, thinner, less flexible vaginal walls and occasional itching and burning near the vaginal opening. A woman experiencing hot flashes, disturbed sleep patterns, headaches, and other occasional symptoms of menopause is unlikely to feel as sexually eager as she would otherwise. However, none of these conditions is permanent untreatable, and many of them aren't inevitable, either. So if you believe that menopause equals the end of sex as you know it, you're wrong.

Myth #2: Menopausal Women Gain Weight, Have Hot Flashes, and Lose Control of Their Emotions

Lots of people think that the typical woman in menopause is fat, flushed, and out of control. While hot flashes, weight gain, and mood swings are all symptoms reported by some women in menopause, they aren't inevitable side effects of the passage. In fact, many women — as many as 10 to 20 percent of women studied — exhibit no symptoms of menopause at all. And while studies show that as many as half of all women in perimenopause experience some weight gain, other women actually lose weight during perimenopause; and many of those who gain weight before menopause lose it afterward (see Chapters 6, 16, and 17 for information about weight management in menopause).

Perhaps as many as 85 percent of menopausal women report hot flashes, but most women find them to be intermittent and, on average, they diminish completely within five years after menopause (see Chapter 5).

Irritability and depression are also symptoms reported by some — but not all — women during perimenopause, but no one should expect depression to be a long-term, ongoing fact of life. In fact, depression is reported at much higher rates among women in their twenties and thirties, and some studies have shown that depression actually decreases in postmenopausal women. And even if you do experience mood swings, they don't have to become part of your identity during menopause (see Chapter 8).

In short, you may or may not have hot flashes, moodiness, and weight gain during menopause — many women don't. But if you do experience these symptoms they are likely to be temporary and can usually be treated.

Myth #3: Hormone Replacement Therapy Is Too Dangerous

Millions of women in menopause use some form of menopausal hormone therapy (MHT), formerly called hormone replacement therapy (HRT). It's true that MHT can have dangerous consequences for women with a history of breast cancer, blood clots, untreated endometrial cancer, and certain other family health concerns. A physician is likely to discourage the use of MHT for women with a history of cancer, and it is definitely not indicated for women with untreated endometrial cancer, but in the end, a careful examination of risks versus the benefits of treating severe menopausal symptoms is the only way to determine a safe, comfortable course of action. Most doctors agree that MHT is one of the most effective methods available today for minimizing both the uncomfortable symptoms (such as hot flashes and vaginal dryness) and health-threatening side effects (including elevated cholesterol levels and bone loss) of menopause. Still, many women continue to view MHT as a treatment option pushed by doctors as a means of making money for both the medical profession and the pharmaceutical industry.

In 2002 the Women's Health Initiative (WHI) study came out with results that seem to show that not only is hormone therapy not protective against some chronic conditions, it may even increase the risks these conditions. Given these results, it halted portions of the study. This brought fear and confusion to patients and clinicians alike. Many women stopped taking their hormones immediately, and physicians began to question what had been common practice.

Further study has shown that while subgroups of patients may at risk for aggravation of their chronic conditions, many women benefit from some sort of menopause hormone treatment, especially for the common symptoms of hot flashes and vaginal dryness. And these therapies have proven protective in the case of osteoporosis and some types of colon cancer. Each woman has a unique set of risks and symptoms, and the best plan is to discuss your own situation thoroughly with your health provider.

You may or may not be a good candidate for MHT, and you certainly can use other methods for treating symptoms. If you do decide to use MHT, you may take it for only a short time. To know and understand your options, read as much as you can on the topic and talk with your doctor and other health care professionals. But keep an open mind, listen to the facts, and learn all you can about MHT (see Chapter 11 for more information). Then make your decision based on fact — not fear.

Myth #4: MHT Is the Only Viable Option for Dealing with the Symptoms of Menopause

MHT isn't the only option for treating menopause symptoms or delaying the aging effects of slowing estrogen production. Depending upon the symptoms you experience, simple lifestyle changes may address your most annoying reminders of perimenopause. Many women in your mother's generation faced a hormone-or-nothing choice. Our understanding of menopause has changed dramatically over the past thirty years.

As women have learned more about the causes and life cycles of certain menopausal symptoms, they feel more comfortable tackling some of them with simple lifestyle changes. You can sleep in a cool bedroom and wear layers of clothing to combat hot flashes, for example. Relaxation therapies can help reduce the occurrence of insomnia, as can changes in eating and drinking habits. If you suffer from anxiety and depression, you might benefit from psychological counseling or biofeedback therapy. A number of herbal remedies, prescription and over-the-counter medications, and dietary supplements are available to help fight off bone loss, high cholesterol, sleeplessness, and other menopause-related health concerns. Women who cannot or prefer not to use estrogen can choose from a number of sound, viable non-MHT treatment options for combating the symptoms of menopause.