Menopause Part II Mikvah.org
The Halchic, Hashkafa and Emotional Perspective on Menopause
With Mrs. Chaya M. Klein and Mrs. Esther Piekarski
Mrs. Chaya M. Klein On Halachic Perspective of Menopause
What is perimenopause and menopause? What age can this be expected to occur?
So much time is devoted to supporting women during their reproductive years. Perimenopause and menopause years are also significant life shifts, yet this time in a woman’s life is not as commonly discussed. Our goal is to provide a space to acknowledge the transition and provide support for those in their perimenopause and menopause years.
Menopause is defined as a full 12 months with no menstrual cycle.
Perimenopause are the years preceding menopause wherein the cycle can become unpredictable and shift quickly.
Menopause is somewhat of a taboo topic that is not often talked about. Some women fear that menopause will turn them into an old lady - perhaps that is one of the reasons it’s a quieter topic. However, that is simply untrue. Women have many youthful and exuberant years post menopause. It’s important to normalize menopause. It is simply the body’s natural transition from the reproductive years to the time that the function of the ovaries start slowing down, and ultimately, stop completely.
Symptoms of perimenopause can take place for up to 10 years before menopause. The average age of menopause is 51, the range is 48-55. If you are slightly around, or below, the range, it is not a cause for alarm.
The gauge for anticipating menopause is when a woman's mother reached that stage; but there are many factors that can affect menopause - such as how many children a woman has birthed, whether or not she is taking birth control among others. Every woman experiences these changes in a unique way. There is no true method to predict menopause. During this time, a women’s menstrual cycle undergoes many changes causing many halachic issues to arise, some of which may cause anxiety. I will now go over several of them, and certainly, every woman should consult her own Rav individually. It is critical to have a Rav that is sensitive, approachable and that you and your husband are comfortable with.
Can a woman go into early medically induced menopause?
Yes, different health issues can cause this such as chemotherapy, or a partial or full hysterectomy. A partial hysterectomy means the ovaries are retained, this procedure is usually when a woman is younger. A total hysterectomy involves the removal of all reproductive organs.
A Rav should be consulted regarding the surgery. Primarily because he will need to determine if it will cause a woman to enter Niddah status. Additionally, the Rav will consider her age - if she is still within childbearing years, there may be alternative treatments that will retain her ability to have children.
A Rav should be consulted about any gynecological procedures because each procedure can have impacts on the niddah and tahara process as well as a woman’s emotional state throughout the process of surgical intervention.
What role does a Rav play during perimenopause and menopause?
Again, I cannot stress this enough, it is important to have an empathetic Rav with whom you are comfortable speaking about your body and your intimate life. A Rav will advise you how to maintain tahara status throughout unpredictable cycles and events of staining - both common during this stage of life. It is also imperative to have a doctor you are comfortable with and trust. As it is common for medical issues to arise at this time.
Is wearing colored underwear to avoid becoming Niddah advisable?
A halachic ruling is more lenient with colored underwear however it is best to consult a Rav regarding wearing dark colors versus light colored underwear. Tthe latter can show stains more clearly and may be a source of anxiety for some.
From a Halchic standpoint, there are only two colors: black and everything else. If a woman has personal anxieties about stains then that’s a matter for a woman to discuss with her Rav.
Some Rabbonim suggest that a woman check herself before having relations because during the perimenopause years bleeding is so unpredictable. This should only be done at the advice of a rav. Some Rabbonim will advise this protective measure until a woman has gone 6 months without a cycle and it then becomes more likely that there will not be vaginal bleeding.
âSome women also are more comfortable wearing a panty liner because they're so uncertain of when something may occur and they want to avoid the embarrassment of blood seeping through their clothing, however a lining can also show staining more clearly. If a woman wants to wear a panty liner, again, she should consult her Rav about their use to see whether or not the liner is mekabel tuma, and what to do if she does find any stains on her liner.
