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The Wrong Kind of “Hot”

Posted in Condition News, tagged , , on April 19, 2013 | Leave a Comment »

Now that the FDA advisory panel has pulled the plug on two nonhormonal drugs to treat hot flashes and night sweats, what’s a grumpy, sleep-deprived, sweaty, menopausal woman to do?

For most of us, hot flashes are uncomfortable and inconvenient. For some of us, hot flashes are debilitating and make it hard to sleep or function normally. And except for hormone therapy, no treatment regimen is guaranteed to alleviate them.

So, chalk up yet another inhibitor to sex (as if we needed one). It’s hard to feel “in the mood” when your nightie’s soaked and sweat is running down your back—and this is pre-foreplay.

It may be possible, however, to manage the frequency and intensity of hot flashes with some simple home remedies. For some women, these techniques work well; for others, not so much. As in so much of life, it’s a matter of experimenting until you discover what works for you.

These more natural approaches fall into four categories: lifestyle changes, identifying the triggers, controlling your environment, stress management, and botanical remedies. If you’re bothered—or handicapped—by hot flashes, a combination of these might help. Even if the cure isn’t perfect, your overall health should improve. In the long run, that’s a whole lot better than popping a pill.

Lifestyle changes

A generally healthy lifestyle goes a long way to making you feel better all over. You’ll mitigate other problems, like diabetes and obesity, and you just might find your hot flashes are less frequent and intense as well.

A healthy lifestyle includes

  • A diet of high-quality, fresh fruits and vegetables, whole grains, low in fat and processed foods
  • Regular exercise that gets your heart-rate up and doesn’t injure your joints: brisk walking, swimming, free weights, yoga, tai chi
  • Losing weight, if necessary. You may have put on some menopausal baby fat (haven’t we all?), but be aware that a higher body mass index is related to more frequent hot flashes, according to the North American Menopause Society (NAMS).

Identifying triggers

While hot flashes are maddeningly unpredictable, they often seem associated with certain triggers, which are unique to every woman. Try to identify yours. Common triggers include

  • Caffeine, alcohol, and cigarettes (even passive smoke may be trigger one)
  • Anxiety, stress, and stressful situations
  • Hot drinks and spicy foods. If you’ve ever watched someone eating a habanero pepper, well, that’s enough to give you a hot flash right there.
  • Stress
  • Hot, stuffy, or crowded rooms
  • Activities that produce heat—ironing clothes, washing dishes, strenuous exercise
  • Did we mention stress?

Managing stress

Stress is linked in several studies to more frequent hot flashes, and you can bet they’ll happen at the most inconvenient times. When you’re heating up at a stressful moment, remember that, while embarrassing and uncomfortable, hot flashes aren’t life-threatening or even particularly noticeable to others. A few inconspicuous comfort measures will help you get through the moment, even in tense situations:

  • Breathe. Instead of panicking inwardly, consciously take deep, relaxing breaths.
  • Get up and walk around.
  • Open a window.
  • Try meditation, massage, yoga, relaxation or other therapy.
  • Maintain a sense of humor. You have to admit, the whole thing is kind of funny.

Conrolling the environment

Because the hormonal changes you’re experiencing have temporarily (or not so temporarily) messed with your body’s temperature-regulating mechanism, you can compensate (in part) by controlling the ambient temperature. Some easy ways to do this include

  • Keep the house, especially the bedroom, cool and well-ventilated.
  • Cotton (or fibers that wick moisture away from your skin) is your friend. Use cotton bedclothes and keep a spare pillowcase handy. Or, check out cooling bedsheets like those at DriNights. Keep a clean, cotton t-shirt beside the bed.
  • “Keep a frozen cold pack under your pillow, and turn the pillow often.” (From NAMS)
  • Check out the Dry Babe website for a line of “absorbent sleepwear for hot mamas.” These could lead to a little heated action of their own.
  • Wear clothes in layers that you can shed or add as necessary.
  • Carry a pretty Oriental fan in your purse.

