Menopause Today: Waking up in Midlife |
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Menopause is not a disease, but a natural event-the end of fertility-resulting from the ovaries' decreased production of the sex hormones estrogen and progesterone. Menopause happens to all women, but affects each woman uniquely. Many women report feeling more confident, empowered, involved, and energized than in their younger years. For some women, however, menopause-coupled with midlife emotional and social crises-can contribute to serious health problems. One thing is true for all women: menopause is a signal to start, or continue, a good health program.
Longevity and quality of life for women are improving. Women are staying healthy and remaining active longer. These factors help explain the increasing attention to menopause and the need to better understand the changes experienced during and after menopause.
What Is Menopause?
The word itself refers to the last menstrual period and signifies the transition from a reproductive to a nonreproductive stage of life. Menopause is usually characterized by the absence of a period for 12 consecutive months. A women stops menstruating when her ovaries stop producing ova (or eggs). At this time, production of the hormone estrogen by a woman's body is greatly reduced. A woman will also enter menopause immediately after surgical removal of the ovaries.
| Physical Symptoms of Estrogen Loss |
- Hot flashes, night sweats
- Vaginal dryness
- Vaginal thinning and loss of elasticity
- Vaginal and bladder infections
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| Some Not-so-evident Symptoms of Estrogen Loss |
- Heart disease
- Osteoporosis
- Cancer
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Living With Hot Flashes
About two-thirds of all women have hot flashes during perimenopause (the time immediately prior to natural menopause-usually six years or more). Hot flashes and night sweats can lead to a variety of psychological effects, such as moodiness. Without adequate sleep, anyone can become tired and irritable, but it's a myth that "menopause" itself makes you irritable. Women who have hot flashes usually do so for three to five years, but many women have hot flashes only for a few months while others "flash" for many years. It's helpful to identify your hot flash "triggers." |
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| Identify Your Triggers |
- A warm environment
- Stress
- Hot or spicy foods
- Hot drinks
- Alcohol
- Caffeine
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| Good news! Ways to Alleviate Hot Flashes |
- Get regular exercise to promote better, more restorative (REM-stage) sleep
- Avoid or eliminate your hot flash triggers
- Keep cool by dressing in layers, using a fan, and sleeping in a cool room.
- Reduce stress with yoga or meditation
- Avoid spicy foods, hot drinks, caffeine, and alcohol
- Talk to your clinician about prescription drugs or alternative remedies.
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Soy, Phytoestrogens, and Vitamins
Some women have found relief from hot flashes from over-the-counter remedies such as soy foods. Eating soy foods like tofu, tempeh, soy milk, or roasted soy nuts may be helpful for hot flashes and other menopause effects, but more research is needed to clarify the effectiveness and ideal "dose." |
| Talk to your healthcare provider about all vitamins, minerals, and supplements you are taking. Currently, a treatment category undergoing intensive research involves "phytoestrogens," naturally occurring compounds in certain plants, herbs, and seeds that are similar in chemical structure to estrogen and/or produce estrogen-like effects. In certain Asian cultures where large amounts of phytoestrogen-containing foods are consumed, women reportedly have fewer hot flashes and may be at a lower risk of heart disease, osteoporosis, and some cancers. |
| Oral vitamin E taken in relatively high doses (400 IU a day for maximum effect) also may help with hot flashes and lower the risk of heart attacks. Vitamin E may prevent the oxidation of cell membranes and LDL cholesterol which in itself lowers the risk of heart disease. |
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Avoiding Heart Disease
Women's bodies make less estrogen after menopause, which is why they are more likely to get heart disease at that time. Women tend to think of heart disease as a "man's" disease. In fact, heart disease is the number-one killer of women in North America. Many more women die from heart disease than from breast cancer. |
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| Know Your Risk Factors |
- Advancing age
- Having a close relative who had a heart attack or stroke before age 60
- Cigarette smoking
- Physical inactivity
- High blood pressure
- High cholesterol
- Diabetes
- Stress
- Drinking more than three alcoholic beverages daily
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| Control Your Risk Factors |
- Stop smoking
- Get regular exercise
- Control blood pressure
- Control cholesterol
- Control weight
- Reduce stress
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Get Adequate Exercise
Physical inactivity is a lifestyle risk factor for many serious diseases. Unfortunately, adequate exercise is missing from many women's lives. Some report fewer hot flashes when they exercise regularly. Proper exercise will prevent serious disease in the years to come also. |
Keep Weight in Check
Menopause does not cause weight gain, but it may seem that way because as we age, we lose muscle and gain fat. The only way to prevent or reverse this process is to exercise. If you lose weight without exercise, you lose approximately 50 percent lean tissue and 50 percent fat. To lose almost 100 percent fat, exercise and cut back on fat calories.
Not only is aerobic exercise important (at least 30 minutes every day), but weight bearing exercise is equally important. The more muscle one has, the more permanent is the weight loss. Muscle speeds the metabolism (calories you burn daily), so that you burn more body fat and leave it off.
| Your most appropriate percent body fat and weight are based on your age, health status, fitness level, body build, and other individual factors. Check with your physician or dietitian for the most appropriate body fat for you. You can be the same height and weight and have different body compositions at different times in life, and therefore, have different calorie needs. The more muscle you have, the more you can eat to maintain weight because your metabolism is higher. General guidelines for body fat percentages are as follows: |
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Men: 10-20 percent |
(Average is less than 20 percent) |
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Women: 18-27 percent |
(Average is less than 24 percent) |
Psychological Factors
In today's youth-oriented society, getting older is difficult for many women. Women in midlife often begin to experience changes in self-concept, self-esteem, and body image. They may begin to think about their own mortality and become introspective about the meaning and purpose of their lives. Some women are caught in a "sandwich" generation, raising children of their own and at the same time taking care of their aging parents. On the flip side women may begin to experience the empty nest syndrome and feel very alone when it is just herself and her spouse. Another term that is becoming familiar to many women is "boomerang kids." This is when women send their children out into the world, but in fact they soon come back home and sometimes with grandchildren in tow.
Although these changes can be an opportunity for positive growth, some women react to the multiple stressors of midlife by feeling overwhelmed, out of control, angry, emotionless, and/or numb. These changes tend to coincide with the hormone fluctuations even though there are no scientific studies to support the belief that natural menopause is responsible for true clinical depression, anxiety, severe memory lapses, or erratic behavior. (Menopause Guidebook, The North American Menopause Society, 1998.)
Ways to Beat Stress
Although many stressors cannot be altered, coping skills can be learned.
| Balance and harmony can happen, along with a sense of control. |
- Take time to relax
- Talk with friends
- Make time for play
- Look for the opportunities: education, new job, new role
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| As you experience the physical, social and emotional changes of approaching menopause, you have a chance to identify your own goals for midlife wellness. By setting your sights on new goals, you can find that menopause is the time of new beginnings. |
Edited by Rebecca Stolz, RN, BSN
This material was presented at the Spring 1999 Women's Lecture Series, sponsored by the Cooper Clinic as a public service.
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