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Menopause
Menopause is an individualized
experience. Some women notice little difference in their bodies
or moods, while others find the change extremely bothersome and
disruptive. Estrogen and progesterone affect virtually all tissues
in the body, but everyone is influenced by them differently.
Hot Flashes
Hot flashes, or flushes,
are the most common symptom of menopause, affecting more than
60 percent of menopausal women in the U.S. A hot flash is a
sudden sensation of intense heat in the upper part or all of
the body. The face and neck may become flushed, with red blotches
appearing on the chest, back, and arms. This is often followed
by profuse sweating and then cold shivering as body temperature
readjusts. A hot flash can last a few moments or 30 minutes
or longer.
Hot flashes occur
sporadically and often start several years before other signs
of menopause. They gradually decline in frequency and intensity
as you age. Eighty percent of all women with hot flashes have
them for 2 years or less, while a small percentage have them
for more than 5 years. Hot flashes can happen at any time. They
can be as mild as a light blush, or severe enough to wake you
from a deep sleep. Some women even develop insomnia. Others
have experienced that caffeine, alcohol, hot drinks, spicy foods,
and stressful or frightening events can sometimes trigger a
hot flash. However, avoiding these triggers will not necessarily
prevent all episodes.
Hot flashes appear
to be a direct result of decreasing estrogen levels. In response
to falling estrogen levels, your glands release higher amounts
of other hormones that affect the brain's thermostat, causing
body temperatures to fluctuate. Hormone therapy relieves the
discomfort of hot flashes in most cases.
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Some women
claim that vitamin E offers minor relief, although there
has never been a study to confirm it. Aside from hormone
therapy, which is not for everyone, here are some suggestions
for coping with hot flashes:
* Dress in
layers so you can remove them at the first sign of a flash.
* Drink a glass
of cold water or juice at the onset of a flash.
* At night
keep a thermos of ice water or an ice pack by your bed.
* Use cotton
sheets, lingerie and clothing to let your skin breathe."
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Vaginal/Urinary
Tract Changes
With advancing age,
the walls of the vagina become thinner, dryer, less elastic
and more vulnerable to infection. These changes can make sexual
intercourse uncomfortable or painful. Most women find it helpful
to lubricate the vagina. Water-soluble lubricants are preferable,
as they help reduce the chance of infection. Try to avoid petroleum
jelly; many women are allergic, and it damages condoms. Be sure
to see your gynecologist if problems persist.
Tissues in the urinary
tract also change with age, sometimes leaving women more susceptible
to involuntary loss of urine (incontinence), particularly if
certain chronic illnesses or urinary infections are also present.
Exercise, coughing, laughing, lifting heavy objects or similar
movements that put pressure on the bladder may cause small amounts
of urine to leak. Lack of regular physical exercise may contribute
to this condition. It's important to know, however, that incontinence
is not a normal part of aging, to be masked by using adult diapers.
Rather, it is usually a treatable condition that warrants medical
evaluation. Recent research has shown that bladder training
is a simple and effective treatment for most cases of incontinence
and is less expensive and safer than medication or surgery.
Within 4 or 5 years
after the final menstrual period, there is an increased chance
of vaginal and urinary tract infections. If symptoms such as
painful or overly frequent urination occur, consult your doctor.
Infections are easily treated with antibiotics, but often tend
to recur. To help prevent these infections, urinate before and
after intercourse, be sure your bladder is not full for long
periods, drink plenty of fluids, and keep your genital area
clean. Douching is not thought to be effective in preventing
infection.
| Side
View of the Pelvis |
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| The side view
of the pelvis and its contents after menopause shows the
slight dropping of the uterus, bladder and rectum. Also
notice how the vagina becomes shorter and narrower.
Source:
W.Utian and R.Jacobowitz, Managing Your Menopause,
New York: Prentice Hall Press/Simon & Shuster, 1990,
p.29.
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Menopause and
Mental Health
A popular myth pictures
the menopausal woman shifting from raging, angry moods into
depressive, doleful slumps with no apparent reason or warning.
However, a study by psychologists at the University of Pittsburgh
suggests that menopause does not cause unpredictable mood swings,
depression, or even stress in most women.
In fact, it may even
improve mental health for some. This gives further support to
the idea that menopause is not necessarily a negative experience.
The Pittsburgh study looked at three different groups of women:
menstruating, menopausal with no treatment, and menopausal on
hormone therapy. The study showed that the menopausal women
suffered no more anxiety, depression, anger, nervousness or
feelings of stress than the group of menstruating women in the
same age range. In addition, although more hot flashes were
reported by the menopausal women not taking hormones, surprisingly
they had better overall mental health than the other two groups.
