"There is enough elegance in the human system," Georgetown University physiology professor Estelle Ramey was saying, "that wherever we look, we have enough helicopters."
Dr. Ramey was talking, in general, about the useful backup systems -- she calls them "beautiful redundancies" -- in the human body, the systems and pathways that take over when another is interupted or damaged or, you might say, poorly maintained.
Specifially, she was talking about some of the physiological implications of menopause, that often misread, misinterpreted, misunderstood, and sometimes mistreated stage in the life of the human female.
Take sex, for example. The sex drive in women isn't dependent on estrogen at all. As a woman's child-bearing years draw to an end, her estrogen production plummets; her sex drive does not. "It may even be increased," says Ramey, "because she no longer has to worry about getting pregnant."
In any case, "The sex drive in women is dependent on adrenal Androgens, not estrogen."
In addition, after menopause, hormones very much akin to estrogen begin to be produced by the adrenal gland. They vary in wide degree from woman to woman and aren't as active as the hormones of youth.
Ramey will be the chief speaker -- on the endocrinology of menopause -- at a workshop on menopause at 9:30 a.m. May 10 at St. Mark's Church, 10701 old Georgetown Rd., Bethesda. The workshop is co-sponsored by the Communnity Psychiatric Clinic and the Wheaton Community Mental Health Center. A contribution of $5 will be requested from those attending.
Natalie Shaw, the Montgomery County psychologist who organized the workshop as a sequel to an earlier one on hysterectomies, wants to explode the myths. "There are plenty of articles in the medical journals about menopause," she says. "The trouble about reading them is that there is very little agreement."
Some of Shaw's initial research has confirmed anybody's worst fears about how our Western culture is doing its best to twist middle-aged women into the menopausal stereotype of the shrill, hysterical, hairyfaced, sexless harridan.
An exaggeration? Try this quote from Dr. David Reuben's continuing best-seller, "Everything You Always Wanted to Know About Sex:"
"As the estrogen is shut off, a woman comes as close as she can to being a man. Increased facial hair, deepened voice, obesity, and the decline of breasts and female genitalia all contribute to a masculine appearance. Coarsened features, enlargement of the clitoris and gradual baldness complete the picture. Not really a man, but no longer a functional woman, these individuals live in a world in intersex . . . sex no longer interests them."
"To many women," the book continues, "the menopause marks the end of their useful life. They see it as the onset of old age, the beginning of the end. They may be right. Having outlived their ovaries, they may have outlived their usefulness as human beings. The remaining years may be just marking time until they follow their glands into oblivion."
Reuben paints this dismal picture as a preface to his own bias in favor of estrogen therapy, a procedure shown to be linked to endometrial cancer. New studies released this week indicate a link to breast cancer as well. Furthermore, estrogens have been largely discredited as the youth restorative they were once purported to be.
Estelle Ramey is not altogether opposed to the use of estrogens -- providing "the right agent is used and the right dose." There is, she says, evidence that estrogens delay the onset in some women of osteoporosis, the condition in which bones become porous, increasing fragile and prone to breaking.
"This is an unsolved problem of great magnitude," Ramey says, and should be a "major project for the future. We cannot afford to just shrug our shoulders and say it (estrogen therapy) is poison.The problem is finding out how to use it and how to protect the women."
In the main, of course, Reuben's unhappy portrait of the woman in her so-called change of life is about as accurate as that provided centuries ago by then-prevalent conventional wisdom.
Says Shaw, "Most of the myths about menopause, it turns out, are based on myths about menstruation. In ancient times people saw women as having poison inside of them and the monthly flow was a way of purging the evil of their bodies. Women were put into separate huts at this time and not talked to or dealth with because they were so dangerous. It was said they could turn wine sour, make seeds sterile and wither grass -- all kinds of powerful things. Menopause, then, becomes a bad thing, because women can no longer rid themselves of their poisons . . .
"That's what we still have to deal with," says Shaw, "you know, the idea that we're useless creatures by the time we reach menopause."
But why is it, she wonders, that in cultures where post-menopausal women are cherished and revered (as in China), the typical symptoms of menopause are much lessened than they are in our own, for instance.
There are new theories suggesting that stress may play a role in exacerbating the symptoms of menopause, as well as nutrition, smoking habits, exercise and a woman's own self-image.
That self-image cannot help but be affected by the negative signals. Writes Rosetta Reitz in her book on menopause, "The input is so negative, so loaded against us, that the feedback affects women's image of themselves. If your world doesn't think much of you, how can you yourself?"