别再妖魔化更年期
Women Can Have a Better Menopause. Here’s How.
JEN GUNTER
2021年5月27日
Menopause has long been treated as a pre-death, a metamorphosis from a woman to a crone with her exit ticket already punched. This is because a woman’s worth was measured by her reproductive ability and by extension her femininity, as defined by a narrow, misogynistic standard.
长期以来，绝经一直被当作死亡的前一阶段，是女性变成老太婆的过程，她在这个世界的退场券已经剪了票。这是因为女性的价值是以她的生殖能力来衡量的，进而延伸到以一种狭隘的厌女标准定义的女子气质来衡量。
The medical language of menopause today reflects that trope. For example, it’s common to say that in menopause the ovarian supply of eggs has been “exhausted,” but the concept of failure or fatigue is never applied to the penis — otherwise the term would be “penile failure” or “penile exhaustion,” rather than the more euphemistic “erectile dysfunction.”
当今有关绝经的医学语言反映了这种老生常谈。例如，一个常用的说法是，卵巢的卵子储备在绝经期已经“枯竭”，但衰竭或疲劳的概念从来不用于阴茎，否则会有“阴茎衰竭”或“阴茎枯竭”的说法，而不是更委婉的“勃起功能障碍”。
Many young girls who received no information about puberty woke up one morning covered in blood from their first period, terrified they were dying. This was my own mother’s experience in the 1940s. For many women, menopause is a mirror of that — an assortment of unexpected symptoms they may be embarrassed to discuss openly.
许多没有接受过青春期性教育的女孩，在一天早上醒来后看到身上第一次月经的血时，都很害怕，以为自己要死了。我的母亲在20世纪40年代就有过这种经历。对许多女性来说，绝经与初潮类似，是经历可能会让她们羞于公开谈论的各种出乎意料症状的开始。
We can do better by embracing the idea of a feminist menopause. Women deserve to experience these changes in their bodies equipped with facts and free of fear, shame or secrecy. A feminist menopause rejects the patriarchal notion that a woman’s worth is tied to her ovarian function and that the end of her reproductive life represents the end of her productive life. The medical community should provide women with far more information about how their hormones change in middle life, what they should expect and what can be addressed with medical treatment.
通过接受女权主义对绝经的看法，我们能做得更好。女性应该用基于事实的准备，而不是恐惧、羞耻或保密，来经历她们身体的这些变化。女权主义对绝经的看法拒绝了男性主宰的观念，即女性的价值与她的卵巢功能相关，她生殖时期的结束意味着她有效生命的结束。医学界应当为女性提供更多的信息，让她们了解荷尔蒙在中年时期是如何变化的，她们应该有什么预期，以及什么问题能用医疗手段来解决。
The word “menopause” comes from the Greek words for month and cessation, referring to the final menstrual period. In reality menopause is a transition akin to puberty, a procession of hormonal changes that leads from one biological phase of life to another. Menopause is a consequence of changes in both the ovaries and the brain. Women are born with a finite number of eggs, or oocytes, and decades of ovulation cause the supply and quality of oocytes to decrease, affecting the production of estrogens and progesterone as well as the brain’s response to these hormones. Medically, this time is known as the menopause transition. These hormonal changes often begin in a woman’s mid-40s, can last for years and typically produce symptoms such as menstrual irregularities, hot flushes (or flashes), vaginal dryness, depression, difficulty sleeping and brain fog.