Only the Rav can determine this. âRemember, Rabbanim are never looking to keep us apart, their goal is to allow husband and wife to be together, but of course, only in tahara. A Rav will go out of his way to find every way possible for a woman to retain her tahara status.
Even on colored underwear, if discharge of a questionable or problematic color occurs that includes any of the following scenarios, a Rav should be consulted regarding whether a woman has entered the niddah state:
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If there is a ‘hargasha’ - her personal feeling of the start of the period
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If there are repeated events of staining
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If the staining seeps through the underwear to the next layer of clothing
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If there is a large amount (some say the size of a folded dollar bill) or a large clump that is not absorbed into the fabric)
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If this occurs at a time a period is expected
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If this staining occurs following any physical or emotional trauma
What are some suggestions to help navigate this phase of life?
Make sure to have a very good Ob/gyn, specifically one with expertise in menopause. This may be a different practitioner than the person you saw during your childbearing years. Many ob/gyns focus on women in their reproductive years and don’t have much time in their schedules for women in their perimenopause and menopause years. If you feel that your doctor does not give you the time of day, avoid taking it personally and find someone who specializes in menopause.
Pursue holistic care, such as homeopathy (always with a licensed practitioner) , and acupuncture. Nutrition based care as well as herbal and vitamin supplements can also help take the edge off any discomfort.
What does a woman need to be mindful of regarding a Mikvah calendar ?
Typically, women are encouraged to be âaware of their personal calendar and the requirement to separate in anticipation of the times when we expect our period to begin according to the precise halachic calculations. Changes in a woman’s cycle during perimenopause years will impact the calendar, which can cause the feeling of routine to be somewhat lost and off-kilter.
Staining issues or irregularities can cause the start of the period to be confusing. Also determining if a discharge of blood is staining or the start of the period can be confusing so the recommendation is to ask a Rav who will determine this for you.
As a general rule - when a Rav gives a psak of niddah, always ask “How do I mark this on my calendar”? This way you can lean into your “new normal” in terms of your cycle and can anticipate different patterns than you may be used to.
Does a woman who continuously misses a period in perimenopause years need to mark her calendar accordingly?
According to halacha, if 90 days have passed, and she has not had any cycles due to her age, she is considered a woman who is not expected to bleed.
âShe then follows the halachos of what is called a zekeina, an older woman. This means that she is not required to keep the halachos of the calendar (the Onas HaVeses), unless/until she once again has three cycles that are less than 90 days apart. At that time she is required to resume keeping the laws of the calendar until she again goes 90 or more days with no cycle.
If she has three cycles that are themselves 90 days or more apart, she should consult her Rav on what to do regarding her calendar.
What is the Halacha if a woman has a Fixed Cycle = a Veses Kavuah and then has irregular periods?
If a woman has a Veses Kavuah, she should consult her Rav, as soon as she misses even one cycle and again as soon as even one cycle resumes. She should see her doctor to ensure that any irregularities in her period or missed cycles are actually due to perimenopause and no other medical reason.
Can a woman become Niddah after menopause?
Once a woman has gone 12 months with no cycle only then is she considered to have reached menopause. Anytime there is vaginal bleeding after menopause it should be brought to her doctor's attention immediately and once there is a medical determination for the cause of bleeding a Rav should be consulted on how to proceed regarding her nidda/taharah status.
After menopause there are still several scenarios in which a woman can enter niddah status. Anytime a woman becomes niddah, including during/after menopause, she must follow the usually protocol to attain taharah: âwait the five-day minimum, do a hefsek tahara, count seven clean days, perform full chafifa, and immerse in the mikvah. Only then can she be declared taharah, and resume intimacy with her husband.
âEven after menopause any gynecological issues, such as fibroids and polyps, may cause bleeding. Some of these conditions will be considered niddah and some not, depending on where the blood is originating from. Again, a Rav should always be consulted.
