Menopausal Changes

Menopausal Changes

They're Bound to Happen Sometime

Your girlfriend called the other day, and you still can't get the conversation out of your mind.

"I've noticed some changes in my body lately," she said. "And I can't help wondering if I'm starting."

"Starting what?" you asked, half distracted by thoughts about your upcoming vacation.

"Menopause."

Menopause! That sure caught your attention. Here was your best friend--the one that's only a few years older than you--talking about a health issue that you didn't think you had to worry about yet. You knew it would happen to both of you eventually. But not now. Not so soon. Neither of you is even 50 years old yet. Menopause was meant for your mother and your great-aunt. It's something for . . . older women.

For most women, menopause is a landmark of aging, says Ellen Klutznick, Psy.D., a psychologist in private practice in San Francisco who specializes in women's health issues. How women respond to it varies greatly.

While women who've already gone through menopause often see it as a new beginning, younger women who aren't there yet tend to feel more anxious about the transition, says Dr. Klutznick. "They are worried about how they are going to feel when they are 50 and about feeling old. They see it as aging," she says.

First, menopause marks the end of a woman's reproductive years. "The biological clock is ticking away for a lot of these younger women, and it's frightening," says Dr. Klutznick. For them, menopause is about the loss of their fertility, and in a society that places great emphasis on youth, beauty and reproduction, this can be difficult, she says. The loss of the potential to have children can be hard even for women who are finished having children or for those who never planned to, agrees Brian Walsh, M.D., director of the Menopause Clinic at Brigham and Women's Hospital in Boston. "They have lost the ability to choose. A door has been closed," he says.

Women are also concerned about how menopause is going to affect their physical appearance. They're worried that their bodies and skin won't be the same--that their breasts will sag, their faces will wrinkle and their waists will thicken, says Dr. Klutznick. And all that is tied to their sexuality, she says. They worry that when they walk into bars or restaurants, men won't be looking at them--they'll be eyeing the younger women in the room or the football game on television, she says. Aging in a youth-worshiping society makes some women feel invisible and devalued, says Dr. Klutznick. It is not that the women feel old physically but that society sees them as old. Women in this age group ask Dr. Klutznick "What do I have to look forward to but getting old? Who's going to want me?"

Understanding Menopause

Literally speaking, menopause refers to a woman's last period. Technically, a woman must not have menstruated for an entire year to be menopausal. The average age for menopause in the United States is 51, although women can go through it earlier. About 1 percent of women experience menopause before they reach age 40.

Women who have their ovaries removed during a hysterectomy become menopausal virtually overnight, says Joan Borton, a licensed mental health counselor in Rockport, Massachusetts, and author of Drawing from the Women's Well: Reflections on the Life Passage of Menopause. They often feel as if they were propelled into menopause without any preparation. Women who have undergone chemotherapy can also go into early menopause.

In natural menopause, a woman's final period is surrounded by a number of years in which other physical changes occur. This is what is known as the climacteric or perimenopause. It generally begins several years before menstruation ends, says Dr. Walsh. During this time, women can experience a whole range of physical changes, including hot flashes, night sweats, sleep difficulties, vaginal dryness, skin changes, hair loss, mood swings, depression and weight gain. Hot flashes, which are often the symptom of most concern to women who are approaching menopause, affect approximately 75 to 85 percent of postmenopausal women.

All these changes, and the loss of the periods themselves, are triggered by decreasing levels of estrogen, one of several hormones produced by the ovaries. As a woman ages, her ovaries do, too; they shrink in size, stop releasing eggs and produce less estrogen.

Your Risks down the Road

Estrogen also boosts bone quality and strength, so its decline at menopause can place women at increased risk for osteoporosis, a disease in which bones become brittle and fragile. Osteoporosis results in an estimated 1.5 million fractures per year. One-third of all women over age 65 experience spinal fractures, and one in three women in their nineties fracture their hips (compared with one in six men). Overall, between 25 and 44 percent of women experience fractures after menopause due to the disease.

The decrease in estrogen that accompanies menopause increases the risk of heart disease, the number-one killer of American women. That's because estrogen is a natural protector against heart disease. Without it, women and men are equal in their efforts to avoid heart disease. This means a woman's risk for heart attack and stroke goes up after menopause. Before age 65, one in nine women will experience a heart attack, according to the American Heart Association. After 65, that rate skyrockets to one in three.

Planning Ahead

You can't avoid menopause. But there are some things you can do now, before you get there, that can make the whole experience a little easier for you. Menopause doesn't have to be a trying time, and it doesn't have to make you look and feel older. Here's what you can do.

Get a move on it. Exercise is one of the best things women can do ahead of time in order to fare better during their menopausal years, says Dr. Walsh. Exercise places stress on bone, increasing its density and strength. Women's bones lose density after menopause--at the rate of about 4 to 6 percent in the first four to five years. So the stronger they are to start off with, the better. Weight-bearing activities such as walking and running are best, experts say. Exercise also helps keep your cholesterol levels down, offering protection against heart disease.

Eat right. Get on a nutritious diet low in saturated fat, says Dr. Walsh. This will help reduce cholesterol and the risk of heart disease, he says, both of which go up after menopause. Experts recommend that you keep your fat intake to 25 percent or less of the total calories you consume.

