Table Of ContentPsychosolllatics in
Peri-Menopause
Psychosoltlatics in
Peri-Menopause
Edited by
A. A. Haspels
and
H.Musaph
~
In~
MTPPRESS LIMITED
International Medical Publi hers
Published by
MTP Press Limited
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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