英文的“绝经”(menopause)一词来自希腊文的月和终止，指的是最后一次月经。实际情况是，绝经期是类似于青春期的一个过渡，是引起身体从一个生命阶段进入另一个阶段的一系列激素变化过程。绝经是卵巢和大脑发生变化的结果。女性出生时具有数量有限的卵子（又称卵母细胞），几十年的排卵使卵母细胞的储备和质量下降，这将影响雌激素和孕激素的产生，以及大脑对这些激素的应答。医学上，这段时间被称为绝经过渡期。这些激素变化通常始于女性40多岁时，能持续好几年，引发的典型症状包括月经不规律、潮热红（又称潮红）、阴道干燥、抑郁、睡眠困难和脑雾。
Eventually, a woman has her last menstrual period — an event that’s generally considered the hallmark of menopause. But in fact, that event plays a relatively small role in the process. The final menstrual period can be important for knowing when to stop contraception, and its arrival can determine how physicians investigate abnormal menstrual bleeding. But what really matters for the day-to-day lives of people with ovaries starts years before the final menstrual period and lasts a lifetime, as the hormonal changes of the transition can increase women’s risk of conditions such as heart disease, stroke, dementia and osteoporosis. Of course, women may also be relieved at the end of menstrual cramps and heavy or irregular periods, or fears of unexpected pregnancies.
最终，女性会来最后一次月经，这次月经通常被认为是绝经的标志。但事实是，最后一次月经在整个过程中起的作用相对很小。最后一次月经对知道何时不再需要避孕可能重要，其到来可能决定医生如何调查经血异常的问题。但对有卵巢的人来说，对她们日常生活真正重要的影响始于最后一次月经的好几年前，而且持续一生，随着过渡期激素的变化，女性患心脏病、脑卒中、老年痴呆和骨质疏松症等疾病的风险会增加。当然，女性也可能因为不再有经痛、月经过多或不规律的问题，或不再担心意外怀孕，而感到宽慰。
But many women are unaware of the basic biology of menopause and don’t know what to expect when they are no longer expecting a regular period. They may worry that a hot-flush inferno will leave them dripping with sweat at work, or dread addressing the issue of vaginal dryness with their sexual partner. What woman wants to admit that she now plays for a team that society has deemed irrelevant? Throw in the fact that much of menopause happens “down there,” and the resulting information void is unsurprising.
但是，许多女性缺少对绝经的基本生物学了解，也不知道当她们不再期待有规律的月经后该期待什么。她们可能担心无法控制的潮红热会让她们在工作时突然一身大汗，或害怕向性伴侣提阴道干燥的问题。有哪个女人愿意承认，她现在加入了被社会视为无关紧要的团队呢？考虑到绝经的大部分发生在“下面”，由此造成的信息空白就一点也不令人惊讶了。
The ramifications of both this lack of information and the taboos around menopause are significant. Women may not discuss bothersome symptoms with a medical provider, erroneously assuming there are no safe, effective therapies. As a physician and author who writes and speaks frequently about women’s health, I’ve heard from many women that they felt their doctors could not or would not answer their questions about changes in their bodies. They have described being dismissed with blank stares or platitudes such as “It isn’t that bad” or “That’s just part of being a woman,” or told to come back when they are “really in menopause.” Why does no one ever say that erectile dysfunction isn’t that bad, or that it’s just part of being a man?
信息缺乏以及围绕着绝经的禁忌带来的后果都非常严重。女性可能不会与医疗提供者讨论困扰她的症状，错误地认为没有安全有效的治疗方法。作为一名经常撰写和讨论女性健康问题的医生和作家，我从许多女性那里听到过，她们觉得医生不能或不愿回答关于身体变化的问题。她们描述了医生用没有表情的眼光，或诸如“没那么严重”、“这只是作为女人的一部分”把她们打发掉，或告诉她们“真绝经了”再来看看。为什么没人说勃起功能障碍没有那么严重，或者那只是作为男人的一部分呢？
So profound is the knowledge gap that many women aren’t sure of the markers of menopause. Are they in it or done with it? This confusion can be traced back to the misdirected emphasis on the last menstrual period as well as the confusing terminology: The menopause transition, the time leading up to the final menstrual period, is often called premenopause; perimenopause describes the menopause transition plus the first year without a period. But there is no last call announcing the final menstrual period, so a woman is considered to be postmenopausal (or sometimes just “in menopause”) once a year has passed without a period. Since that last period doesn’t typically affect how we manage most of the menopause experience, it’s common to describe the entire process as menopause.
