The period from conception to birth is the first profound journey for the human soul, the one by which spirit joins matter and enters the world. Men and women's lives are marked with many psycho spiritual passages. Being born, coming into sexual maturity, assuming the adult role of man or woman, pregnancy, giving birth, menopause and death are all significant life passages rich with change and meaning at both inner and outer levels. In a culture that has lost touch with the sacred place of significant life passages, the process of moving from one life stage to another is often invisible, silent and done in isolation. Rather than being a time of community recognition and celebration, these passages are often times of shame, loss and aloneness.

While I write this article on the eve of my 40th birthday, the mother of a not yet three year old child, menopause has already touched my life for many years. For the last decade, I have been listening to the experience of my friends - all sensitive women, moving through peri-menopausal and menopausal passages. The intense pain, disruption, inner turmoil and isolation each of these brave and powerful women experienced has made a strong impression on me. Why were highly sensitive, emotionally grounded, strong and powerful women going through hell on earth during this particular passage in their lives? I have been living with that question for many years.

Menopause is a different experience for each woman who passes through it. Because our bodies are unique and different, like giving birth, where every labor is different, no two women experience menopause the same way. Some women have no disturbing symptoms and even arrive on the other side wondering what all the fuss is about. Other women have constant and numerous symptoms. The menopausal passage has the potential to alter women's lives mentally, emotionally, physically, and spiritually, and many women move through this profound life passage alone.

This article represents an attempt at opening some doors and beginning to explore the deeper roots of the menopausal experience in this culture. To paint a meaningful and accurate picture of the menopausal journey, I interviewed four women ages 44-55 to gather stories of their menopausal passage, and two professionals who work with women passing through menopause. I find it significant that all four women I interviewed wanted to remain anonymous both because of the vulnerability of their experiences and the impact public attention might have on their professional lives.

The two professionals are Pat Rackowski, a menopause educator and massage therapist from Dorchester, MA and Camilla Parham, a family practice doctor in Lincoln, MA. Pat is an incredible source of knowledge and information about all levels of the menopausal passage - mental, emotional, physical and spiritual - as well as a compassionate counselor. Camilla is a visionary and forward thinking physician with an unusual medical service called Health Care for Human Beings who seeks to empower her clients looking to her for medical care. She is able to integrate conventional medical resources and alternative medical possibilities. Both women are unique and special resources for women passing through this change of life.

This article is divided into two parts because of the broad scope of issues involved in exploring menopause. The first part focuses on medical and physical issues. The second part focuses on emotional and psycho spiritual issues and will be printed in Spirit of Change Magazine next issue.

Providing some language to navigate the menopausal passage is useful. The following are some distinctions and definitions that characterize this life transition.

Peri-menopause is a transitional time preceding menopause. It can start 8-10 years before formal menopause actually occurs. This period is different for different women, and can start as young as your early 40's.

Pre-menopause occurs roughly between ages 43 and 47, and is characterized by periods which are still pretty regular.

Peri-menopause occurs roughly between ages 48 and 51 and is characterized by irregular periods and the wide variety of symptoms most commonly associated with the change of life.

Post-menopause occurs roughly around age 51+ when a woman has had no period for at least one year. In this phase, most peri-menopausal symptoms disappear completely. It is in this phase that women speak of what anthropologist Margaret Mead named "post-menopausal zest," a burst of energy brought on perhaps, by the disappearance of menopausal symptoms.

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The Medicalization Of Menopause

Camilla Parham is a physician who is profoundly aware of the emotional and spiritual aspects of menopause and how they relate to the medical and physical issues women face. "Our culture does not hold menopause as a rite of passage. For decades we have been pushing it under the rug. Now we are medicalizing it. We have certain drugs that get women through the more immediate and frightening symptoms that accompany menopause. However, women are not being told that sudden cessation of these medications often produces worse symptoms than they had before."

Many women are looking at lifetime commitments to these drugs, meaning 20 to 30 years of daily medication. Because many of these treatments are fairly new in the big picture of things, we don't have 20 to 30 years of data illustrating the impact of this kind of commitment to such drug regimens. "Estrogen can stimulate some breast and uterine cancers," notes Camilla. "A physician today is put in the position of trying to maintain pre-menopausal levels of estrogen through exogenous sources, namely horses and chemicals, rather than relying on the woman's own body's metabolic processes."

