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THE WISDOM OF MENOPAUSE

CREATING PHYSICAL AND EMOTIONAL HEALTH


DURING THE CHANGE

Dr. Christiane Northrups #1 New York Times bestseller The Wisdom of Menopause has inspired more than a million women with a dramatically new vision of midlifeand will continue to do so for generations to come. As Dr.
Northrup has championed, the change is not simply a collection of physical
symptoms to be fixed, but a mind-body revolution that brings the greatest opportunity for growth since adolescence. The choices a woman makes
nowfrom the quality of her relationships to the quality of her diethave
the power to secure vibrant health and well-being for the rest of her life.
Now completely revised, this groundbreaking classic draws on the current
research and medical advances in womens health, and includes:
a new section on sex after 50and how you can rejuvenate your sex life
updated mammogram guidelinesand how thermography can assist with
breast health
the latest on the glycemic index, optimal blood sugar levels, and ways to
prevent diabetes
dietary guidelines revealing that hidden sugarnot dietary fatis the main
culprit in heart disease, cancer, and obesity
all you need to know about perimenopause and why its critical to your wellbeing
a vital program for ensuring pelvic health during and after menopause
strategies to combat osteoporosis and strengthen bones for life
With this trusted resource, Dr. Christiane Northrup shows that women can
make menopause a time of personal empowermentemerging wiser, healthier, and stronger in both mind and body than ever before.

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The Wisdom of
Menopause
Creating Physical and Emotional
Health During the Change
Revised and Updated

Christiane Northrup, M.D.

bantam books
new york

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Contents

List of Figures
Acknowledgments

Introduction: The Journey Begins


Midlife: Redefining Creativity and Home
Blazing a New Trail

Chapter 1. Menopause Puts Your Life Under a Microscope


Not Me, My Marriage Is Fine
The Childbearing Years: Balancing Personal and
Professional Lives
Why Marriages Must Change at Midlife
My Personal Fibroid Story: The Final Chapter
The Joy of Co-creative Partnership
The Forces That Change the Goose Also Change the Gander
Real Menopause Hits
My Marriage Goes Bankrupt
Armadillo Medicine: The Power of Vulnerability
Celebrating the Past While Creating a New Future

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Chapter 2. The Brain Catches Fire at Menopause


Our Brains Catch Fire at Menopause
Learning to Recognize and Heed Our Wake-up Calls
Is It Me or Is It My Hormones? Debunking the Myth
of Raging Hormones
The Multiple Roles of Your Reproductive Hormones
Embracing the Message Behind Our Menopausal Anger
Emotions, Hormones, and Your Health
How Our Midlife Brains and Bodies Are Set Up to Heal
Our Past
Finding a Larger Meaning

Chapter 3. Coming Home to Yourself: From Dependence


to Healthy Autonomy
The Empty-Nest Syndrome
Boomerang Babies
Powerful Feelings, Powerful Healing
Caring for Ourselves, Caring for Others: Finding the Balance
Hitting Pay Dirt: Getting Clear About Money at Midlife
Coming Home to Yourself
Vocational Awakening at Midlife
A Road Map for Navigating Unknown Territory

Chapter 4. This Cant Be Menopause, Can It? The Physical


Foundation of the Change
What Is Happening in Your Body: Hormonal
Changes
Perimenopause Is a Normal Process, Not a Disease
The Three Types of Menopause
Perimenopause and Hormonal Levels
Is There a Test I Can Take?
Menopause and Thyroid Function
Menopause and Adrenal Function
What to Expect in Your Transition

Chapter 5. Hormone Therapy: An Individual Choice


A Brief History of Hormone Therapy
Bioidentical Hormones: Natures Ideal Design
A Hormone Primer: Essential Information Every Woman
Should Know

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CONTENTS

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How to Decide Whether or Not to Take Hormones


A Dusting of Hormones
How Long Should You Stay on Hormones?

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Chapter 6. Foods and Supplements to Support the Change

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209

Basic Principles of Herbal Therapy at Menopause


Menopausal Healing Foods
Traditional Chinese Medicine and Acupuncture for
Menopause
Start Somewhere

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224

Chapter 7. The Menopause Food Plan: A Program to Balance


Your Hormones and Prevent Middle-Age Spread 225
Making Peace (Once Again) with My Weight
226
Six Steps to Midlife Weight Control
228
The Hormone-Balancing Food Plan
243
Optimizing Midlife Digestion
262
The Final Frontier: Accepting Our Bodies
268
Chapter 8. Creating Pelvic Health and Power
What Is Yours, What Is Mine, What Is Ours? Reclaiming
Our Boundaries
Hormonal Imbalance: Fuel to the Fire
Menstrual Cramps and Pelvic Pain
Heavy Bleeding
Fibroids
An Empowered Approach to Surgery or Invasive Procedures
Master Program for Creating Pelvic Health
Urinary Health