The women taking hormones worried more about their bodies and
were somewhat more depressed.
However, this could
be caused by the hormones themselves. It's also possible that
women who voluntarily take hormones tend to be more conscious
of their bodies in the first place. The researchers caution
that their study includes only healthy women, so results may
apply only to them. Other studies show that women already taking
hormones who are experiencing mood or behavioral problems sometimes
respond well to a change in dosage or type of estrogen.
| Studies
indicate that women of childbearing age, particularly those
with young children at home, tend to report more emotional
problems than women of other ages. |
The Pittsburgh findings
are supported by a New England Research Institute study which
found that menopausal women were no more depressed than the
general population: about 10 percent are occasionally depressed
and 5 percent are persistently depressed. The exception is women
who undergo surgical menopause. Their depression rate is reportedly
double that of women who have a natural menopause.
Studies also have
indicated that many cases of depression relate more to life
stresses or "mid-life crises" than to menopause. Such
stresses include: an alteration in family roles, as when your
children are grown and move out of the house, no longer "needing"
mom; a changing social support network, which may happen after
a divorce if you no longer socialize with friends you met through
your husband; interpersonal losses, as when a parent, spouse
or other close relative dies; and your own aging and the beginning
of physical illness. People have very different responses to
stress and crisis. Your best friend's response may be negative,
leaving her open to emotional distress and depression, while
yours is positive, resulting in achievement of your goals. For
many women, this stage of life can actually be a period of enormous
freedom.
What About
Sex?
For some women, but
by no means all, menopause brings a decrease in sexual activity.
Reduced hormone levels cause subtle changes in the genital tissues
and are thought to be linked also to a decline in sexual interest.
Lower estrogen levels decrease the blood supply to the vagina
and the nerves and glands surrounding it. This makes delicate
tissues thinner, drier, and less able to produce secretions
to comfortably lubricate before and during intercourse. Avoiding
sex is not necessary, however. Estrogen creams and oral estrogen
can restore secretions and tissue elasticity. Water-soluble
lubricants can also help.
While changes in
hormone production are cited as the major reason for changes
in sexual behavior, many other interpersonal, psychological,
and cultural factors can come into play. For instance, a Swedish
study found that many women use menopause as an excuse to stop
sex completely after years of disinterest. Many physicians,
however, question if declining interest is the cause or the
result of less frequent intercourse.
Some women actually
feel liberated after menopause and report an increased interest
in sex. They say they feel relieved that pregnancy is no longer
a worry.
For women in perimenopause,
birth control is a confusing issue. Doctors advise all women
who have menstruated, even if irregularly, within the past year
to continue using birth control. Unfortunately, contraceptive
options are limited. Hormone-based oral and implantable contraceptives
are risky in older women who smoke. Only a few brands of IUD
are on the market. The other options are barrier methods--diaphragms,
condoms, and sponges--or methods requiring surgery such as tubal
ligation.
Is My Partner
Still Interested?
Some men go through
their own set of doubts in middle age. They, too, often report
a decline in sexual activity after age 50. It may take more
time to reach ejaculation, or they may not be able to reach
it at all. Many fear they will fail sexually as they get older.
Remember, at any age sexual problems can arise if there are
doubts about performance. If both partners are well informed
about normal genital changes, each can be more understanding
and make allowances rather than unmeetable demands. Open, candid
communication between partners is important to ensure a successful
sex life well into your seventies and eighties.
| For
most women, natural menopause is not a major crisis and
does not influence their opinion of their general health. |
| In
a society that places so much value on youth and beauty,
it's not much fun to think about menopause. But when you
get there, you find it doesn't really make that much difference;
you concentrate on how you feel about yourself, not on
how you think others see you. I continue trying to improve
myself, to keep learning and keep active. It's not your
age that counts, it's how you handle it. |
Osteoporosis
One of the most important
health issues for middle-aged women is the threat of osteoporosis.
It is a condition in which bones become thin, fragile, and highly
prone to fracture. Numerous studies over the past 10 years have
linked estrogen insufficiency to this gradual, yet debilitating
disease. In fact, osteoporosis is more closely related to menopause
than to a woman's chronological age.
Bones are not inert.