信息如此匮乏，以至于许多女性不确定了解绝经的标志。她们是在绝经期呢，还是已经绝经了？这种困惑可以追溯到错误地强调最后一次月经，以及令人困惑的术语：绝经过渡期（即最后一次月经前的那段时间）通常被称为绝经前期，围绝经期指的是绝经过渡期加上不再来月经后的第一年。但没有宣布这是最后一次月经的最后通知，所以如果女性已有一年时间没来月经的话，她就被认为处于绝经后（有时就叫“已绝经”）。因为最后一次月经不影响我们如何应对绝经期的大多数经历，所以将整个过程描述为绝经就很普遍了。
The reliance on missed periods for a diagnosis can be frustrating, so it’s no surprise that an assortment of companies now sell tests that promise to tell a woman where she is in her menopausal transition. But the truth is that no single blood, saliva or urine test can accurately determine whether or not a woman is close to her final menstrual period. The hormonal chaos of the menopause transition is so great that one month hormone levels could suggest menopause, and two months later they could be normal. These tests are largely meaningless because they provide a snapshot of hormones that change constantly, and therapy for troubling symptoms doesn’t depend on hormone levels. These tests merely take advantage of the gaps in medicine for profit.
依赖错过的月经来诊断能令人沮丧，所以，各种各样的公司现在都在销售许诺能让女性知道她处于绝经过渡期哪个阶段的检测，也就不足为奇了。但事实是，没有一个单独的验血、验唾液或验尿的检测能准确地确定女性是否临近她的最后一次月经。绝经过渡期的激素变化如此之大，以至于某月的激素水平可能预示绝经，而两个月后的水平又可能正常了。这些检测在很大程度上没有意义，因为它们测的是不断变化的激素水平在某刻的状况，而治疗令人困扰的症状并不取决于激素水平。这些检测只是利用了医学知识的空缺来牟利。
There are proven, effective treatments for many symptoms of menopause. Perhaps the most well known is menopausal hormone therapy, or M.H.T., which is often called hormone replacement therapy (a phrase that should be discouraged, as it suggests an abnormality where none exists). M.H.T. is typically a form of estrogen, and women with a uterus will also need a progesterone or a progesterone-like hormone to protect against an increased risk of cancer. Despite data that tells us that M.H.T. is low risk for most women who start before the age of 60, there is often a reluctance among medical providers to prescribe it and among women to take it.
对绝经期的许多症状，都有被证明有效的疗法。最有名的也许是绝经期激素疗法（简称MHT），通常称为激素替代疗法（应该尽量不用这个名称，因为它暗示一种并不存在的异常）。MHT用的通常是一种雌激素，有子宫的女性还需要服用一种黄体酮或类似黄体酮的激素，预防患癌风险的增加。尽管数据告诉我们，MHT对大多数60岁之前开始使用的女性风险很低，但医疗提供者往往不愿开这种药，女性也不愿服用。
The past two decades have seen a wealth of exciting new menopause research. Scientists have learned that some antidepressants and other treatments can reduce hot flushes. Hormonal treatments can help genitourinary symptoms (vaginal dryness and pain during sex) of menopause. Research has shown that brain fog is real — and temporary. We are in an era of a medical menopause renaissance, and yet many women are not benefiting from it.
过去二十年，出现了大量令人兴奋的关于绝经的新研究。科学家已经了解到一些抗抑郁药和其他治疗方法可减轻潮热红。激素治疗能帮助缓解绝经期的泌尿生殖系统症状（阴道干燥和性交疼痛等）。研究表明，脑雾是真的，也是暂时的。我们在医学上正处于一个绝经的复兴时代，但许多女性并没有从中受益。
As a result, women seeking information may turn to sources that appear to be knowledgeable, but that also, coincidentally, often offer products — many untested and even harmful — to treat the symptoms of menopause. Hence the growing market for over-the-counter supplements that are marketed to menopausal women and promise relief for symptoms like hot flashes and sleep difficulties, many with very little supporting data. In the United States, supplements are not tested for safety, and some “menopause supplements” contain ingredients that are either not proven to help with symptoms or may cause actual harm.
