The Wisdom of Menopause

by Christiane Northrup

  One very common physical problem in the years leading up to menopause, for example, is fibroid tumors in the uterus. Forty percent of all perimenopausal women in our culture are diagnosed with one or more fibroid tumors, and many of them will undergo midlife hysterectomies to deal with the problem. In conventional medicine, we doctors are content to explain that fibroids occur so frequently in women in their forties because of changing hormone levels, with too much estrogen being produced compared to progesterone.

  Though this is true as far as it goes, it is not the whole truth. I know this both personally and professionally, through the experience I had with a fibroid tumor that was first diagnosed when I was forty-one. Bodily symptoms are not just physical in nature; often they contain a message for us about our lives—if we can learn to decipher it. Sometimes, as happened with me, the message becomes clear in stages, with its full meaning available only in retrospect. But what I learned firsthand over the course of the eight years during which I was processing the experience of my fibroid is that we attract precisely the illness or problem that best facilitates our access to our inner wisdom—a phenomenon that is both awe-inspiring and sometimes terrifying. Though this is true throughout our lives, it hits us harder and more directly during perimenopause and menopause, as though nature is trying to awaken us one last time before we leave our reproductive years, the era when our inner wisdom, mediated in part by our hormones, is loudest and most intense.

  I had a fibroid as my wake-up call. Another woman might have had a flare-up of migraine headaches, or PMS, or breast symptoms, or high blood pressure, or any of the several other conditions so common at perimenopause. Your body’s message to you will be in the language that best breaks through your particular barriers and speaks most specifically to the issues you need to change in your life. The wisdom of this system is very precise.

  MY PERSONAL FIBROID STORY:

  THE FINAL CHAPTER

  My fibroid was initially diagnosed in 1991, several years before my first book, Women’s Bodies, Women’s Wisdom, was published. By then I had been working on the book for over three long years, and for a while there it felt literally like a stuck creation. In my darkest moments I sometimes doubted that the book would ever be published. I assumed at the time that my fibroid was related to my frustration at how long it was taking me to finish the book and get it out into the world. Fibroids can often represent blocked creativity, or creativity that hasn’t been birthed yet, usually because it is being funneled into dead-end relationships, jobs, or projects. (Blocked creative energy can also express itself in other locations, such as the ovaries, fallopian tubes, lower intestines, lower back, bladder, and hips, as well as the uterus—all of which are part of the second female energy center, or what Eastern medical practitioners call the second-chakra area.)

  When Women’s Bodies, Women’s Wisdom was finally published, it was well received, much to my surprise. I had secretly feared that I’d be vilified by my beloved profession for writing the truth as I saw it about the profound connection between women’s lives and their health. Though the book wasn’t exactly embraced with open arms by my fellow OB-GYNs, it wasn’t rejected, either. And the women for whom I had written it received it with great enthusiasm.

  I was happy and relieved about the response I got, and my fibroid remained quiescent. It didn’t go away, but it didn’t get much larger, either. It remained as a kind of semidormant whisper from my inner wisdom. I knew the fact that it was there was not a fluke. It meant something. So I vowed to remain open to its message.

  Over the next few years I continued to heed my inner voice—as far as I was able to understand it. I tried to change relationships that weren’t working for me, I found new ones that were more reciprocal, more of a partnership, and I tried to follow my creative instincts wherever they led me. Thus, after more than a decade of what had been deeply fulfilling work with my colleagues at Women to Women, I found that my heart was increasingly drawn to writing and teaching. Because I was eager for my message to reach a larger audience than ever before, I began to reduce my involvement in the center.

  I gave up my surgical practice and gradually, ever so gradually, cut back on direct patient care, too. Though I was very excited by the new direction my life was taking, I was conflicted about losing this close connection with my patients. I loved having a regular practice in which I saw the same women year after year, helping them in times of illness, celebrating with them as they learned the skills of creating health. But the pile of charts requiring my attention at the end of each day was increasingly giving me a knot in my stomach.

  Meanwhile, the monthly newsletter that I had started in 1994 was doing well, and I was spending a great deal of time researching and writing it each month. I also began traveling around the country teaching and lecturing. All during this time of change I was trying to understand what my fibroid was attempting to teach me—especially when, after having been stable for almost four years, it began to grow larger, until finally it was the size of a soccer ball. Although I didn’t feel that my life was acutely out of balance in any way, I was aware that the various changes I was making were accompanied by a lot of guilt, and that guilt about doing something we love is always a clue that points to blocked energy. But since I was feeling so fulfilled in my work life (despite feeling guilty that I was having too much fun), I did not understand what the blockage could be.

  On Thanksgiving Day of 1996, while trying to find something to wear for dinner that would conceal the now visible swelling in my belly, I finally realized that I was tired of trying to dress around my fibroid, tired of the discomfort it caused me whenever I lay down on my abdomen. I decided that it was time to give up my attempts to shrink it through visualization, homeopathy, diet, and acupuncture. I was ready to ask for help and have my fibroid surgically removed.