Keep an eye on PMS. If you have premenstrual syndrome, or PMS, keep a log of your symptoms and pay attention to any changes. Sometimes PMS symptoms become far more intense as women enter menopause, says Dr. Klutznick, and they can serve as a signal for you that you are becoming menopausal. Some possible changes you might notice are PMS symptoms that last longer than usual and a feeling that your mind is fuzzy, she says. If you notice changes, tell your doctor. She can perform a simple blood test called the FSH test, which measures the amount of FSH, or follicle-stimulating hormone. Before menopause, your body produces enough FSH to help follicles develop and trigger ovulation. At menopause, however, you have fewer follicles, and it takes more FSH to get one to mature and ovulate. So your body pumps out more of the hormone than it used to. If your test shows a high FSH level--say, above 40--that means you are officially in menopause.

Quit smoking. If you stop smoking at a younger age, that can help you experience a gentler menopause, says Dr. Walsh. Smokers are more likely than nonsmokers to have menopausal symptoms, he says. Smokers also have a tendency toward lower bone mass, putting them at greater risk for osteoporosis. Smoking can cause you to experience menopause earlier, experts say. They think it's because nicotine may somehow contribute to the drop in estrogen. So stopping smoking now could delay menopause a bit.

Get your calcium now. While the decrease in bone mass accelerates at menopause, it begins around age 35. After 35, women lose 1 percent of their bone mass per year. So be sure to consume enough calcium. The current Recommended Dietary Allowance for adults is 800 milligrams of calcium, but some experts suggest 1,000 milligrams a day for premenopausal women and 1,500 milligrams for postmenopausal women.

Unfortunately, most women consume only about 500 milligrams a day through diet. You can come closer to the protective amounts by adding low-fat dairy products and canned fish with bones (such as salmon) to your daily diet. For example, one serving of low-fat milk gives you 300 milligrams of calcium, and one serving of low-fat yogurt contains 415 milligrams.

You can up your calcium intake through nondairy foods, too: Three ounces of canned sockeye salmon contains 203 milligrams of calcium, and 1/2 cup of raw tofu contains 258 milligrams.

Another way to increase your calcium intake is through supplements. The amount that you should take and the type of tablet you use--calcium carbonate, calcium lactate or calcium citrate--will depend on your individual health needs, so consult your doctor.

Know your cholesterol levels. Get your cholesterol levels checked, says Dr. Walsh. Menopause can cause levels of HDL (high-density lipoprotein) cholesterol, the "good" kind, to decrease and levels of LDL (low-density lipoprotein) cholesterol, the "bad" kind, to rise. So the better your cholesterol profile before menopause, the greater your chances of keeping it low once you hit menopause. Experts say that the best measurement to use is the ratio of total cholesterol to HDL cholesterol. A ratio of less than 3.5 is considered low, between 3.5 and 6.9, moderate, and over 7, high.

Talk to your mom. Women often follow the same patterns as their mothers, says Dr. Walsh, particularly if they have similar health experiences. So ask your mom about when she started menopause and what it was like for her.

When the Time Comes

If you think you may be entering menopause, or if you're there already, here are some things you can do.

Get support. "The most valuable thing is gathering together with other women," says Borton. By talking with other women, either one-on-one or in support groups, you can learn about various symptoms and gather information about doctors and health care professionals whom other women go to, like and recommend, she says. "Talking with other women and sharing experiences helps women feel supported and not so isolated," agrees Dr. Klutznick. One option is to join a support group. Call your local hospital to find out about groups in your area. Or talk to other women.

Find the right doctor. Menopause will bring lots of physical changes and lots of questions, particularly about hormone replacement therapy (HRT). HRT is recommended to help replace missing estrogen and keep bones strong. But it is also controversial, mainly because it may increase your risk of certain cancers. "The key is to get a doctor who will work with you--one who will honor your decision," says Borton. Ask your friends about their doctors. And don't be afraid to shop around until you find a doctor you like.

Choose a mentor. Find a woman 10 to 15 years older than you who has been through menopause and whom you admire and respect, says Borton. "Spend time with older women, exploring with them what it is that holds meaning in their lives," she says. "Numbers of us feel that doing this has helped us cross the threshold into seeing ourselves as older women and embrace it in a way that feels really wonderful." In addition to identifying or finding women who can serve as mentors in your day-to-day life, look for older women in the public eye whom you can follow and learn from, she says.

Stay lubricated. The decrease in estrogen that women experience with menopause can cause vaginal dryness. The elasticity and size of the vagina changes, and the walls become thinner and lose their ability to become moist. This can make sex painful or even undesirable, says Dr. Klutznick. Surveys indicate that this happens in 8 to 25 percent of postmenopausal women. While premenopausal women can generally lubricate in 6 to 20 seconds when aroused, it can take one to three minutes for a postmenopausal woman.

Women can stay lubricated by using water-based vaginal lubricants such as K-Y jelly, Replens and Astroglide, which are available over the counter, says Dr. Klutznick. Steer clear of oil-based lubricants such as petroleum jelly; studies indicate that they don't dissolve as easily in the vagina and can therefore trigger vaginal infections. HRT can also help alleviate the problem, says Dr. Klutznick.

Stay sexually active. Studies indicate that women who stay sexually active experience fewer vaginal changes than those who don't. Sexual activity promotes circulation in the vaginal area, which helps it stay moist. For women without partners, masturbation helps promote circulation and moistness in the vagina, she says.

Keep it cool. The hot flashes women experience during menopause can range from a warm sensation to a burning-hot one in which a woman flushes and sweats. It can help to dress in layers and to keep the environment cool, experts say. Some women suck on ice cubes and drink cold liquids or visualize themselves walking in the snow or swimming in a clear lake. Hot liquids and spicy foods can trigger hot flashes, so keep those to a minimum. Experts don't completely understand what causes hot flashes, but they think that the decline in estrogen somehow upsets the body's internal thermometer.