According to Dr. Burnside, "In most cases, female depression is an emotional and physiological response to constricted and unrewarding social roles, and is best understood as demoralization."

The SHOP program offers a woman concrete ways to develop her self-esteem, to expand her role in society, to meet new friends, to work outside the home and to develop better support networks. Dr. Burnside found that women who had already expanded their circle of friends and interests outside the family suffered a lot less depression after menopause.

The SHOP program has been proven highly effective in treating depressed older women without drugs or therapy. A one-year follow-up study has shown that SHOP's positive effects are lasting.

Is Menopause A Disease ?

Menopause is known to be associated with decreasing estrogen levels, but what is not known is whether these decreased levels of estrogen do in fact cause all the symptoms of menopause. There is no direct proof that estrogen lack causes bone loss, heart disease or other ailments associated with the menopause.

Germaine Greer puts it more succinctly in her book, The Change:

"The proponents of HRT [hormone replacement therapy]... have never proved that there was an estrogen deficiency, nor have they explained the mechanism by which the therapy of choice effected its miracles. They had taken the improper course of defining a disease from its therapy..."

Dr. Jerilynn Prior, researcher and Professor of Endocrinology at the University of British Columbia, agrees. In an article in the A Friend Indeed newsletter (Jan/92), she puts it this way:

"Linking the menopausal change in reproductive capability with aging, and making menopause a point in time rather than a process, and labelling it an estrogen deficiency disease, are all reflections of non-scientific, if you will, prejudicial thinking by the medical profession."

Dr. Prior says that no study proving the relationship between estrogen deficiency and menopausal symptoms and related diseases has yet been done. "Instead," says Dr. Prior, "a notion has been put forward that since estrogen levels go down, this is the most important change and explains all the things that may or may not be related to menopause. So estrogen treatment at this stage of our understanding is premature. This is kind of backwards science. It leads to ridiculous ideas like calling a headache an aspirin deficiency disease."

Since it is commonly assumed that menopausal symptoms were due to estrogen deficiency, in many studies, progesterone levels were not even measured. Both Dr. Prior and Dr. John Lee, a clinical instructor at the University of California Medical School, Department of Family Medicine, believe that menopausal symptoms including bone loss are mainly caused by a deficiency of progesterone.

Dr. Prior found she could reverse bone loss by giving 10mg of synthetic progesterone (Provera) alone daily for ten days a month. In fact, Dr. Prior points out that during menopause progesterone decreases 1,200 percent from its baseline while estrogen only decreases 50 to 100 percent from its baseline. Dr. Lee found he could reverse bone loss and, furthermore, could control hot flashes and other menopausal symptoms using a natural form of progesterone in a skin cream with no apparent side effects.

Should I Or Shouldn't I Take Hormones ?

Doctors disagree about whether all menopausal women should be on hormones, which hormones and whether hormones should be reserved for the use of women with severe hot flashes, severe vaginal dryness, or women at high risk for bone loss or heart attacks. There is no agreement as to how many years hormones should be taken. Increasingly, doctors believe that all menopausal women should be on both estrogen and progesterone until death.

There are two ways in which hormones are being prescribed. Hormone replacement therapy or HRT means taking both estrogen and progesterone together. Estrogen replacement therapy or ERT means taking estrogen alone.

Women who take HRT,or ERT, according to Germaine Greer, may be taking more than five times the amount of estrogen that they had in their bloodstream before menopause. Older women seem to adapt to levels of estrogen at a fifth of their previous levels derived from the ovaries, adrenals, and fatty tissues. Taking HRT may cause the body to stop producing its own estrogen.