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A WOMAN’S “MIDDLE YEARS” BRING CHOICES AND CHANGES
Women who turn 40 today have a lot more going for them than those who
reached  that milestone a generation ago. Many still have young children
at home, having started their families later than their mothers did.
And, because so many of them work outside the home, they have a wide range
of interests and activities in addition to their home life.
While Mom may have agonized over what she would do when the kids left
home, today’s woman is more likely to wish them well and then to launch
a new career or concentrate on putting the romance back into her marriage.
Reaching 40 does not signal the end to her satisfying sex life and, for
an increasing number of women today, “mid-life crisis” is not even in their
vocabulary.
If sex has been an important and enjoyable part of your life during
your younger years, there is no reason to expect it to change because you
have suddenly crossed an arbitrary age barrier. In fact, it might
just get better; inhibitions often disappear once the fear of pregnancy
is gone and, with the “nest” empty, there may be time for more leisurely
lovemaking. One of the more important ingredients for a healthy sex
life after 40 is unquestionably good communication with your spouse.
During the middle years, there are a number of physiological changes
that take place in a woman’s body. Some can be modified; some can
be controlled; but none can be avoided altogether. The important
thing is to realize which is which.
Since no one yet has found the Fountain of Youth, there is no magic
formula to ward off aging. While science continues its search for
the genes that decide how people age, we know that to a large extent how
a person ages is strongly influenced by some controllable lifestyle factors:
exposure to sunlight; whether or not they smoke; whether or not they exercise
and eat well; how they handle stress; and their overall outlook on life.
The Boomers Hit 50
 Look around you. In case you haven’t noticed, there is a huge
number of women between the ages of 45 and 55 in this country today.
In fact, between now and 2010, at least 40 million women will be at menopausal
age. As this giant Baby Boomer generation sails past 50, they are
more likely to change the way we think about menopause just the way they
have changed just about everything else in our society. They are
talking about issues their mothers only dated whisper, and they are debunking
the so called mysteries of “The Change” by deciding that it is no longer
the beginning of the end.
Today, women appear to have chosen to think of menopause as a threshold
that signals a time in their lives when they are free to do all those things
they have waited a lifetime to do. This is really not a new phenomenon.
Anthropologist Margaret Mead is credited with saying, “There is no greater
power in the world than the zest of a post-menopausal woman.” It appears
that a great many Baby Boomer women believe her with their “lead, follow,
or get out of the way” attitude.
In recent years, it appears that American women are experiencing the
symptoms of menopause earlier than the previous average age. Research
suggests that women who fall into the Type A personality style -- who are
constantly on the go and who are often under considerable stress -- often
experience early menopause. Generally speaking however, the “average”
age of menopause is 51.
Somewhere between the ages of 45 and 55, women begin to experience a
year or two of irregular periods, fluctuations in body temperature, and
some other unfamiliar and vague physical or emotional symptoms. The
biological impact of the change does not happen overnight, it is a gradual
process that may cover as much as ten years. After a woman has gone
for an entire year without menstruating, the process is considered complete.
Just as it is impossible to predict when it will occur, there is no
way of knowing ahead of time exactly how the process will affect a woman.
Some are virtually unaware of any change at all, and others find themselves
suffering from a wide range of unpleasant and frightening symptoms.
As the hormonal changes begin to occur, it is not unusual for a woman to
feel “strange” and even a little off balance.
The “classic” symptom of menopause is the hot flash -- or medically
speaking, vasomotor instability -- when the skin temperature rises, then
falls, and is accompanied by sweating and heart palpitations, nausea and
anxiety. Research shows that three out of four women experience them.
An important thing to understand is that until a woman has been without
a period for a year, she may still be ovulating. That means that
-- unless a pregnancy is desired -- contraception is still needed.
While there are a number of options for birth control during this time,
many women are concerned about taking the “pill” because they say they
remember warnings about risks when taking the pill over age 35.
The Pill at 40
As it turns out, there are almost as many “myths” about birth control
pills as there are about menopause. In fact, more than half the women
in recent studies were unaware of the pill’s non-contraceptive health benefits.
As hard as it is to believe, the pill is celebrating its 40th birthday,
and like the familiar advertising slogan, its “come a long way, baby.”
The early birth control pills contained significantly more estrogen and
progesterone than they do now, and there are also many more formulas and
dosages to choose among today.
In 1989, when the Food and Drug Administration (FDA) announced that
oral contraceptives were safe for women to use without interruption until
menopause, the announcement was met by overwhelming silence. What
the FDA considered to be a major policy change was all but ignored by women
because too many believed the pill was more dangerous than pregnancy.
