"We've been too long without those powerful, honest, wise women of old--too long without images of their beauty, power and strength. Welcome them back. They are inside each of us--waiting to be born through the initiation of menopause."

More women than at any time in history are now approaching, or are in the midst of their menopausal years. There are three stages in the menopause transition: Premenopausal--before our period stops. Perimenopausal--when we notice changes in periods. Postmenopausal--One year after our last period. These stages can last 13 years. That is 15-20% of a woman's total life!

CROWN THE CRONE In Vicki Noble's tarot book Motherpeace, the Crone tarot card represents "the menopausal phase of a woman's life, where she can begin to think seriously of spiritual meaning, and embark on a quest that had previously been out of reach if she was engaged in the usual female functions of childbearing and rearing. "She has gained control of the sacred fire." which means she is holding onto her menstrual blood. "She has learned the power of energy retention and transmutation." As far as a pause from men, Noble says "The Crone is probably celibate, but not necessarily sexually inactive--just temporarily without a partner, possibly by choice. She represents a "time-out" in relationships, and a turning inward that will heal and rejuvenate her." I suggest we expand the three archetypal stages of a woman's life known as Maiden, Mother and Crone and insert a stage between mother and crone. I am not crazy about the term crone--sounds like crow, looks like witch. How about another description and title? Let it describe a renewal of juicy energy, not just sitting bent over the fire stirring a pot and casting spells. Hey let's have some fun and dance...

Lonnie Barbach, Ph.D., has a psychology practice in San Francisco and Mill Valley. For appointments call 415/383-0755. The Pause can be purchased at most bookstores. Marlene Smith and her associates can be contacted at the Menopause Clinic in Berkeley at 510/848-6004. Menopause News is bi-monthly and costs $25 a year. Call Judy Askew for a subscription at 415/567-2368. Web site: http//www.well.com/~mnews. E-mail mnews@well.com. For information all her monthly support group at St. Mary's Hospital in San Francisco, call 415/750-5775. Lani Simpson sees clients at the East Bay Menopause Clinic at 510/450-1148. Tapes of the menopause conferences can also be purchased at this number. To find out more about the workshop "Men on Menopause", acupuncture and herbal treatments, call Dr. Yen Wei Choong, Director of the Yellow Emperor Natural Healing Center is San Anselmo @ 415/459-2160.

There will certainly be many "crones" in my generation. Independent women whom I can't imagine fading into nursing homes. I know my girlfriends will be stirring it up on the dance floor way into the next century!

Though I do not view this transition that all women face with complete acceptance and anticipation of greater freedom and changes in my life. I have reason to fear menopause. Dark clouds surround my grandmother's death. She took her life in her mid-forties. They blamed her suicide on menopause. What could have been so terrible that she did not want to greet her grandchildren into the world, or stay with her husband in the golden years? She never talked to anyone about her depression. One did not talk about "female problems."

It is good that knowledge is now growing exponentially about menopause and its symptoms. Women are talking! This is the reason I write this article. Women no longer need to go into the Pause in the dark as my grandmother and many others have. We can dream new roles for ourselves--dancers, healers, travelers, lovers! Combining the tribal with the techno modern roles we find ourselves weaving.

I have interviewed several people who have incorporated menopause health care and information in their profession. Here is what they have experienced and learned in their own passage through menopause:

Lonnie Barbach, Ph.D., has been practicing psychology in San Francisco and Mill Valley for 24 years. She specializes in relationship, sexual and menopause issues and is the author of numerous best-sellers on intimacy and sexuality. Her latest book is titled, The Pause: Positive Approach to Menopause.

Why did you write The Pause?

At 43 I felt extremely fatigued and didn't know why. I never had hot flashes in the beginning and this made it more difficult to pinpoint. I had heart palpitations, was very irritable, had to urinate six times a night, the joint in my neck was extremely tender. I felt deep fatigue, couldn't think straight, and had many other bizarre symptoms I didn't understand. It was three years before I realized my condition was caused by changing hormones related to menopause. I found out many women, like myself, had menopause symptoms, but their doctors told them it was too early.

