A ritual to honor wisdom

For many women, the transition from actively engaged 50-year-old to septuagenarian retiree is daunting. Not only are there the unpleasant physical changes of menopause, but there is the emotional challenge of watching children move away and begin their own families, while being left with the uneasy task of facing mortality.

Yet at age 60 or 70, women still have many years, if not decades, ahead of them to pursue new careers, hobbies and educational endeavors. What was missing for many was a way to celebrate this Jewishly.

Then, in 1986, the late Savina Teubal, a Los Angeles woman who was 60 at the time, created the simchat chochmah (“joy of wisdom”), a ritual that celebrates wisdom and what lies ahead in a woman’s life. In an article Teubal wrote that was included in the 1992 anthology “Four Centuries of Jewish Women’s Spirituality,” she explained how she created the ritual as a way to celebrate the transition into the next stage of life. 

“I created a ceremony, a rite of passage from adult to elder, to establish my presence in the community as a functional and useful human being,” she wrote. “The ritual also served some personal needs: that of facing my mortality, for instance … I felt that a crone ceremony filled a significant need in our society.”

In the nearly three decades since Teubal created this ritual, women in the Reform, Reconstructionist and Renewal movements of Judaism have chosen to celebrate a simchat chochmah at the beginning of either their seventh or eighth decade of life, reclaiming their importance in society as holders of wisdom and productive members of the community. 

Although there is no standard way to celebrate, many women base their ceremonies on Teubal’s blueprint. One common feature is the presence of the song, “L’chi Lach,” at some point during the festivities, as well as shared personal reflections on life from each of the participants.

Part of the preparation for the ceremony involves religious study. Women celebrating their simchat chochma often choose to focus on the stories of strong, older women in the Torah, and use that as a jumping-off point for reflecting on their own lives as mature women in a Jewish context.

Among those who have had the ritual is Nancy Federman of Westlake Village. On June 8, she and three of her closest friends — Frima Telerant, Patty Kaye and Judy Maller — celebrated their simchat chochmah together at First Neighborhood Community Center in Westlake Village, a venue that comfortably held all 200 guests and had plenty of outdoor space for dining, dancing and shmoozing after the service.

“We wanted to do something special to mark our 70th birthdays with a Jewish ritual, with each of us doing something new that we had never done before, like wearing a kippah or tallit, or reading Torah aloud in public,” Federman said.

After a service that consisted of prayers, blessings, Torah readings and shared personal reflections from each woman, there was a ceremony that involved activities such as tree planting, singing, traditional dancing and, of course, lots of delicious food. The women also gathered six barrels worth of nonperishable food items to donate to Jewish Family Service’s SOVA Community Food and Resource Program. 

The entire planning process, from start to finish, took two years, but it was worth it, according to Federman.

“To me personally,” she said, “the simchat chochmah was an opportunity to celebrate not only a significant birthday, but also to share my strong Jewish identity with family and friends, and reaffirm my faith and the mitzvot I perform. And it did just that.”

The women all met each other between 20 and 40 years ago, through a mix of religious studies courses and well-timed introductions via mutual friends.

“We realized a while ago we were the same age, born in 1943,” said Kaye, also of Westlake Village. “We celebrated our 60th and 65th birthdays with a getaway trip, but wanted to do something very special for our 70th.  We also wanted to do something Jewish. Because we are close friends, we felt that we would enjoy planning and holding this wonderful event together.”

Federman was aware of the ceremony, and shared the idea with the other women. They then watched “Timbrels and Torahs,” a 2000 film about the ritual, and started planning in earnest from there.

During the ceremony, each of the women shared their reflections with family and friends in a different way.

“I used ideas of community, transition and friendship,” Kaye said. “I spoke of my mother, who at 101, was present. I also stressed how extended family and good friends have influenced my life, and how I hopefully will continue to learn from all of them.”

Maller, who lives in Encino, spoke about a specific Shabbat experience that she and her husband had in Lublin, Poland.

“We had Sabbath services in a popular restaurant in the old city. There was a klezmer band that was rocking, and the place was packed with Polish people stamping their feet and clapping to Yiddish and Hebrew music and participating in a Jewish service. I thought of those people struggling to become Jews again in a place like Poland. This celebration was a turning point in my life,” she said.

Telerant of Westwood talked about the women who had the greatest influence on her life — her mother, mother-in-law, friends and daughters — and how they, and Judaism, taught her how to navigate the difficult intricacies of the world and the relationships within it. 