Botanical remedies

Finally, a few botanicals have been associated with relief of hot flashes. Again, research is inconclusive: Some women are helped while others aren’t. But the remedies are relatively safe and free from serious side effects. You could try:

  • Black cohosh. Already commonly used in Europe, this member of the buttercup family may be the most promising herbal treatment for hot flashes.
  • Soy and red clover contain plant-based estrogen, which isn’t as effective and doesn’t work the same way as the estrogen synthesized for hormone treatments. Still, some women say they help.
  • Vitamin E. Again, scientific evidence is scant, but some women say these supplements work for them.

Just because a supplement is “natural” doesn’t mean it’s automatically safe for everyone. Some herbal supplements are quite potent, and others could interact with medication you’re taking or exacerbate a physical precondition you already have. So consult with your doctor or pharmacist before taking botanical remedies.

If you discover a remedy that works for you—please share!

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More from the Trenches

Posted in The Good Stuff, tagged , , on February 19, 2013 |

In a previous post Dr. Susan Kellogg Spadt, a MiddlesexMD medical advisor, described some of the impediments to sexuality that she sees affecting women as they age. The list, which began with internalized ageism, sexual scripts from our families of origin, and low self-esteem, continues in this post…

Performance anxiety. Men aren’t the only ones who worry about “performing.” All those physical changes to our sexual apparatus that are discussed on MiddlesexMD—vaginal dryness, pain, reduced sensation, lack of interest—can contribute to performance anxiety for women, too.

As one 52-year-old woman said, “I can no longer tell how my body is going to behave. It makes me nervous in bed.” As with men, this inability to trust or predict how your body will respond can affect your ability to enjoy or your desire to have sex. Some women (and some men) just decide not to be sexual anymore.

Women need to know that there is help for these physical changes—again, all the things discussed on the blog and the website—such as moisturizers, lubricants, vibrators, and dilators. These tools can help us remain comfortable and familiar with our changing bodies, so that we’re less anxious when we’re with our partner.

Depression. Older women get depressed at somewhat higher rates than younger women. That’s what the research says. Not only that, but the side effects of some antidepressants include decreased desire, vaginal dryness, and delayed orgasm.

So what’s a woman to do?

Talk to your healthcare provider. You need counseling for the depression, and if medications are affecting your libido, discuss alternatives with your provider. It’s not easy, but you could end up feeling better and enjoying sex again.

Lack of attraction to partner. Yes, I hear this from women—the spark is gone. They just aren’t attracted to their partner anymore.

Maybe the relationship was always difficult or lacked physical intimacy, and the couple stayed together for practical reasons. Or maybe physical changes due to the partner’s aging or illness have affected the woman’s physical attraction. According to the literature, this happens in both women’s heterosexual and lesbian relationships.

Fantasy is one way to mitigate the “turnoff.” Use your imagination to turn the frog into a prince. Sex therapy may be another aid to establishing intimacy.

Lack of partners. There’s no sex without a partner. Duh! Demographics and life expectancies being what they are, the older we get, the fewer our options for partners.

Some of us may be able to date casually or to self-pleasure for sexual release, but for others, this may not be an option. Again—no easy answer.

Making peace with the situation. “Normal” covers a lot of ground. And while we clinicians are always seeking to define it, the fact is that “normal” for one patient may be very different for another.

Despite all the impediments and changes, I’ve found that women generally find their way to a sense of equilibrium with regard to their sexuality. And we clinicians have to respect that.

You define what’s normal for yourself. If you are at peace with your decision to abstain from sex, then abstinence is normal for you. Likewise, if you choose to be sexually active well into your nineties, then that’s also normal.

However, if you experience frustration, anxiety, discomfort, or pain regarding your sexuality, then you should bring this up with your healthcare provider. We can help, and sometimes the solutions are simple.

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Q: How long can perimenopause go on?

Posted in Questions...and answers, tagged , , on November 30, 2012 |

Perimenopause, also called menopause transition, starts with variation in menstrual cycle length. Cycles can go from every 28 to 30 days to every 21 to 24 days—or 21-40 days. Cycles that are closer, further apart, longer, shorter, heavier, or lighter are all considered normal for perimenopause. Rarely, women go from having regular periods to having none, skipping the “transition.”

