Menopause And Old Age

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Islamic Medicine
Staff member
By Prof. Hassan Hathout

The word menopause literally means cessation of the menstrual function, and is only a single incident along a broader complex of changes as the woman grows older referred to as the climacteric, which spans perhaps several years. As normal menstrual function is the expression of cyclic hormonal changes associated with ovulation, it follows that the menopause usually heralds cessation of the reproductive function. The human female is almost unique amongst mammals (except some rare types of elephants and whales) in that her reproductive life does not continue althrough her biological life, and it is not uncommon for women to have more than one third of their lives after the menopause. Perhaps God's wisdom saw that woman's life should not be totally occupied with reproduction.

As a woman misses her period at an age when she expects the menopause, the differential diganosis of pregnancy should be considered. Period delays are a common feature preceding the menopause, and a woman should not consider herself immune to pregnancy just because of these period delays. Both medical science and Islamic jurisprudence require one year of cessation, of menstruation to consider that menopause has been established. A definite age limit beyond which menstrual function (and hence reproductive function) cannot continue has eluded both medical workers and muslim jurists. The American and British laws declined to define a cut-off age beyond which pregnancy is impossible, although it is known that fertility dwindles in the late thirties and approaches zero after fifty. And yet I and no doubt other obstetricians have looked after a patient who married after the age of fifty and gave birth to her first (and only) child at the age of fifty one. The child was a boy that had congenital pyloric stenosis, had a successful operation and was otherwise normal. Old Islamic writers had their views in this respect based on observation and on medical knowledge of their day, but without direct religious directive. Ibn-Qudama of the Hanbali school in his book "Al-Mughni': ascribed a saying to Aisha-wife of the prophet, claiming that women don't get pregnant after the age of fifty, while others raised the limit to sixty.

Unexpected occurrance of pregnancy, even after established menopause, should be extremely rare and is theoretically impossible. Reported cases are explained on the basis of bodily changes conducive though belatedly of an ovulation; a flash in the pan as professor Jeffcoate calls it. Such reports we did not find in medical literature but are referred to in the Quran of prophet Zakar.iya the Quran says:

"There did Zakariya pray to his Lord saying: O my Lord! Grant unto me from You a progeny that is pure: for You are the One to hear prayer. While he was standing in prayer in the chamber, the angels called unto him: God does give you glad tidings of Yahia, witnessing the truth of a Word from God, and noble, chaste and a prophet of the goodly company of the righteous. He said: 0! My Lord! How shall I have a son seeing I am very old and my wife is barren? Thus, was the answer, does God accomplish what He wills." (3:38-40)

The case of Sarrah, wife of Abraham, was perhaps more surprising because of her much older age. Sarrah was infertile and she chose Hagar for Abraham who begot Ismail for him. Abraham took Hagar and Ismail to Makka, later to build the Kaaba together as a house of worship to God (Ismail is the great grandfather. of Mohammad). Years later, after she was well past her menopause, Sarrah had her greatest and happiest surprise:

"There came Our messengers to Abraham with glad tidings. They said: Peace. He answered: Peace and hastened to entertain them with a roasted calf But when he saw their hands went not towardsthe meal, he felt some mistrust for them and conceived a fear of them. They said: Fear not; we have been sent against the people of Lut. And his wife was standing (there). And she laughed but We gave her glad tidings of Isaac, and after him of Jacob. She said: Alas for me! Shall I bear a child seeing I am an old woman and my husband here is an old man? That would indeed be an amazing thing. They said: Do you wonder at God's decree? The grace of God and His blessings be on you, 0 you people of the house! For He is indeed Worthy of All Praise, Full of All Glory." (11:69-73)

At another site the Quran also refers to Sarrah:

"Has the story reached you of the honoured guests of Abraham? Behold, they entered his presence and said: Peace! He said: Peace unusual people. Then he turned quickly to his household and brought a fat calf, and placed it before them. He said: Will you not eat? (When they did not eat) He conceived a fear of them. They said: Fear not. And they gave him glad tidings of a son endowed with knowledge. But his wife came forward (laughing) aloud: she smote her face and said: a barren old woman! They said: Even so has your Lord spoken, and He is Full of Wisdom and Knowldge. " (41:24-30)

Whatever the explanation of the mechanism underlying the belated pregnancy of the wife of Zakariya and that of Sarrah, the concept of the miracle is well taken by us muslims, for when God wills something He says: be and it is.

