The Menopause Toolkit and Summer Sci-Fi

One of the worst feelings a woman of a certain age can experience is when someone stupidly asks, “When is your baby due?” and points to the bulge that is not in fact a baby bump, but padding that appears once one’s ovaries have run out of eggs.

And so when researchers from Monash University in Australia published this week, in the journal Climacteric, a “practitioner’s toolkit” to help primary care providers recognize and possibly treat symptoms of menopause, I was intrigued, and then thrilled to discover the phrase “central abdominal fat deposition (even in slim women).” Guilt over the intractable status of my middle began to fade.

I wrote about the menopause toolkit for Medscape, quoting one ob/gyn who loved it, another who thought it stated the obvious. News aggregators parroted the press release, a few dropping in a “breakthrough” or two, as if a woman in the throes of menopause doesn’t know it.

Fiona Jane, MD and Susan Davis, MD and their colleagues created the toolkit, which is more a labyrinth of linked flowcharts than something you’d use to change a tire or clean teeth. The investigators tapped their clinical experience, published diagnostic algorithms, various position statements, and the peer-reviewed literature. The information-packed toolkit is also available in stand-alone form. It targets women over 40, and is so detailed that the International Menopause Society has endorsed it for global use.

I learned a few things.

In addition to discovering that my bulge is due to putting up with low estrogen instead of replacing it (I’m a DES daughter of a mom who had breast cancer, so no thanks, plus some estrogen products come from horse pee), I became aware from the toolkit that “formication” means “crawling sensations on skin.” A biologist might not mind that one so much.

I learned that “dyspareunia” is painful intercourse, which I would have known about had I paid more attention to those Osphena ads on TV. (My husband is in love with the willowy Osphena lady).

I also learned from the menopause toolkit that in addition to hormones served up in all sorts of contraptions and dosages, women take antidepressants, clonidine, gabapentin, eye of newt, and undergo hypnosis and cognitive behavior therapy and something called stellate ganglion blockade to temper what the docs call “vasomotor symptoms” or “hot flushes,” but the rest of us call “hot flashes.”

Having read the flowcharts several times for Medscape, I’d like to make a few recommendations for extending the menopause toolkit.

1. Some entries require more information than fits in the tiny boxes of the flowchart. Specifically, “no interest in sex” as a symptom may simply reflect the fact that a woman’s partner is an australopithecine. Or she’s exhausted. Or she refuses to take hormones to reinstate someone else’s idea of what should be her sex drive. “Poor sleep?” Please.

2. A few entries could use more graphic descriptions. “Dyspareunia” might be more recognizable as “agony when a giant pole is repeatedly shoved up a desiccated orifice.”

3. “Hot flush” sounds like a function of a bidet. How about “awakening stark naked drenched in a pool of sweat?”

4. The toolkit mentions “overall diminished well-being” and depression, anxiety, and irritability. Might these so-called symptoms instead be reactions to such external stressors as an adult child returning home? Costly medical care? Pressure at work? Being ignored or taken for granted?

5. Despite the above, I suggest adding “sudden cessation of higher brain functions, particularly recall, reasoning and concentration” as a description of the well-known “menopause brain.”

6. The toolkit seems to ignore the sudden loss of bladder control that is a hallmark of menopause, unless it is subsumed under the rather vague “localized urogenital symptoms.” The sounds of a dripping faucet, waves crashing ashore, or rain can all precipitate an event, as can unanticipated laughter. (See Poise pads)

7. Add the vivid dreams, such as iridescent eels writhing out of all body openings.

8. I’ll let my husband Larry have the final word: Another indication of menopause is a partner joining the witness protection program.

P.S.: MY TAKE ON SUMMER SCI-FI ON TV: The Leftovers and Under the Dome are explorations of religion with science a mere backdrop, but Extant hit it out of the park.

The Leftovers is the HBO adaptation of Tom Perrotta’s novel that explores the aftermath of a Rapture-like phenomenon that suddenly whisks away 2 percent or so of global humanity. Under the Dome is the second season of the TV version of the Stephen King book, and this week’s episode concluded with a dramatic if anti-science “We are all here for a reason.” After watching the two shows back-to-back I can only conclude that the missing 2 percent from one show somehow ended up under the dome of the other.

In the premier of Extant, on CBS, Halle Berry’s astronaut character Molly Woods returns from a 13-month solo mission preggers. In flashbacks aboard the ship she looks just as great in her form-fitting suit as Sigourney Weaver did in Alien before that reptilian thing blasted out of her non-menopausal middle.

Molly comes home to second husband John (Goran Visnjic aka Dr. Luka Kovac from ER, so glad to see him again!) and his invention, their young son Ethan who is a “humanic,” some sort of android/Damien devil child. After just one episode, Extant seems to have recombined Rosemary’s Baby, V, The Omen, Village of the Damned, Alien, the Exorcist, the X-Files, and even Blazing Saddles.

Stay tuned. I know I will.