Chapter 9. Sex and Menopause: Myths and Reality


The Anatomy of Desire
Sexuality at Menopause: Our Cultural Inheritance
Menopause Is a Time to Redefine and Update Our
Relationships
Hormone Levels Are Only One Part of Libido
Secondary Libidinal Support: Estrogen and Progesterone
Testosterone: The Hormone of Desire?
Aids to Lubrication
Telling the Truth
Ten Steps to Rekindling Libido

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Chapter 10. Nurturing Your Brain: Sleep, Mood, and Memory 362
Enhancing Midlife Sleep
366
Depression: An Opportunity for Growth
376
Memory Loss at Menopause: Is This Alzheimers?
388
Hormones and Alzheimers
392
Nonhormonal Ways to Protect Your Brain
393
Maximizing Midlife Wisdom
399
Chapter 11. From Rosebud to Rose Hip: Cultivating
Midlife Beauty
Making Peace with Your Changing Skin
Preventing or Treating Wrinkles
Midlife Acne
Rosacea
Hair in the Wrong Places
When Good Skin Care Isnt Enough: Deciding on Cosmetic
Procedures
Varicose Veins

Chapter 12. Standing Tall for Life: Building Healthy Bones


Osteoporosis: The Scope of the Problem
Were Designed for Lifetime Sturdiness
How Healthy Bone Is Made
Are You at Risk for Osteoporosis?
Measuring Bone Density
What About Bone-Building Drugs?
Get Strong
Healing Your Fitness Past
The SunlightBone Health Connection
Shore Up Your Earth Connection with Plant Medicine
Straight, Strong, and Flexible for Life: Master Program for
Healthy Bones and Joints

Chapter 13. Creating Breast Health


Our Cultural Inheritance: Nurturing vs. Self-Sacrifice
The Emotional Anatomy of Breast Cancer
Program for Creating Breast Health
Breast Cancer Screening
The Promise of Thermography
Putting Breast Cancer Risk in Perspective

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The Breast Cancer Gene: Should You Be Tested?


The Effect of HT on Breast Health
Bioidentical Hormones and Cancer Risk
The Tamoxifen Dilemma

Chapter 14. Living with Heart, Passion, and Joy: How to


Listen to and Love Your Midlife Heart
The Heart Has Its Say at Menopause: My Personal Story
Cardiovascular Disease: When the Flow of Life Is Blocked
Palpitations: Your Hearts Wake-up Call
Gender Bias and Heart Disease: Our Cultural Inheritance
Reducing Your Risk for Heart Disease
Carbohydrates, Sugar, and Heart Health: What Every Woman
Should Know
Cardioprotective Supplements
Foods for Heart Health
What About Aspirin?
Get Moving!
The Heart-Estrogen Link: Whats Really Going On?
How to Love and Respect Your Midlife Heart
The Heart-Opening Effect of Pets
The Intellect Is Certain It Knows, but the Heart Always Wins

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Epilogue: The Calm After the Storm

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Resources

637

Notes

667

Index

727

About the Author

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introduction

The Journey Begins

n the year or two before I actually started to skip periods, I began


to experience an increasingly common feeling of irritability whenever my work was interrupted or I had to contend with a coworker or employee who was not as committed to accomplishing the
job as I was. Looking back, I recall that when I was in my thirties and
my children were younger, their interruptions when I was in the middle of writing an article or talking on the phone were only mildly irritating to me. My love and concern for their welfare usually
overrode any anger or frustration I might have felt.
But as I approached menopause, I found myself unable to tolerate distractions such as my eighteen-year-old asking me, When is
dinner? when she could clearly see I was busy. Why, I wondered,
was it always my responsibility to turn on the stove and begin to
think about my familys food needs, even when I wasnt hungry and
was deeply engrossed in a project? Why couldnt my husband get the
dinner preparations started? Why did my family seem to be almost
totally paralyzed when it came to preparing a meal? Why did they all
wait in the kitchen, as though unable to set the table or pour a glass
of water, until I came into the room and my mere presence announced, Moms here. Now we get to eat?
The same thing occurred when it was time to get into the car and
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take off on vacation. Only when I myself made a definitive move


