Menopause -- Fact or Fiction
A Major Turning Point
Menopause is one of the major turning points in a woman's life.
Some women dread reaching menopause while others look forward to it.
Some feel it is an affliction that will make them unattractive, lonely, helpless, and useless. They mourn the loss of their fertility and youth.
Other women discover that it gives them a new lease on lifephysically, emotionally, sexually, and spiritually. They are enthusiastic about becoming free of their concerns about pregnancy and premenstrual syndrome (PMS). Most experience a wide range of feelings, from anxiety and discomfort to release and relief.
If you are like most of today's women, you will live a third of your life after menopause. Planned Parenthood urges you to plan ahead for what could prove to be one of the most rewarding and enriching times of your life.
"It wasn't the profound change that some of my friends describe. It seemed like a natural progression from one stage to another nothing very dramatic."
A.F., Hoboken, NJ
What Menopause Means
Menopause is the time at "mid-life" when a woman has her last period. It happens when the ovaries stop releasing eggs. Most often it is a gradual change. Sometimes it happens all at once.
Perimenopause is the gradual period of change leading into menopause. It affects a woman's hormones, body, and feelings. It can be a rocky, stop-start process that takes years. "Climacteric" is another word for the time when a woman passes from the reproductive to non-reproductive years of her life.
The ovaries' production of estrogen slows down during perimenopause. Hormone levels fluctuate, causing changes just as they did during adolescence. But for many women, the changes leading to menopause are much more intense than those of puberty.
These changes may also be affected by a woman's feelings about aging.
The time after menopause is called postmenopause.
Surgical menopause occurs if the ovaries are removed or damagedas in a radical hysterectomy or chemotherapy. In this case, menopause begins immediately, with no perimenopause
Temporary "stress menopause" occurs when women in their late 30s or older have no periods for long stretches of time. It can be caused by stress, chemotherapy, grief, illness, bulimia, anemia, or excessive exercise.
As most women approach menopause, their menstrual periods become irregular they happen closer together and/or further apart. Other common signs include:
- achy joints
- difficulty in concentrating
- hot flashes
- early wakening
- mood changes
- night sweats
- conditions commonly associated with PMS
- changes in sexual desire
- extreme sweating
- frequent urination
- vaginal dryness
A woman may have one, some, or none of these signs. But the ones she does have can be so unpredictable and disturbing that she can feel like she's "going crazy."
A woman's experiences during menopause may also be influenced by other life changes:
- children leaving home
- changes in domestic, social, and personalrelationships
- changes in identity and body image
- divorce or widowhood
- increased anxiety about aging and death
- loss of friends, loved ones, and financial security
- increased responsibility for aging parents
- anxiety about loss of independence, disability, or loneliness
Increasing numbers of perimenopausal women also have young children to care for.
Whatever the cause or circumstance, the conditions women experience before and after menopause are very real and sometimes very serious. While 10-15 percent of American women experience no signs of menopause, another 10-15 percent become physically or emotionally disabled for various periods of time by these conditions.
"Everybody is different. No one should worry about it until they see how it is for them then decide what to do."
D.A., Boston, MA
Perimenopause may begin as early as 35. It starts about two years earlier for women who smoke than for women who don't.
Women reach menopause at different times. The timing is not related to race, class, pregnancy, breastfeeding, fertility patterns, the birth control pill, height, age of menarche (first period), or age at last pregnancy.
The average age for menopause is 51. If menopause is reached naturally or surgically before the age of 40, it is called early menopause.
Estrogen levels drop very abruptly during surgical menopauseespecially when both ovaries are removed at the same time. This often intensifies the conditions associated with menopause and may lead to major physical and emotional changes, including depression.
It is somewhat reassuring to remember that perimenopause is just a phasethat all these symptoms are temporary. For most women it will last two or three years, though for some it lasts as long as 10 or 12 years.
It is important to remember that all women need regular checkupswhether or not they are menstruating.