Since I didn't know what to do about my own menopausal transition, I decided to create what I wanted to read. I started researching the subject four years ago. I was also interested in the emotional and sexual aspects that were affected by menopause as these subjects are a major part of my career. The reason I called the book The Pause is I compare this transition to pushing the pause button on the VCR. It is a transition for women, but they will go back to real life. Most women I talked to were only given hormones if postmenopausal, but women need something (information and treatment of symptoms) before that stage so the perimenopausal symptoms can be recognized, understood and they won't think they are crazy.

Were you in menopause at 46 when you wrote your book?

Yes. Now I'm 50 and still in transition although I continue to cycle every month. I now have very few symptoms. I have learned to manage the ones I experience. It is not affecting my life in a negative way.

When did menopause come out of the closet?

Until very recently, there was no information on menopause. Gail Sheehy's book The Silent Passage was the first popular one of its type and that was published in 1991. (This is only 5 years ago!)

How were you affected sexually by menopause?

Early on I had no desire. I was tired and just wanted to sleep. I also experienced burning with intercourse. There was a period of time I thought I had a bladder infection. This was at the same period I was getting up to urinate many times a night.

How did you take care of that?

My lack of sexual interest changed when I took a homeopathic remedy. Acupuncture helped with the burning. This was all before I knew I was in menopause. Ultimately, I started taking phytoestrogens.

What are you taking now?

Tri-estrogen. I found a soy product that works well for me--especially my brain. Initially, I did homeopathy for the fatigue. Acupuncture and herbs helped maintain my personality. But nothing worked for my fuzzy brain. I would stand up to give lectures and forget what I intended to say. My brain was marching through molasses. I finally found a soy product called Phyto B that supplies natural estrogen.

I understand that women in other cultures do not have the same menopausal problems. Why do American women suffer so and how can they remedy that?

There are a lot of things that effect women in different countries. One is genetics, another is cultural attitudes, and a third is diet. We now think that because of all the phytoestrogens in soy products, which are big part of the Japanese diet, women there do not experience hot flashes. Now there are studies showing phytoestrogens also protect against prostrate & breast cancer.

I do not think that all menopausal symptoms can be attributed to psychological attitudes (and she is an psychologist!). I got hit at 43 with menopause, way before I had any ideas about it, so my symptoms could not have been psychological, they were physiological. Some women think it is all psychological because they had no symptoms. There may be psychological problems, but I don't believe that is what the majority of women are experiencing. Though, it wouldn't hurt to change our negative cultural attitudes about menopause as they do create one more stress factor.

What advice do you have for women and their partners during menopause?

In The Pause I have a chapter written to men. I thought men would not read a whole book on the subject, but they might read a chapter if their partner requested it. My advice to partners is: help relieve the woman's stress load. This might include taking the kids so she can get some exercise or going for exercise with her. I also encourage the man to ask for physical and emotional "weather reports." Questions like: "How are you doing today?", rather than dismissing everything that she says due to menopause. I want men to know there may be an exaggerated response during these hormonal fluctuations, but there is a real reason for the woman's upset. With a "weather report", he is more likely to know if it is better to help or stay out of the way.

Do men have a similar change that is not recognized yet and that women need to be understanding about?

Maybe, but it is not the same. Menopause is a major change in function in a woman's body. Men go through something more subtle called an "andrenopause". This happens over a long time and some men experience emotional dips and night sweats. We don't know much about menopause, and we know even less about the andrenopause men go through.

Is there anything else you would like to talk about?

I would like women to know that estrogen affects the brain and they are not going crazy. There are lots of alternatives to handling the symptoms. I compare it to pregnancy where every woman experiences it differently. Some have morning sickness, others don't. If you have a problem, treat it--otherwise do nothing. If you do hit a problem and one solution doesn't work, there is always something else. I had one woman who went to four doctors. Estrogen made her depressed, which happens to 10% of the women who take it. Soy milk turned her around. She now carries cartons of soy milk in her purse and drinks several a day.