toward the door did my family mobilize. It felt as though my presence caused them to lose their own personal initiative to take charge
of a situation, be it dinner or a family trip. Still, during my childbearing years I accepted this, mostly good-naturedly, as part and parcel of my role as wife and mother. And in so doing, I unwittingly
perpetuated it, partly because it felt so good to be indispensable.
During perimenopause, I lost patience with this behavior on all
levels, whether at home or at work. I could feel a fiery volcano within
me, ready to burst, and a voice within me roaring, Enough! Youre
all able-bodied, capable individuals. Everyone here knows how to
drive a car and boil water. Why is my energy still the organizing principle around here? My indignation grew as I mumbled to myself, If
I were a man in the prime of life and at the pinnacle of his career, I
wouldnt be interrupted like this. Everyone would be wondering how
to help me, instead of the other way around!
Little did I know that these bursts of irritability over petty
family dynamics were the first faint knocks on the door marked
Menopausal Wisdom, signaling that I needed to renegotiate some of
my habitual relationship patterns. Nor did I know that by the time I
began to actually skip periods and experience hot flashes, my life as I
had known it for the previous quarter century would be on the
threshold of total transformation. As my cyclic nature rewired itself,
I put all my significant relationships under a microscope, began to
heal the unfinished business from my past, experienced the first pangs
of the empty nest, and established an entirely new and exciting relationship with my creativity and vocation.
All of the changes I was about to undergo were spurred, supported, and encouraged by the complex and intricate brain and
body changes that are an unheraldedbut inevitable and often
overwhelmingpart of the menopausal transition. There is much,
much more to this midlife transformation than raging hormones.
Research into the physiological changes taking place in the perimenopausal woman is revealing that, in addition to the hormonal
shift that means an end to childbearing, our bodiesand, specifically, our nervous systemsare being, quite literally, rewired. Its as
simple as this: our brains are changing. A womans thoughts, her
ability to focus, and the amount of fuel going to the intuitive centers
in the temporal lobes of her brain all are plugged into, and affected
by, the circuits being rewired. After working with thousands of
women who have gone through this process, as well as experiencing
it myself, I can say with great assurance that menopause is an excit-

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INTRODUCTION

ing developmental stageone that, when participated in consciously,


holds enormous promise for transforming and healing our bodies,
minds, and spirits at the deepest levels.
As a woman in midlife today, I am part of a growing population
that is an unprecedented 48.5 million strong in the United States
alone. This group is no longer invisible and silent, but a force to be
reckoned witheducated, vocal, sophisticated in our knowledge of
medical science, and determined to take control of our own health.
Think about it: more than 48 million women, all undergoing the
same sort of circuitry update at the same time. By virtue of our
sheer numbers, as well as our social and economic influence, we are
powerfuland potentially dangerous to any institution built upon
the status quo. Baby boom women (those born between 1946 and
1964) are now the most affluent and influential group in the world.
Its clear that the world is changing, willingly or otherwise, right
along with us. And in many instances, its changing for the better.
Its no accident that the current movement of psychospiritual
healing is composed largely of women in their thirties, forties, fifties,
and sixties. We are awakening en masse and beginning to deliver
a much-needed message of health, hope, and healing to the world.
My personal experience, now shared by millions of others, tells
me that the perimenopausal lifting of the hormonal veilthe
monthly cycle of reproductive hormones that tends to keep us focused on the needs and feelings of otherscan be both liberating and
unsettling. The midlife rate of marital separation, divorce, and vocational change confirms this. I, for one, had always envisioned myself
married to the same man for life, the two of us growing old together.
This ideal had always been one of my most cherished dreams. At
midlife I, like thousands of others, had to give up my fantasies of how
I thought my life would be. I had to face, head-on, the old adage
about how hard it is to lose what you never really had. It means giving up all your illusions, and it is very difficult. But for me the issue
was larger than where and with whom I would grow old. It was a
warning, coming from deep within my spirit, that said, Grow . . . or
die.Those were my choices. I chose to grow.

MIDLIFE: REDEFINING CREATIVITY AND HOME


For most women, identity and self-esteem are generated by our associations and relationships. This is true even for women who hold
high-powered jobs and for women who have chosen not to marry.

