Menopause

As Americans are living longer, how we are viewing middle age is changing. Forty used to be considered "middle age". Now, 55 is becoming accepted as "middle age". Women are living more active and vigorous lives well into old age. Most women are living a third of their lives after menopause. Menopause used to be a "taboo" subject, now it is the topic of articles in news magazines, segments on the morning news shows, friends are discussing it and books on menopause have flooded the marketplace. Women are viewing menopause as another phase of life, rather than a disease. They are taking charge of this aspect of their lives and moving forward. Many see it as a new beginning, rather than an ending.

Menopause technically means the "end of menstruation". What is readily apparent to any woman entering this phase of life - the symptoms can begin as many as ten years before the period ends. This transition time is known as the peri-menopause. Many symptoms we associate with menopause actually begin during the perimenopause as the estrogen levels are decreasing. Most women reach menopause between the ages of 45 and 55.

What is Menopause?
Menopause is when your ovaries stop functioning and your periods stop. You can think of it as puberty in reverse. Your reproductive system is gradually winding down. You were born with hundreds of thousands of eggs in your ovaries. The number of eggs has been decreasing through the years. Throughout your childbearing years, not all of your eggs have reached maturity and released. Each month the eggs that did not reach maturity were reabsorbed by your body. As you approach menopause, only a few thousand eggs are left.

Beginning in your early 30's, the levels of estrogen and progesterone produced by your ovaries have been declining. This decline escalates when you enter perimenopause - usually three to five years up to menopause. When the supply of eggs is finally exhausted, ovulation stops. The levels of estrogen and progesterone drops so low you stop menstruating. We know you have passed menopause when you have no periods for 12 months.

When Can I Expect to Enter Menopause?
The average age of menopause is 51, although the normal age is from 45 to 55. One way you can predict what age you will be is to ask your mother or sisters how old they were. Often women begin and end their menstrual life about the same age as their mother did.

What Can I Expect?
The diminishing amount of estrogen produced by your ovaries produces changes in your body. These changes occur slowly over time and are different for everyone. Some women notice very little change while other women find it difficult to cope with the dramatic symptoms caused by these changes.

• Hot Flashes - Hot flashes are the most common symptom of menopause. They are probably the symptom most associated with menopause, with as many as 75% of women experiencing them. A hot flash is a sudden rush of heat that spreads over the upper body and face. Some women experience a simple warming; others have acute flashes with sweating.

  Hot flashes can occur any time of the day or night. They usually last from thirty seconds to several minutes. Some women have hot flashes for a few months, other women complain about them for years. Other women do not have hot flashes at all.

• Sleep Difficulties - Many women complain of problems with sleep as they enter menopause. Some women are awoken from a deep sleep by hot flashes. Others have a harder time getting to sleep or staying asleep.
• Vaginal and Urinary Tract Changes - The loss of estrogen causes changes in the walls of the vagina. Some women experience vaginal problems during the perimenopause, others don't have symptoms until they are well past menopause. The vaginal lining becomes thinner, drier, and less elastic as you age. You may have burning or itching. Some women have bleeding or burning with intercourse.

  The bladder and urethra can lose muscle tone with lower levels of estrogen. This can lead to a loss of bladder control. You may notice leakage when you sneeze, cough, laugh, or exercise.

• Bone and Body Changes - Lower estrogen levels can result in osteoporosis. The bones lose density and become fragile. Older women are more likely to break bones. The hip, wrist, and spine are the bones most likely to break.

  Until menopause, estrogen has protected women from heart disease, partially by keeping the cholesterol levels down. There also seems to be a relationship between estrogen levels and the development of plaque inside the blood vessels. This buildup can cause blockage and lead to heart disease.

• Emotional Changes - Minor emotional distress can occur with the changes associated with menopause, along with the social changes that can occur in a woman's life. Contrary to prior belief, studies show there is no increase in serious psychiatric disorders in women entering menopause. The emotional distress felt by most women come from sleep disturbances or other nuisance symptoms. This is also the time of life when many women's lives may be in an upheaval due to their children leaving home or they may become caretaker for an aging parent. Menopausal symptoms make the stress you are normally under harder to cope with.

Sexuality
Many women find sex to be more rewarding after menopause. They no longer have to worry about birth control and may now have more time to spend with their partners. Some women though, do find the changes with menopause do have an impact on their sexuality. They may have vaginal dryness or may lose interest in sex.

Hormone Replacement Therapy and vaginal lubricants can help return moisture and elasticity to the vagina and make intercourse more comfortable. There are many vaginal lubricants or moisturizers that can be bought over the counter. If you have been having sexual intercourse on a regular basis, you may not notice vaginal changes with menopause. Regular sex may help the vagina retain it's natural elasticity.

A decrease in libido, or sexual drive, can occur with menopause. Lower hormone levels may decrease your sex drive or may affect your ability to have orgasm. Hormone replacement therapy can help some of these changes. Be sure to talk to your doctor or midwife about your concerns. Trying different positions and engaging in longer foreplay may also help.

Birth Control
Here you are, you are having symptoms of menopause, but are also continuing to have periods. You will need to continue to use birth control until you have not had a period for one year. Despite having menopausal symptoms, you can still get pregnant.

You can choose from the following birth control methods:

• Birth control pills - A low dose birth control pill is safe for many women over 40 who do not smoke. Since the pills contain estrogen, they can alleviate the menopausal symptoms you may be having in the perimenopausal period.
• Barrier Methods - condoms, diaphragm, and spermicides are easily attainable at the pharmacy. Lubricated condoms may help with vaginal dryness, as can spermicides in jelly or cream form.
• Intrauterine device (IUD)
• Hormonal injections -(Depo-Provera) and implants (Norplant)
• Sterilization - male or female

Diet and Exercise
Eating a balanced diet will help you stay healthy before, during, and after menopause. It is important to eat a variety of foods to make sure you get all the essential nutrients. As you enter menopause, you should pay close attention to the amount of calcium you are receiving in your diet. The calcium is important to help build strong bones. Women over the age of 50 should be getting 1,000 mg of calcium each day if they are on hormone replacement therapy, 1,500 mg each day if they are not. Ask your pharmacist which calcium supplements contain calcium carbonate, as these brands are best at slowing bone loss.

Exercise is very important as you get older. Regular exercise slows bone loss and improves your overall health. Walking and aerobics are good weight-bearing exercises.

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