Psychosomatics 43:343-345, August 2002
© 2002 The Academy of Psychosomatic Medicine
The Change Before the Change: Everything You Need to Know to Stay Healthy in the Decade Before Menopause
By Laura E. Corio, M.D., and Linda G. Kahn, New York, Bantam Books 2000, 434 pages $24.95, ISBN 0–553–10876–X
Joan S. Zofnass, D.S.W.
Key Words: Menopause
In writing this book, Laura E. Corio, M.D., a board-certified obstetrician/gynecologist for more than 20 years, has taken on the task of presenting a comprehensive account of the physical and psychological changes women experience as they approach midlife. She notes in the introduction that when she began her training, as one of only 10 women in her medical school class, PMS and menopause were not part of the curriculum. She was inspired to write this book after noting a pattern of complaints and symptoms in her aging patient population that culminated in menopause. Based on this experience, she came to see the cessation of menses as one of the last signs of this process rather than its hallmark and thus placed the focus of her book on the perimenopause, the entire decade leading up to the actual menopause. Her goal in writing her book was to educate the reader about the physical and emotional changes that take place prior to and following menopause and through that knowledge to empower the female reader to take a more active role in discussing health care with her physician and in adopting health-promoting behaviors.
The book is divided into two parts, the first dealing specifically with the symptoms and signs of perimenopause in a number of body systems and the second with the relationship between these changes and long-term health, with an emphasis on preservation and prevention. The first chapter is an introduction to the concept of perimenopause, explaining the hormonal changes and accompanying physical symptoms, with questions for the reader to ask herself to determine if she is indeed perimenopausal. The second chapter sets the pattern for those that follow. Beginning with a thorough review of the normal menstrual cycle, Dr. Corio then highlights one of the hallmark symptoms of perimenopause, menstrual irregularities, including light periods, heavy periods, infrequent periods, and frequent periods. To help the reader differentiate "normal" from problematic bleeding, she highlights in a gray box the symptoms that suggest that immediate medical intervention should be sought. Case vignettes are presented that illustrate the symptoms discussed and their treatments. The chapter ends with a review of the treatment options for the symptoms described. Taking a holistic treatment approach, the use of herbs, foods, and phytoestrogens to alleviate the symptoms focused on in the chapter is reviewed before moving on to explore possible medical and surgical treatments.
The next five chapters follow the same format, with a review of symptoms and their etiology, the highlighting of symptoms that require more rapid medical assessment/intervention, illustrative case vignettes, and holistic treatment recommendations. Chapter 3 addresses hot flashes and insomnia, highlighting "the brain-body connection," that is, the changes in neurotransmitters that lead to both hot flashes and the mood changes of perimenopause. In a few concise paragraphs, Dr. Corio elegantly reviews the neurochemical basis of hot flashes, the premonitory aura that accompanies them, and perimenopausal mood changes. Those with clinical or personal interest should read pages 45–50, as her explanation here, as elsewhere, of the biological underpinning of these symptoms is concise but comprehensive. There is a cautionary listing of over a dozen different types of medications that can cause hot flashes by influencing the thermoregulatory system of the brain. The chapter concludes with a review of various treatments of perimenopausal hot flashes including, again, a range of the vitamins/herbs, phytoestrogens, and medical treatments currently available.
Chapter 4 explores hormone-related changes in mood, memory, and thinking. Dr. Corio presents in a few pages a good review of the biological relationship between depression and the reproductive life cycle, highlighting the symptoms of major depression that should send the reader in search of "professional help." The next section deals with memory change, first reviewing the difference between short- and long-term memory, then focusing on the various causes of memory loss, including dementia, other illnesses, and medications. The chapter ends with a discussion of headaches in the perimenopause, their cause and treatment.
Chapter 5 discusses the barriers to enjoyable sexual function in the perimenopausal period, while Chapter 6 reviews the disturbing outward changes of the aging female body, including wrinkles, "shape-shifting," and weight gain. Here is a scary thought, ladies: "Anovulation alone reduces energy expenditure by 15,000–20,000 calories per year." This certainly helps explain why despite all those recommendations to maintain one's weight at high school graduation level, the high school graduation cap and gown now fits better than the cheerleader outfit!