âAny gynecological procedure that is performed, aside from a routine pelvic exam, may render a woman niddah. A Rav should be consulted regarding any scheduled gynecological procedure. In the case of âan emergency gynecological procedure, before going home she should get all the details of what was done and relay the information to her Rav who will then advise her if she needs more details or if he has enough information to make a psak regarding her status. A woman should never ignore vaginal bleeding at this point.
Marriage and Remarriage in Menopause Years
If a woman is getting remarried in menopause years, even if she was married before and never went to the mikvah again after her last period, she must go to the mikvah âprior to her remarriage due to what the Gemara calls dam chimud, a small discharge of blood that may occur due to the excitement of getting married.
What is a trauma that requires checking for blood in menopause years?
Any emotional trauma requires a woman to check herself. For example a tragedy - lo aleinu, or someone close to her passes away, r’l, or being involved in an accident, among other things, can cause trauma which can bring on a period. Our bodies are reactive to emotions which can trigger the release of hormones, and create questionable or unexpected situations. A woman should always consult her Rav to determine what to do in such a case.
As you can clearly see from the discussion above, it is of paramount importance to have a doctor who will be patient enough to guide you through this transitional stage of life, and a Rav with whom you are comfortable reaching out to as the need arises.
Mrs. Esther Piekarksi on the Emotional and Hormonal Aspects of Perimenopause And Menopause:
What are emotional aspects that come up during this time in a woman’s life?
The sharp hormonal changes a woman experiences in this time trigger hot flashes, mood swings, and a grieving period for the loss of her childbearing years. There are women who were not blessed with children and there are woman who had a different number of children than she imagined.
Single, never-married women that go through menopause experience a unique pain of neither having been married, nor having children. We have to acknowledge and make space for this experience.
Part of the grieving process is giving up on dreams, whether it is not having had children or having birthed a different amount of children than previously envisioned. So it is saying goodbye, and letting go, to a certain potential aspect of their lives.
We are in a generation where people get married later in life than they did 50 years ago. They may need to say farewell to the potential of having children. There is also the fear of aging which can bring up many questions and uncertainties. Additionally, the fear arises of having children later in the reproductive cycle (from ages 42-47) when it is statistically common to have a child born with irregularities such as Downs Syndrome and other often age related conditions.
Insomnia, a common symptom of perimenopause and menopause, causes a lot of tension and emotions. Women are typically not as regulated and calm as usual.
In larger families a woman may be juggling marrying off children while raising a toddler and teen-ager. Dealing with the unknown of the road ahead is another emotional fear that is common in this time.
Women in today’s world tend to get stressed more quickly by day-to-day events. Anything out of routine causes an emotional reaction and I often help the people I speak with to calm down, and normalize what they’re going through. People tend to have anxiety if their period is off by just a little bit, and sometimes women’s imagination gets the best of them. This can add to the tension, emotion and stress. It is important to develop the tools to help center yourself, calm down and not let your imagination control your mind. Ask yourself, “What helps me calm down when I’m nervous?” - maybe a walk, or breathing deeply for a few moments, sitting down with a hot beverage, putting on relaxing music- these simple interventions can be very impactful.
As Kallah teachers, we explain the beauty of going to the Mikvah including the anticipation of being with her husband again following the period of separation. Some women are afraid of what it will be like when that buildup of excitement goes away in menopause. On the other hand, it is more common now to get married later in life so there are women who have not experienced decades of being in a rhythm of separation and coming together intimately with their husbands. The adjustment to the on and off rhythm of intimacy may not be as smooth.
Some women are afraid of what it could mean to always be available, intimately. Life expectancy is longer now, and a woman can calculate from the start of keeping the laws of mikvah until menopause that she may have double the amount of years without Mikvah so there is the very real question of what will my life look like without the rhythm of Mikvah.
And I’ve had women who were pregnant and nursing for many months without needing the mikvah who’ve said that the quality of their relationship with their husbands felt deeper when they were in the Mikvah rhythm.
