Change with Grace...

Unbiased and physician provided information regarding menopause and the change of life.

I am a physician and as such I am a scientist. Though many people (including some of my colleagues) consider the appellation of scientist to be accorded appropriately only to those who inhabit laboratories I know differently. I know that to be a scientist is to be one who makes a commitment to knowledge, discovery and accuracy. It is to be a person who not only seeks to make discoveries but who also questions the current “knowns.” It is to start each day and address each situation with a mental construct predicated primarily upon inquiry. While the goal of such an endeavor is certainly not to reinvent the wheel each day or to discard the baby with the bathwater, it is to understand the limits of one’s knowledge and with that understanding, to proceed in a manner that allows room for refutation and modification of one’s practice based on the best evidence. It is to know that there are many things that are not known or are, in fact, unknowable. It is to realize that a multitude of competing interests may interfere with actual discernment. It is to realize that a partial truth my mask a complete lie. So, to practice medicine properly, it is imperative that one view oneself as a scientist and proceed to act in a manner consistent with this belief. One facet of such an existence involves a commitment to the pursuit of the truth and to apply such discovery to patient care. Why am I saying this? I am saying this because I desire that my site not be considered by you as simply one site among many but rather, a definitive and useful source for matters involving aspects of the climacteric. The web is approaching ubiquity nowadays and a source of almost unlimited amounts of information and disinformation. Very many good sources of information exist but also some very poor ones. Some sites purposely attempt to mislead while others espouse a peculiar view that may be a result of one individual’s limited experience. With this site, I will attempt to fulfill my role as scientist to individuals seeking such information as I provide. Due to the sheer volume of information on the topic it will be, perforce, limited in some ways. I cannot review every study or respond to every inquiry as I simply lack in time and other resources to do so. Not all perfectly valid inquiries can be vetted or addressed. I will do what I can with what I have and my expectation is that the site will evolve every day to address more efficiently and accurately the concerns of the community accessing this site.

I am not an iconoclast – it is the rare individual who could assume such a role after four years of college, four years of medical school and a four year residency but I do retain some of the substance from which our profession sprang and that is, the habit to question, consider and reconsider. I do believe in objective truths but I also see such truths as more likely to inhabit those spaces considered within the disciplines of ethics and morals . I see room for multiple truths to coexist in matters of medical treatment and that such multiple truths spring from the varied life experiences of patients.

Strictly speaking, the “climacteric” is the name given to the “change of life.” This change of life is experienced by women with the gradual diminution, and ultimately cessation, of estrogen production by the ovaries.

Climacteric is a term often used synonymously with the term menopause however such use is not quite correct. Menopause merely refers to the cessation of menses. The cessation of menses is but one change, albeit the most commonly experienced and obvious, of the climacteric. The climacteric is actually the whole change of life and menopause is but one of its manifestations. Manifestations of the climacteric include a host of physiologic changes brought about by senescence of the ovaries with their consequent reduction in production of steroid hormones. Women may experience such a change in the ovarian function in a number of different ways. Commonly, such changes may be broadly classified into three categories:

    •    Vasomotor instability
    •    Menopause
    •    Atrophy of hormonally responsive tissues

The climacteric is a part of the normal aging process and typically is not indicative of any pathologic process or disease.

With apologies to the linguists and anthropologists among us: As a language changes and evolves (or occasionally devolves) certain terms or phrases necessarily come to the fore or recede into the background. Much of this depends on common use and it is common use by which they are received into or rejected from the lexicon. Sometimes we see a less apt word fall (appropriately) into a state of desuetude in favor of a more descriptive or appropriate term. Other times we see a perfectly suited word fall out of use due to a shift in the dominant paradigm or an improvement in the understanding of the underlying process for which that term was previously most useful. Other times we see a perfectly good word discarded for no apparent good reason what so ever. Unfortunately, the term climacteric seems to be one that has fallen out of favor of late. This is unfortunate as it is the very term that is most perfectly suited to the “change of life.” It has been usurped, inappropriately I believe, by the less descriptive and more limited term “menopause.” We encounter physicians and websites that proffer “menopause” as the term best suited even though it describes but one component of the climacteric. We see physicians describe themselves as specialists in “menopausal medicine” as if they can treat the menopause or as if menopause is not merely a fact but rather a problem or the descriptive term for what is a far more complex change in the hormonal milieu of a woman. With your help we can restore the term climacteric to its rightful place as the proper term for the change of life.

Knowledge of the climacteric enables a rational response to it. A portion of this knowledge is the realization among health professionals of the sheer number of patients who will be experiencing the climacteric. Demographers tell us that the proportion of our population age 65 and older will balloon. In fact the number of patients greater than age 65 will double over the next 20 years. This, in turn, will result in far greater numbers of American women living into their 80s and 90s – ages where a failure to address the medical issues surrounding estrogen deprivation earlier in their course will become compounded. When one considers that this increase in longevity is not accompanied by a delay in the climacteric one will clearly see that women will spend an increasingly large portion of their lives deprived of estrogen. Simple math demonstrates that many women may spend one third of their lives post-menopausal. Demographics and epidemiology indicate that any attention placed on this matter is time well spent. The costs, both financial and personal of failing to manage post-menopausal health issues will be staggering.

This website is intended to provide information regarding the climacteric. It is not intended to substitute for the care of a medical professional. Some of the contents of this site may be controversial or not widely accepted. In such cases where the information herein differs from that which you may receive from your medical professional, I encourage a discussion of this with your physician. In addition, throughout this website, the occasional use of a brand name will appear. The presence of brand names is for my convenience only and does not constitute an endorsement of that product. This site’s content and information is for educational purposes only. It is not intended that this site be used for the diagnosis or treatment of any health problem or as a substitute to consulting a licensed medical professional.

Copyright 2009. Breith Healthcare Services, Inc. All Rights Reserved