Taking More from Menopause than Hormone Replacement Therapy

Menopause as growth-promoting crisis rather than drug-taking opportunity
Published on April 29, 2011 by The Psychoanalysis 3.0 Writing, Group in Psychoanalysis 3.0

New results coming out of the Women’s Health Initiative have put controversies about Hormone Replacement Therapy back in the news. Once again we ask: Why is menopause so difficult for some women? And why is Hormone Replacement Therapy so controversial?


During menopause a combination of physical, emotional and social factors come together that can create a crisis in a woman’s identity. These physical changes often lead to psychological disorientation: Who am I? I’m not what I once was, but what am I becoming? At the same time social roles are changing: Children are leaving home, parents are getting sick and dying, beauty is fading. In addition, there can be a loss of hair, muscle tone, memory, loss of concentration, loss of sleep. As Dorothy Parker once said, “getting old is not for sissies”

One of the most troubling, and least talked about, aspects of menopause is a diminishing sex drive. A recent article in the New York Times, The Sex Drive, Idling in Neutral refers to this phenomenon but does not connect it to menopause although the women referred to the article are in the age-rage referred to as “perimenopausal”. This decrease in a woman’s sex drive can lead to serious disruptions in the relationship.  Thus, all the elements that have defined a woman’s identity for the previous 20 or 30 years may begin to come apart.

Several years ago a woman I’ll call Alice came to me for psychotherapy.  She had become destabilized and depressed while going through menopause.  Alice told me she had consulted with her gynecologist, explained all of her symptoms and ended up surprised and disappointed that the only thing the gynecologist offered was Hormone Replacement Therapy (HRT).  Knowing that HRT would not solve the changes in her identity brought on by menopause, we addressed this crisis in her life, which as many crises do, created opportunities for growth and expansion.

Hormone Replacement Therapy is very effective for treating hot flashes and insomnia.  If a woman has these symptoms and is not a high risk for breast cancer, she should seriously consider taking HRT.  It is a life-saver for many women.  But HRT will not solve the existential crisis that many women face at menopause. There is a tendency to focus on the pill rather than the developmental milestone.  Without a doubt it is easier to take a pill than grapple with the changes in self and identity that are inevitable that this stage of life.

Two important books were published in the early 1960’s that set the stage for current controversies: Betty Friedan’s The Feminine Mystique (1964) and Robert Wilson’s Forever Feminine (1961).  Their messages were diametrically opposed: Friedan’s message to post-war women was, “There is more to life than being a wife and mother.”  Wilson’s message was, “All there is to life is being a wife and mother so when you reach menopause you are bound to become depressed.  But there is hope!  You can take HRT and get it all back.”

Friedan, in her last book, The Fountain of Age (1993) excoriated the medical profession for pathologizing menopause and the drug companies for promoting HRT as cure for a “disease.”  Friedan took the position that if a woman had a meaningful life, including a profession and fulfilling relationships, she would have better things to do with her time than to suffer from menopause. The Women’s Movement, she stated, had done away with the need for menopausal symptoms. You can imagine my surprise when I entered menopause, became depressed and disoriented and then found out that the Women’s Movement was supposed to have eradicated all symptoms of menopause!

Menopause is acute and transitory — maybe even transitional. HRT can ease the transition for some women.  But Wilson was wrong; it does not “cure” menopause and will not fool anyone into thinking that a 50 year-old woman is young and nubile. She can be sexy, gorgeous, vital, engaged, satisfied, content, curious, or whatever — with or without HRT — but just not young and nubile. Menopause, with all its hassles and pain, allows you to put your life under a magnifying glass. The combination of physical, psychological and social factors converge to create a crisis in women’s identity that is also opportunity to tackle problems that have too long been swept under the rug. I have found that menopause, both personally and in the lives of my patients, can lead to dramatic development if one remains open to reflection, growth, and change.