Our Bodies, Ourselves (112 page)
Read Our Bodies, Ourselves Online
Authors: Boston Women's Health Book Collective
SAFER SEX DURING PERIMENOPAUSE AND POSTMENOPAUSE
If you are sexually active, you are at risk of getting a sexually transmitted infection, including HIV. Dryness of the vaginal lining (and, in postmenopause, the thinning of the lining) may result in irritation from insertive sex, resulting in increased access for bacteria or viruses. Practicing safer sexâthat is, using condoms or latex dams for protectionâcan reduce the risk of STIs. For information on how to protect yourself, see
Chapter 10
, “Safer Sex.”
Many women report memory gaps or lowered ability to concentrate during perimenopause and postmenopause. The relation among cognitive function, memory, and hormones is not fully understood. Occasional forgetfulnessâthose “senior moments” so many of us talk aboutâmay also reflect general stress, specific worries, depression, lack of sleep, not having paid attention to details, or being distracted by things such as a phone ringing, a child yelling, or a dog barking. A fifty-two-year-old woman says:
With all the changes that are going on in my body, no wonder I can't remember other things! And no wonder I sometimes get a bit weepyâa whole part of my life is behind me now. Luckily, these feelings don't last long. I've heard that postmenopause is a breeze after perimenopause
.
In fact, the brain's capacity to reorganize its cells and grow connections continues throughout life. Brain exercises such as reading, doing crossword or other puzzles, and engaging in
social activity or stimulating conversations can sometimes improve memory.
Sleep deprivationâfrom whatever causeâshould not be underestimated as a cause of memory and concentration issues. If you're having trouble sleeping, resolving that issue may also improve your memory and ability to think.
Some women report that hormone therapy helps with their perceived loss of cognitive function,
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but it is not yet clear whether estrogen or progesterone (alone or together) is helpful for memory.
Clearly, hormonal shifts can affect our moods. Current research suggests that during perimenopause, when reproductive hormones are unpredictable and erratic, women may become moody and even depressed. Those with a history of postpartum depression, a family history of depression, or severe PMS may be particularly at risk, especially those who are not physically active and do not take time for themselves or pay attention to their bodies' signs and signals. Of course, sleep deprivation and midlife stresses can contribute as well. The relationship between perimenopause/postmenopause and mood, or the more serious and sometimes debilitating condition called depression, is complicated and not fully understood.
Most women find that emotional ups and downs smooth out well with the low and steady hormone levels of postmenopause, although being postmenopausal, especially in a youth-oriented culture, brings its own challenges. Even if you've never needed counseling or medication, you may want to consider getting help if mood swings or depression before or after menopause are seriously disrupting your life. However, though the ad campaigns of drug companies have toutedâand individuals have reportedâthe positive effects of HT on mood, the Women's Health Initiative data showed that the most prescribed combined oral estrogen and progestin had no clinically meaningful effect on participants' overall vitality, mental health, or depressive symptomsâat least on average.
After the ups and downs of perimenopause, some women scarcely notice postmenopause. The periods end, period. If you have had uterine problems, such as heavy bleeding or fibroids, they may clear up without treatment when your estrogen levels drop. Endometriosis will usually get better. A fifty-six-year-old woman says that reaching menopause is “wonderful”:
No more bloating, sore breasts, menstrual migraines, back pain, greasy hair, and zits. I now realize I felt like I had been pregnant for thirty-five years!
Despite the continuation for some of us of a variety of effects such as hot flashes and vaginal dryness, many women find the evenness of the postmenopausal decades energizing as they begin a new phase that will last the rest of their lives. See
Chapter 21
, “Our Later Years” for a discussion of some of the dynamics, issues, and health questions of this time.
Many of the changes associated with aging and the postmenopausal years that were once thought biologically inevitable are actually preventable and sometimes even reversible. Heart disease and osteoporosis are two examples. During perimenopause and earlier, you can take active
steps to maintain good health and lessen the impact of these and other chronic conditions associated with aging. Acquiring healthy habitsâexercising, eating healthfully, quitting smoking, and reducing dependence on caffeine, sugar, and alcoholâis always a good place to start.
Physical activity becomes increasingly important in midlife. The ratio of body fat to muscle mass increases as we grow older, and without exercise we lose more muscle mass. We typically begin to lose bone mass in our thirties, often because of physical inactivity and sedentary jobs. Happily, an increasing number of women of every age have rejected this norm and are on the move. A woman in her fifties says:
I took up tae kwon do, Eastern self-defense, which appealed to me as a Japanese American. To my amazement, after a few months of kicking and hitting an imaginary opponent, my chronic insomnia and stiff neck disappeared. Gone also were the painful attacks of gastritis. I began feeling more energetic. . . . That was more than five years ago. Today, all the ailments that I thought I would have to live with the rest of my life are gone
.