  After scheduling the surgery, I started to take a GnRH agonist, a medication that decreases estrogen levels and therefore shrinks fibroids. This creates an artificial menopause, with many of the same side effects experienced by women in real menopause, such as memory change, hot flashes, and bone loss. Nonetheless, I decided that the benefits I would get from shrinking the tumor—the smaller the tumor, the smaller the incision, and the lower the risk of excessive blood loss—were worth the inconvenience, especially since I was only going to be taking the drug for two months.

  Little did I know that the benefits would extend far beyond the shrinking of the tumor. Looking back on this period now, I see that the two months of artificial menopause brought on by the drug jumpstarted the changes in my brain—and my life—that set the stage for a complete cleansing and reorganization of some of my closest relationships, including, ultimately, my marriage.

  Fired Up and Having My Say

  One evening, a couple of weeks after I started taking the GnRH agonist, all of the family, including our household manager and former nanny, whom I shall refer to as Lida, was gathered before the television set watching an episode of ER. At the end, one of the nurses was telling a visitor that he should come in and talk to his friend, a man who had been so badly burned that he was near death. Observing that the nurse was not telling the visitor the truth about how serious his friend’s condition was, Lida said to me, “Do they teach you to be like that in your medical training?” “Be like what?” I asked her. “Do they teach you to withhold the whole truth when the situation is very dire?” she clarified. After thinking about her question for a minute, I replied that there was indeed an unspoken belief among our teachers in medical school that patients (and family and friends) were not really able to handle the truth, and that this belief resulted in many things being left unsaid—a fact that was beautifully illustrated in what we had seen on television.

  My husband stood just then, drawing himself up to his full, quite impressive height, and proclaimed, “Of course they don’t teach you that. I don’t know what you’re talking about!” Something within me snapped. After years and years of down-regulating my personal
truth to make myself acceptable to my husband and to every authority figure like him in medical school, I simply couldn’t keep still another moment. I told him that I felt that I—and everybody else—had been socialized in a thousand nonverbal ways to talk with my patients in a certain way, and that this way left out a lot of the truth of their experience and mine. Of course there was no Don’t Talk to Patients 101 course, I said, but I’d learned by example that a hand on the doorknob, the sight of a doctor racing from bed to bed on rounds, conveyed a world of information to patients about what they could and couldn’t expect in the way of communication and contact with their physician.

  As the conversation heated up, my husband and I retired to the bedroom to spare the others our anger. And for the next forty minutes I felt myself grow taller and taller with my own truth. I told my husband what I believed—about medical practice, about our relationship, about the inequity in the way we’d been living all these years—and I offered no excuses for what I said, nor any attempt to make it easier to hear. This was one of those amazing volcanic eruptions that occur from time to time when the lid finally blows on the container overstuffed with things we know but can’t talk about because we are female and have been taught that in order to survive, we must keep quiet so that authorities (mostly men) will like us. Everything we’ve tried to ignore and struggled to keep beneath the surface bursts forth in all its unedited glory. At the end, my husband did not look as tall as he had at the beginning, and he was speaking softly and apologizing to me. That was the turning point in our marriage. There was no going back.

  What had happened in that moment when I suddenly opted to speak out instead of remaining silent was a direct result of my artificial menopause. Usually menopause comes on gradually, of course. But when it happens more or less instantly because of medication, as it did for me, or because of surgery or radiation, as it does for other women, the sudden hormonal changes can result in insights about our lives that are as dramatic and unexpected as the hot flashes that often plague us at this time. Though my own premature menopause was not permanent and the hot flashes ended as soon as I stopped taking the medication that caused them, the inner change brought about by that brief menopausal interlude was permanent. It brought to the surface all the hidden conflicts in myself and my marriage. Fibroids don’t jump out of the closet and land on your uterus. They represent blocked creativity—usually from funneling creative energy into a dead-end job or relationship. I had been trying for years to make my marriage work. And my body was telling me that it was time to stop.

  THE JOY OF CO-CREATIVE PARTNERSHIP

  Although until that time I had been in a marriage that had silenced my voice at home, it had not stopped me from becoming increasingly vocal in my work, and I was now being heard by people far beyond my immediate circle. My career star was definitely on the rise. I had co-founded a very well-known women’s center, become president of the American Holistic Medical Association, and written a book that had brought me enormous validation for my work and my ideas. My faith in my own work—work that I absolutely adored—was growing all the time.

  I was also proud of the fact that I was contributing more and more to the family finances, and as usual had looked to my husband for approval—but that was not to be.

  As happens for so many women at midlife, around this time I found a new model for partnership. I first met Dr. Mona Lisa Schulz when she was a medical student and I was finishing up Women’s Bodies, Women’s Wisdom. She came to Maine to do a clinical rotation with me in OB-GYN and to learn my approach to women’s health. As a Ph.D. in behavioral neuroscience, Mona Lisa also assisted me in scientifically validating the clinical observations I’d gleaned from many years of following the same patients. Up until then, my training had led me to believe that hands-on clinicians weren’t really scientists. Scientists were people who didn’t dirty their hands with the messy details of patients’ actual lives, preferring instead to gather data under perfectly controlled conditions. The kind of medicine I was practicing was anything but controlled, given that I was helping women choose individual solutions to their health care problems based on a partnership between doctor and patient, and between the patient and her own inner wisdom. This, surely, was not science. Mona Lisa, fresh from her Ph.D. defense, helped me to see that my work was indeed scientifically valid.

