The two things that block us from feeling our natural desire for all kinds of pleasure, including sexual pleasure, are anger and self-doubt. At midlife, when all the unfinished business of the first half of our lives rises up to be cleansed, it takes great courage to own our anger and use it as fuel to burn through years of self-doubt and self-limitation—whether sexual or otherwise. Deciding to see ourselves as irresistible, sexy, beautiful, and deserving of pleasure is an act of power. Deciding to tell our mates and our children what we want without undue anger and resentment is also an act of power. This is an inside job. We don’t need a white knight to rescue us, a new job, or breast implants. We need to know, deep in our cells, that we are worthy of the best that life has to offer—and that we have the power to attract it by making time for and concentrating on what brings us pleasure. The crucible of menopause is the ideal time to allow our self-doubts and anger to be burned away so that we may truly reclaim the erotic—the life force—in our lives. In her book Women’s Anatomy of Arousal: Secret Maps to Buried Pleasure (Mango Garden Press, 2009), Sheri Winston has a section called “Becoming an Erotic Virtuoso.” When I read it, I had an aha moment. My body said yes to that idea! Deep inside, nearly every woman I’ve ever met wants to be in touch with what Sheila Kelley, founder of the S Factor pole dancing exercise program for women, calls her “inner erotic creature.” We long to express the sex goddess inside us. For many, she got silenced in childhood or adolescence. But now, at midlife, we have the skills and the discipline to channel our erotic energy into pathways of health and pleasure that promote the health and happiness of everyone around us. We’re not irresponsible teens anymore. So give yourself the space, time, and attention it takes to awaken your full erotic potential. Doing this will enhance your circulation, raise your nitric oxide levels, balance your hormones, and make you more magnetic—and it will make you feel wonderfully alive and vital!
10
Nurturing Your Brain:
Sleep, Mood, and Memory
The changes that go on in women’s brains at midlife prepare us for living with more wisdom and meaning than ever before. This new wisdom gets wired in our brains as we move from the alternating current of our menstruating years to the more direct current available after menopause. As this natural adjustment takes place, we may find ourselves experiencing disturbing symptoms, ranging from insomnia and depression to forgetfulness. Rather than succumbing to the common cultural view that we are about to begin the long, slow glide into senility and depression, we need to realize that the brain changes we are experiencing are usually normal—temporary bumps in the road that can be alleviated when we have the courage to see them as messages from our inner wisdom. No study has ever shown that menopause per se increases one’s risk for any mental disorder, whether depression, forgetfulness, or anxiety, unless we are already predisposed to them. Perimenopause amplifies our brain and thought patterns, highlighting the areas that need support and change.
Fighting or trying to control mental symptoms with denial, drugs, or even overdependence on mental techniques such as meditation is ultimately doomed to fail. Instead we need to heed the messages behind our symptoms, support ourselves fully with sound information, and, when necessary, be willing to take life-changing action.
Given our culture’s love affair with control, this approach takes a great deal of courage and faith. Some women have to go through painful breakdowns before they are ready to relinquish this struggle for control.
PRUDENCE: The Anxious Siren
Prudence, a corporate attorney married to a college professor, first came to see me when she became pregnant with her first child, at the age of thirty-four. Prudence and her husband appeared to be the perfect couple, with the kind of dual-career lifestyle to which many of us aspire. Prudence’s pregnancy, labor, and birth were normal, but postpartum she fell into a dark depression that lasted for about six months. During this time she sought help from a psychiatrist and went on antidepressant medication for about a year. She subsequently remained stable except for rather severe PMS symptoms such as anxiety, mood swings, and cravings for sweets that lasted from midcycle through the first day of her period. Prudence was able to control these symptoms with progesterone cream, diet, and exercise. I never pressed her further to see what was going on in her life that might be precipitating her PMS symptoms. Her program was working, she was satisfied, and I intuitively felt that Prudence was not interested in looking more deeply into her life or her psyche. That all changed at perimenopause.
When Prudence began skipping periods in her mid-forties, she couldn’t seem to get a handle on her PMS symptoms anymore. She didn’t know exactly when to use the progesterone cream, and her former self-discipline when it came to diet and exercise disappeared. In addition to this, she often found herself unable to get to sleep at night. But Prudence had another worry that completely surprised me: every time she skipped a period, she worried that she might be pregnant. Since her husband had had a vasectomy after their child was born, I knew that something had definitely changed in her life.
When I asked Prudence if there was anything unusually stressful going on, she admitted to me that she was having an affair with a coworker. She said, “I don’t know what has come over me. I never thought I’d ever do anything like this. But I feel possessed. When I’m with David, I feel young and wild—as though a part of me has awakened that I didn’t even know existed. I’m interested in sexy black underwear for the first time in my life. I sit at my desk, and when I should be going over legal briefs, I fantasize about my next business trip with him. I feel higher than a kite when we’re together or I’m even just thinking about him. But when I have to be home and we can’t see each other for a while, I crash. I feel anxious and depressed and I can’t sleep.”