Aerobic exercise, such as walking, swimming, biking, and dancing, makes your heart work harder and strengthens the muscles and ligaments that support the skeleton. Weight-bearing exercise builds bone. Strength training with weights helps maintain muscle strength and improves balance. Yoga promotes flexibility and balance. There's exercise to fit almost any kind of physical limitation, including isometric muscle toning and chair yoga if you are not mobile. It's important to exercise the whole body, so as to keep up strength and flexibility everywhere.
ARE YOU BEING ABUSED?
Abuse may be a factor in depression. According to the Women's Health Initiative (WHI), in a study of nearly 92,000 women ages fifty to seventy-nine, 11.1 percent had suffered some form of physical or verbal abuse; of those abused, 10.9 percent reported some level of physical abuse, while 89.1 percent had been subjected to put-downs, severe criticism, and threats.
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If you are being abused in any way, reach out to supportive friends, appropriate services, and your health care provider. (For more information, see
Chapter 24
, “Violence and Abuse.”)
Exercise can lower blood pressure and reduce the risks of heart attack and stroke, arthritis, emphysema, and osteoporosis. It is essential to maintaining a healthy weight (although exercise alone will not generally lead to weight loss). It can help improve posture, sleep, and bowel function and relieve depression and hot flashes, and it makes most people feel better overall. After exercise, blood rushes to the skin, bringing with it extra nutrients, raising skin temperature, and increasing the collagen content. Skin actually thickens, becoming more elastic and less wrinkled. Some women find that regular exercise improves their sexual response and feelings of sensuality.
Women in midlife often complain of difficulty controlling weight gain. This is probably due to a combination of slower metabolism, decreased activity, and increased caloric intake. The tendency to gain weight during midlife is important for women's health because of the relationship between high body mass index (BMI) or high waist-to-hip ratio and high blood pressure and diabetes.
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Women with a 35-inch or more waist are more likely to have metabolic changes that increase their risk of diabetes. The factor most consistently related to this midlife weight gain is a decrease in physical activity; exercising regularly can make a difference.
PREMATURE MENOPAUSE
If a woman's periods cease before the age of forty, it is known as early or premature menopause. Premature menopause can be caused by certain surgeries and medical treatments, and by early changes in ovarian function that are not yet well understood.
Surgical menopause
In women who have not yet reached menopause, surgical removal of the ovaries (oophorectomy) will lead to an abrupt drop in hormone levels. This results in the same changes as those in natural menopause except that testosterone levels are lower after oophorectomy, but the abruptness can make the transition more difficult. Removal of the uterus (hysterectomy) with the ovaries left in place does not bring premature menopause, although menstrual bleeding stops and fertility ends and the hormonal changes of perimenopause may occur at a younger-than-average age. (For discussions of
hysterectomy and oophorectomy
.)
Treatment-induced menopause
Premature menopause can occur as the result of chemotherapy, pelvic or whole-body radiation therapy, or other drug therapies used for cancer treatment. Some women who have undergone cancer treatments experience a temporary alteration of ovarian function; for others, the impact is permanent.
Premature ovarian insufficiency (POI)
Approximately 1 percent of women under the age of forty will experience the unexpected onset of night sweats, hot flashes, sleep disturbances, and other perimenopausal symptoms. Periods may dwindle or stop. Once known as premature ovarian failure, this condition is now referred to by many as premature ovarian insufficiency (POI), because the ovaries rarely “fail” entirely. Instead, ovary function becomes insufficient to maintain a regular menstrual cycle.
Causes of POI include genetic factors (chromosomal irregularities, particularly fragile X syndrome and Turner syndrome) or an autoimmune process. Viral infection may also play a role. Some women with POI also suffer from other autoimmune disorders, such as Addison's disease (adrenal problems), or experience other endocrine disruptions, such as thyroid disease. Diabetes, lupus, rheumatoid arthritis, and inflammatory bowel syndrome are also thought to be connected to POI, as are environmental toxins. Still, more often than not, researchers are unable to determine an exact cause for premature menopause. Family history can be important, in that some women come from families where it is common.
