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Understanding Angelina Jolie's Choices

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Angelina Jolie's bilateral mastectomy and possible oophorectomy (removal of her ovaries) are shocking headlines in women's health news. At 37 (soon to be 38), her choices in taking control of her future health have made her a role model for different reasons this time around. In Angelina's case, a significant risk of breast cancer appears to have driven her very personal decision. However, these choices don't come easily or without considerations of the consequences that may accompany them. As women, we all make sometimes difficult decisions which affect our health and therefore, the people who love us as well. No one is entitled to question or judge such personal decisions; and such is the case with Angelina Jolie. If Angelina opts for an oophorectomy (removal of her ovaries), she will experience "surgical menopause." Surgical menopause allows for no gradual transition into menopause.

Our ovaries don't turn on and off like light switches in the natural course of life. A myth, as inaccurate and dangerous as any that pervades American society, is that women enter menopause as if falling off a cliff. One month we're fertile, sexual, high-spirited women; the next, we're changed and no longer fertile, fraught with mood disorders and lacking stamina. The truth couldn't be more different. Far from falling into menopause, we change gradually, subtly; hormonally physiologically and psychologically over the course of about a decade. Usually, in the transitional decade of our forties, the changes are minute and myriad, but each one makes biological and psychological sense in our evolution towards maturity. Although not well known, one term encompasses the gradual process that takes place (usually from approximately age 40 through 50) in women; perimenopause. The prefix PERI means "about" and I like to think of it as applying in two senses:

• The PERI in perimenopause refers to the issues, events and developments that surround and cluster "about" menopause.
• And, the PERI in perimenopause refers to what the process is all "about"; that is, the full meaning of menopause in the course of human development.
When we transition slowly, naturally into menopause we may experience symptoms such as:
• Diminished libido (sex drive)
• Hot flashes/ night sweats
• Mood changes (which can include irritability, anxiety and depression)
• Insomnia
• Changes in weight/ and body weight distribution
• Memory changes
• Vaginal dryness
• Diminished energy

However, when the ovaries are surgically removed, the "gradual" process doesn't occur and our body may experience what sometimes is referred to as "hitting the wall." With surgical menopause, the ovaries are removed and the production of the hormones that they produce is abruptly halted. Given the fact that hormones are our body's "natural coping chemicals"; and as the list above mentions, this sudden change can affect quality of life issues as well as heart and bone health.

Knowledge is everything. Knowing what roles our hormones play, both physically and psychologically, gives us a "heads up" regarding what we may experience if menopause happens very suddenly, due to surgical menopause. And, we can explore all of our options which of course include the old standbys of diet, vitamins and exercise; but also nontraditional (complementary) as well as traditional options. Remembering that we each make decisions that are intensely personal and private regarding our health care, encourages us to support (certainly not judge) our best friend, sister, co-worker, etc. if their choices are different than our own. There is no "One size fits all" in women's health, so each of us needs to do our homework and make choices based on what is best for us; knowing that those choices can always change, just like we do.

Founder of Full Circle Women's Health in Colorado, Stephanie Bender has significantly contributed to a much larger understanding of women's health through her books, lectures and television appearances. Her most recent book is, "End Your Menopause Misery, " which she co-authorized with Treacy Colbert. You can post a comment or read more about Stephanie on her website, by clicking here. You can also follow her on Facebook by clicking here.