MANILA, Philippines - I turned 40 recently. With the age came an occasional lower back pain, which intensifies each time I realize I have already entered a phase of great change.

I have heard stories about menopause, of how it transforms a woman into another being. Many surface from the tough years more empowered and with a richer appreciation for life.

Others find the process excruciating not only for themselves but also for their significant others whose lives are affected as well.

Yet many women are unaware of the earlier years when subtle changes actually begin. At times, the unease of these changes is dismissed as part of one?s everyday struggle at work and home.

The recently released book ?The Transition Years: Perimenopause in Filipino Women? (2008, University of San Agustin Publishing House), by Dr. Alice Sun-Cua, emphasizes the importance of giving attention to perimenopause?the earlier years of subtle yet profound physical changes. The book is the outcome of Sun-Cua?s more than two decades of OB-GYN practice.

Better lives

She presents data and case stories that allow women to identify symptoms and seek medical attention early enough to help them achieve a better quality of life.

In my own attempt to understand the subject, I consulted related books, most of them foreign publications.

While the female body may share a universal response to the ?transition years,? there
is still a felt distance from the ways these experiences are dealt with here and abroad. The worldview is different, as well as the philosophies behind remedies or treatment.

To bridge this knowledge gap, Sun-Cua designed a Filipino version of the Women?s Health Questionnaire developed in London to come up with findings on the different concerns of perimenopausal women.

What got me deeply interested in the book, despite the medical terminologies I had to struggle with at times, was the way Sun-Cua gives an ?insider? viewpoint on the issue through interviews with key informants. Her technique (no recordings included) encouraged women to talk freely about physical changes and the more intimate facets of their lives.

By carefully noting down the women?s specific concerns, she was able to zoom in on the variables and conditions that specifically affect Filipino women. Although I had to remind myself the book was medical literature, I could not help but imagine the stories of these women beyond what were revealed in the interviews. They became concrete entities, immediate and real.

While belonging to the 43-48 age group, the key informants came from different social levels. When I read through each interview, I noticed the women were not distinctly aware of the changes taking place in their bodies.

Many expressed their feelings in words many of us could at once understand?nalulungkot, nababalisa, kinakabahan at sobra ang niyerbos at tumatahimik na lang sa isang sulok?while attributing what they were going through to their relationships and environment.

Real people

I find these interviews as one of the many strengths of the book. What we see are real people who participate in the grit of life.

More importantly, I hear Sun-Cua?s voice as a poet and essayist in her interaction with the key informants. Despite what could have been an overwhelming medical undertaking, she is able to control and present the findings in a most readable form.

I also find sensitivity in her conceptual framework, in which she acknowledges the perimenopausal stage as a ?balancing act.?

The transition gives way to certain realizations over the benefit of others, such as attending to the needs of children and caring after aging parents, while also adapting to the many changes occurring within the body.

Yet in the findings, we read of these women as not overly anxious and accepting of the change in a more positive mindset.

That the study lasted for six months with 279 women responding to the Filipino version of the Women?s Health Questionnaire only attests to the high degree of the findings? validity.

In this regard, Sun-Cua breaks through a medical area that has suffered from a lack of well-researched data. And like any other groundbreaking study, her endeavor aims at encouraging other inquiries into the area.

Reading the book has been a learning experience for me. Not only am I grateful to know that my occasional back pains and moodiness can be part of this transition period, but that they can also be dealt with.

Change frightens and informs at the same time. And with books such as this to inform us, I am certain we would all come out of the transition years revived and renewed.

?The Transition Years? is available at Solidaridad Bookstore, Padre Faura St., or call the Department of OB-GYN, San Juan de Dios Hospital, Pasay City.

Dinah Roma-Sianturi is the director of the Bienvenido N. Santos Creative Writing Center of De La Salle University Manila, and assistant professor in the DLSU?s Department of Literature. Her poetry book, ?A Feast of Origins? (University of Santo Tomas Publishing House, Manila, 2005), won the National Book Award in 2006.