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Excerpt
This book is coauthored by three colleagues in a women's health practice; their unusual collaboration includes a psychologist and two general internists (from Brown University School of Medicine and Rhode Island Hospital). The authors stress individualization of approaches to women's health and giving "the maximum amount of information and freedom to make important health care decisions." The authors also instruct the reader how to use the book. They use a biopsychosocial approach and are good teachers.
Each chapter has a section on communicating with one's doctor. The authors point out that an individual must make important concerns known immediately to a health care professional and that the patient must also be assertive enough to pursue those concerns.
The book has very good chapters on the natural history of menopause, hot flashes, sexuality, maintaining our health (including strong bones, healthy hearts, and hormone replacement), myths of depression, realities of stress, hysterectomy, and promoting a healthy lifestyle. Each chapter has a positive outlook in addition to a considerable amount of useful information.
The area about which I know the most, depression, is extremely well-covered. The Massachusetts Women's Health Study is quoted to emphasize that there is no increase seen in depression with natural menopause, although there may be with surgical menopause. The authors point out that the media rarely picture midlife or older women in a positive light. They also describe clinical examples and quote studies for emphasis, distinguishing between depression as a symptom and as a "clinical" syndrome. Unfortunately, in their biological description of depression. I could not find mention of biochemical changes—such as the decrease in ne-motransmitters in depressive illnesses—and their relationship to reproductive hormones. The psychological and social areas, however, were well-covered. Especially interesting was the history of the term "empty nest." first used in a 1966 paper by Dylen. who was describing 11 women, suffering from major depressive syndromes in a psychiatric hospital in Boston. Nine of the 11 had problems with their adult children, and the empty nest concept as a contribution to depression in menopausal women is questionable.
The authors write about increased rates of depression in minority women but don't mention if this is mild or severe clinical depression: this area needs considerably more research. The authors do emphasize how poverty and abuse affect depression. The section on treatment is good—but it doesn't sufficiently emphasize how frequently depression, a treatable condition, is missed. The discussion of alcohol and substance abuse is excellent.
I liked the section on stress and the chapter on promoting a healthy lifestyle. There is an excellent bibliography, although I was sorry it omitted very good papers on women's adult life development by Notman, Gilligan. and others. Overall, the writing was outstanding, although I was turned off by occasional attempts at being too chatty, such as. "But the demise of these eggs is not a big deal." This kind of comment was rare, however, and the authors do not talk down to the reader. The book has a glossary and an index.
I highly recommend this book for patients, clinicians, and media researchers.
