— More and more, people have been questioning why relatively little is known about the menopausal transition and its effects on the mind, body and emotions. Compared to males, illnesses in women are more slowly diagnosed and often blamed on psychological weakness. There is also a well-known and acknowledged history of gender, ethnic, and economic-social bias in medical research which has yet to be righted. Thankfully, the situation is starting to improve, but we have a long way to go to correct the origins and centuries of neglect, mistreatment, and imbalance of attention to women's health issues.
In presenting this material, we’ve felt compelled to help others understand the history of ignorance of the female midlife hormone changes. We needed to do this, not only to understand some of the experiences of the older women we spoke with, but also to shine a light on instances where this ignorance is still holding women back from living their best lives, and in some instances, doing real harm.
For example, according to science writer Ada McVean from McGill University, in modern culture “when we say someone is hysterical, we mean that they are frenzied, frantic, or out of control.”14 However, historically hysteria was categorized as a disease. Its symptoms were similar to normal menopausal symptoms. From the Wikipedia entry, “Female Hysteria,” these included “anxiety, shortness of breath, nervousness, sexual desire, insomnia, fluid retention, heaviness in the abdomen, irritability, loss of appetite for food or sex, and a ‘tendency to cause trouble for others’”. Women in the mid-19th to early 20th centuries were sometimes forced to permanently enter an insane asylum or to have a hysterectomy. It was thought that removing the uterus would “normalize” symptoms. According to medical historian Louise Foxcroft, at least one Victorian gynecologist recommended tortuous remedies such as injections of acetate of lead into the womb to supposedly control symptoms. Other solutions included bleeding by application of leeches and frequent use of opium and other sedatives.
The word “hysteria” was dropped from the official Diagnostic and Statistical Manual of Mental Disorders in 1980. At that time, sexist attitudes were still very high in all fields of western medicine. Women were subjected to innuendo, incorrect or limited advice, condescending behavior, and dismissiveness. The language for describing symptoms was not well developed, and many women didn’t know how to describe their symptoms. One of the women interviewed for this book, now in her 80s, said that when she was in her mid-40s, she told her gynecologist that three weeks out of the month she felt “like the molecules that are me are just floating around in space,” which sounds like brain fog. She then told him, “The week I get my period is the only time I feel solid, like myself.” His illogical solution? To perform a hysterectomy (surgical removal of the uterus), which at that time meant a two week stay in the hospital.
Thankfully, since then the medical field and culture in general, in many parts of the world, have made progress in understanding menopause and treating symptoms appropriately. But this isn’t the case everywhere. Shadows of ignorance and prejudice linger about the natural progression of the female life cycle. One positive change is that some scientists are calling for the removal of the word “hysterectomy” from medical vocabulary, to be replaced with “uterectomy," which simply means removal of the uterus. Their justification is that though the word hysterectomy is related to the Greek word for uterus, hysterus, the term uterectomy conveys none of the centuries of sexist beliefs that claimed that the uterus was the seat of female "hysteria.”
Now that we are beginning to understand and respect what women are experiencing, it is clear that the changes aren’t “all in our heads.” There are real biological and physiological processes happening to our bodies, minds, and voices, causing them to evolve. The more we know, the more we can help ourselves and each other.
The three of us together bring over 100 years of experience as vocal pedagogues, voice teachers, vocologists, and professional singers. We have taught every level of singer from ages 4 - 93. We’ve worked with thousands of singers. Yet, in writing this book, we each discovered things about ourselves that we didn’t know, and had revelations about our own vocal journeys.
For the first time, here is a resource for female singers that addresses issues they, specifically, may face as a result of menopause. It is the book we wish we’d had 20 years ago. We hope it helps women everywhere realize that they are not alone during this time of change, and that it provides guidance toward strategies that work best for them, if and when they are needed. We hope, also, that it offers insight to those for whom the journey is yet to begin.
— Paulie is an 81-year old retired psychotherapist and former athlete. Paulie didn’t actually start singing until she was 60 years old! Prior to that, she was a trained pianist, dancer, and physical education teacher before earning her PhD in psychology. She understands the discipline and curiosity required to learn and train brain function and coordination. Paulie revealed, “Movement and the routine of training have always been my safety net, my self-therapy to survive a very abusive childhood and parents.”