“I hope that the traditions and values of Judaism which have enriched my life are embedded in my children and that they will teach them to theirs. Living Jewishly has given shape and meaning to my life and to theirs,” she said. “Whatever the future brings, I know that I will be able to deal with the challenges ahead because of my faith, my traditions, my family and my friends.” 

Researchers stop biological clock during chemo

Girls as young as 14 who are exposed to chemotherapy for treating breast cancer, Hodgkin’s disease, and other non-malignant diseases such as lupus, put their reproductive system at risk. The chemotherapy can trigger premature menopause and leave women infertile.

New research by an Israeli team of doctors, led by professor Zeev Blumenfeld from the Rambam Medical Center and the Technion Faculty of Medicine in Haifa, has found an effective new treatment that helps keep a woman’s reproductive health intact while undergoing aggressive chemotherapy treatment.

Blumenfeld and his colleagues have found that a monthly injection of a gonadotropin-releasing hormone (GnRH) agonist before and throughout chemotherapy treatment can reduce the risk of premature menopause from 50 percent to less than 8 percent.

Blumenfeld and his colleagues compared ovarian function in a group of women with Hodgkin’s lymphoma receiving a monthly injection of a GnRH agonist. The women were given the injection before the start of chemotherapy until its end. Researchers compared these women who were treated with a similar dose of chemotherapy against Hodgkin’s, but without the GnRH agonist.

As reported in the journal Fertility and Sterility in January, only 3.1 percent of women in the GnRH agonist group developed premature ovarian failure. In contrast, 37 percent of the patients who did not take the GnRH agonist developed premature ovarian failure.

The researchers also found the treatment works in women with breast cancer and leukemia.

“We’ve just published a unique report of a young Israeli woman who had two bone marrow transplantations. She underwent a very aggressive chemotherapy treatment,” Blumenfeld said.

“With only one bone marrow transplantation, there is more than a 96 percent chance she would become menopausal and unable to have children. We put her on a GnRH agonist and now we were lucky to find that she is pregnant again with her second child. This is an exceptional case and probably the first worldwide of spontaneous conceptions after two bone marrow transplantations in the same patient.”

A GnRH agonist is a synthetic peptide modeled after a brain neurohormone that stimulates the pituitary gland to release hormones. The peptide has been used in a number of ways from delaying puberty in very young children to managing female disorders such as menorrhagia and uterine fibroids. It is also used in in-vitro fertilization treatment.

Doctors have long speculated that women who have been pretreated with GnRH agonists could be spared from suffering the lasting effects of premature menopause. The recent Israeli study strengthens the scientific argument.

Given to women from the reproductive age of 14 to 40 years, the GnRH agonist was able to suppress the menstrual cycle and temporarily create “a pre-pubertal hormonal milieu,” Blumenfeld said.

Due to a decreased count of platelets, a side effect of chemotherapy, the GnRH agonist injection also prevented the severe menstrual bleeding associated with chemotherapy, Blumenfeld found.

Currently, there are three other methods for preserving fertility in women exposed to chemotherapy and include preserving both unfertilized and fertilized ova. None are extremely successful. This new treatment developed by Israeli scientists could increase the likelihood that a sick woman will one day be able to conceive when she recovers.

Fertility and health is an important focus for Israeli scientists. Last year an Israeli team from Hadassah University Hospital in Jerusalem were the first who succeeded in removing eggs from pre-pubescent cancer patients — some as young as 5 — and bringing them to maturity before freezing them, giving the girls a better chance to one day have children.

According to Dr. Ariel Revel, from the in vitro department at Hadassah, until now scientists had thought viable eggs could only be obtained from girls who had undergone puberty.

Blumenfeld is a friend of Revel’s, and acknowledges that Israel is a worldwide leader in the field of fertility. He says that Israeli fertility clinics see in comparison to the population size more IVF cycles than any other country in the world — about 1,500 cycles per one million people.

“We think we are the leader,” Blumenfeld said. “Both the Israeli Jewish and Arab Israeli population are faced with social pressures to have more children. Maybe for this reason our reproductive technology and research is very developed.”

Karin Kloosterman is the associate editorial director of ISRAEL21c, a media organization focusing on 21st century Israel.

Femarelle drug treats menopause onset osteoporosis sans hormones

The connection between menopause and osteoporosis is well-documented. At the onset of menopause, following the decrease of estrogen in the body, the bone undergoes a yearly decline of bone mass density (BMD) of 2 percent to 3 percent a year in the first seven years following menopause. This leads to the development of osteoporosis, which affects 50 percent of postmenopausal women today.