Theresa, a 44 year old woman navigating peri-menopause has found that many medical doctors suffer from a lack of complete information. "One of the most difficult issues is that the phenomenon of peri-menopause is so misunderstood by male doctors. It hasn't been part of their experience. A lot of doctors, both male and female, will see a woman going through depression or anxiety during peri-menopause, but they won't acknowledge it. The woman may have other physical issues or problems effected by hormone decrease, which also go unacknowledged. While tests can be done on hormonal levels, they may not accurately show the whole picture because hormonal levels fluctuate. I had to play detective, research the subject and talk to many people before I had a complete physiological picture of what was going on."

The lack of complete information about the menopausal passage, and the limits of conventional medical professionals were obstacles encountered by all of the women I interviewed. All of them found themselves working long and hard to find information and sources of support, often alone. Each woman also found that a holistic approach to understanding and treating their symptoms during the menopausal passage was essential. Not only the body, but the emotions, spirit and soul required attention and healing as well. Even the environment was found to contribute to the severity and spectrum of peri-menopausal symptoms for many women.

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Dr. John Lee's book What Your Doctor May Not Tell You About Menopause, discusses the syndrome of estrogen dominance. In our bodies, there is a natural balance of estrogen and progesterone. When we have too little progesterone, we experience estrogen dominance. Most of the classic symptoms of PMS including bloating, headaches, irritability, mood swings, and food cravings are associated with too little progesterone. Many of the symptoms of PMS arc also the symptoms of menopause.

In the menopausal process, progesterone dies away first. Research is being done to see if endocrine disrupters found in our environment and our food are a source of infertility. However, studies of whether these same endocrine disrupters are causing symptoms for women with PMS and menopause would also be important.

"Chemicals are in pesticides that are sprayed onto fruits and vegetables. Hormones are put into meat, especially chicken. Other toxins in the environment are left by industry," notes menopause educator Pat Rackowski. "They get into our water and food chain. These toxins cause hormonal change. The destruction we are doing to the earth may be the roots of our own biological destruction. It will be a shame if we bring about population control that way."

Our eggs and ovaries are extremely sensitive to chemicals and the environment. This is why women who have chemotherapy go into menopause. The rest of their eggs are destroyed by the chemicals. Women who smoke have an earlier menopause. Their eggs are destroyed by the toxins.

The extent of pollution and chemicals in our foods is unique to our generation. "Too much estrogen outside leads to too much estrogen inside us as we go into menopause," reflects Anne, one of the women I interviewed. The chemicals and toxins in our environment enter our body through the food chain and all other ways we take in elements of our environment, like breathing. "This throws off the balance of estrogen with progesterone and steroid hormones. Estrogen dominance might explain why some women are going into menopause earlier," says Anne.

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Women's Voices

The stories of the four women I interviewed are each unique. Two, Anne and Theresa, had tumultuous experiences at physical, emotional, mental and spiritual levels. The other two, Judy and Beth, experienced some physical symptoms and major life transformation, but not in as grueling a way as Anne and Theresa.

Anne is a 50 year old woman in menopause. At 44, peri-menopausal symptoms started. At 48 she was in full menopause. "It felt like my hormones and my life had become unglued. My life as I had known it fell apart. It seemed like a classic descent into the underworld. What was hardest to figure out was what was personal and spiritual healing, what was menopausal, and what belonged to the trauma experience." Anne's symptoms included fatigue and adrenal exhaustion, hot flashes and night sweats, early morning wakefulness, sometimes cyclical depression around ovulation, blood sugar level swings, numbness and tingling in an arm and hand, a fuzzy head, decreased exercise tolerance and dry eyes.

"I went through every possibility before going on hormones," Anne reflects. It was. a shock to me that I had the reactions and symptoms I did. I never had problems with my period my whole life. It was regular. I had no PMS or cramps. I exercised and was in good shape. I thought I would breeze through menopause." Anne did extensive research on menopause and peri-menopause, did therapy and acupuncture, took classes on the menopausal experience and received menopausal counseling.