Some women even miss going to the mivkah while pregnant and nursing, and some women are looking forward to the menopause years when the kids are out of the house and there are less demands on the couple’s time. Then when the moment finally comes, sometimes, a couple's expectation of being completely unrestricted is a bit less exciting than expected.
What are some tips for women to help them get through this emotional time?
Like Mrs. Klein said, get a good medical practitioner who is calm and understanding. Take an approach of going above and beyond- lechatchila ariber.
Avoid panic and stress and remember that you can transcend this. Medical literature often speaks of middle-age crisis and empty-nest syndrome in early menopause years. These statuses don’t necessarily apply to everyone. As religious women,this is a time many of us begin to marry off our children and our house does empty somewhat. But as Jews we value hachnasat orchim, and being family oriented mean that often the married children visit and grandchildren are often in the home. Shabbosim can be busier than the weekday which offers a nice balance when perhaps you want to enjoy both time with the family and guests and still enjoy alone time with your husband and yourself. Yes, the house may be quieter but it’s not completely empty. Sometimes a woman may go through a career crisis. Years ago, women were primarily homemakers, and now women are holding powerful positions in the workforce thus adding another dimension to the menopause years.
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In the secular world, a woman in perimenopause years is going through many changes simultaneously. She has finished raising children, doing carpools, going to sports practices, cooking dinner and packing lunches. Now, not only did she complete her menstrual cycle, she's also sending the kids off to college and she often experiences empty-nest syndrome. In the secular world there is a high rate of divorce at this time, which is correlated with the convergence of these factors.
Whereas, in the religious world there are protective factors because often women at perimenopause age are still raising children, and life goes on despite the changes.
The conversation around this stage of life is supportive and mentors and peers alike can encourage women to see the beauty in this time. Yes, there is a bit of grieving at the thought that the childbearing years are behind us. Our grown children may not be in contact with us the way we might have hoped for. Our children may live far away and we may not get to see them so often. This calls for the need to let go of a vision we held, even slowly.
This shift also offers the space to embrace other opportunities, to get involved in areas where a woman may not have previously had the time. Another part of the grieving process is letting go of dreams. Our family life may not look the way we imagined it would be at this point in life.
It is important to take the attitude of acknowledging the shifting of life stages, to validate that shiftand not ignore it. Myself and a group of friends were talking and one person mentioned that she’s on hormone replacement therapy which can be helpful to some. Another was advised by her doctor to have her reproductive organs removed so as not to cause any problems further down the road (which today is not advisable. The procedure would only be advised if a woman is a candidate for a full hysterectomy due to a prolapsed uterus, or being at risk of certain cancers). After this conversation with my friends, I went to my doctor and asked if there was anything I should do medically to address this shift and he said, “ a woman like yourself who’s gone through so many pregnancies will be totally fine during perimenopause.” My pregnancies were not so easy and he reminded me that I built resilience during each one and advised me against other medical intervention. I responded to him, “with pregnancy, I endured hardship and afterwards I had a beautiful baby- there was an end goal. And after this stage what will I have?” He said, “knowing you, you’ll go through it and have a healthy attitude towards it.” So indirectly he led me to a healthy mindset on menopause. I realized, similar to pregnancy, this can be a time for a woman to develop newness in her life. I challenged myself to find the good out of all symptoms of perimenopause, staining, being short tempered and insomnia. This was my own personal experience, and again, each woman's experience, symptoms. medical and halachic advice will vary. In my case, my doctor challenged me and I feel that this is the idea of going above and beyond- lchatchila ariber- going into the stage with the attitude of: yes, it’s difficult and yes, something good will emerge.
Tips to Support Physical Routine and Health
Add exercise to your routine several times a week including pelvic exercise to support the changes of the body’s reproductive organs. Be mindful of your diet; add flaxseed which can reduce symptoms such as hot flashes, mood disturbances, and vaginal dryness. Add omega 3 fatty acids which support disruptions to the body’s digestion of fats which is common during menopause. Ensure to eat many fruits and vegetables. Strengthen muscles and bones as a preventative measure to osteoporosis. Assess your home and ensure there is nothing that can cause a fall, bones can be more brittle during menopause and beyond.
