Psychosolllatics in Peri-Menopause Psychosoltlatics in Peri-Menopause Edited by A. A. Haspels and H.Musaph ~ MTPIPRnE~SS LIMITED International Medical Publi hers Published by MTP Press Limited Falcon House Cable Street Lancaster, England. Copyright © 1979 MTP Press Limited Softcover reprint of the hardcover 1s t edition 1979 All rights reserved. No part oft his publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission from the publishers. ISBN-13: 978-94-011-7700-9 e-ISBN-13: 978-94-011-7698-9 DOl: 10.1007/978-94-011-7698-9 Phototypesetting by Rainbow Graphics, Liverpool and Waterlow (Dunstable) Ltd. Contents Committees 6 Preface 7 List of Contributors 8 y Introduction W.H.G. Wolters 2 The post-ferti~e life of non-human primates and other mammals 13 Esther C. Jones 3 Transcultural influences in peri-menopause 41 Marcha P. Flint 4 Endocrinology and management of the pen menopause 57 A. A. Haspels and P. A. van Keep 5 Pain and peri-menopause: some psychosomatic reflections 73 M yriam de Senarclens 6 The trigger function of the menopause 83 H. Musaph 7 Psycho-social aspects of the menopause 101 Liesbeth Severne Index 121 Corn.rn.ittees Dutch Society for PsychosOInatic Research Honorary CODlJDittee Professor R.C. Aitken, Edinburgh, Scotland Professor J.J. Groen, Oestgeest, Holland Professor Y. Ikemi, Fukuoka City,Japan Professor M. Knobel, Campinas, Brasil Professor A.J. Krakowski, Plattsburgh, USA Professor W. Linford Rees, London, UK Professor J. Money, Baltimore, USA Professor R. Pierloot, Kortenberg, Belgium Professor M.F. Reiser, New Haven, USA Professor M. Rosenbaum,Jerusalem, Israel Professor E.D. Whittkower, Quebec, Canada International College ofPsychosoDlatic Medicine Publication CODlJDittee Chairman: Herman Musaph, Amsterdam Members: Renata Gaddini, Rome W. Linford Rees, London 6 Preface The peri-menopause is emerging more and more as a subject for study by the doctor, the psychologist, the social worker, the gerontologist, the clinical chemist, the public health specialist, the sociologist, the psychiatrist and the experimental pathologist. The results of studies are gradually becoming known to the public, particularly to the prospective clients, ageing women. Women have begun to ask for treatment and they will most likely determine whether oestrogen replacement therapy comes into vogue. Psychosomatics in peri-menopause is an important sub ject, since the life-span of the woman has extended to nearly twice that of her fertile period. The life-expectancy for women in industralized countries is now some 70-75 years. This means that most can now expect to spend one third of their lives in the post-menopause. Consequently, there is now much more time than before in which to notice, experience and be bothered by peri menopausal changes. Moreover modern medicine has much more to oner than mere moral support to sufferers from ailments connected with progressing ovarian failure during peri-menopause. Although we cannot promise eternal youth - as Wilson does - there are more possibilities for treatment than 10 years ago. A.A. Haspels H.Musaph List of Contributors Marcha P. Flint Herman Musaph Department ofA nthropology Department ofM edical Montclair State College Sexology Upper Montclair University ofU trecht New Jersey 07043 Utrecht USA The )Vetherlands Ary A. Haspels M yriam de Senarclens Department ofO bstetrics Lecturer ofP sychosomatic Gynaecology and Gynaecology University ofG eneva University ofU trecht Geneva Utrecht Switzerland The Netherlands Liesbeth Severne The Late Esther C. Jones International Health Foundation Department ofA natomy Brussels University ofB irmingham Belgium Birmingham Pieter A. van Keep WillemH.G. Wolters Director Department ofP ediatrics International Health Foundation University ofU trecht Geneva Utrecht Switzerland The /lfetherlands 8 1 Introduction W. H. G. Wolters It will seem logical to most of you that the tenth anniversary of the Dutch Society for Psychosomatic Research ~hould be celebrated in a children's hospital. It may, however, seem paradoxical that a tenth anniversary should be an occasion for a symposium devoted to the peri-menopause. But before I concentrate on today's subject I should like to single out briefly a few points from the development of the Dutch Society for Psychosomatic Research and the history of psychosomatics in general in the Netherlands. It was the Amsterdam Psychosomatics Study Group with Groen, Bastiaans and others which provided the most impor tant stimulus for scientific research in the field of psycho somatics. Their work received international recognition and together with a number of other researchers in Britain, Ger many, Canada and the United States they created and sup ported an international movement. When in 1968 Musaph and Wolters conceived the idea of setting up the Dutch Society for Psychosomatic Research, relatively little interest had been shown in the subject in this country. Not much scientific research