Certainly no discussion of perimenopause would be complete without a discussion of the biological clock, and Dr. Corio does not disappoint. In Chapter 7, she reviews the reproductive life cycle, fertility and infertility, and birth control options as well as simple steps to improve fertility. The processes used to assist reproduction are explained. While various aspects of infertility are addressed, including a clear list of questions that Dr. Corio asks her patients in an effort to understand what might be contributing to the problem, there could have been more attention paid to the psychological issues confronting women who have postponed having a family until their mid- to late 30s or early 40s, both single women desperate to marry and have kids quickly and those struggling to get pregnant within a relationship.
Part 2 of the book is focused on staying healthy, starting with a detailed chapter on bones and osteoporosis risks. The next chapter deals with cardiac disease in women, including a discussion of cholesterol and the various elements of a lipid profile. Another chapter reviews breast disease, addressing lumps and hormones, whether to be tested for the breast cancer gene, and breast cancer risk as well as the different types of breast cancers and treatment options. The next several chapters cover the uterus, ovaries and cervix, the colon, and the thyroid gland. Each chapter includes a review of risk factors as well as self-help strategies and medications that might decrease risk and improve overall health. Finally, we get Dr. Corio's prescription for a healthy perimenopause: a variety of health-promoting behaviors, including diet and exercise. She provides a detailed explanation and heartfelt endorsement of the Mediterranean diet, her personal and professional favorite. Several appendices review the herbs, phytoestrogens, and hormones she has suggested for use in perimenopause as well as those to avoid and provide a checklist of screening tests.
Dr. Corio's book is aimed at a lay audience and provides the reader "with the information you need to take charge of your perimenopause." In the midst of typing this review, my secretary asked if she could borrow the book, and a colleague, reading the review over her shoulder, took it home for the weekend, certainly an indication that there is an eager audience for it. Their reviews are still pending. The book is clearly written and encourages healthy behavior as well as educating the reader about available medical/surgical treatments. Instead of being a passive and worried patient, the reader can be informed and take an active role, working with her physicians to obtain the best medical care possible, and can be reassured that she is not alone in her concerns. The more knowledgeable a woman is in understanding how her body should function, in understanding what is changing and why and what she can do to feel better, the better prepared she is to see that everything that can be done is done. The physiological explanations might be more than the average reader wants to know, but a medical professional could comfortably recommend it to a patient or friend struggling to make sense of the demands of a changing body. For a medical audience, Dr. Corio's book is informative and easily read, and her simple explanation of complex physical processes could also serve as a welcome review or refresher for the physician willing to overlook the sometimes "too cute" chapter titles: "Not Tonight, Honey!" "Can Somebody Open a Window?" and "I'm Losing My Mind!" tended to set my teeth on edge. However, moving beyond this, the book is worthwhile not just to patients but for psychiatrists and other mental health professionals who want to understand the etiology of the physical complaints they are hearing about from their patients and who would like to know more about alternatives that might help ease these transitions. The professional reader will find much of value in this book but may find the case vignettes less helpful. Each is marked by unwavering patient compliance and gratitude and physician omniscience that may leave the reader wondering (a) Why aren't my patients as nice as Dr. Corio's? (b) Why aren't I as smart as Dr. Corio? and (c) Maybe I should call Dr. Corio for an appointment!
Having moved into the second half century of my own life, many of the topics discussed by Dr. Corio were familiar old friends to me. I can only speculate on the impact of reading this book earlier in life, before passing through my perimenopausal years. Despite the cheerful, take-charge message, the litany of complaints, complications, and treatments might have been too disheartening, and the panoply of vitamins and herbs suggested might have overwhelmed me (or my pocketbook or even my medicine cabinet!). While we will all certainly age, if we are lucky, not every woman will be tormented by every symptom and syndrome discussed. For some women, menopause will be just a blip on their physical and emotional radar, while even the most unfortunate could not possibly be so unfortunate as to experience every disturbing symptom described herein or even a majority of them. On the other hand, to be forewarned is to be forearmed, and with this book in hand, the educated reader should feel less alone and less helpless in confronting the "growing pains" of perimenopause.
Get information about faster international access.
Privacy Policy
Copyright © 2002
Academy of Psychosomatic Medicine.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
|
