September 23, 2013

Menopause, a Potential Killer



Writing on this subject of Menopause and these unwanted traumas and what they can do to a person if left undiagnosed, has been one of the most difficult writings I have ever had to put in print.
  When you read it you will understand why.  I have lost my nerve and deleted this blog twice, but hopefully it will stick this time.

I browsed through the books for sale at the college library today, something I love doing; you can pick up some fun and interesting books in excellent condition for very little money.  In the past I’ve bought both fiction and nonfiction, feeling like I’ve rescued a friend in the process. Today I spotted this book: Menopause and the Mind, by Claire Warga, PH.D. 

Something clicked and an image became illuminated in my mind.  I immediately opened the pages, and as I skimmed through the contents and their subjects, I knew then I had to buy this book, if for no other reason than to help me research this subject of Menopause, knowing it must have some answers to these nagging questions of mine, about these unwanted physical and mental changes I’ve now been forced to endure for possibly the rest of my life.  The important question for me:  How does menopause change psychological perspectives, altering the mind’s eye, and can they be reversed?  At the very moment I asked myself these questions I had a mental image of Virginia Woolf coming into my view.

For a number of years I’ve been interested in Virginia Wolf, not just her literature with its unique style, but how it all comes together to tell me her story; what this woman was about, inside and out; how she lived, where she lived, and why she lived.  I have dug into her fascinating history; from her stories, to stories written about her; from her diaries, to biographies putting these little pieces of her self together.  And all during this time I felt a determination, a need to see what lead her to her suicide.  I had no idea as to the why I needed to know, I just knew there was something much more than what has already been written. What I’m about to say is as much about me as it is about her. Maybe that’s the “why” in all of this.

From the first moment I began to read Virginia Woolf’s novel, To The Lighthouse, she spoke to me in a strange and mystical voice, a voice I had never heard before.  And with the help of Dr. Ilana Simons, a true teacher on this subject, I began to search for that deeper meaning of why she chose to take her life.  I know I’m not the only one who feels a deep connection to Virginia Woolf; she has a long list of admirers.  And, I know the popular consensus for Virginia Woolf’s suicide is that she had bipolar disorder.

Definition
Bipolar disorder — sometimes called manic-depressive disorder — is associated with mood swings that range from the lows of depression to the highs of mania. When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts in the other direction, you may feel euphoric and full of energy. Mood shifts may occur only a few times a year, or as often as several times a day. In some cases, bipolar disorder causes symptoms of depression and mania at the same time.

These symptoms apparently drove her into the river to her death.  But something else was telling me to keep looking for something other than this obvious and speculative diagnosis.  I didn’t get these feelings of bipolar from her, whether right or wrong, this answer did not wholly satisfy me enough to accept.

  As I continued to read about VW, I found times when I had to stop and step away, mentally walking away from something that became my emotional, subjective triggers; intense, compellingly, in metaphorical and honest beauty.  Over time, I’ve written to and about VW, and I’ve listed these writing references at the end of this blog.

There is nothing more personal than our own story, whether fiction or nonfiction; putting that story in writing makes life all that more real.  We write that story by living it every day, whether we like it or not.  Virginia Woolf couldn’t help but make you feel a full awareness of what life means, a true story; she was more than aware of her own personal stake in her challenges she met, fought, and concurred, and eventually lost; her writing as proof, her writing affected her self as well as her readers.

  Virginia Woolf manipulated her words, as we all try to manipulate life; she could hide from the truth in metaphor, as I often do, she could overtly throw words out to you, or into space, or into your face; she edited and re-edited, just to see if there was more to see - to see her own reactions, to live up to these words, or maybe hating them, and eventually throwing them away; or maybe save and ponder for another day.

I was in my twenties when I first experienced what is called a “hot flash”, but it felt more like I was losing control of my mind.  I was out to dinner with my husband, and in a split second I saw the room from eyes that weren’t mine, as if I were looking down upon myself.  Then a noise out of nowhere felt like it was coming through my ears, a noise so obscure, I couldn’t quite identify this hum of sorts, like a thousand bees at work on its hive in my head. 