Do you find that your friends talk about menopause openly with you?

Remember, I wrote a book about it so I can't go to a dinner party without talking marital, sexual or menopause issues. I don't know if most other women talk openly about their transition.

****

All the professionals I interviewed concerning menopause mentioned Chinese medicine as being very helpful in abating their own and their patient's menopause symptoms.

Dr. Yen Wei Choong is Director of the Yellow Emperor Natural Healing Center in San Anselmo. Yen Wei offers a "Men on Menopause" workshop at his clinic but says few men have shown an interest in the subject. This says a lot about men's willingness to go through the change with their partners. Yen Wei also treats menopausal symptoms at his clinic and I asked him how:

The reason for menopause in Chinese medicine is that at a certain age the chi starts to diminish. The healthier you are, the later this happens. The average woman goes into menopause at 49-years-old. If she is not so healthy, it could start in the early 40's. My 60-year-old teacher in Taiwan still had her menstrual cycle. Tai Chi, Chi Kung, and acupuncture all boost chi for the kidneys and kidney energy is the root of all chi in the body.

We can delay menopause by strengthening the kidney chi, retaining the vital fire and water elements in the body. Yin (water/female) and Yang (fire/male)--this is the battery. If kidney chi is deficient and out of balance the fundamental fire flares up and causes hot flashes. The kidney chi should keep the body cozy and warm with the vital fire, not hot, irritable and angry. This is caused by not enough essential water to hold the fire in check in the body. If we tonify the kidney chi, then the fundamental fire can moisten the body and a woman can control her internal fire. This recharges her battery and delays the aging process, naturally without artificial drugs and hormones. We can not avoid getting old, just delay it!

Do men have an equivalent change to menopause?

The change for men happens around 64. The formula is 8 squared for men (64) and 7 squared for women (49). This is the average age of the change for healthy people.

The change in men is caused also by the weakening of the kidney chi. The Chinese medicine viewpoint is that sex is fine for men after 64, but they should not ejaculate. At this point the kidney essence stops generating and if men continue ejaculating after that age, they will lose their treasured kidney essence and this will run down the battery.

***

Marlene Smith, L.Ac., is a licensed also a acupuncturist and herbalist with an office in Berkeley. Marlene studied Traditional Oriental medicine in the U.S. and mainland China. Her practice focuses on the treatment and education of women approaching menopause.

Why and when did you open the Menopause Clinic?

I'd been practicing acupuncture for eight years. As I approached the age of menopause two years ago, I became aware of the need for alternative treatment and information on the subject. I reflected on what my mother had gone through and realized it didn't have to be that way for my generation. When the possibility came to focus on menopause, I saw it as a way to expand my practice and provide a service that many women can use.

How old were you when you started menopause and how old are you now?

My symptoms started at 45. I am 47 now.

What were the symptoms you experienced?

Hot flashes and fatigue. I didn't have depression, although that is a very common symptom.

What age are most of the women that come see you?

It varies a lot. The age range is from about 35 to 50. Some of the younger ones are indeed perimenopausal.

Do you incorporate Oriental medicine techniques you learned through acupuncture at your clinic?

I use the Traditional Oriental medicine techniques which are listening, observing, and touching. From that information, I am able to diagnose where the root of the symptoms are coming from. I then treat my patient using a combination of acupuncture, herbs, dietary and lifestyle changes.

So there is no general treatment for menopause?

In Chinese medicine, menopause is an individual experience. It is not viewed as a disease state, but as a natural progression in a woman's life. It is taken on a case-by-case basis. In fact, two women with the same symptoms may be treated with different principles.

Do you encounter women who are afraid of menopause?

Afraid and angry.

Why angry?

Because of our culture and the emphasis on youth. They are fearful and angry that they may have reached a stage in life where their value and usefulness is lessened.

Is this reality or just fear?