  Until I met her, I had found precious few local physicians who took the same approach to medicine that I did, and fewer still who were willing to talk about it publicly. That was a time when it still wasn’t safe to call yourself “holistic,” so there weren’t too many other volunteers for possible professional martyrdom. But Mona Lisa was one of them. She shared my vision as well as my willingness to take risks, to speak out.

  Our work together back then was an effective model for both right-brain intuition and left-brain intellect. It was also a partnership between two professional women who were both peers and friends.

  More Validation: My Message Goes to Television

  Early in 1997, I began working on my first two public television specials. Soon after GnRH had jump-started my brain, I met Jack Wilson and Bill Heitz, two producers from Chicago whose wives had suggested they track me down and put my work on television. Co-creating what eventually turned out to be four successful public television specials with Jack and Bill also boosted my self-confidence. Now I had the experience of being truly seen and highly valued not only by a rigorous scientist, but by two people who had believed in me even when I was a complete novice as a television personality.

  This was an enormously exciting time for me. However, by this point I was out of the office more often than I was in it. My dream of teaching and writing, of bringing my message to an ever wider audience, had become a full-time reality—and then some. Reluctantly I cut the cord with Women to Women completely, selling my share of both the business and the building to my partners. The work I was doing no longer fit the model that we had started together. I knew it was time to go out on my own.

  THE FORCES THAT CHANGE THE GOOSE

  ALSO CHANGE THE GANDER

  As I was making and experiencing all these changes in my life, my husband was going through changes of his own. His midlife reevaluation started with questioning his career goals. The era of managed care was forcing him to change the way he practiced, and he found himself increasingly unhappy in his work. He was also becoming very anxious about money, a fear that my own success seemed only to intensify, rather than to soothe. I couldn’t understand why he worried so much about our finances. After all, I reasoned, I was making good money, and we were in this together.

  One reason for his anxiety was that he was thinking about retiring when our younger daughter graduated from high school—which was just two short years away. In contrast, I felt as though I was just hitting my stride, and I had no intention of retiring, then or ever. During the retirement-planning sessions my husband scheduled with our accountant, I felt as though we were in two different worlds. There didn’t appear to be any computer programs designed to take into account two sets of goals as different as the ones my husband and I described in these meetings.

  Like many other men at midlife, my husband seemed to deal with his anxiety about change by trying to exert more and more control over our financial resources—resources that were increasingly from my earnings. Or perhaps he had always exerted that kind of control and I was just now waking up to it. For, like many women, I had always been convinced that my husband was better at money management than I was, so I had turned it over to him. He did all the planning and paid all the bills, spending hours at his computer each week doing so. As he went through his midlife crisis, this task seemed to fill him with ever more dread and worry every time he did it, with the result that he tried to micromanage my own expenditures. A part of me was convinced that we were indeed overspending, and I was always on the verge of succumbing to the same fears that plagued him.

  But no matter how hard I tried, I could never live within the budge
t he considered appropriate to our circumstances. I found myself hiding purchases from him, lest he blow up at me. Of course, the conflict between the ideals I had been promoting all these years to my patients and the reality I was living was not lost on me. But my fear of my husband’s anger was very real. I let myself be controlled by it, and silenced by it, for years. Even then I was still in some ways the person who wanted more than anything to please and to appease as a way to earn love.

  REAL MENOPAUSE HITS

  Two weeks after leaving the center I had co-founded nearly fifteen years before, my “official” hot flashes began. They were much less intense than the drug-induced hot flashes I had experienced earlier—flashes so extreme that I routinely removed my winter coat and stripped down to a tank top in the middle of a Maine winter! Nonetheless, they were eloquent enough to make me realize that I was finally entering menopause for real.

  It was December 18, 1998—the end of a year and, as it turned out, the end of an era. The separation I had just negotiated from Women to Women was only a warm-up for what was about to happen on the home front—though on the surface things looked fine, even festive. The day my hot flashes started was also the day I, my husband, and our daughters embarked on a long-awaited family ski trip to Austria, where we would spend Christmas with my mother and my siblings. This was something I had dreamed for years about doing.

  The trip was wonderful in many ways, and I was very happy to be with my extended family in such a magical place, but I felt the strain in my marriage as never before. When I looked at other couples around us, men and women who were clearly engaged with and enjoying each other, I felt very alone. I found that I was avoiding my husband on that trip, skiing mostly with my daughters, my sister, and my mother. I simply didn’t want to use my energy to try to soothe my husband and keep him comfortable, as I had always done before. The coming of my hot flashes had signaled another stage in my own midlife reevaluation—a commitment to setting healthier boundaries, to taking better care of myself, to speaking the truth.