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Menopause is not a disease, nor a dramatic event
leading to sudden behavioral alteration. It remains one of the most
misunderstood phases in a women’s life cycle, especially because so many
variants fall under the single word, menopause. Women who undergo surgical
menopause may have an entirely different physiological and symptomatic
experience than women who proceed spontaneously through this event. Moreover
not all women who experience natural menopause will have the same ovarian
function afterwards – good reason for such a spectrum of possible effects.

 At one level the news is good – we are talking
about menopause and, in many instances, taking appropriate actions. At another
level, the degree of ignorance about menopause still troubles me. So how would
I best describe the significance of the menopause?

 Menopause is important at three levels:

a lead indicator of changing demographics: a signal event highlighting the
gradual demise of the dominating youth culture and the growing impact of aging

a driver of public health policy: a marker in the life cycle of women that
identifies and determines the potential for risk factor identification, early
disease diagnosis, leading to reduction of disability and its attendant health
care costs

personal level: enhancing quality of life through appropriate changes in
personal behavior and appropriate medical management

This week I will discuss the first item above –
demographics. This is the background to an issue of critical importance in
relation to health policy, the economy, the political challenge, and the
potential demand for expensive delivery of medical services.


No woman needs fear that she stands alone as she
approaches menopause. There has been a real increase in the actual number of
women reaching and living well beyond this time. The median age at natural
menopause is 51.3 years (that is, the age at which 50% of American women will
have transitioned though menopause).

 Media headlines have warned: NEW POPULATION TRENDS
TRANSFORMING United States.  These
trends really do exist. They are occurring throughout the world and have
far-reaching implications for the future. Some countries have high birth rates
resulting in more young people. These are usually developing nations where
disease rates are higher resulting in greater infant mortality. Even these
countries are showing major growth in the population of older people. An
example of a high birth rate country would be Mexico.

Other countries have low growth rates. Fewer babies
and better health services result in more people living to an older age. These
are invariably the more developed countries. Japan and Sweden are good
examples. Russia too has a greater population of older individuals but is less
developed than Japan or Sweden.

 The United States falls somewhere between Mexico
and Sweden. The population statistics are quite striking. In 1900, the median
age of people in the United States was 22.9 years. By 1950, it was 30.2. It was
around 35 at the turn of the century and is projected to be 37.3 by the year
2030. This means the average age of the population is gradually increasing. The
increased number of people living to an old age can be more easily imagined if
you realize that 1 in 10 of the population today is over age 65. By 2030, this
figure may be 1 in 6.

 There is unequivocal evidence that the population
of women over age 50 has changed significantly over the course of history. The
life expectancy for a woman born during the time of the Roman Empire was about
29 years. During the late medieval period, this increased to 33 years. By 1841,
in England and Wales, the average female life expectancy had reached 42 years.
A dramatic change developed during the late nineteenth and early twentieth
centuries; the expectation of life at birth had increased to 74.9 years by
1970, and closer to 80 by 2011. So in just the past century, life expectancy
has almost doubled.

 Of course, all those years ago there were women who
lived to a very ripe old age. Looking at how many years a woman was likely to
live from birth onward can be very misleading. Most women historically died
from complications of childbirth or the effects of various epidemics, and fewer
were left to live into old age. Another way of looking at the numbers is to
consider how long a woman can be expected to live if she is healthy at age 50.
This has increased from about 20.6 years in 1900 to about 30 years in 2000.
Only now more women have been reaching the increased age, and for each decade
over age 50 that they remain well, the final number gets larger. It is thus
possible that the modern woman can anticipate spending virtually half of her
life after menopause!

There are no exact figures for the absolute number
of postmenopausal women, or the number reaching menopause on an annual basis.
In the Unites States, there were an estimated 45.6 million postmenopausal women
in 2000. This number is expected to increase to more than 50 million older than
age 51 by 2020. In Canada, it is estimated that by 2026 almost a quarter (22%)
of the Canadian population will be composed of women older than 50. Worldwide,
the number of postmenopausal women is expected to rise to 1.1 billion by 2025.

Life expectancy for men has not matched that for
women. This creates an increasing proportion of single or widowed women. Unless
the death rate for men is drastically cut, the gap in life span between men and
women is likely to widen, even though both live longer.

 The bottom line is that more women are living
longer, and consequently have more time to be exposed to illnesses, some of
which are related to or impacted by menopause. But the number of older men also
continues to increase, driving the average age of the population ever higher,
and the likelihood of more of these individuals requiring expensive long-term
health care becomes ever greater.


 There is so much of the above that will impact our
future as a society, as individuals, our quality of life, the nature of the
healthcare we receive, the positions taken by our politicians, and so on, just
to list a few.

 What do you consider to be the most important
issues that will result from this remarkable demographic change?

 How do you think these issues will impact on your

Do you think women in general are aware of the
changing demographics, or in fact care about them?

 What should we be demanding of our representatives
in congress to influence the future in a positive direction?

 I will discuss much of this further over the next
few weeks.

 Wulf Utian MD PhD DSc

MENOPAUSE – Why one size does not fit



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