Slowing the process of bone loss, while alleviating menopausal symptoms, requires a therapy that targets the physiological mechanisms affected by estrogen. And the general treatment prescribed by doctors has traditionally been hormone therapy.

However, a consensus is growing throughout the medical world regarding the increased risk of blood clotting for women taking hormones. Fifteen percent to 20 percent of women have a genetic history of blood clotting, and many recent studies point to increased health risks associated with hormone therapy.

“Unfortunately, hormone therapy has risky side effects for some women,” said Dr. Israel Yoles, an Israeli gynecological expert who practices at the Sheba Medical Center and runs the Ashdod Center for Women’s Health. “Hormones increase the risk of clot formations, which can lead to stroke.”

As one in five women are exposed to such life-threatening risks, physicians have faced a major dilemma regarding how to manage the symptoms associated with the onset of menopause.

“The medical community is anxious to find a solution, which can fight the acute symptoms of menopause without increasing chances of blood clotting,” said Yoles, who is also the medical director of Se-cure Pharmaceuticals Ltd., a company that has developed a dietary supplement that it believes could be the solution.

Se-cure’s flagship product, Femarelle, was launched in 1999 and is now available in 15 countries, including the United States. It is derived through a unique enzymatic procedure that creates a specific biochemical composition proven to combine the treatment of menopausal symptom relief and bone loss.

“Femarelle activates the estrogen to relieve menopausal symptoms and help prevent osteoporosis, but it won’t activate the estrogen where it’s not wanted, like in the breasts or the uterus,” Yoles said.

He explained that for such a therapy to be safe, it must be selective — affecting estrogen receptors only in specific sites without affecting tissues where any change can have dangerous consequences. Which is exactly what Femarelle does — acting as a novel selective estrogen receptor modulator (SERM) drug.

“The idea behind the category of SERM drugs was to produce a compound which acts selectively in activating estrogen in various parts of the body,” Yoles said.

Femarelle has been proven in clinical studies to exert stimulatory activity on the estrogen receptors that control menopausal symptoms and the process of bone buildup, while having a blocking effect on estrogen receptors in the breast and the uterus. Moreover, Femarelle was shown to have a unique mechanism of action on bone buildup through increased osteoblast activity, having a direct effect on bone formation.

“We’ve shown it’s efficacy and safety in numerous clinical trials and can now say that Femeralle effectively treats menopausal symptoms and elevates bone mass density, but at the same time selectively delivering the estrogen to the body,” Soles said.

In October, findings of the effectiveness of Femarelle were presented to the international medical community at the seventh Congress of the European Society of Gynecology in Paris by Dr. Lila Nachtigall, former president of the North American Menopause Society (NAMS) and director of the Women’s Health Center at New York University.

“She’s well known around the world for her work in menopause studies,” Soles said. “Her studies have shown that women who displayed no clotting problems responded to oral estrogen fine. But women with borderline clotting signs had accelerated clotting signs after taking the estrogen. The tendency to produce clots is aggravated due to taking oral estrogen.”

However, Nachtigall’s recent study on Femeralle, which was presented in Paris, showed that when given the drug instead of oral estrogen, the women with borderline signs showed no increased clotting signs.

“People who heard the presentation in Paris were very excited about the results,” said Yoles, who attended the meeting with Nachtigall. “And just as importantly as the results on its efficiency, the study showed that Femarelle was safe.”

That point is of utmost concern for both Yoles and Se-cure CEO Ron Gutterman, who founded the company in 1997.

“The new generation treatments need to show evidence of more than therapeutic relief; proof that the risks do not outweigh the benefits of treatment is at the forefront of consumer concern,” said Gutterman. “The new age drugs are expected to integrate treatment of the different mechanisms involved in illness and to target the cause of an illness, rather than only its symptoms. The successful development of Femarelle has cemented this concept.”

“What we’re saying, ultimately, is that if a doctor prescribes hormone therapy, then fine,” Yoles said. “But there is growing concern among both doctors and women who are hesitant to take the hormone treatment. So try Femarelle as first line of treatment. It’s been proven to be safe and effective.”

David Brinn is editor of ISRAEL21c, a media organization focusing on 21st century Israel.

Top 10 Things to Do Before the Change

No matter where you are in the menopause transition, it’s never too late (or early) to get your health act together to ensure the next 40 or so years are as terrific as or better than the first were. Here are 10 things you can do right now.