At first Prudence simply wanted my opinion about contraception and also whether or not she should go back on antidepressants or start using sleeping pills. She also wanted to know what effect medication might have on her newly recharged sex drive. Though I agreed that drug therapy of some sort might be an option to help her symptoms, I also wanted to help Prudence make the link between her perimenopausal mental symptoms and her life.
Why was she having the affair now? At first she told me that her marriage was fine and that her husband was a good man. But after a few minutes she broke down in tears and told me that he had not been given tenure at his university and had become more difficult to live with over the past year or so. As is so often the case, Prudence’s husband was also going through a midlife crisis of sorts, but he preferred not to talk about it. This was especially difficult for Prudence because her own work life was better than ever. In fact, given her husband’s discouragement and apparent depression, she increasingly preferred being at work to being at home.
I asked Prudence what the affair had done for her. She thought it over for a moment and replied, “It makes me feel alive, powerful, and sexy in a way I haven’t felt before.” Prudence’s uncharacteristic affair allowed her to move into a part of her brain’s temporal lobe—an area that had probably been relatively shut down since her late teens or early twenties but which, as we’ve already seen, becomes increasingly activated during perimenopause. The temporal lobe is associated with ecstasy, sensuality, transcendent experiences, and creativity. Its messages are always present, but they are often overridden by our frontal lobes—the centers in our brains associated with rules, regulations, childhood programming, and conventional morality.
At midlife our bodies and brains cry out for balance, and the dictates of our souls become increasingly persistent. Those who have been overly intellectualized and controlled need to break free and become more fluid and spontaneous, while those who have lived in the moment, pursuing pleasure and creative self-expression with abandon, now need to rein themselves in with more structure and self-discipline if they are to stay healthy.
Though I don’t prescribe midlife affairs, I do recognize how therapeutic a passionate out-of-control experience
of some kind can be for women like Prudence. (This is delightfully illustrated in the movie It’s Complicated with Meryl Streep and Alec Baldwin.) Regardless of the circumstances that awaken a woman’s joy and ecstasy at midlife, she will flourish only to the degree that she relinquishes her need to control her world. Affairs are sometimes just another means of controlling joy by allowing oneself to feel fully only through sex and only within contrived, secretive parameters. Instead, midlife calls us all to learn how to trust bliss, joy, and pleasure within a healthy and sustainable container as part of our daily lives.
I suggested to Prudence that she spend a few months thinking about the following questions, either alone or with the help of a therapist or other professional: Did she love her husband? Did she intend to stay married to him and grow old with him? What were the circumstances that led to the affair? What feelings had it brought up for her? Did she believe that it was possible to feel the ecstasy of the affair in other parts of her life? Was her affair important enough to her to risk losing the life she had built with her husband? Was she willing to see the link between her symptoms and her life?
Prudence told me she’d think about what I had said. She then went to see a psychiatrist for her depression, anxiety, and insomnia. Over the next two years she went through a series of medications, none of which worked for very long and all of which gave her side effects. After having been given prescriptions for Prozac, Celexa, Effexor, Xanax, Valium, Elavil, and Desyrel, Prudence was finally offered Nardil, a monoamine oxidase inhibitor (MAOI), which required her to be on a special diet. After all these attempts at trying to find peace through pills, many of her symptoms were still present.
Prudence did not return to my office for an exam until two and a half years later. Her affair had come to an end, she told me, and she was still married. When I asked her how her husband was doing, she told me that he had found another teaching job but seemed to be just marking time until retirement. Before she left, Prudence began to sob. Through her tears, she said, “I feel as though my body is totally out of control. The more I try to control my symptoms, the worse things get. I have no idea what to do next.” I told Prudence that she had finally reached “breakdown to breakthrough”—a place that, while uncomfortable, is usually the first step toward living more fully and joyfully. I also told Prudence the truth: you have to feel it to heal it.
Prudence is now going to a therapist to work through the aspects of her life that require changing. Prudence’s body and mind had presented her with a dilemma that simply couldn’t be solved with more control or more information. She finally surrendered and knew that she had to take her life and her health one day at a time.
Midlife teaches us a liberating truth: many aspects of our lives, including our mates, our families, our children, and our jobs, are simply not under our control. True mental health always involves striking a balance between certainty and ambiguity. At midlife the kinds of certainty and control that often served us well earlier in our lives must now make room for another way of being in the world. We must learn to trust our inner wisdom, a reality that we cannot see, taste, touch, or measure—let alone control.
ENHANCING MIDLIFE SLEEP
Midlife women often go through changes in their sleep patterns, not unlike those we experienced at adolescence. Some of us find ourselves needing more sleep than ever, some suffer from insomnia, and some find that sleep simply isn’t as refreshing as it used to be.
