In ancient times, human beings believed that because a woman did not bleed As millions of American baby boomers approach mid-life, "menopause talk," no longer a whispered secret or a knowing look, is growing louder and more articulate. It's also politically and personally controversial.

Amid the clamor of conflicting positions, women are asked to make medical decisions that determine the quality and length of their lives. In order to make the best choice for herself, a woman needs confidence, self respect and accurate, relevant information. Some women lack all three.

HRT or Not

The most life-challenging decision for a woman approaching menopause concerns osteoporosis, cardiovascular disease and cancer. The bottom-line choice for a woman is usually presented like this:

Take HRT (Hormone Replacement Therapy) and reduce risk for osteoporosis and cardiovascular disease but also increase the odds for contracting cancer of the breast and uterus lining. Do not take HRT and reduce the cancer risk but increase the odds for developing osteoporosis, heart attack or stroke.

Take estrogen straight and chances for ovarian cancer go up. Take estrogen with progesterone and chances for ovarian cancer go down.

Points to Consider in Making Choices

There are at least five realms of information for mid-life women to consider in making health care choices: medical information, personal history, family history, cultural influences, and personal principles.

1. A woman needs to prepared to get second, third and even fourth medical opinions before embarking on any drastic physical intervention. Taking hormones for years or the rest of your life is a drastic intervention.

She should question the source of information being presented to her. Were the studies large enough to have valid results? For example, oft cited early studies on the progesterone factor in decreasing ovarian cancer risk were small and exploratory.

Were they studies of women? Many NIH studies through 1990 excluded women out of concern that women's hormones would affect results.

2. Evaluating her past and present general health provides important information. For example, HRT is not recommended if a woman has any history of cancer or acute liver disease.

3. Knowing the female healthy history in the family is useful. However, even when the information is grim, she can factor in the life styles and environmental influences which may have affected her mother, aunts, grandmothers, and cousins. They may have been exposed to asbestos, eaten diets heavy in meat, fat and sugar, not exercised, smoked or had insufficient calcium.

My mother, troubled now at 77 with osteoporosis, said "If I had known smoking depleted calcium in my body and would make osteoporosis twice as difficult for me, I would have quit years ago."

4. Cultural influences need to be considered. Our culture sells ideas, people and products through media images. The profit mentality perceives the large number of women entering mid-life as potential consumers of numerous menopausal products. Traditional advertising may focus on maintaining a youth appearance, freedom from inconvenient sensations or powerful health benefits. It plays down the lack of information, or faulty information, based on medical studies which have excluded women.

5. Finally, a woman's personal principles are a most important consideration. She must honor her deepest self if she is to live well with her decisions.

Support and Guidelines

A woman's best equipment to care for herself during and after menopause includes an appreciation of a woman's life stages. A growing ability to listen, read and recognize her changing body sensations is also important.

Supportive and trustworthy friends and family are valuable, plus new friends and associates who bring a fresh and responsive view to the woman's developing feelings and perceptions. We all need to acknowledge emotional shifts which are similar yet different from the challenges which have always accompanied women's cyclical rhythms.

Perhaps most important, a woman needs more than ever the woman's ability to be respectfully attentive to new feelings and perceptions emerging from her developing changing self. These small but continually growing and developing aspects of her authentic self become her true guides in her journey through the stages of being a woman.

With confidence and self-respect women can question the validity of available information and educate themselves concerning their bodily process, general health care, new research, source, quality and side effects of various recommended drugs and hormones. Then they can make informed choices which support the highest possible quality of life.

Lastly, we need to remember, menopause is part of the natural feminine cycle. It's part of the wonder of being a woman.

5/29/98