1. Choose the right health-care provider

Perimenopause is the perfect time to find a health-care provider you can trust to help you manage any serious medical problems, should they arise in the future. Ask your friends for recommendations or check out the NAMS list of credentialed Menopause Practitioners (

Menopause Goes Mainstream

After years of being talked about in hushed tones as “the change of life” — or not being talked about at all — menopause is now in the spotlight. Two recent plays, “Is it Hot in Here … Or Is it Me?” and “Menopause the Musical” literally put menopause center stage. A support group at Cedars-Sinai Medical Centers, called “Red Hot Mamas,” is part of a nationwide program. There’s even a World Menopause Day.

So it’s no surprise that the topic is also being explored in a Jewish context as women increasingly look to their tradition for meaningful ways to mark this transition.

“Jewish tradition has been silent for a lot of years about menopause and other biological passages that women go through, and the losses and stresses that these passages represent,” said Rabbi Debra Orenstein, spiritual leader of Makom Ohr Shalom in Tarzana.

“In the last 25 to 30 years, we’ve begun to fill in some of these gaps. Menopause touches on getting older, on loss of fertility, on mortality and femininity. Judaism has a lot to teach about these themes.”

Using Jewish sources and existing traditions, rituals have been created to recognize menopause as well as childbirth, abortion, miscarriage, retirement and a host of other biological milestones and significant life events that have not traditionally been formally acknowledged. While many women are creating their own ceremonies, an increasing number of books provide suggested formulas and inspirational readings. Ceremonies can range from a simple blessing to an elaborate seder.

“Many menopause rituals draw on Pesach metaphors, and many use mikvah. There are also menopause prayers based on new moon blessings and tkhines [Yiddish women’s prayers],” noted Orenstein, who edited “Lifecycles Volume 1: Jewish Women on Life Passages and Personal Milestones” (Jewish Lights Pub, 1998). Examples of seder-based ceremonies can be found on the Web site Ritualwell.org. One incorporates expanded meanings of such Pesach symbols as the four cups of wine, the four questions, the shank bone and matzah.

Regarding the middle matzah, author Shoshana Silberman writes, “One section will stand for a part of me that is gone. The other section will stand for what lies ahead. These parts will be united at the end of my journey.”

Other ceremonies focus on the mikvah.

“More and more women are discovering the mikvah as part of marking — of moving from one stage of their lives to another,” said Penelope Oppenheimer, supervisor of the Rabbinical Assembly’s mikvah at the University of Judaism. “Mikvah represents the womb of the Jewish people. So when you come to the mikvah you’re actually being reborn, which opens itself up to the idea that you are emerging into a new self. It isn’t a matter of losing things, but of going toward something that’s new and exciting and different … and that has worth as a Jewish experience.”

In addition to ceremonies around Passover and the mikvah, women are creating their own Jewish interpretations. Speech therapist Linda Kaufman created and participated in a midlife ritual along with five other women as part of a class at the Academy for Jewish Religion in Riverdale, N.Y.

“We looked at the roles we’d played up to this point in our lives, and what we wanted to commit ourselves to [now],” Kaufman said. “I thought it was transforming.”

As a result of her experience, she helped start a Lifecycles Havurah for women at Makom Ohr Shalom.

So why has it taken this long for Judaism to recognize such integral moments of women’s lives? Both Oppenheimer and Orenstein agree that pointing to a patriarchal society is too simplistic. Oppenheimer says the lack of rituals around menopause may have resulted from the “inherent value of modesty at a time when menopause was considered a very private matter.”

Orenstein noted that menopause is a relatively modern phenomenon. Women continued to have children throughout their lives, which were much shorter in ancient days. But in our time, the lack of recognition of such events as miscarriage or menopause has caused many women to suffer in silence.

“Making ritual available takes away any aspect of shame,” Orenstein said.

She believes that rituals for these occasions “provide a communal way to address” such major life transitions.

Orenstein said there is no “standard” menopause ritual at this time because it hasn’t had time to evolve. By contrast, naming ceremonies for girls have been occurring much longer and versions are offered by the Reconstructionist, Conservative and Reform movements.

“It wasn’t until the 1998 edition that the Conservative rabbi’s manual offered a full-blown ceremony for naming a baby girl, as well as prayers for grieving miscarriage and stillbirth,” Orenstein said. “My hope is that the next edition will include prayers for [getting older] and menopause, too.”

In the meantime, she said, women who sit down to create their own rituals learn about and forge a stronger link with their tradition. And that’s something worth celebrating.