98 percent of women experience a natural menopause—one year without menstruating—between ages 40 to 58. I have seen one or two women at age 60 still menstruating—but somebody has to be that 1 to 2 percent! We really are unable to predict the age of menopause for any given woman. Again, for most women the symptoms of perimenopause last for four to eight years, but, again, there are a few stragglers who have them longer than most.

Any bleeding after menopause deserves investigation and evaluation, so it is important to differentiate post-menopausal bleeding from a few lingering periods.

I sense from the question that you’re ready for a “change”! Hang in there. It’s coming.

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The Stages of Menopause

Posted in Condition News, tagged , , , on September 17, 2012 |

Last week I wrote about the STRAW guidelines and STRAW + 10, an update based on the review of research done in the 10 years since the original guidelines were published. Because not all of us have reached menopause, defined as one year without menstruating, some of us are interested in what we can learn from the detailed phases!

For context, remember that STRAW draws three large phases: reproductive, menopausal transition, and post-menopausal. The recent review and enhancement of the model outlined four specific stages within that “menopausal transition” that has many of us looking for answers.

During Late Reproductive Years, your ability to have a child is declining. Your menstrual cycles may be shorter and either lighter or heavier. During the first week of your cycle, the follicle-stimulating hormone may rise more than before as your body works to continue reproduction. The length of this stage varies a lot, but it could be as much as nine years.

Perimenopause officially begins with the second stage, Early Menopausal Transition. During this stage, you’ll see more unpredictability in your menstrual cycle—you may even think it’s not predictable at all! And because your body is producing more estrogen but less progesterone, you may see an increase in PMS symptoms like irritability and bloating. This stage can last four years or longer.

Late Menopausal Transition is the second “half” of perimenopause (I put “half” in quote marks because it’s probably shorter than the first stage—a year up to a couple of years). This is when you’re likely to experience the “typical” symptoms associated with menopause: hot flashes, difficulty sleeping, and mood changes. You may not have a period for a couple of months. At this point, the big trend line for hormones is a decline, but both estrogen and progesterone production can vary wildly from day to day.

Finally, you reach Early Postmenopause. Again, this is marked by a full year without a period. If you haven’t already experienced hot flashes and other menopausal symptoms, you may now, or they may be worse for a while. Because estrogen and progesterone levels are very low, this is when other symptoms become apparent, like vaginal dryness or thinning of vaginal tissues.

As I’ve said before, there’s no clear roadmap that’s infallible for every one of us. I understand, though, the desire to understand what’s happening and to try to predict what lies ahead. I have a friend who’s 56 and still, by the STRAW + 10 stage definition, in “late reproductive years”; by the guidelines, she could be 69 before she reaches menopause. Can that be true? My medical equipment doesn’t include a crystal ball!

But not having a precise roadmap doesn’t change my recommendation to all of us: Learn about what lies ahead, whether it happens fast or slow, early or late. Do what you can to compensate for or manage the changes in your body as you’re aware of them, just as you pick up your reading glasses more often when the menus are hard to read. And, because it’s true that as hormones decline, we “use it or lose it,” stay as sexually active as you choose to be. It’s good for your health, it’s good for your relationship, and it’s good for your self-image.

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Tracking Menopause: More Detailed Guidelines for Docs

Posted in Condition News, tagged , , , on September 14, 2012 |

About ten years ago, a group of medical professionals put their heads together to create a set of guidelines that would chart the course of normal menopause in a more systematic way. They came up with a series of three stages that were each divided into several phases that women normally experience during menopause. These were the reproductive stage, which contained three phases; the menopausal transition, which contained two phases; the postmenopausal stage, which contained two phases.

The stages were determined by the changes that normally occur in a woman’s menstrual cycle and by follicle-stimulating hormone (FSH) levels. (Read this MiddlesexMD blog post for more information about FSH.)

Each phase was given a number, from -5 for the early reproductive phase, in which a woman has regular menses but increasing FSH levels, to +2 for late postmenopausal phase, in which menstruation has completely stopped.

This diagnostic system is called the Stages of Reproductive Aging Workshop, or STRAW, and it’s been a widely used tool for further research. But clinicians have also found it useful as a roadmap for normal menopause—to determine where a woman is in the transition and to predict the course ahead.