结果是，寻求信息的女性也许求助于看似是知识的来源，但这些来源恰巧也常常提供治疗绝经期症状的产品，许多是未经检验，甚至有害的产品。由此形成了一个不断增长的市场，向绝经期女性兜售非处方补品，这些补品承诺缓解潮热红和睡眠困难等症状，但很多补品没有多少支持其有效性的数据。在美国，补品不需经过安全性试验，一些“更年期补品”包含的成分要么未被证明有助于缓解症状，要么可能造成实际伤害。
There is also a growing market for compounded, so-called bioidentical hormones. These products aren’t subject to adequate regulatory oversight, and a recent report from the National Academies of Sciences, Engineering and Medicine concluded that there is limited information about the safety and effectiveness of these products. Personally, I only trust my health to an estrogen that’s approved by the Food and Drug Administration. I want to know exactly what my body is absorbing, and I simply can’t have that precision and safety with a compounded product. That many women feel more comfortable using products that are not recommended by menopause experts says as much about the communication gaps in medicine as it does about those who prey upon women. These gaps are especially troubling given that the science is not lacking.
还有一个不断增长的、用所谓生物等同激素配置的复方的市场。这些产品没有足够监管，美国国家科学院、工程院和医学院(National Academies of Sciences, Engineering and Medicine)最近一份报告的结论是，有关这些产品的安全性和有效性的信息很有限。就本人而言，为保障自己的健康，我只相信得到了食品和药物管理局(Food and Drug Administration)批准的雌激素。我要精确地知道我的身体吸收的东西，复方产品根本无法让我得到这种精确度和安全性。许多女性更容易接受不是绝经期专家推荐的产品，这即说明了医学沟通上存在的差距，也反映了那些从女性身上牟利者的能力。考虑到有关的科学知识并不少，这种差距尤其令人不安。
Western medicine has already found ways to educate patients about significant hormonal changes. After all, pediatricians routinely discuss puberty with their patients at annual checkups and tailor their conversations to age and symptoms. Doctors should have similar discussions with women in their late 30s, so that their patients are prepared. Menstrual irregularities, hot flushes, depression and brain fog can start several years before the final menstrual period, which typically arrives in a woman’s early 50s. These conversations can also spur women to take steps to protect their health in menopause by increasing exercise and ensuring adequate calcium intake, for example.
西方医学已经找到教育就医者了解重大激素变化的方法。毕竟，儿科医生在每年的常规体检时都会与就医者讨论青春期的变化，并根据年龄和症状来讨论问题。医生也应该与将近40岁的就医女性有类似的讨论，让她们有所准备。通常在女性50岁以上出现的月经不规律、潮热红、抑郁和脑雾，可能在最后一次月经的几年前就开始了。这些讨论还能激励女性采取措施，例如通过增加锻炼和确保足够的钙摄入，来保护绝经期的健康。
For too long, women have had to fight to learn the facts about menopause, to take up arms for their health and their sanity. Speaking up about the concerns of a female body as it ages should be considered normal, not brave.
长期以来，女性不得不为了解绝经期的事实而奋斗，为了身体和精神的健康，用知识武装自己。站出来为变老的身体说出女性的担忧，应该被认为是正常的，而不是勇敢的。
Menopause isn’t a death sentence. We must dispel the misogynistic notion that a woman’s worth is tied to her estrogen and her age. Instead we should think of menopause as a new phase of life and the last period as just one landmark along the way. When women need help navigating their symptoms and the health implications of menopause, clear, non-sexist information and proven therapies should be available. At some point getting help for menopause won’t require an act of feminism, but that will never happen if we stay silent.
绝经不是判死刑。我们必须杜绝那种认为女性的价值与她的雌性激素水平和年龄紧密相关的厌女观念，而是把绝经看作人生的一个新阶段，把最后一次月经看作人生道路上的又一个里程碑而已。女性在需要帮助、应对绝经期症状及健康影响时，应当向她们提供明确的、无性别歧视的信息，以及经过检验的治疗方法。有那么一天，找到绝经期的帮助将不再需要采取女权主义行动，但如果我们继续沉默的话，那一天就永远不会到来。