For many years, as women we cared for others. We continue to care for others in various ways throughout our life. Menopause is the time to have an added layer of caring for yourself. Strengthen yourself, physically, spiritually and emotionally. This is also a form of caring for the ones you love. Create a foundation for the future of your health; set yourself up for good health as you approach middle age. If perhaps you had an unhealthy habit that you could “get away with” perhaps the start of menopause is a time to evaluate whether that habit is still serving you productively.
Social and Self-Actualization Tips
Maintain your friendships. If you haven’t focused on friendship during your child rearing years, now is an opportune time to build new friendships.
Part of the motivation for preserving your physical and emotional health may be for the purpose of caring for aging parents. It can be difficult to witness parents age and deteriorate in health. Being well and strong both physically and emotionally can support this process.
I often advise women to very simply make a list of things that they enjoy, hobbies, classes etc. Now is the time to start reinventing yourself. Many medical books suggest radical changes, and I would say implement the changes in smaller, more manageable doses. Where your life still feels familiar, with the level of focus turned to yourself a bit more.
Hashkafa on Menopause:
On 28 Nissan, the Rebbe said, “I did everything I can now it’s up to you - do everything you can.” In a woman’s younger years when her period is more scheduled and predictable - we count the days to prepare for Mikvah. In a way, it is Hashem setting up our intimate lives, it’s very scheduled. In the perimenopause and menopause years the schedule goes away and then our approach to our marriage and intimate life echo’s the Rebbe’s approach to Moshiach- “We have to do all that we can.”
Marriages are not always automatic bliss. A good relationship constantly requires effort. It is as if Hashem says, “Ok, for many years, I was determining the dates and now it’s up to you to bring excitement and beauty to your marriage.” Similar to Moshiach, we have to work for it, we cannot simply wait on the sidelines. No matter at what age you married, whatever vessels were created in the beginning years of marriage are now utilized, when a couple can no longer rely on the built in rhythm of mikvah. Women are in a constant taharah status, almost like a Moshiach status wherein we have to do all that we can!
If your children are younger you may be wondering when things will calm down and the kids will be more independent. In menopause, you will find that the busyness of life and child rearing slows; when there is more time available for you and your husband to devote to each other the deeper closeness does not happen on its own, remember to put in the effort, even in small subtle ways to kindle and grow your marital connection. Investing into one’s marriage never stops, it’s up to husband and wife to take the steps to make it happen. Just like the process of bringing Moshiach. Sometimes you need to forget about spontaneity, and schedule time to be together. This may not feel romantic, and surprising but life gets busy and we get caught up in our responsibilities.
There are many things women can engage in to fill their lives and build depth. This is an added blessing of being connected spiritually as Torah learning is vast and endless; if you haven’t felt so connected spiritually during child rearing years now is a perfect time to build your spirituality for yourself and also for adult children who can benefit from parents as a spiritual anchor.
Having Children in Perimenopause Years
The mitzvah of Peru Urevu does not stop, if we are healthy and our husbands are in agreement then we may continue to have children. For women who have anxiety and fear over having children at this age, talk to your Rav, mashpia and doctor. Some women say to their Rav “the thought of having a child that’s not healthy is too much to bear”. If you decide to stop having children it is a halachic matter and should be discussed with a Rav; age is a factor that your Rav will take into account.
Autumn children, babies born to a couple at a later age, are definitely a blessing. Hashem chose you to have children at that age. If Rav and husband are encouraging then go ahead and have children. This is a very individual case by case decision.
You may encounter funny comments from others of pregnancy in your mid 40’s. Globally it’s more common to be pregnant even into the mid 40’s. Try glowing in happiness and lean into the bracha. Remember to claim your power over your mindset; don’t let the outside world determine how you feel. Give over the message that you are happy with about your pregnancy and you look at it as a blessing.