"It was no big deal for me. I had good role models, who didn't see age as a problem. I kept my periods regular with the Pill until I was 58 six hot flashes later, and, voila!, it was over."
M.G., Akron, OH
Hot flashes are sudden explosions or mild waves of upper body heat that last from 30 seconds to five minutes. They are caused by sudden changes in hormonal levels in the blood. Hot flashes often start with a tingling sensation in the fingers. The tingling is followed by fast rises in skin temperature from the chest to the face and rapid heart palpitations.
Seventy-five percent of women have hot flashes during perimenopause. Fifty percent of women have one each day. Twenty percent have more than one a day. Ten percent have them up to five years after menopause. They are very uncommon after that.
Hot flashes often include drenching sweats that can soak the bedding when they happen at night.
Some Tips for Relieving Hot Flashes:
- Try regular exercise, biofeedback, cold showers, decreased stress, and cooler rooms.
- Reduce intake of tea, alcohol, hot beverages, and spicy foods.
- Wear thin layers of all-cotton clothes that can be removed.
- Keep a hot-flash diary to learn what triggers them.
Women who have hot flashes generally weigh less than women who don't.
"Women should start learning and reading about menopause long before it happens, because there are very dangerous health risks that can be avoided."
C.C., Santa Fe, NM
Osteoporosis is the loss of bone mass. One of the causes is loss of estrogen after menopause. After menopause, women lose between 2-5 percent of bone mass per year for five years. This puts women with thin bones at high risk. Bones become more brittle and more likely to break as they become less dense. Complications can be fatal.
Osteoporosis has no symptoms in the early stages. It causes back and abdominal pain in the late stages. Bone density testing is recommended:
- following menopause or any other prolonged time without menstruation
- if a woman takes steroids, which can cause rapid bone loss
- if a woman has an overactive parathyroid gland, which can lead to rapid bone loss
Bone loss begins after age 35. That's why it is very important for women of all ages to build bone mass with weight-bearing exercise like walking, running, and weight lifting and with calcium- and vitamin D-rich dietsat least 1,000 mg of calcium before menopause and 1,200 mg after menopause.
Estrogen replacement can help stop osteoporosis, so can newer, non-hormonal medications.
Those at highest risk are women who:
- are white or Asian
- weigh less than average for their height
- have early menopause
- have a family history of osteoporosis
- have a diet low in calcium and vitamin D
- have a diet high in caffeine, alcohol, or protein
- have hormonal conditions like diabetes, hyperthyroid, Cushing's disease
- don't get enough exercise
- take thyroid or cortisone medications.
- See more information on this see 7 supplements for better bones.
"Sex is better!"
M.B., Bloomington, IN
After menopause, many women have increased sexual desire because they no longer worry about unintended pregnancy. On the other hand, about one-third lose some of their sex drive.
Sexual desire is often diminished during symptoms of perimenopause, but it is often restored when these conditions subside.
Vaginal dryness and the thinning of genital tissue can lead to discomfort during sexual intercourse and masturbation. Over-the-counter, water- soluble vaginal lubricants may be helpful. Estrogen replacement creams restore the tissues and are available by prescription.
Menopause is nature's original contraceptive. But wait a full year after what seems to be the last period before giving up contraceptives. Menstruation may be very sporadic for some time toward the end of perimenopause.
Using the Pill during perimenopause may mask menopause because periodic bleeding will continue. Women who use the Pill can have their hormone levels checked to find out if menopause has been reached.
Remember: Menopause is no protection against sexually transmitted infections. Male or female condoms are always necessary during sexual intercourse if you or your sex partner have more than one partner.
KEGEL EXERCISES FOR BETTER MUSCLE TONE
Kegel exercises help firm up the vaginal canal, control urine flow, and enhance orgasm. Tighten and relax the muscles you use to stop urination.
Do at least five Kegels in a row several times a day:
- Tighten a little count five.
- Tighten a little more count five.
- As hard as possible count five.
