Read an Excerpt
Chapter One
Deep Impact
Hormones and the Brain
Pam's Story
Pam woke with a start. Her heart was pounding and she had the horrible feeling that something was seriously wrong. She put her hand to her chest to feel her heart beating. At first, the beat was just rapid, but then the pounding became irregular and her breath came in short gasps. She thought, "My God, I'm having a heart attack. I'll wake Jack and have him call an ambulance." Her mind was racing with panic. Pam tried to rein in her thoughts, but there was no stopping this train of fear and loss of control. The panic became so intense that her body was covered in perspiration, soaking her nightgown. "I'm going to faint," she thought.
Here was this forty-four-year-old, high-powered executive, president of her own company, sitting in my office telling me this story of her panic attack three nights earlier. Pam was experiencing symptoms she could not understand — not just the panic, but also severe moodiness, irritability, and forgetfulness that were wreaking havoc in her marriage and work life. She wept at the slightest provocation. "At one point I was watching people singing Christmas carols on television," recalled Pam. "When they sang '0 Little Town of Bethlehem,' I dissolved into tears. It was absurd. There was something very wrong and it was affecting not only my body but my mind."
Pam wondered whether there was a link between her symptoms and menopause, which is why she came to see me. Her symptoms followed a pattern familiar to me, but I needed to hear more of her story.
In the midst of her panic she had gotten out of bed,walked into the bathroom, and closed the door so the light wouldn't wake her husband. The face in the mirror wasn't familiar. It was pale and frightened. Her eyes looked as if she were about to cry. Her anxiety surged, and the panic was once again uncontrollable. She raised her fist and lunged forward, stopping just short of crashing her hand into the mirror. Pam thought she might wake Jack, hoping that he'd hold her and make the fear go away. He'd always calmed her down in the worst crises, at least in the past. Jack had been her refuge.
Lately that closeness had changed. Pam could get angry with Jack in a flash, and for seemingly no important reason. Of course, this would cause him to withdraw. Tolerance was never one of Pam's outstanding traits, but now, when the children would lose things, she'd fly off the handle. What was happening to them? What was happening to her? Last week, she couldn't find her car keys for three whole days. She finally found them when, in search of a missing earring, she opened the top drawer of her bedroom dresser. It was where she'd always put things whenever she was in her cleaning mode. "Normally," she said, "I'd have retraced my steps and found them right away."
The memory loss really frightened Pam. Her mother had Alzheimer's disease, and she was terrified at the mere thought that she, too, could be afflicted. She remembered how maddening it had been to answer the same question over and over again, because her mother didn't remember what Pam had said moments earlier. Pam worried that her memory lapses might be the beginning of a much larger problem. "Lately at work, when my secretary asks for a decision on a simple problem I can't make up my mind. That's not at all like me. This whole thing is a nightmare. I feel like I'm losing my mind."
I've heard that desperate statement — "I feel like I'm losing my mind" — repeatedly from women who are passing through menopause. Based on my years of research and clinical practice, I can reassure them that if their problem is a hormonal imbalance, the problem can be rectified, and once it is, their many painful and disruptive symptoms will abate. Pam had offered many clues that her difficulties could be attributed to hormonal imbalance — namely, the combination of night sweats, insomnia, panic attacks, weepiness, and memory problems. These are all classical symptoms of estrogen deficiency associated with menopause.
But there was one area Pam hadn't touched upon. I asked her, "How have the sexual relations between you and your husband been going?" She paused before answering, "I'm glad you asked. I was a little reluctant to raise the subject, but the other night Jack and I talked about this. He and I have been avoiding each other lately, and we haven't made love in God knows how long. I told him I had lost interest in sex, and the last time we made love it was painful. He remembered that it had been uncomfortable for him as well, and he was worried that some of my sexual disinterest might be his fault. Both of us kept saying, 'It's not you, it's me.' "
"This is not your fault, nor is it your husband's," I said. "Hormones affect the brain. Your symptoms may result from a hormone imbalance, and hormone imbalances can be treated." This is what I tell my patients, and it is often the first glimmer of hope they've had after a long period of suffering.
Pam had come to me for a consultation because she suspected that her symptoms — including her cognitive, mood, and sexual difficulties — could be caused by hormone fluctuations, perhaps from early menopause. Pam and Jack had long assumed she was too young to be menopausal, but they felt they had to find out if there was a biological cause and solution to their mutual misery. Jack summed it up perfectly during their late-night talk: "We are both getting older, but it's too early for this."
