THE MIDLIFE BIBLE - A Woman’s Survival Guide by Michael P Goodman, MD, (http://www.caringforwomyn.com/book) Robert D Reed Publishers, Bandon, OR 97411 (www.rdrpublishers.com), © 2004, ISBN: 1-931741-32-8, 276 pp.

Review by Del Meyer, MD

Rudy Manikan (Indian Church Leader)

The cover story in a recent U.S. News and World Report, "The Menopause Maze - What Women need to Know Now - New Risks and Rewards of Treatment," leaves women as confused as ever. The Women’s Health Initiative (WHI) study had enrolled 161,000 women. Recently 11,000 women on the estrogen arm of the study received a letter that the study was being stopped prematurely. This highlights the controversy around Women’s Health.

In her Foreword to Dr Goodman’s book, the author of It’s My OVARIES, Stupid!, Elizabeth Lee Vliet, MD, states "‘Midlife’ women’s health isn’t a simple subject. This is a time when change impacts all dimensions of our lives. But at the most fundamental biological level, it is a time when our unique hormone changes are creating incredible and complex interactions between the physical, psychological, social and spiritual aspects of our being. . . " ". . . I write this foreword not just as a physician and scientist. I also write as a woman who has been there with the tribulations and challenges of ‘menopause.’" I am a ‘midlife woman’ who is on the journey, along with you readers. I have lived it firsthand. I know what it is like to go through the tumult of erratic cycles and feel like my body belongs to an alien creature. I know what it is like to feel ‘sharp’ and then suddenly feel like a switch has been flipped and my brain turned to mush, trapping and holding my words and thoughts hostage with yet another hormone shift. . . I know what it is like to struggle to find hormone balance amidst life stresses, a changing body and multiple medical problems. It isn’t a simple matter. There isn’t one simple answer that works for every woman. What works for you will be different from what works for your friend. Women facing the challenges of midlife have much to consider. It IS a life-changing time - positive, negative, and all points in between these opposites."

In the introduction to The Midlife Bible, Dr Goodman provides personal background that explains the genesis of the book. He left private practice after 25 years. Part of this decision was due to self-imposed restrictions on patient care as a result of the love/hate relationship between the medical profession and HMOs. He began contracting with large health-care systems doing routine gyn appointments because they were "backed up" for over six months. His other job was as an obstetrical hospital intensivist with a group of perinatologist (the specialty that focuses on the period around the time of birth). This job provided him with 24 hours of a non-stop obstetrical rollercoaster with side-dishes of gyn disasters. In contrast, he thought the Kaiser HMO low-key office work would provide a suitable counterpoint. Although the realm of independent private practice in the brave new HMO world was a memory, he would never enter that arena again. The lion’s share of his work at Kaiser involved annual exams and midlife problems of a group of people deemed as problematic in the world of managed care because they took too much time: women in their 40s and 50s.

Although Goodman respects Kaiser for so successfully and stably providing quality, low-cost medical care for so many years, where they and the entire managed care system fall short is the provision of care to/for women in midlife and other individual situations which require time, patience, and the ability of the practitioner to listen to and talk with (not at) the patients. It is virtually impossible in the managed care world of 15-minute office visits for a physician well versed in the alternative regimens for the travails of midlife, to have patients participate in a well-crafted therapeutic regimen.

Goodman left his assignment with Kaiser- Permanente after six months. When he asked for a letter of reference for a position at another Kaiser facility, his chief demurred, stating that he took too much time with his patients. "The worst part, however, according to her, was that after I left, the patients I had seen were not happy with their subsequent providers. It seemed I had taken more time with them, listened to them, actually answered their questions, and allowed them to participate in a therapeutic plan; altogether NOT in the managed care treatment mode. In short, I had not become ‘Kaiserized’ (... ‘managed care-ized’)."

"In this context, I realized that health care for women, providing the time and surroundings to help, enable, and empower this passage, was simply not available in the two-million plus geographic area in which I lived."

"It was at this point that the need for a 'listening' practice, with easy availability of prolonged office visits, first came to mind. Out of this realization, 'Caring for Women' was born and I re-entered, as an independent practitioner, the arena of private practice."

It was at this time that Goodman was compelled to peruse available literature relating to the feminine midlife. "Nowhere, however, in the over 50 texts I reviewed, did I see a complete but concise, informative, readable, up to date, inexpensive book that covered ALL of the issues of feminine midlife. PMS. Peri-menopause and menopause. ‘Natural,’ nutritional, lifestyle and hormonal approaches. Bone density problems. Sexuality issues. Fatigue states. Stress. Vulvar pain problems. Incontinence and prolapse (when the uterus falls from its normal position). Late childbearing. Relationship issues. What’s brand new and what’s on the horizon. How, as a midlife woman, to get what you need from the managed care system. One that specifically helped the reader to see the path that was safest and best for her."

"Passage through midlife," Goodman writes, is "rather like surfing. A lot of paddling, sometimes sun, sometimes clouds. Always salt water. Waiting, treading water. Then riding the wave. Hopefully cruising, but sometimes crashing. Up and down, riding it in. Hopefully in control; frequently out of control. Feeling your own power and powers out of your control.

Midlife is certainly a time of transition. Transition from fertility to maturity. From youth to older age. There is no reason why life, if it’s good, cannot continue to be good. And if it’s crap-why it can’t be modified or changed."

Nature (or fate) periodically provides windows of opportunity for us to take stock of both our physical and spiritual lives. For a woman, menopause is one of those windows which may either be a peep hole or a floor-to-ceiling vista, depending on attitude and circumstance.

Goodman says this is not just another book about menopause. The Midlife Bible covers most of the issues encountered by a woman passing through midlife. It should also be read by her partner. It appears that Goodman has covered a lot in a readable fashion that our "Midlife" patients will find helpful. Be sure to order your copy of The Midlife Bible, at http://www.caringforwomyn.com/book or http://www.rdrpublishers.com/cgi_bin/books.cgi?db=books&uid=default&view_records=1&keyword=goodman&Submit=Search.