- Relax in reverse steps, counting five at each step.
"What surprised me was how little information I had and I think of myself as pretty informed."
T.B., New Orleans, LA
There are many therapies for the conditions associated with menopause. Hormone replacement therapy (HRT) works for millions of women. But the hormones used in HRT may pose risks as well as benefits. Many women avoid those risks by choosing alternatives, including: homeopathy, Chinese medicine, herbal treatments.
Alternative therapies may also have undesirable effects. It is best to consult a skilled, experienced practitioner to determine the remedy, dose, and treatment schedule for whatever therapy is chosen.
Hormone Replacement Therapy HRT uses pills, patches, implants, and vaginal creams to restore estrogen and other hormones lost during perimenopause and menopause. Testosterone is sometimes used to increase sexual desire.
Non-Hormonal TreatmentOver-the-counter creams without estrogen are also available.
HomeopathyHomeopaths use minute doses of medicines that in larger doses cause symptoms like those of the condition being treated. For example, a remedy made from onions is used to treat colds with symptoms like runny nose and teary eyes.
Herbal TreatmentsHerbalists use herbal extracts, capsules, and infusions, especially those rich in phytosterolsplant estrogens and progesterones.
Chinese MedicineChinese medicine practitioners use acupuncture and herbal treatments to harmonize a person's life energy or Qi (chee).
Many women also benefit from counseling during mid-life changes.
"Take the hormones when they're offered but weigh the benefits against the risks, first."
B.F., Boca Raton, FL
Up to 20 percent of menopausal American women use HRT because they believe the benefits outweigh the risks. It is believed that prolonged use of estrogen replacement reduces the risk of heart attack by nearly 50 percent. Women base their decisions on their individual and family medical histories.
- prevents osteoporosis
- eliminates hot flashes
- improves energy, mood, and sense of well-being
- decreases insomnia
- may decrease risk of heart disease
- may restore sexual desire
- may reduce the risk of Alzheimer's disease
- may reduce the risk of colorectal cancer
- may improve concentration and memory.
- may cause symptoms like PMS
- may increase risk for breast cancer
- may have other undesirable side effects, including:Vaginal bleeding, fluid retention, nausea, loss of hair, headaches, itching, increased cervical mucus, and corneal changes that prevent the use of contact lenses
Some Conditions That May Affect the HRT Decision
Breast CancerOnly one out of 2,500 women under 20 develops breast cancer. The rate rises every year after that. By 50, the rate soars to one out of every 41. At 60, one out of every 28 women develops breast cancer. It is widely believed that using HRT for 10-15 years increases a womans risk of getting breast cancer by 30 percent.
Heart DiseaseBefore they turn 50, women have three times less risk of heart attacks than men. Ten years after menopause, when women are about 60, their risks increase to equal men's risks. Women can protect themselves against heart disease by not smoking, eating a healthy diet, and getting exercise. Estrogen replacement therapy is likely to offer protection as well
Some Treatment Resources
Planned Parenthood (mid-life services)
Many Planned Parenthood centers offer midlife services. For more information and an appointment with the center nearest you, call toll-free: 1-800-230-PLAN.
North American Menopause Society (to find physicians)
P.O. Box 94527
Cleveland, OH, 44101-4527
800-774-5342 (for ordering materials)
The National Osteoporosis Foundation (bone-density testing and physician referrals)
1150 17th Street, NW
Washington, DC 20036
National Center for Homeopathy
801 N. Fairfax St., Ste. 306
Alexandria, VA 22314
American Association of Acupuncture and Oriental Medicine
433 Front Street
Catasauqua, PA 18032
"Form a partnership with other women and the best health care provider you can find! They'll help you stay in charge and in control."
C.H., Eugene, OR
Society offers few rites of passage for womenespecially when it comes to biological changes. More and more women are forming self-help support groups to help navigate the changes that menopause bringspsychological, emotional, spiritual, social, as well as physical. Families and friends can provide important support, too.
