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Menopause
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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:
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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. |
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. |
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.
| Healthy bone | Osteoporotic bone |
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| Source: Dr. Robert Lindsay, Helen Hayes Hospital, West Haverstraw, N.Y. | |
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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