Book Review
Frank Talk about Menopause
Review by June LaValleur, M.D.
Like its forebearer, Our Bodies Ourselves: Menopause offers women multiple perspectives on sex and health, mostly based on accurate science.
Editor’s Note: In 1973, a nonprofit health advocacy group published a book on women’s health that was a radical departure from the pink pamphlets handed to girls in school or to adult women in clinics. Frank (if not blunt) and explicit (sometimes shockingly so), Our Bodies Ourselves not only included information about women’s anatomy but also featured first-person accounts of sexual experiences, pregnancy, depression, desire, and other topics that were considered taboo in those days. The book has since been republished in a dozen editions and more than 20 languages.
The group that created the first book, the Boston Women’s Health Book Collective, has now developed a new book for women who have come of age—middle age, that is. So we asked mature women’s health expert June LaValleur, M.D., of the University of Minnesota Medical School to take a look at Our Bodies, Ourselves: Menopause and let us know if it’s one she’d recommend to patients. Here’s her response:
Much as they did in 1973, the Boston Women’s Health Book Collective has put together a collaborative work on the menopausal transition. Each of the 21 chapters in Our Bodies Ourselves: Menopause is written by between one and eight authors, with the input of even more advisors. The book both suffers and benefits from this collective style. On one hand, the personal quotes, perspectives, and experiences will likely appeal to women who happen to share a particular writer’s experience. But throughout, readers will find slightly different definitions of menopause and slightly different interpretations of studies, which has the potential to muddle understanding about a very complex phase of a woman’s life.
Chapter seven tackles one of the most complex issues of all: hormone therapy. The information is based on the original data that emerged from the NIH-funded Women’s Health Initiative in 2002. Unfortunately, in the time it takes to write, edit, and publish a book, some of that material is already out of date. For example, the study design has been criticized for including in the same cohort women ages 50 years to 79 years, and there have been recent re-evaluations of the data. An article in the April 4 issue of the Journal of the American Medical Association, for example, points out that the increased risk for cardiovascular and heart disease in women receiving hormone therapy was seen only in women 20 or more years past menopause. However, the increased risk for stroke with hormonal therapy was present regardless of when treatment began. Such nuances are important, and patients need to be aware of them.
In other chapters, the authors include important information on so-called “natural, compounded, and bioidentical” hormones. They discuss a letter that was sent to the Food and Drug Administration from the National Women’s Health Network, a nonprofit public interest group. The letter rightly asserts “that women are being misled by unsubstantiated safety and efficacy claims about compounded hormones that have not been proven effective or studied for long-term safety.” This is important information for women who are seeking therapy for symptoms such as hot flashes.
I was especially impressed with the chapter on vulvovaginal changes. This is a topic often ignored by practitioners and not discussed by women, as evidenced by one woman’s statement in the book: “I can talk to my sister about everything. Everything but this.” The authors clearly discuss the vaginal effects of lack of estrogen as well as other conditions of the vulva.
In the chapter on sexuality, the authors include stories from women who have experienced changes in sexual function. They discuss the importance of communication in a relationship and how relationships change over time. They also discuss the “medicalization of female sexual desire.” But missing from this great discussion is any mention of the lack of FDA-
approved pharmacologic therapies for female sexual dysfunction in spite of the millions of women who themselves state they have a sexual function problem! Also missing is psychologist Rosemary Basson’s redefinition of female sexual function as circular—being affected by many things—as opposed to the very male-oriented definition proposed years earlier by Masters and Johnson. This would have been an excellent addition to this chapter.
Other chapters cover everything from incontinence to uterine problems and memory and mood to bone and heart health, as well as various cancers. The facts in these are accurate and as thorough as necessary for this type of book.
Women of all ages would find the final two chapters on politics and change enlightening. Issues such as health disparities, insurance coverage, the government’s role in health, and health care reform are at least raised even if no solutions are offered.
Overall, Our Bodies Ourselves: Menopause is an excellent resource for women passing through midlife. A wide variety of topics are discussed in understandable terms, and there is a very good resource list at the end of the book. Even though the book does not always cast physicians in a positive light—“It seems that physicians have such limited knowledge about menopause,” writes one contributor—and even though it has some flaws, the book is worth recommending to perimenopausal and menopausal patients seeking a frank discussion of real health issues. MM
June LaValleur is an associate professor in the department of obstetrics, gynecology, and women’s health at the University of Minnesota Medical School.