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With Childbearing Behind Her, and One-third Of Her Life Ahead… MENOPAUSE SIGNALSMEANINGFUL CHANGES
There is no question that over the years, menopause has gotten a bum wrap. Far too many women approach this time in their lives with fearful apprehension, half believing that their productive years might truly be over. A recent opinion survey revealed that only 27 percent of 500 women polled by National Family Opinion felt that they had enough prior information about menopause. Without knowledge, menopause can indeed be a frustrating and frightening experience. Today, with Baby Boomer’s approaching 50, there are an increasing number of women entering the menopausal years who have a voracious appetite for information about managing their health during the middle years. Armed with the facts, women are coming to view menopause as neither a catastrophe nor the end to a happy and meaningful existence. More and more women in their fifties and beyond are proving that they can hold their own in the boardroom and the bedroom. BOTH A BIOLOGICAL AND EMOTIONAL EVENT Menopause, or the female climateric - a term derived from the Greek word meaning “top rung of the ladder” - is the stage in a woman’s life during which ovulation and menstruation cease. Somewhere between the ages of 45-55, women typically experience a year or two of irregular periods, fluctuations in body temperature, and some other unfamiliar and vague physical or emotional symptoms. About 1.5 million American women enter menopause each year. While the age at which this happens may vary widely, the “average” age of menopause is 51 - in an expected life span of 78 years. The biological impact of the change does not happen overnight; it is a gradual process that is divided into three stages that may cover as much as ten years. The first is premenopause, when the ovaries gradually decrease their function. Periods become irregular- more infrequent in some cases, or for other women two back to back and not another one for six to eight weeks. Many women say that their periods are lighter while others complain of a very heavy flow for one or two days, followed by days of spotting. All these are consistent with a decline in ovarian function and changing hormonal levels. The second stage is menopause itself. There is a further decline in ovarian function and periods cease completely. After a woman has gone for an entire year without menstruating, she enters the third-postmenopausal- stage of life. Ninety- five percent of all women have gone through menopause by age 55. THE SYMPTOMS VARY Just as it is difficult to predict with any certainty when menopause will occur, knowing ahead of time how the process will affect a woman is equally hard to accomplish. Some are virtually unaware of it until they realize that several months have elapsed between periods, but others find themselves suffering from a full range of unpleasant and frightening symptoms. The only thing that ALL women experience is the marked change in hormonal status as they proceed through menopause. It is these hormonal changes that are at least partly to blame for the wide range of symptoms. As the ovaries cease to function, they no longer produce estrogen. This causes the pituitary gland to send out more luteinizing hormone (L.H.) and follicle-stimulating hormone (FSH) in a last - ditch effort to entice the ovaries into action again. Although most menopausal symptoms are generally attributed to a lack of estrogen, for many women it is the high levels of LH and FSH that trigger the problems. As all these hormones begin to interact, it is not unusual for woman to feel off balance and “strange”. When you consider that there are 300 different tissues in a woman’s body that respond either directly or indirectly to the estrogen, it is not surprising that withdrawal from the hormone could produce such a multitude of symptoms. The classic symptom of menopause is the “hot flash” - medically known as a vasomotor instability - when the skin temperature rises, then falls, and is accompanied by sweating and heart palpitations, nausea and anxiety. There is a sudden rush of heat to the upper body, starting in the chest area and rapidly spreading upward to the face, neck and arms. The skin reddens and breathing may also become more shallow. In some women, the hot flash is accompanied by an itching sensation. As the episode passes, the woman may feel chilly and drained. It may last for only a few minutes and may go totally unobserved by those around her. While the exact cause of hot flashes is unknown, some researchers believe that falling estrogen levels prompt an overreaction by the hypothalamus, the region in the brain that regulates body temperature. These hot flashes can occur only once a month or several times in an hour; they may begin months before menopause stats and continue for years after periods end. A recent survey revealed that three out of four women experience them. For some women, they may be brought on by stress, exercise or entering a warm or cool room. Caffeine and alcohol seem to aggravate their symptoms. Menopause does not send women into full clinical depression as was once believed. Estrogen withdrawal does, however, produce a drop in the production of endorphins, the brain’s “feel good” substances, so it is logical that there would be some emotional adjustments as hormone levels change. There’s another reason for women to feel irritable and stressed out. Falling estrogen levels, scientists believe, may also produce a decline in dream-rich REM sleep. Wakeful nights for months on end, punctuated by occasional night sweats, would ten to make anyone feel on edge. Many women complain - if they talk about the subject at all - about vaginal itching and other troubling symptoms like dryness and discomfort during intercourse. These symptoms, too, are the direct result of lower estrogen levels but are unfortunately interpreted by many women as an indication that their sexuality is about to come to a screeching halt. While changes that often occur in the urinary tract may be linked to falling estrogen levels, some may also be related to muscle weakness or damage from an earlier childbirth; either can cause bladder control problems. Estrogen stimulates collagen, the fibrous support tissue woven into the walls of the bladder and other organs. As the amount of collagen decreases, the bladder shrinks, and pelvic floor muscles weaken causing incontinence. The same vasomotor irregularity that triggers hot flashes is also believed to be the cause of rapid heartbeat or palpitations during menopause. They are generally harmless, but can be frightening and troubling nonetheless. Any irregularities in heartbeat should be checked out with your physician, who may prescribe medication such as a low dose of beta-blocker. While none of these short-term symptoms can be considered life threatening, they could certainly do damage to a woman’s quality of life. The late 40’s and 50’s - often called Middle Age - are years that involve change and reassessment for both men and women. By this time, a couple’s children are often grown and are leaving home (the empty nest syndrome); the choice career opportunities may be going to younger and more energetic employees; and there are signs in the mirror that can no longer be ignored - graying hair, new wrinkles and proof that gravity does indeed exist. Coming to grips with these changes, and the emotional upheaval that they sometimes produce, can be a real challenge. Just as the specter of menopause haunted our mothers and grandmothers, the new image of today’s “superwoman” sailing through menopause undaunted can be equally damaging if it makes some women feel like a failure. Every woman is different and her experience will be unique, as well. Today, there is absolutely no reason for women to fear menopause and the changes it will produce. Access to accurate and timely information can help demystify the process and provide a good foundation for women to discuss their concerns with their doctor. Just knowing that they are not alone in experiencing strange symptoms and that there are medications and therapies available to assist them in “getting through” menopause helps many women. Ask your doctor how you
can minimize the symptoms of menopause and how to
protect your health during the middle years. You’ll be
glad you did.
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Randy A. Birken, M.D., F.A.C.S., F.A.C.O.G. Copyright 2000-2006 Randy A. Birken, M.D., F.A.C.S.,
F.A.C.O.G. All Right
Reserved
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