into psychosomatics had been carried out and general interest in the subject was limited. There was, however, in a number of clinics and hospitals a growing interest, noticeable among psychiatrists and clinical psychologists, who in the course of their everyday work were confronted with the psychosomatic and somatophysical reactions of sick people. Meanwhile, psychosomatics as a discipline had become less concentrated on the illness as such, specific conflict-con- 9 lO PJ~ychosolllatics in Peri-.Henopause stellations and specific clusters of personality traits, but more on the doctor-patient relationship, the psychotherapeutic possibilities of treating psychosomatic complaints, the influence of the hospital environment on sick behaviour and the effect of socio-cultural factors on that behaviour. In wider circles, too, the interest in psychosomatic and somatophysical phenomena gradually increased. In this connection I would like to refer to the growing realization that hypertension, obesity and heart infarctioris are partly determined by a complex network of physical and psychological factors. The Dutch Society for Psychosomatic Research has actively furthered the interest in psychosomatics ever since its establish ment by means of internal discussions and the organization of what might be termed 'market-days', where young researchers in particular were and are encouraged to present their methods and results. The Society has organized various teaching ac tivities on subjects in the psychosomatic field. One important activity in recent years has been the organization of symposia, among which I would like to mention those on aggression, hypertension, heart infarctions, bio-feed back and psycho-social care in hospitals. The reports of these symposia have in most cases been published as books. Worth a separate mention is the very successful International Sym posium on Symptom Formation which was held in Amsterdam in 1973 under the excellent guidance ofMusaph. This congress consolidated the Dutch position in the International College of Psychosomatic Medicine which is proving to be a most stimulating meeting-ground for our members and foreign researchers or field workers. It is certainly through the contacts we have made via the International College of Psychosomatic Medicine that we were able to invite a number of eminent guests from abroad to exchange ideas about the peri-menopause. I should like to make a few marginal notes on the subject of this symposium. Time Essay of April 1978 contains an essay about the older woman under the title 'In Praise of Older Women'. The increasing interest shown in older women was not triggered off by men, but by a series of changes in women themselves. 'The Introduction II way they run their lives, the way they see themselves, seems to have caused the response in men'. Partly influenced by feminism and other social trends women dare to be themselves more, and to push aside many existing rules and customs. No longer does the older woman have to dress in a matronly fashion; she can make a career for herself, have children out of wedlock. .. Young men are moreover discovering the older woman as an interesting sexual partner with possibilities not to be found in her younger sister! An essay like this must sound like music to the ears of the older woman. The fact that an essay like this, is and can be published at this moment in time is conditioned by social backgrounds and it is not purely accidental that we are holding a symposium on the peri-menopause today. In addition to certain scientific discoveries (which will be focussed upon in the paper by Professor Haspels, in particular the development of certain oestrogens) and the demographic factors, such as the increase in the number of older people in general and the decrease of the idolatry of youth, there are other factors involved of which I shall mention a few briefly: 1. The partial lifting of the taboo surrounding sexuality or certain aspects of sexuality has certainly had a positive influence on how women experience the menopause and come to terms with it. It is not long ago that both menarche and menopause were regarded as near-illnesses - events which demoralized the person concerned and evoked all kind of defence reactions. The woman had to be avoided or given extra consideration, but could not really be accepted as fit. Primitive fears in the male, and male feelings of being threatened must have played a large part here. The man drew up pseudo-scientific rational izations in order to distantiate himself from these events and to force his wife to live according to his views. Many women must have been glad to arrive at a certain age and thereby acquire a perfect alibi for discontinuing an already unhappy pattern of sexual intercourse. 2. Our greater insight into the complex interaction of physio-psychological and socio-cultural factors have to some extent made it possible for us to determine with a higher degree