Unfortunately, insomnia makes the entire midlife transition harder. Insufficient sleep increases our levels of corticosteroids and catecholamines, stress hormones that can, over time, throw off our hormonal balance and depress our immune system. Studies show that 20 to 40 percent of women have sleep disorders, and women are far more likely than men to have insomnia after the age of thirtyfive.1 Perimenopausal women often need more sleep than do men of the same age.2
Sleep restores both physical and mental energy. Experimental animals have been shown to die from sleep deprivation. Insufficient sleep leaves us obviously drowsy, fatigued, and irritable. We also suffer from decreased concentration, lowered efficiency, decreased work motivation, and a higher rate of errors in judgment. This is why the Federal Aviation Administration has strict rules about how much sleep flight crews require. When we are sleep-deprived, we are more accident-prone, since our brains will fall into “micro-sleeps” that may not be apparent to those around us. And research shows that a good night’s sleep is important for maintaining healthy blood pressure.3
Sufficient sleep is also related to maintaining a healthy weight. I’m willing to bet that many of you have lost two to three pounds or more overnight after a sound sleep! Sleep quite literally makes you look and feel lighter. A 2005 study done at Columbia University showed that the less sleep subjects got, the more likely they were to be obese.4 Those who only got four hours or less of sleep a night were 73 percent more likely to be obese than those who slept from seven to nine hours each night, while those getting five hours a night were 50 percent more likely and those getting six hours a night were 23 percent more likely to be obese. Researchers believe that when you don’t get enough sleep, your body produces less of the hormone leptin, which signals your body that you’re full, and more of the hormone ghrelin, which tells your body you’re hungry—leaving you feeling both hungrier and less satisfied.
Insomnia Is Often a Message from Our Inner Guidance
At menopause, insomnia and fatigue are frequently the result of unprocessed and unresolved emotions such as anger, sadness, or anxiety, which often accompany the enormous changes of midlife. The brain chemicals that are important for sleep undergo changes in many women at menopause, and they are also profoundly affected by our feelings.
For example, it is not uncommon to be so exhausted emotionally after a fight with a spouse that despite going to bed early and sleeping for ten hours, you still feel tired. One of my patients realized that her insomnia was associated with chronic worry about her daughter’s seeming inability to find a career and a living situation that suited her. Her sleep problem resolved when she decided to stop enabling this twenty-three-year-old by allowing her to live at home without making any contribution to the household. She insisted that her daughter find a job—any job—and learn how to support herself in the world.
One of my perimenopausal patients could not understand why she was having trouble sleeping. She said she was not having hot flashes or sweats, did not drink coffee, and wasn’t really stressed. I asked her if she slept better when she was not in the same bed as her husband. She said, “Yes. I’ve noticed that I do.” I told her that this was a sign from her inner wisdom. She replied, “But what am I supposed to do? You can’t not sleep with your husband.” I told her that although I couldn’t tell her what to do about her sleeping arrangements, she still needed to be aware of the connection. She might consider sleeping separately for a while. She would learn a lot by how her husband responded to this suggestion. And a new arrangement could open the door to even more intimacy later on.
How Much Sleep Is Enough?
Our inherent biological rhythms are also taxed by the demands that modern life makes on our sympathetic nervous system, which is responsible for keeping us alert. We forget that the electric lightbulb has only been around for a very short time, evolutionarily speaking, and most of us weren’t meant to stay up until midnight every night. Taking naps, sleeping late on dreary mornings, or going to bed at sunset are regarded with disdain in our culture. Instead, we worship hyperactive individuals who work sixteen hours a day, and we even brag about how little sleep we get!
In medical school, particularly after lunch as I was sitting in lectures, I would fantasize that there was a bed up on the podium, where I could sleep while the lecturer droned on. Some of this fatigue was from low blood sugar; I was eating too many carbohydrates. But even with a better diet, I couldn’t have stayed alert on only five to six hours of sleep a night. Whenever I get too little sleep I feel extremely groggy in the morning and
have difficulty getting motivated to do my work. It’s important to be flexible and compassionate about our needs when life makes extra demands. Like it or not, what we really need during those times of unusual demands is to get into bed and let our parasympathetic nervous systems restore us. The much-maligned midday nap can be profoundly rejuvenating. Some corporations have even found that the productivity of their employees goes up when they are allowed to nap. Sleep is an indispensable bodily function, as important as breathing and eating. It is hands down the most effective way for the body to metabolize excess stress hormones and inflammatory chemicals, which if left unchecked can eventually result in chronic degenerative diseases such as high blood pressure, arthritis, and cancer. Sleep is critical for bodily rest, for consolidation of learning and memory, and also as a way to help us sort out in our minds and bodies the things we have learned and experienced during the day. You’ve probably noticed how a good night’s sleep helps you integrate new information or even new physical skills, such as exercise or dance moves that you may have struggled with the day before. When we allow ourselves to “sleep on” something, we’re actually allowing ourselves to make connections in our sleep that we couldn’t have made before.
Research has shown that our most restful sleep takes place when we are following our internal biological rhythm. For some that means getting up with the sun and going to bed relatively early, between nine and ten at night. This takes discipline, and it may not be your natural rhythm. Think back on a time in your life when you felt clearest and most rested. What time did you go to bed and what time did you wake up? In other words, synchronize your daily clock with your biological one.
The Wisdom of Menopause Page 44