Into my thirties, and after a major surgery, depression came alive and real.  I struck it down, trying to ignore it, getting on with my life.  Personal problems started intervening, only to compound the depression. Depression struck like a vengeance, this time I was withdrawing completely.  I entered into a six year weekly, one on one, program of psychotherapy.

Now into my forties, I underwent a partial hysterectomy for medical reasons, and upon recommendation my surgeon left one ovary to keep the hormones doing their job as long as possible, keeping me generally healthy.

But, over time, an ovary starts to “dry-up”, as my doctor put it, and during that time I started to have more strange physical symptoms. My head took the brunt of this bizarre onslaught.  Before the extreme heat struck again, covering my entire body with sweat, saturating my face and clothes, I felt a loud roaring rushing through my head like a train that wouldn’t stop, not just the hum of bees this time; this was the unbearable prelude, the warning.

It disrupted my daily life, to say the least, so I consulted my internist. He gave me a prescription for hormone replacement, Premarin, the smallest dosage, and to be only taken five days a week, M-F he said; let’s try this regimen, because there is no need to go any stronger if this works.  It did the trick.  No more loud trains, no more unwanted heat coursing through my body.  I got my life back on track.

Into my sixties, and about two years ago, doctors thought it would be a good idea to take their patients off of hormone therapy.  My cardiologists said go off NOW, today; and my primary physician said to take my time.  I hated the thought of going cold turkey, so he suggested I wean myself, slowly.  But neither of these doctors warned me of the possible symptoms I would be showing after I stopped taking this pill.

Everyone’s physical reactions during menopause has varying degrees, and I thought I was way past the age for those symptoms to rear their ugly heads, but taking NO hormone replacement did not bode well with my body.  I couldn’t see how no estrogen was the better alternative, whatever those alternatives might be.

I had a history of depression, but dealt with it by way of psychotherapy.  Now, I had that issue to deal with, again.  I’d been depression free for twenty years.  Now, as my hot flashes increased in intensity, my stress and anxiety levels increased, and anxiety levels were accompanied by depression.  The heat is bad enough, but seconds before that hits, I could feel my mind sinking down into what felt like a deep bottomless nothingness, hitting me broadside, out of nowhere; with distress, I cried, it was so emotional and physically debilitating, falling into that place I feared, hour after hour, day after day.

I started drinking heavily.  Depression worsened – a vicious cycle.  As we all know, drinking is not the answer, it only causes endless depression. I was desperate to escape, so I chose to throw away caution just to have something numbing, anything to take away that pain.  It just compounded all of these symptoms, but I wasn’t willing to give up that drink, not until I had my nurse practitioner tell me to STOP, and stop now, she said, unless I was trying to kill myself. I was damaging my liver, and liver transplants are far and few between, and risky.  Suicide was not far from my mind. Was I trying to kill myself?  What choices did I have?

She prescribed an antidepressant, and said it was known to help reduce hot flash episodes, and hopefully the depression would subside.  It worked on the depression, but the hot flashes still hit, but thankfully without a severe precursor, and residual depression.

During all of this time, working through my “menopausal syndrome”, I read a bit about Virginia Woolf’s mental state. I was hearing something in her voice as she wrote… I wandered a great deal about how she handled perimenopaus and menopause, and what symptoms she may have had during these years in her life. Virginia Woolf’s age was 59 when she killed herself, but I wondered what she was feeling, what was happening to her mind and her body in years prior to the time of her death.  Something told me it had to do with this topic of menopause, and had little or possibly nothing to do with bipolar disorder.  It was just a hunch, a speculation, not much more than that, it was just something I felt inside of me, nothing I could prove. Feelings are not scientific.  Yes, I know that.

When I started reading this book by Dr. Claire Warga, I had to see if there was any correlation between her findings, and what my feelings were about Virginia Woolf.  I’ve always thought of VW as an intricate blend of sensibilities.  She was, in my words, hyper-tuned to people and the world in which they lived.  