They are made up of healthy, living tissue which continuously
performs two processes: breakdown and formation of new bone
tissue. The two are closely linked. If breakdown exceeds formation,
bone tissue is lost and bones become thin and brittle. Gradually
and without discomfort, bone loss leads to a weakened skeleton
incapable of supporting normal daily activities.
Each year about 500,000
American women will fracture a vertebrae, the bones that make
up the spine, and about 300,000 will fracture a hip. Nationwide,
treatment for osteoporotic fractures costs up to $10 billion
per year, with hip fractures the most expensive. Vertebral fractures
lead to curvature of the spine, loss of height, and pain. A
severe hip fracture is painful and recovery may involve a long
period of bed rest. Between 12 and 20 percent of those who suffer
a hip fracture do not survive the 6 months after the fracture.
At least half of those who do survive require help in performing
daily living activities, and 15 to 25 percent will need to enter
a long-term care facility. Older patients are rarely given the
chance for full rehabilitation after a fall. However, with adequate
time and care provided in rehabilitation, many people can regain
their independence and return to their previous activities.
For osteoporosis,
researchers believe that an ounce of prevention is worth a pound
of cure. The condition of an older woman's skeleton depends
on two things: the peak amount of bone attained before menopause
and the rate of the bone loss thereafter. Hereditary factors
are important in determining peak bone mass. For instance, studies
show that black women attain a greater spinal mass and therefore
have fewer osteoporotic fractures than white women. Other factors
that help increase bone mass include adequate intake of dietary
calcium and vitamin D, particularly in young children prior
to puberty; exposure to sunlight; and physical exercise. These
elements also help slow the rate of bone loss. Certain other
physiological stresses can quicken bone loss, such as pregnancy,
nursing, and immobility. The biggest culprit in the process
of bone loss is estrogen deficiency. Bone loss quickens during
perimenopause, the transitional phase when estrogen levels drop
significantly.
Doctors believe the
best strategy for osteoporosis is prevention because currently
available treatments only halt bone loss--they don't rebuild
the bone. However, researchers are hopeful that in the future,
bone loss will be reversible. Building up your reserves of bone
before you start to lose it during perimenopause helps bank
against future losses. The most effective therapy against osteoporosis
available today for postmenopausal women is estrogen (see Managing
Menopause). Remarkably, estrogen saves more bone tissue than
even very large daily doses of calcium. Estrogen is not a panacea,
however. While it is a boon for the bones, it also affects all
other tissues and organs in the body, and not always positively.
Its impact on the other areas of the body must be considered.
Cardiovascular
Disease
Most people picture
an older, overweight man when they think of a likely candidate
for cardiovascular disease (CVD). But men are only half the
story. Heart disease is the number one killer of American women
and is responsible for half of all the deaths of women over
age 50. Ironically, in past years women were rarely included
in clinical heart studies, but finally physicians have realized
that it is as much a woman's disease as a man's.
| Influences
on Bone Development |
| Increases
bone formation |
Speeds
bone loss |
| Dietary
calcium |
Estrogen
deficiency |
| Vitamin
D |
Pregnancy |
| Exposure
to sunlight |
Nursing |
| Exercise |
Lack
of exercise |
CVDs are disorders
of the heart and circulatory system. They include thickening
of the arteries (atherosclerosis) that serve the heart and limbs,
high blood pressure, angina, and stroke. For reasons unknown,
estrogen helps protect women against CVD during the childbearing
years. This is true even when they have the same risk factors
as men, including smoking, high blood cholesterol levels, and
a family history of heart disease. But the protection is temporary.
After menopause, the incidence of CVD increases, with each passing
year posing a greater risk. The good news, though, is that CVD
can be prevented or at least reduced by early recognition, lifestyle
changes and, many physicians believe, hormone replacement therapy.
Menopause brings
changes in the level of fats in a woman's blood. These fats,
called lipids, are used as a source of fuel for all cells. The
amount of lipids per unit of blood determines a person's cholesterol
count. There are two components of cholesterol: high density
lipoprotein (HDL) cholesterol, which is associated with a beneficial,
cleansing effect in the bloodstream, and low density lipoprotein
(LDL) cholesterol, which encourages fat to accumulate on the
walls of arteries and eventually clog them. To remember the
difference, think of the H in HDL as the healthy cholesterol,
and the L in LDL as lethal. LDL cholesterol appears to increase
while HDL decreases in postmenopausal women as a direct result
of estrogen deficiency. Elevated LDL and total cholesterol can
lead to stroke, heart attack, and death.
| Percentage
of Deaths from Specific Conditions |
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