How does menopause change the intimate life of a couple?
Many women experience vaginal dryness. A lubricant can be helpful. Men also go through changes with age. It’s important to be more relaxed and easygoing. Getting in the mood may require more effort.
Moving into a time where the house is perhaps less full and quieter, gives yourself more time to devote to your intimate life. We may move a little slower with regard to intimacy and that’s ok, a slower pace does not mean intimacy is over. If necessary, there may be some medical interventions that can improve intimate life.
Final Mikvah Visit
The last time going to the Mikvah can be unknown and cannot necessarily be planned in advance. A woman with an early, medically induced menopause may have a better idea of when her last cycle will be. Hashem is the one who gives us a cycle along with the ability to have a monthly renewal and a yearning to be with our husbands. Now, Hashem places us in a state of menopause and it is our responsibility to find the good part of this season of change. It is a transition, transitions can be daunting and maybe even a little painful. This is one of the reasons for mezuzah, moving through doorways represents transition which needs an added layer of protection. During perimenopause, a woman should treat each Mikvah visit as her last one and increase her prayers, not out of fear, but rather gratitude to Hashem that I can do this mitzvah with deeper kavanah.
For women who haven’t had children, menopause can be even more painful.
We need to be understanding of this experience and hold space for this part of our population. It is helpful to have a good mashpia. Menopause teaches us that women are not created solely for the purpose of having children. The same G-d that created women determined whether, or not, a woman will have children as well as the number of children a woman will have. Validating that woman’s experience can help move her to a different place where she can access a shifted sense of purpose, one that transcends being a mother.
Other Resources for Menopause:
The Rebbe said that every woman is a Shlucha. When women wrote to the Rebbe that they are busy with child-rearing the Rebbe encouraged women to be involved in other endeavors as well, such as writing and organizing different community events. The Rebbe encouraged women not to be in a state of retirement and to be involved and maintain an active role in community building. The Rebbe gave us guidance in the realm of continuing to work, to not stop and to continue developing a sense of purpose and giving.
To reiterate what we mentioned earlier, don’t go it alone. Build the right support team for yourself including, friends, a Rav, mashpia and therapist. Don’t be afraid to ask for extra help when you need it. Now is your time to receive a bit more than you may be accustomed to. Cultivate your life to help you let go and come to a sense of peace and acceptance of the life stage you have arrived at.
For those that are married, include your husband in the process of menopause. Some husbands are empathetic and understanding. Simply explaining the symptoms and sharing openly, can be very helpful to both husbands and wives. There is a release that comes with telling someone you love about a challenge you are going through. Sharing with your husband creates an opportunity for him to receive and have heightened sensitivity to you and your symptoms. âDon't leave him out of the picture and don't carry the burden alone.
This is an opportune time to double down on simcha, emunah and bitachon. There is a wealth of Jewish literature and learning that delves into these topics.
As touched upon earlier, attitude is a critical component of menopause. Embrace it as much as possible. Ultimately, a healthy outlook is, as written in Tanya: the brain rules over the heart. It also rules over the body. Remind yourself over and over again that you’ll move through the challenges ahead. Some women actually feel great and maybe even better in menopause years.
Even if you're not a career woman, find a way to contribute. Look for areas to volunteer; as we know giving is receiving. We get a high from helping others in a very natural human way. The older years are the perfect time to give. Be proud of your wisdom and life experience and share it. Find a niche of your expertise that you’ve garnered over the course of your life, whether you do or not have an advanced degree. There is a lot of giving to be done and a lot of life to live.
Mrs. Chaya M. Klein is a kallah teacher and administrator for mikvah.org
Mrs. Esther Piekarski is a Shlucha in Tel Aviv, Israel and a kallah teacher and lecturer for over 45 years.
This is a transcript of a podcast on Mikvah.org. You can listen to the full recording here.