Men also experience mid-life changes that may include decreased ability to become erect, depression, and the loss of muscle mass, sexual desire, and a sense of well-being. But the hormonal changes of "andropause" are more gradual. Women and men need to educate their partners about the changes they experience. They can try to build common ground for mutual support by keeping one another informed. Couples counseling is often very valuable for partners in mid-life
Ensure continued good health for yourself: annual Pap tests, pelvic and breast exams, and mammograms can help prevent cervical and breast cancer. A good low-fat, high-calcium diet and plenty of weight-bearing exercise three or more times a week may help prevent osteoporosis and heart disease. Use condoms to protect against sexually transmitted infections. Start preparing for perimenopause and menopause as early as possible. Today is a good timeno matter how young you are.
Menopause can be a wonderful thing to look forward to. But it is all a matter of luck! But you can increase your odds. Just give up smoking, take up exercising, eat well, keep informed, and don't let useless myths get you down."
H.R., Miami, FL
Many women discover a sense of liberation after menopause. They are eager to say good-bye to premenstrual syndrome, cysts, fibroids, childrearing responsibilities, worries about unintended pregnancy, and the gender-role stereotypes associated with youth! They find they're tough enough to handle gender-role stereotypes associated with age, and they welcome a world in which 50 years of wisdom can guide their lives.
Many others face increased responsibilities and declining health. Instead of being freed of many responsibilities, they inherit the care of aging parents or other family members. Many suffer ill health and reduced financial status and are overwhelmed with the profound losses of those they love.
But on the whole, postmenopausal women are the least likely of all women to be depressed. They have a greater sense of well-being than at any other point in their lives.
Postmenopausal women often become leaders in their families and communities. They can enjoy the pleasures of introspection, rest, heightened career pursuits, or an intensified sense of their sexuality or femininity. They may retreat or they may take up new challenges with restored vigor. Whatever they choose, they are more likely to do what pleases themselves than they are at any other time in their lives.
Perimenopause can be a challenging time to reassess life's goals. Menopause can be a new beginning, a gateway to personal growth.
"It's all tied into the way we feel about aging. It's not something that's easy for people in our youth-worshipping culture to deal with."
W.L., Chicago, IL
Books to Read
As you approach your mid-life changes, you may find these books useful:
Managing Your Menopause, Ruth S. Jacobowitz and Wulf H. Utian,
Prentice Hall, 1990
The Change, Germaine Greer, Alfred A. Knopf, 1991
The Complete Book of Menopause, Susan Perry and Katherine O'Hanlan, M.D., Addison-Wesley, 1992
The Silent Passage, Gail Sheehy, Random House, 1992
Menopause & Midlife Health, Morris Notelovitz, M.D., Ph.D., and Diana Tonnessen, St. Martins Press, 1993
Menopause: A Midlife Passage, Joan C. Callahan, Indiana University Press, 1993
The Pause, Lonnie Barbach, Dutton, 1993
Ourselves, Growing Older, Paula B. Doress-Worters and Diana Laskin Siegal, Simon and Schuster, 1994
Without Estrogen, Dee Ito, Random House, 1994
Estrogen The Facts Can Change Your Life, Lila E. Nachtigall and Jan Rattner, HarperCollins, 1995
What Your Doctor May Not Tell You about MenopauseThe Breakthrough Book on Natural Progesterone, John R. Lee, Warner Books, 1996
Wise Women Dont Have Hot Flashes, They Have Power Surges!, D. Reid Wallace, St. Gerard,1996
Off the RagLesbians Writing on Menopause, Lee Lynch and Akia Woods, New Victoria, 1996
What Every Women Needs to Know about EstrogenNatural and Traditional Therapies for a Longer, Healthier Life, Karen Anne Hutchinson and Judith Sachs, Plume, 1997
Dr. Susan Loves Hormone Book: Making Informed Choices about Menopause, Susan Love, Random House, 1997
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Revised: November 14, 2006