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Men, by contrast, usually get most of their identity and self-esteem


from the outer worldthe job, the income, the accomplishments, the
accolades. For both genders, this pattern often changes at midlife.
Women begin to direct more of their energies toward the world
outside of home and family, which may suddenly appear as a great,
inviting, untapped resource for exploration, creative expression, and
self-esteem. Meanwhile, men of the same agewho may be undergoing a midlife crisis of their ownare often feeling world-weary;
theyre ready to retire, curl up, and escape the battles of the workplace. They may feel their priorities shifting inward, toward home,
hearth, and family.
Its an ironic transposition: the man is beginning to look to relationships for his juice; the woman is feeling biologically primed to
explore the outer world. In married couples, this often produces profound role shifts. In the best of all worlds, the man retires or cuts
back on work, becoming the chief cook and bottle washer at home,
and providing emotional and practical support for his wifes new interests. She, in turn, goes out into the world to start a business, get an
education, or do whatever her heart dictates. If their relationship is
adaptable and resilient, they adjust to their new roles. Some are so
energized by their newfound freedom and passion that they fall in
love all over again. If a womans partner is not willing to grow, however, he (or she) may become jealous of her success and independence, and put pressure on her to continue to care for him as she has
always done. He may even get physically sick, often in the form of
heart disease and/or clinically dangerous high blood pressure. Its important to note that this is not a conscious or willful act; hes simply
responding to the promptings of our lopsided culture.
A woman often finds herself in the difficult position, then, of having to choose between returning to the role of caretaker to nurture
her husband at the expense of her own needs and pursuing her own
creative passions. Its an old story, common to women in many
cultures, not just our own. The woman in menopause, who is becoming the queen of herself, finds herself at a crossroads of life, torn between the old way she has always known and a new way she has just
begun to dream of. A voice from the old way (in many cases its her
husbands voice) begs her to stay in placeGrow old with me, the
best is yet to be. But from the new path another voice beckons, imploring her to explore aspects of herself that have been dormant during her years of caring for others and focusing on their needs. Shes
preparing to give birth to herself, and as many women already know,
the birth process cannot be halted without consequences.

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Caring for others and pursuing unexplored personal passions are


not necessarily mutually exclusive choices, but our culture makes
them seem so, always supporting the former at the expense of the latter. This is part of what makes the midlife transformation so much of
a challengeas I know only too well.

BLAZING A NEW TRAIL


Throughout most of human history, the vast majority of women died
before menopause. The average life expectancy for a woman in 1900
was only forty. For those who survived, menopause was experienced
as a signpost of an imminent and inevitable physical decline. But
today, with a womans life expectancy at eighty-four years, it is reasonable to expect that she will not only live thirty to forty years beyond menopause, but be vibrant, sharp, and influential as well. The
menopause you will experience is not your mothers (or grandmothers) menopause.
Heres the truth: most Americans dont get old at age sixty-five,
either physically or mentally. The groundbreaking research of Lydia
Bronte, Ph.D., former director of the Aging Society Project (funded
by the Carnegie Corporation) and author of The Longevity Factor
(HarperCollins, 1993), reveals that many people will have three different careers over their life span. Bronte says theyll likely have their
first career in their thirties and forties, another in their fifties and
early sixties, and still another in their seventies. Almost half of the
people who Dr. Bronte studied had a major peak of creativity beginning at about age fifty and, in many cases, lasting for twenty-five to
thirty years. That means that the new middle age is from fifty to
eighty!
Women of the World War II generation, in contrast, whose female role models tended to be like June Cleaver on Leave It to
Beaver, had an entirely different social and political environment in
which to make their transition. Menopause (like menstruation, for
that matter) was not discussed in public. Today this is no longer true.
As we break this silence we are also breaking cultural barriers, so
that we can enter this new life phase with eyes wide openin the
company of more than 48 million kinswomen, all undergoing the
same transformation at the same time. And, as youll soon discover,
the changes taking place in midlife women are akin to the power
plant on a high-speed train, whisking the evolution of our entire society along on fast-forward, to places that have yet to be mapped.

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Whether you climb aboard this fast-moving train or step aside and let
it pass will play a major role in how far you go and how you feel
along the way.
Ultimately, Ive found this journey bracing, exciting, and healthenhancing. And Im certainly not alone. A 1998 Gallup survey, presented at the annual meeting of the North American Menopause
Society, showed that more than half of American women between
the ages of fifty and sixty-five felt happiest and most fulfilled at this
stage of life. Compared to when they were in their twenties, thirties,
and forties, they felt their lives had improved in many ways, including family life, interests, friendships, and their relationship with
their spouse or partner. In other words, the conventional view of
menopause as a scary transition heralding the beginning of the end
couldnt be further from the truth.
When I wrote the first edition of this book back in 2001, I truly
wanted to believe that statement. I had faith in it, even though my
heart was broken and the life I had known for twenty-five years was
dying. Now, ten years later, I see how clearly every moment of that
perimenopausal labor pain was a necessary part of my rebirth into
the happy, healthy, fulfilled woman I have become today.
So no matter what is happening in your life right now, take heart.
Please join meand the millions of others who have come before and
will come afteras we transform and improve our lives, and ultimately our culture, through understanding, applying, and living the
wisdomand joyof menopause and beyond.