In some situations it is both. There is no getting around the fact that our culture has placed a higher value on youth than wisdom and doesn't honor maturity.

How do you help women with this?

I talk about the reality of what their life is coming to and focus on the positive changes that will be occurring. I stress that this stage of life can be the beginning of many new opportunities.

Have you noticed a trend that during and after menopause women are more attracted to women than men?

No, I haven't noticed a trend in that direction, but that would make a very interesting sociological study!

How long do all the stages of menopause usually last?

It varies tremendously. A women isn't clinically menopausal until she hasn't menstruated for one year. A woman can experience perimenopausal symptoms for a number of years before she is clinically menopausal.

So treatment and acknowledgment of the different stages of menopause aren't recognized in Western medicine?

I had a number of women come into my office who's doctors say they can't be in menopause, so they don't treat them. Especially if the woman isn't in the upper age range group. If she is under 47, her symptoms are frequently ignored. Though depression is one of the symptoms allopathic (Western) medicine is too eager to treat.

So what should a woman my age, 43, be aware of?

Women your age or younger should begin to put attention on bone strength and heart health. It is never too early to start preventing bone loss, as well as heart disease. One of the main reasons Western medicine prescribes Hormone Replacement Therapy is to prevent these diseases. If women are concerned about taking HRT, one of the best ways to counter that is to be conscious of bone and heart health at a young age.

What do you recommend?

Dietary considerations, exercise, Chinese medicine using acupuncture and herbs. All of these insure that a woman is constitutionally healthy. Women can have sub-clinical conditions that will only get worse as their bodies enter the stressful time of menopause if they do not take care of their health in earlier years.

Do you suggest that women stop drinking coffee?(coffee supposedly draws calcium out of the bones.)

Not across the board. Moderation is my favorite thing to recommend. If a woman's body type is vulnerable to the abuses of coffee, then I would certainly recommend that she stop drinking it. But if she has moderate consumption and is not caffeine-sensitive, then I wouldn't have any reason to recommend abstinence.

***

Lani Simpson, D.C. is co-founder and Director of both the East Bay Menopause and PMS Center along with Lisa Keller, OB-GYN, and the Osteoporosis Diagnostic Center in Oakland. Lani has been a chiropractor for 15 years specializing in women's health care utilizing nutrition, natural hormone balancing and sports medicine. She also produced the first "Heat Is On" menopause conference in the East Bay in 1994. The second conference was held this October and over 500 women attended . The motto of the conference is "Don't wait until you're 45 to find out what you should know at 30."

How did you get interested in menopause as a career?

I was seeing an increasing number of women in my practice who were having significant menopause symptoms including hot flashes, insomnia, and mood swings to name a few. Not only were the symptoms confusing to them, but the plethora of information, both medically and alternatively, on menopause and its treatment was overwhelming.

There are huge numbers of baby boomer women now dealing with menopause. Women in this country seem to be having more problems than women in other countries. At menopause, Japanese women do not have the same amount of symptoms we do. There is no word for hot flash in their vocabulary.

Japanese women also have significantly less breast cancer than women in the U.S.. In the Bay Area, one in eight women will experience breast cancer in their lifetime. The highest rates in the world is in Marin County where one in every seven women will contract this disease in her lifetime.

Conventionally, we go about treating symptoms, but I am interested in looking for the cause of the symptoms. Breast cancer, fibroids and osteoporosis indicate there are hormone imbalances. Why do we have the highest incidence of breast cancer in the world? The answer is multi-factural, however it has been proven that we are getting estrogen-like chemicals from pesticides, building materials, plastics, etc. These estrogen-like substances are called xeno-estrogens. This is very compelling information and many researchers believe that these chemicals are also affecting men. Prostate and testicular cancer are on the rise and there are some studies that show that sperm counts are significantly lower in men today than they were 30 years ago.

