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A word on menopause and the childless woman

The psychological effects of the “change of life” can be particularly tough on those without kids, explains Dr. Gail Saltz.

A few weeks ago in this column I wrote about the psychological aspects of menopause. When I originally spoke about this topic at the Women’s Health Symposium at the Weill Cornell Medical Center in New York City, my audience was married women, most of whom had children. My column was based on that talk.

Now I’d like to address this from the viewpoint of women who do not have children.

People take different paths in life, some by choice and some by happenstance. Some women choose not to marry or be mothers, and are content with that path. Others wanted marriage but never found the right person to marry; others wanted children but faced infertility issues.

Certainly, the idea that life is not limitless comes to the fore at this stage of life, as does the question of whether you’re accomplishing your life goals. This applies whether or not you have a spouse or children.

But women who feel their situation is a matter of particular circumstances, not choice — for example, those who don’t have the spouse and children they wanted, or those who ended up in a bad marriage — can find this a time of particular pain and regret.

As difficult as it is to endure the physical symptoms of menopause, it is more difficult if you’re feeling lonely and lacking an intimate partner to talk it over with, even if you do have important and meaningful friendships. There are extra stressors that accompany this time of life, as well: aging relatives, concerns about finances and retirement, feelings about an aging body.

No doubt about it — it can be a tough situation. Menopause is the demarcation of the latter part of life and a powerful reminder of finality.

Whatever choices you have made — whether you became a doctor and not a lawyer, whether you married this man or that one — you might regret the untaken path. This does not mean you made poor choices or that you wouldn’t make the same choices again. It means you are mourning the loss of possibility.

And this is most certainly a loss — one that you must mourn as you would mourn any other loss.

Dealing with thoughts of what might have been — whether these things were out of your control, or in your control but still didn’t turn out the way you wanted — is difficult. You may feel angry and disappointed with yourself.

It’s easy to become defensive: “I didn’t do it — it happened to me.” But being stuck in this “I’ve been cheated” mind-set only traps you in an endless cycle of bitterness, like a hamster on a wheel.

If you seem unable to achieve your life goals, examine your role in this. If you never get what you want, you probably hold at least partial responsibility. Becoming aware of this lets you feel more in control of the future. Nobody ever has supreme control, but it’s possible you can seize more control.

The second half of life is a stage when many people re-evaluate their priorities. Make time to do things that feel generative and creative — writing, painting, traveling, studying, or whatever else makes you look forward to the future.

It also helps to talk to women in the same situation — single women your age, for example, rather than married friends who are busy planning the prom for their high-schoolers. And remember — it’s entirely possible to find a partner at any age.

Grieve and mourn for the things that passed you by. But then look forward. Turning back the clock is not an option. Concentrate instead on what you do have and can have. And if you feel really paralyzed and saddened by regret, consider therapy.

Dr. Gail’s Bottom Line: The age of menopause brings with it the realization that you no longer have the possibilities of many life choices. This requires mourning, acceptance and a move toward new ways of feeling creative.

Dr. Gail Saltz is a psychiatrist with New York Presbyterian Hospital and a regular contributor to “Today.” Her new book, “Becoming Real: Overcoming the Stories We Tell Ourselves That Hold Us Back,” was recently published by Riverhead Books. For more information, you can visit her Web site, .

PLEASE NOTE: The information in this column should not be construed as providing specific medical or psychological advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician, psychiatrist or psychotherapist. Copyright ©2004 Dr. Gail Saltz. All rights reserved.