A legislation consequent upon a well established menopause concerns the ruling on the "Idda" or waiting period of the menopausal woman who has been widowed or divorced. During the childbearing period of life this would be three menstrual cycles following divorce and four months and ten days following widowhood. For the post-menopausal established in her menopallse by absence of menstruation for one year, the waiting period after either events is three months. We have already advocated the possible resort to an ultrasound examination as a confirmatory evidence that there is no pregnancy in the uterus. This would also help for the menopausing woman who gets her period every few months but has not completed one year of amenorrhoea yet.

"Such of your women as have passed the age of monthly courses, for them the prescribed period, if you have any doubts, is three months, and (is the same for) those who have no courses." (65:4)

Another legislation ensuing upon menopause is some leeway for the postmenopausal woman in the matter of strict observance of the rules of dressing referred to in a previous chapter:

"Such elderly women as are past the prospect of marriage, there is no blame on them if they lay aside their (outer) garments provided they make not a wanton display of their beauty: but it is best for them to be modest, and God is One who sees and knows all things." (24:60)

The climacteric is associated in nearly forty per cent of women with a number of symptoms of variable range and severity. Some are indications of the normal ageing process aftecting men and womtn, while others are the result of cessation of the ovaries to produce the female sex hormone, estrogen. The latter comprise the well known hot flashes due to vase motor instability and associated with a feeling as if hot water is poured on the face. neck and other parts of the body. Estrogen deprivation also plays a role in depletion of calcium trom the bones at a rate of perhaps one per cent every year causing a hump on the back. shortening of stature due to somewhat compressible vertebrae and more brittle bones more liable to fracture if traumatised. Psychological stress may also develop in some women and some allowance should be made if they are sometimes sharp or nervous. This is aggravated if the woman aquires a sense of unwantedness as the children have grown up, or the "empty nest syndrome" if the children have left the house, or insecurity in marital life as she feels she is ageing and can no more procreate. Considerate treatment is necessary, keep marital love warm if not fiery, and indulgance in useful activities is both opportune and fulfilling.

When the hot flashes are disturbing inspite of explanation and reassurance, estrogen may be given to alleviate them. Irresponsible use of estrogen, however, is not recommended for it is a drug that can cause side effects and is suspected by many of being possibly an endometrial precarclnogen.

We are aware of medical professionals who push it a bit too far and give estrogen (subcutaneous implants) for the purpose of stimulating sexual apetite. This does not seem to be justified, for although there is no age limit for sexual activity, husband and wife should enjoy it at their natural albeit slower-pace. To artificially kindle the tire, and in one consort only, sounds like the satiate (non-hungry person) artificially throwing out in order to be able to eat and enjoy food again. This focusing on oversensuality is both unnatural and unbecoming.

The ordeal of growing to old age is commoner in women than in men. The primary sex ratio (at conception) is about 130 males to 100 females. Attrition during pregnancy hits males more than females and 106 males are born to every 100 females. At puberty the sexes are about equal in number, but the tertiary sex ratio at death denotes that more men die than women of the same age, and in the various age categories in the old there are more woman widows than men. In communities where strong family ties still exist, it is a highly regarded value to extend tender loving care to an old parent. The case is not so in many societies, and aging has to be endured either in the prison of individual loneliness or of the old peoples, home. In a previous chapter we alluded to the horrible concept of the 'duty to die' when the human 'machine' has outlived its productive span. Although economically sound, this idea ifapplied will to a large measure dehumanize the human race, and lower its ceiling to the level of financial considerations instead of high values. As people attain higher and higher life expectancy with better health care, the problem of old age is growing, and more resources should be recruited to meet it, not only in terms of dollars but primarily of love, compassion and God awareness.
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