If you are under the age of forty and begin to experience irregular menstrual cycles and/or other symptoms of perimenopause (such as hot flashes, insomnia, headaches, or vaginal dryness), a health care provider should assist you to track your experiences, cycles, and ovulation. (See the Centre for Menstrual
Cycle and Ovulation Research website, specifically the “Help Yourself” section [cemcor.ubc.ca/help_yourself], for a daily perimenopause diary.) Other possibilities may need to be ruled out, such as pregnancy, an eating disorder, thyroid disease, endocrine tumors, or other hormone disturbances. Since most primary care providers do not see a large number of women with POI, they may not have enough experience to diagnose, answer questions about, or provide the best evaluation of your condition. In fact, most women report having visited several health care providers before receiving the diagnosis of POI. This means that it's very important for you to understand your body, note any changes or concerns, and seek a specialist if needed.
It is a mistake to assume that POI is the same as normal menopause except that it occurs earlier. There is a distinctive set of physical and emotional concerns when a woman's ovaries become insufficient at a young age. This includes a higher risk of cardiovascular disease and osteoporosis. Fertility is affected, and this is a major concern for many women with POI. Because young women with diminished ovarian function may see a return of ovulation periodically, approximately 5 to 10 percent of women with POI who have unprotected intercourse do become pregnant spontaneously. For others who want to become mothers or add to their families, many turn to assisted reproductive technologies, such as egg donation, embryo donation, surrogacy, or adoption.
Treatment
Though there is no cure for diminished ovarian function, many good treatment options are available that can alleviate symptoms and minimize complications. Most clinicians recommend that women with premature menopause, if they have no contraindications such as cancer, go on hormone therapy until they reach the age of fifty-one to fifty-two or the natural age at menopause.
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(Therapy with transdermal estradiol and oral progesterone is one example.) More research is needed on the benefits and risks of hormone therapy for premature menopause, but some recent evidence supports the use of transdermal rather than oral estrogen for POI.
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Coping with early or premature menopause
Most women who experience early or premature menopause describe it as a shock. They suddenly feel “out of step” with other women their age and never expected to have to face these types of challenges and decisions at this point in their lives. It is very important to allow yourself to grieve and to have your emotions acknowledged and validated. A good support network can help you successfully manage the long-term impacts throughout your life. Increased support for women with premature menopause is becoming available. One example is Early Menopause (earlymenopause.com), a well-done noncommercial support website for women. Also visit the National Women's Health Center (womenshealth.gov/menopause/early-menopause).
IN TRANSLATION: MENOPAUSE IN OTHER CULTURES
Bengali booklet.
Nigerian booklet.
Group:
Sanlaap (India) and Manavi (USA)
Country:
India
Resource:
“Aamaar Shaastha, Aamaar Sattaa” (My Health, My self), a Bengali booklet based on
Our Bodies, Ourselves
Websites:
sanlaapindia.org; manavi.org
Group:
Women for Empowerment, Development, and Gender Reform (WEDGR)
Country:
Nigeria
Resources:
Print and nonprint materials based on
Our Bodies, Ourselves
in pidgin English and Yoruba
Website:
ourbodiesourselves.org/programs/network
“The effects of menopause on the sexual, reproductive health and lives of women [have] been our major work,” says OBOS's partner in Nigeria, Women for Empowerment, Development, and Gender Reform (WEDGR).
In Nigeria, a primary goal of marriage is to have children. Women who do not have children are often blamed for infertility and ostracized by family and community. This attitude, which stems largely from a lack of information, also applies to postmenopausal women, who are no longer able to become pregnant.
In a survey conducted by WEDGR, 85 percent of men who did not have children and whose wives were approaching or in postmenopause freely admitted to having sex with other women with the intent to reproduce. The men were unaware that infertility can be ascribed to both men and women or that menopause is part of every woman's life cycle. After adapting and translating content from
Our Bodies, Ourselves
into pidgin English and Yoruba, WEDGR used the materials to educate the community about the social and biological impact of menopause and the health implications of unprotected sex. As a result of this outreach, there is a growing awareness of menopause as a natural stage, rather than a problem or taboo.
In comparison, OBOS's partner in India, Sanlaap, a feminist nongovernmental organization, reports that though gender segregation and restricted mobility are the norm for women throughout their childbearing years, women past menopause actually gain power and status within the family and society. This power is increased if they have given birth to sons. Older women are allowed more freedom to interact with men. They are often seen as matriarchs and wise advisers in their families. In the rural contexts of West Bengal, a state on the eastern coast, older women often play the roles of arbiters and negotiators to resolve conflicts within and between families.