She was born in a period of time, January 25, 1882, into a family ruled by a scholarly father, where her brothers attended college, and where she was not allowed. Women and taboos were constantly making themselves known in front of her.
  
The world around VW was a man’s world, a discriminatory world, even though she was allowed to read extensively from her father’s library, it was like a hand-me-down, a discriminating parsing of pleasure by her father, drawing a deep, dark line across the world’s view of the sexes.  But, she intervened and crossed that line, to later become an exceptional debate member of the Bloomsbury group, compiled mostly of men; she was determined to be the exception to this rule.
 
I can only imagine her having to downplay her sensitive monthly feelings, this was before the term PMS became known as a popular acronym of today…no matter what these symptoms were, physical or mental, she had to present a front to these young men, and in the same breath she was a determined woman who never threw away her pride in these debates.

There were personal tragedies and circumstances within VW’s life, and these appeared to amp up psychological changes, manifested by unwanted advances made towards her, and in which would later alter her senses and perspectives of herself as she related to the people she was close to during her lifetime. It is all in her writing.

This book by Dr. Claire Warga takes a look at a whole new perspective of the symptoms of Menopause, a list a mile long.  Personal accounts are given by friends and patients of Dr. Warga, some leaving their name, some staying anonymous. I see how taboo this subject would continue to be, from Virginia Woolf’s “female problems” during the eighteen hundreds, and then continue into the nineteen hundreds.  We are now in the twenty-first century, and only now are we beginning to see and understand what a toll Perimenopaus and Menopause will take on the human body.  Men are not exempt, I might add.  Hormones are the necessities for life.

I can’t help but think of Virginia Woolf, after reading these personal accounts in which Dr. Claire Warga sights.  Paranoid Schizophrenia - hearing and seeing that which is not there - forgetfulness, fuzzy brain, memory loss, frustrations, depressions and feelings of being crazy, how does this add up to the  “change of life” symptoms women had, and still have, before science recognized the answers to these physical-mental feelings of wellbeing?  How many women were wrongly diagnosed, sent off to sanatoriums, or a crazy house, and in VW’s case, sent to bed with limited outside contact for months at a time, confined and put on a restricted diet?   It took a determined woman like Dr. Claire Warga to find the answers most doctors hadn’t even thought about, especially male doctors. 

I kept wondering if my feelings about VW were strictly emotional, a result of reading her literature, but if that were the case, how did I base those emotions I was feeling towards her mind?  Was I comparing her life around my own frame of mind?  How could I find the answers to link the equation to suicide?  What did I use as a guide to find that base, other than just “feeling” it? 

How often I thought about Bipolar individuals being misdiagnosed. I can only answer this, knowing it’s possible from my own personal family experiences.

More medical research is finding links between hypothyroid symptoms in women and menopause, and body fat changing the Estrogen amounts to the brain; more links to add to the equation.

Physical all-around health appears to be a major concern, attributed to decline when Estrogen levels fluctuate. I am now considering, in this year of 2013, alternative treatment by specialists in this area of hormone therapy.  Foods and supplements are becoming the more and more accepted norm; when MD prescribed Estrogen is taken away, for cancer causing reasons.

Virginia Woolf was an extremely thin woman, she was constantly losing weight.  Eating habits bordered on bulimia, which may have accounted for more Estrogen loss. 

Determining a reason for her death, for me, is a guess, my guess for closure.  Accepting her as bipolar was just too easy a guess.  At that time no real medications existed for either of these guesses.  Her loss, at what we consider an early age, is felt deeply.  Suicide feels like such a senseless and hopeless act, when in this day and age of medications and diet alternatives we could possibly have saved her, no matter the diagnosis.

  Virginia Woolf’s death, on March 28, 1941, during WWII, was a tragedy that I cannot begin to change for her or myself.  I wish I could turn back the years, but I cannot; I just write my feelings instead. 
These blog posts are not listed in any particular order.





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