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Menopause Puts Your Life


Under a Microscope

t is no secret that relationship crises are a common side effect of


menopause. Usually this is attributed to the crazy-making effects
of the hormonal shifts occurring in a womans body at this time of
transition. What is rarely acknowledged or understood is that as
these hormone-driven changes affect the brain, they give a woman a
sharper eye for inequity and injustice, and a voice that insists on
speaking up about them. In other words, they uncover hidden
wisdomand the courage to voice it. As the vision-obscuring veil
created by the hormones of reproduction begins to lift, a womans
youthful fire and spirit are often rekindled, together with longsublimated desires and creative drives. Midlife fuels those drives with
a volcanic energy that demands an outlet.
If it does not find an outletif the woman remains silent for the
sake of keeping the peace at home or work, or if she holds herself
back from pursuing her creative urges and desiresthe result is
equivalent to plugging the vent on a pressure cooker: something has
to give. Very often what gives is the womans health, and the result
will be one or more of the big three diseases of postmenopausal
women: heart disease, depression, and breast cancer. On the other
hand, for those of us who choose to honor the bodys wisdom and to
express what lies within us, its a good idea to get ready for some
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boat rocking, which may put long-established relationships in upheaval. Marriage is not immune to this effect.

NOT ME, MY MARRIAGE IS FINE


Every marriage or partnership, even a very good one, must undergo
change in order to keep up with the hormone-driven rewiring of a
womans brain during the years leading up to and including
menopause. Not all marriages are able to survive these changes.
Mine wasnt, and nobody was more surprised about that than I. If
this makes you want to hide your head in the sand, believe me, I do
understand. But for the sake of being true to yourself and protecting
your emotional and physical health in the second half of your life
likely a full forty years or morethen I submit to you that forging
ahead and taking a good hard look at all aspects of your relationship
(including some previously untouchable corners of your marriage)
may be the only choice that will work in your best interest in the long
run, physically, emotionally, and spiritually.
From the standpoint of physical health, for example, there is
plenty of evidence to suggest that the increase in life-threatening illnesses after midlife, which cannot be accounted for by aging alone, is
partly rooted in the stresses and unresolved relationship problems
that simmered beneath the surface during the childbearing years of a
womans life, then bubbled up and boiled over at perimenopause,
only to be damped down in the name of maintaining the status quo.
The health of your significant other is also at stake. Remaining in a
relationship that was tailor-made for a couple of twentysomethings
without making the necessary adjustments for who you both have
become at midlife can be just as big a health risk for him as it is for
you.
This is not to say that your only options are divorce or heart attack. Rather, in order to bring your relationship into alignment with
your rewired brain, you and your significant other must be willing to
take the time and spend the energy to resolve old issues and set new
ground rules for the years that lie ahead. If you can do this, then your
relationship will help you to thrive in the second half of your life. If
one or both of you cannot or will not, then both health and happiness may be at risk if you stay together.

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ABOUT THE AUTHOR


Christiane Northrup, M.D., trained at Dartmouth
Medical School and Tufts New England Medical Center.
She is a board-certified obstetrician/gynecologist with more
than twenty years of clinical and medical teaching experience. As past president of the American Holistic Medical
Association, and past Clinical Assistant Professor of Obstetrics and Gynecology through the University of Vermont
College of Medicines program at Maine Medical Center,
she appreciates the need for a partnership between the best
of conventional and complementary medicine. Dr. Northrup is the author of the New York Times bestselling book
Womens Bodies, Womens Wisdom and Mother-Daughter
Wisdomnominated for the prestigious Quill Award,
voted number one by the editors at Amazon.com in both
the Health, Mind & Body and Parenting & Families
categories, and recognized as one of the 50 Best Books of
2005. She is also the author of The Secret Pleasures of
Menopause (Hay House, 2008) and The Secret Pleasures
of Menopause Playbook (Hay House, 2009). She has
hosted seven successful public television specials and her
work has been featured on The Oprah Winfrey Show, The
Today Show, Nightly News with Brian Williams, MSNBC,
Rachael Ray, The View, Good Morning America, PBS, and
ABCs 20/20. Through her monthly e-letter (Womens
Health Wisdom), her website (www.drnorthrup .com), her
Facebook page, her weekly radio show Flourish (www
.hayhouseradio.com), and her subscription-based online
Womens Wisdom Community, Dr. Northrup shares
cutting-edge information about health and flourishing with
women worldwide. She lives in Maine.

Dr. Christiane Northrups

THE WISDOM OF MENOPAUSE


newly revised and expanded

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