Paulie continued, “While I’ve had severe chronic pain, I’ve always enjoyed a robust immune system. I’ve had several sports injuries, resulting in three spinal surgeries, two knee and two hip replacements. My last back surgery was three years ago, and it wasn’t until that last major back surgery, around age 78, that my pain let up considerably.”
After Paulie’s divorce from a long marriage, she moved to a new city to live with a friend. Her friend is an active singer who introduced Paulie to groups to sing with. At age 60, she decided to start taking private voice lessons. “It was a great new beginning for me. I had no younger voice to compare to, so I couldn’t complain about my voice getting older!” She said that singing has been an antidote to pain. Considering Paulie’s many injuries and surgeries, this is a remarkable testimony to how singing can have a strong effect on the brain and perception. She’s been singing the alto part in choirs ever since.
That year, in addition to the divorce, the move, and building new community involvement through singing, she also needed a hysterectomy: Paulie experienced a prolapsed uterus. This condition may occur when the muscles and other supporting tissues of the pelvic floor weaken and can no longer provide support for the uterus. As a result, the uterus can slip down into the vagina, or, in Paulie’s case, protrude out of it. “My uterus fell out of me one day while I was on the toilet. As I was wiping myself, I thought, I’m not supposed to have balls! What on earth is going on?” She had an emergency hysterectomy and had one ovary removed, “...but they couldn’t find the other one.” She was put on estrogen after the operation. “But I went off of HT due to some health scares that were being propagated in the early 2000s.”
“I am very focused,” Paulie said, “and practice consistently with a lot of joy. I have improved a great deal vocally. I am a life-long student who knows how to pursue interests; and since I could read music and appreciate all kinds of music, I enjoyed becoming part of a choir in order to form a new family and a new way of ‘belonging’ in my new life. I now sing in two regular choral groups and participate in a city-wide drop-in group in the African-American tradition. My voice has gotten better and better these past twenty years. I don’t have a beautiful voice, but it is very serviceable in an ensemble. I sing on pitch and with good energy. I take time off when I am not well or recovering from surgery and get right back into it.”
Recently, Paulie went through another major life transition when she moved into her own apartment to live alone for the first time in her life. It was very stressful. She lost her short-term memory, her concentration began to decrease, and she had several falls and minor car accidents. Her walking gait was off and she felt disoriented much of the time. She began working with an integrative health specialist who made recommendations to help her get her memory back, clear her brain fog, and regain her balance. Paulie thought about the potential treatments carefully and decided to proceed with individualized hormone therapy and other alternative treatments. In Paulie’s case, during that 6-month stretch she recovered her memory, her brain fog lifted, and her balance and gait improved. She has the light back in her eyes and feels more like herself again. And she’s still singing.
Paulie has significant insight into medication from her background as a psychotherapist and her extensive experience with medical issues and aging. Her perspective is that “The medical profession has, by and large, brushed off pre-and post-menopausal and aging women and sent them to psychologists. The ethics of my profession state that even psychologists and psychiatrists are supposed to help patients find physical symptoms first, before treating them with drugs. In other words, they are supposed to refer them to appropriate medical doctors first. This doesn’t happen like it should with midlife, menopausal, and aging women because few doctors really know the physical reasons for all of our complaints. Women, during my lifetime and before, have been given drugs and all sorts of cruel remedies for depression, anxiety, rage, feelings of craziness, hyperactivity, hypersexuality, low functioning sexuality, and spaciness. I don’t believe drugs should be given without also recommending therapies for emotional and social well-being.”
Paulie’s story shows that learning something new takes consistent work, realistic expectations, and a love of learning. Thanks to singing, Paulie has experienced tremendous joy and community connection for the past 21 years. As she mentioned several times, she knew she’d have to work at it and welcomed the new challenges. She is also an example of someone who utilizes both western and alternative medicine, integrating what her research and her intuition tell her to do.