Today, after studies have repeatedly given the pill a “clean bill of
health,” there has been increased attention on the beneficial aspects of
the pill. Many physicians are recommending the pill during the years
leading up to menopause to help eliminate familiar complaints such as PMS,
and studies have shown other potential benefits, as well. After more
than a decade on the pill, for example, a woman’s risk of ovarian cancer
may be reduced by 70 percent; the risk of endometrial cancer drops by about
50 percent; and the estrogen in the pill also appears to protect against
bone loss.
There has been concern in recent years about a potential relationship
between the pill and breast cancer. The good news is that more than
50 studies conducted in countries around the world have found that there
is no increased of breast cancer in the years after women stop taking the
pill, as compared with women who have never taken it. Researchers
say that the pill might enhance growth of an existing tumor, but not initiate
a new one.
No medication is without risk, of course, but the birth control pill
has taken some unfavorable publicity over the years that isn’t consistent
with its track record. Women who smoke, especially if they are over
age 35, should not take it. It may also not be appropriate for women
who have a medical history of liver disease, high blood pressure, cardiovascular
disease, blood clots or stroke.
60 Years of Estrogen
 As far back as the 1940’s, doctors found that Estrogen Replacement
Therapy (ERT) could ease the hot flashes and mood swing problems of menopausal
women. Thirty years ago, estrogen replacement somehow got the reputation
for being a Fountain of Youth, so women badgered their doctors for the
promising therapy.
The euphoria quickly evaporated, however, when there was a virtual
epidemic of uterine cancer in the 1970’s. Estrogen users discovered
that their risk for uterine cancer had increased about sixfold.
Later research added still more concern by suggesting a possible link
between estrogen therapy and breast cancer. It didn’t take long before
demand for the therapy vanished. New research has resolved some of
the earlier fears, and doctors are once again comfortable in recommending
ERT for their patients. The studies found, for example, that giving
estrogen in combination with progestin would counteract the risk of uterine
cancer. Then, the research that overwhelmingly demonstrated that
ERT could help ward off heart disease in post-menopausal women helped swing
the pendulum in favor of the therapy.
Heart disease is the number one killer of American women age 50 and
older, and it affects one-third of them between age 50 and 75. Half
of them die from heart disease. A high percentage of studies completed
on the effect of estrogen on heart disease have found that ERT lowers the
risk. New research conducted at Wake Forest University and reported
in the Journal of the American Medical Association (JAMA) last year, questioned
the benefits of ERT in older women who already had cardiovascular disease.
The research raises enough concern about a short-term risk of a “cardiac
event” for this group of women, that it may not be appropriate to start
hormone replacement for them. Scientists agree, however, that this
and other research confirms the need to continue exploring the risks and
benefits of ERT on all potential candidates for the therapy.
Even though estrogen has demonstrated some impressive benefits in reducing
the risk of heart disease and osteoporosis for many women, there are still
some concerns about the relationship of ERT to increased risk for breast
cancer. Dozens of studies have been conducted since 1974 to resolve
this issue, but an “absolute” answer remains elusive. The general
consensus is that ERT involves less risk of developing breast cancer than
having a mother or sister who had the disease.
Recently, researchers at Northwestern University Medical School looked
at data on almost 40,000 women between the ages of 55 and 69 in the Iowa
Women’s Health Study. They found that, except for some uncommon, slow-growing,
highly treatable kinds of breast cancer, ERT does not increase the risk
of this feared disease. Researchers also concluded that the benefits
of hormone replacement do outweigh any increased cancer risk. There
was, in fact, no difference in the risk for getting the fast-growing, life-threatening
tumors that make up about 80-90 percent of all breast cancers between those
who took the hormonal therapy and those who did not.
The important thing to remember in reviewing all the scientific research
and data available out there today, is that there are bound to be conflicts
of information. This is certainly true with the important choices
we have discussed here for women who have entered what is euphemistically
referred to as their middles years -- the time of “reproductive limbo”
before the “M” word takes place while some method of contraception may
still be necessary.
In the final analysis, it all comes down to the individual woman...how
she looks at her own priorities, what risk factors she already faces for
heart disease and cancer, for example, and then how she weighs the potential
benefits against the possible risks. These and other choices about care
and treatment become part of an ongoing process between a woman and her
doctor. This is a partnership in which access to research data and
pertinent background information, a good rapport and exchange of ideas
will lead to informed decisions. It is also, thank goodness, a process
where barriers to effective communication are steadily being eliminated.
Reprinted from yourfamilyshealth.com |