Eventually, she chose to go on hormones. "It was a choice for quality of life," she says. "I'm not a pill taker and I don't like introducing substances into my body. But my body could not function at the extremely low levels it had dropped to." She takes natural progesterone and natural estrogen. "Natural means synthesized from plant substance," Anne explains. "The progesterone is from wild yam. They are naturally compounded by a compounding pharmacist. This means the estrogen and progesterone I take are made especially for me. I co-created my own doses. I did a lot of research, shared my information with the compounding pharmacist and have no side effects. It's important to listen to our bodies and do the research we really need."

Theresa is a 44 year old woman in pre-menopause. At 42, she began to experience symptoms which she now understands to be peri-menopausal. "I believe my symptoms were brought on prematurely by stress," she reflects. "I was sleep deprived, going through too many changes. I was in a new relationship, in graduate school, working 52 hours a week at my job, balancing obligations to friends and family and commitments at home. I was running on empty and stressed to the max. And, my hormone levels went down."

Theresa's greatest symptoms were anxiety and depression, and a major midlife crisis. "I was dealing with identity issues, issues around sexuality, and feeling how trauma and distress in the past had impacted my adult development. The broken places in me became much more magnified. My hypersensitivity became worse. I was isolated. I didn't know that there is a certain kind of anxiety that can happen with hormonal changes, where anxiety and depression can become so intense on a daily basis that it's difficult to drive, it's difficult to function and it's difficult to have relationships."

Theresa eventually went on Klonopin(r) to help her anxiety and bad experience. "I took it for too long and had terrible withdrawal symptoms I hadn't been told about when I finally came off it. I was in such a state of imbalance, I felt like I was living in a state of desperation." She played detective, unearthed many options and created a self-care plan including Zoloft(r) (an anti-depressant), acupuncture, EMDR, herbs and nutrition.

"I looked at nutritional answers including flax seed oil, vitamins B6 and B12 and soy. I took baths with essential oils to calm myself, specifically lavender and eucalyptus. I took ginger and Siberian ginseng ate lots of garlic, got back into meditation and breathing. I wrote in my journal a lot and got back into therapy. I  also tried to reduce the stress in my life. All in all, it was mostly self-diagnosis, a lot of research and talking with a variety of people."

Judy is 55 and in menopause. At 49 she started experiencing peri-menopausal symptoms. "I noticed thinning vaginal walls, night sweats and hot flashes. menopause set in gradually. I started hormone replacement therapy one year ago. Thinning vaginal walls made everything painful and I experienced sleeplessness. I'm on the patch, taking a tiny .05 mg dosage of estrogen. I take progest cream. Friends have been a key part of my support system. I've always looked to therapy and body-work for support. That hasn't changed." What stood out most in Judy's story was the psycho spiritual passage menopause presented, turning her life inside out and questioning all parts of her identity.

Beth is 49 and has had hormone problems due to polycystic ovarian disease. "Hormone irregularity has contributed to depression and weight gain I had to struggle with at intervals prior to any defined time we know of as peri-menopause or menopause. I use Mexican yam cream (transdermally applied progesterone) which is a natural source of balancing an ever changing hormone level. Women in menopause have had tremendous success in relieving emotional anxieties, bloating, and other symptoms using yam cream as a regulator." Beth stresses the importance of talking to other women and not relying on the medical industry for information. "My identity has never been rocked by an inability to have menses," she adds. "I have an unusual sense of self based on a God-given understanding of worth." She is an advocate for self-empowerment and spiritual learning.

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Reclaiming Our Power

Does the lack of complete health information plus the environmental toxicity of our world today pose a greater danger for women in the menopausal passage? "I'm very concerned that women have a trigger risk with breast cancer than hot flashes, insomnia or depression," reflects Camilla Parham. "I'm concerned that doctors help educate women about the bigger picture. It reminds me of where we've gone with women and childbirth in hospitals.

