Women can be their own health protectors without suffering through life-threatening scares like the one Karen survived, but with knowledge. It's time to remove the blinders from both sides of this partnership. Women are no longer Victorian maidens and doctors don't have to examine them under covers anymore. It isn't necessary for gynecologists to be as remote as historian Carl N. Degler, author of Af Odds, tells us they were in the 1800s: "Most physicians, throughout the nineteenth century, in order to avoid any charges of impropriety, bent over backwards not to appear too familiar. As a result, lights were dim during the examination, and the examination and delivery were by touch only; if instruments were used they had to be manipulated under covers! One male writer even pointed out proudly, in justification of modesty, that one of the greatest male obstetricians had been blind!" Dr. Fielding, with his impaired mental vision, acted like a man of the last century.
You probably won't find any blind obstetricians in delivery rooms today, but you may run into a lack of communication between a woman and her doctor, and that in itself is a kind of blindness that leading physicians are trying to cure. The best doctors are now realizing that they can only give women the most complete medical care if women are well-informed. A smart doctor won't automatically fit a woman with an IUD if she wants birth control; instead he'll explain all the different forms of contraception and together, they'll decide what suits her needs. An informed woman will want to feel in control of her body, will take time to listen to the latest findings, and will become one half of a better health collaboration.
Of course, the idea of a woman's having a command of herself is relatively new in America. When a woman talked about taking "control of her body" in the nineteenth century, she meant that she said "no" to her husband once in a while when he wanted sexual intimacy and she didn't. In older, European societies, women were bolder sooner. They were more conscious of their sexual options, the intricacies of their bodies, and their health. Openness between a woman and her doctor happened many years ago. In fact, not just women, but men and women were encouraged to learn more about medicine from their European doctors.
During the first half of this century, birth-control-champion Margaret Sanger let people know that sexual pleasure and procreation could be separated, and American men and women began to grasp their physical choices. The women's movement, which began in the late sixties, spawned important books like Our Bodies, Ourselves in the early seventies, and women began to understand their right to be outspoken. They also enjoyed a deeper comprehension of their bodies and their power. But equality in the doctor's office still hadn't happened.
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During the fertile years there is a gradual depletion of ovarian follicles, and hence the egg cells they contain. This process generally becomes more rapid from the age of 35. At the menopause only a few eggs remain. With the depletion of the follicles, the level of fertility is reduced and oestrogen deficiency begins. As the number of granulosa cells in the follicles reduces, inhibin production also decreases, very gradually. The level of follicle-stimulating hormone therefore changes little.
By the early forties the number of granulosa cells has decreased to such a degree that the level of inhibin they secrete will have fallen to a critical point; the level of follicle-stimulating hormone now rises. Although the menstrual periods may still be completely regular and no menopausal symptoms are being experienced, the rising follicle-stimulating hormone level represents the beginning of the peri-menopause.
As follicle depletion continues over the next few years the level of follicle-stimulating hormone will fluctuate, causing the menstrual cycle to become irregular. The amount of menstrual flow also alters, being sometimes lighter and sometimes heavier. By now the follicle-stimulating hormone will be approaching, or have reached, the point at which the peri-menopause can be said to have begun. Conception is now unlikely to happen. Oestrogen production usually remains near-normal in the early years of the peri-menopause, therefore symptoms associated with oestrogen deficiency, such as hot flushes and vaginal dryness, will not yet be evident. As oestrogen levels fall over the next few years the occasional hot flush, increasing tiredness and perhaps dizziness will occur, and menstrual periods may become more irregular with episodes of heavy bleeding.
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