All these considerations led me to put on the first menopause conference two years ago. I called it "Menopause Woodstock." I gathered together people in the forefront, not only in treating symptoms, but who were looking at why we are having so many problems in the U.S. The other reason I produced the conference was to help women sort out all the menopause-related information that is out there. There are two different extremes. One is the conventional Western way where doctors prescribe Premarin, Provera, and Tums to prevent osteoporosis.

Premarin (pregnant-mare-urine) comes from the urine of pregnant horses. In the U.S., 17,000 horses are kept in tiny stalls in a constant state of pregnation while their urine is collected in catheters. They often live their whole lives this way. Premarin is used by most medical doctors and is the number one estrogen sold in this country. There are other estrogens available that come from plant-based sources that do not include animal abuse. Provera is a synthetic progesterone which has a long list of side effects. It is much better to take a natural progesterone, but pharmaceutical companies can only patent synthetic formulas.

At our clinic we bring together both medical doctors and alternative practitioners.

Women, when considering if they need to take HRT, must consider their breast cancer, heart disease and osteoporosis risk. What we do at our clinic is educate women about their choices. Many women need to take hormones, but there are a lot more body-friendly options than the synthetic ones available. Before a woman even comes to our clinic, we have her fill out a lengthy questionnaire on her general health and any symptoms she is experiencing. We also ask her to record everything she has eaten for the last seven days. She brings this information to her first interview, which lasts an hour.

We collect all this information before we suggest treatment because every women is different! In this day of managed care, most doctors only have 20 minutes to meet with their patient. Our process starts with the diet, then we evaluate what supplements they need to add to that mix. We use herbs and include natural hormone options.

What are some of your recommendations at menopause?

Lifestyle changes are number one. Food and exercise are our principle healers. We need to reeducate people on how to eat healthy diets. Because we presently live in a fat-phobic society, people have even stopped eating healthy fats like olive oil, seeds, nuts, and fish. All of these foods are important to good health. It is not a matter of a non-fat diet, it is a matter of a healthy fat diet. One of our recommendations is to eat a healthy breakfast and lunch, and not to wait till dinner for a real meal. I teach women to realize food is fuel and use it that way. Bagels and coffee for breakfast, then a salad for lunch is not fuel! Not having enough food-fuel during the day can trigger hot flashes and many other symptoms. Simply increasing fat and protein intake early in the day will often result in positive changes within two weeks. Once people see they can make changes, they feel empowered. I like the analogy of a smoke alarm going off in the house--you don't just turn the alarm off--you look for the fire and put it out.

What age do women start menopause on the average?

52, but it is getting lower. I'm in the middle of it and I'm 47. That is considered early, but I smoked as a teenager. This turns out to be a major risk factor for osteoporosis, which I have. I cannot afford any more bone lose. And I am not alone, osteoporosis is at epidemic proportions in this country.

How did you find out you have osteoporosis?

By taking a bone density test which is non-painful, has 98 % accuracy and involves a minute amount of radiation. I suggest that women have it at age 35, not when they hit menopause. Especially if a woman has a history of smoking, alcohol or drug abuse; drinks caffeinated beverages; and is Caucasian with a small and thin build, then I highly recommend it!

What attitude do you encounter in women going through menopause?

There continues to be a negative undercurrent in our society on what menopause means: women can't bear children, they are not of use anymore. It is viewed as a certain kind of death. We live in a society that invests a lot in keeping a youthful appearance. So when women reach menopause, it hits hard. But, menopause is coming out of the closet.

How do you help women deal with these societal attitudes?

Despite the issues of decreased libido and other changes, I see menopause as a positive transition. The real difficulty around it is the lack of information and choice. That is what I offer at the conferences and at our clinic: choice.

I am also getting more in touch with the ritual aspect of menopausal passage. I added drumming, ritual and a comedian at the conferences so the information, though intense, could be presented in a humorous and sacred way.

Do you have a personal ritual that you do for your own passage?

I've thought about this. When I do, that ritual will include being at the ocean. For me the form of ritual might be meditating for a day; allowing myself to think and have feelings about entering into the second part of my life; talking to friends about it; and putting it on the front burner instead of the back burner.