"A woman in labor is not in a centered enough position to make long term decisions in the interests of herself and her baby. She'll often make short-term decisions like opting for medication to manage intense pain if she is not surrounded by supportive people. Perhaps menopause is the same way. Women have been raised not to claim their power. Imagine a society that has advocacy for menopause similar to what some women have available around the birth experience."

Menopause is an inherently vulnerable time. In addition to emotional safety and respect for the spiritual meaning of their experience, women need complete information, education and support to make medical choices true to their own values and needs.

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Helping Navigate The Menopausal Passage: What We Need

Camilla acknowledges three levels that need to be navigated. The first level is knowledge and education. Women simply need more information about the biology of menopause - what happens naturally. The information should not come from drug companies. It is important for women to look at where doctors are getting the information they are handing out on natural menopause.

"If they come from the companies that manufacture estrogen replacement products, chances are the information on cardiac disease, osteoporosis and severity of hormonal changes like hot flashes, may not be accurate," cautions Camilla. "There are many books available written by more neutral sources with basic information on what menopause is and what may be helpful to women. There is information on estrogen replacement therapy and other options. There is a whole book on how to cook in such a way that you have more natural estrogen in your diet through plants. This makes symptoms less traumatic."

The second level is emotional. Women should have the space to talk with other women. They need to tell their story, to share their experience and to gather support. The third level is spiritual - having the space to celebrate and find awe in a new phase of life. "I cannot believe that anything that lasts 30 years in a natural human life cycle is wrong. We may have forgotten what the strengths, joy and power are in this third part of our lives. It's time to rediscover them," says Camilla.

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Linda Marks, MSM, has practiced heart-centered, psychospiritual body-centered psychotherapy for sixteen years.  She is founder of the Institute for Emotional-Kinesthetic Psychotherapy in Newton, and author of LIVING WITH VISION: RECLAIMING THE POWER OF THE HEART (Knowledge Systems, 1988).  She has taught and spoken nationally and internationally, and has been a leader in the emerging field of somatic psychology.  She lives in Newton, MA with her four year old son, Alexander.  Linda's new book EMBODYING THE SOUL: DANCING INTO LIFE is due for release in the spring of 2001.  You can contact her at (617)965-7846 or LSMHEART@aol.com

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• Acupuncture Center of Holliston. Lynn Rothberg, Lic. Ac. treats gynecological, PMS and Menopausal concerns. Holliston, MA. Call Lynn at 508-429-3906.

• Center of the Web. Jane L. LaForce, wise woman herbalist at Jade Hill Farmstead. Manchaug, MA. Call 508-476-7081 for information.

• Conversations About Menopause. A monthly self-help support group that meets the last Tuesday of the month at group members' homes in the greater Boston area. Contact Nancy Ballantyne (617)923-7035.

• Energetic Healing Center. Nancy Jenkins, Lic. Ac. works with issues of menopause, menstruation and PMS. Contact her in Cambridge at 617- 661-2609.

• Health Care for Human Beings. Family physician Camilla Parham offers an unusual medical service incorporating heavy sliding scales, patient empowerment and barter. Office hours in Brighton, Canton and Lincoln. Contact Camilla at (781)259-1691.

• Let's Talk About It. Workshops and individual consultations led by menopause educator Pat Rackowski. Contact Pat at (617)288-6396.

• Psychotherapy Practice for Women. Contact Katy Szal, Jungian Analyst. Providence Rl and Westport Point, MA. 508-636-6062.

• Ultimate Health Center. A medical center integrating both Western and complementary therapies for all healthcare matters specializing in women's healthcare including PMS and Menopause. Worcester, MA. Call 508-753-0006 for appointments.

• Wellspace. Registered dietician Penny Rosenzweig uses natural approaches for relieving major menopause symptoms at this complementary healthcare center in Cambridge. Call 617-876-2660.

• Women's International Pharmacy in Madison, Wisconsin. You can ask them to send a general information package about menopause and hormone replacement. They have pharmacists on staff to answer all kinds of questions about symptoms and dosages. They are an actual pharmacy and do compounding so that a hormone prescription is designed specifically for the person. Contact them at 800-279-5708.