Physicians felt that some sort of system was important because menopause marks such a significant change in a woman’s health and quality of life. Some of these changes are temporary (sleep disturbances, hot flashes), and others, such as changes in bone density and urogenital symptoms, are permanent. Given the importance of this transition, some guideline that outlines a normal course through menopause might help in making healthcare decisions about issues like contraception and hormone replacement.

“When women have an awareness of their progress during the shifting manifestations of natural aging, it can be very reassuring,” says Dr. Cynthia Steunkel at the University of California, San Diego, for an article in Menopause.

While helpful for “normal” menopause, however, the original STRAW guidelines specifically exclude women who smoke, are obese, engage in strenuous exercise, have had a hysterectomy, have a significant illness, such as AIDS or cancer, or who have chronic menstrual irregularities. It also fails to address possible differences due to ethnicity, age, and lifestyle.

In 2011, ten years after the first conference, the group reconvened to update the guidelines to take into account the significant body of new research that has emerged and to broaden the subgroups of women for whom the guidelines would apply. The updated guidelines that resulted from this latest review of the research is called STRAW + 10.

Specifically, the updated staging system includes new measures of specific hormones and other “biomarkers” that help to determine the stages of menopause. It added three new subphases that further define the late reproductive and postmenopausal stages. And it can be applied to “most women,” regardless of lifestyle and ethnic diversity, although some exceptions still apply for issues like ovarian failure and chronic illness.

Despite all the fancy testing and technology, however, the most dependable indicator of the stage of menopause is, still, a woman’s menstrual cycle. “…The menstrual cycle remains the single best way to estimate where a woman is along the reproductive path,” said Dr. Margery Gass, one of the coauthors of the new criteria and the executive director of the North American Menopause Society.

In fact, all those other tests for biomarkers are considered “supportive,” and because of the expense of testing and the need for additional research, they aren’t normally called for. I don’t recommend testing for FSH or other biomarkers, either. The tests just aren’t helpful enough.

The new STRAW + 10 guidelines fills in some gaps left by the original system and gives us all a clearer roadmap (which I’ll detail in another blog post), but since it relies mainly on the menstrual cycle to determine the course of menopause, your best bet, as I said before, is to tune into your body and work to make peace with the changes you’re experiencing. You’re not alone! We’re here to help.

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A Hot Time Tonight

Posted in The Good Stuff, tagged , , on July 16, 2012 |

Let’s face it. When you get to this stage of the game, and especially if you’ve been with the same partner for years, you may be wondering whether sex is really worth all the bother. Is it really worth the time, the mess, the mental energy? Why not just let it go the way of your vanishing waistline?

Well, you might consider that many couples in their mature years have discovered a kinder, gentler sex life that enriches their relationship and keeps their finger on this essential juiciness of life. You might think twice about closing the door to this most lovely of intimacies with a person you love. You might reconsider losing this thing that keeps you in touch with sensuality in the broadest sense. As Dr. Christine Northrup said in an interview, “Menopause is the fork in the road where one side says ‘Grow,’ and the other says, ‘Die.’ Menopause… like the fall of the year, is an open window.”

Libido is a fragile flame at this stage of life. We can snuff it out, or we can coax that flicker into a cozy fire. And like other parts of our life, with some nurturing, some honesty, and some practice, sex can become one of the delights of our mature years.

So, maybe it’s time to rethink attitudes and values you’ve carried with your throughout your adult life. Your body, your libido, and your responses—and maybe your partner’s vim and vigor—are changing anyway, so maybe it’s time to bring some open-mindedness, more compassion and patience (and maybe some new moves) to the bedroom.

First, you have to discover what pleases you sexually. You might have a hard time articulating or even knowing what turns you on. Maybe you haven’t thought about it, or you’ve focused on your partner’s pleasure, or you’ve never enjoyed sex all that much, or you’ve been too self-conscious for that kind of exploration.

Have you ever considered that the biggest turn-on for your partner is when you’re turned on? And that it doesn’t even take penis-in-vagina sex to turn you on? “The good news is, men do not need a penis to pleasure a woman,” says Dr. Northrup, “and it’s very important to a man’s self-esteem that he know how to pleasure a woman.”

So, the first order of business is to find out what pleases you and then to communicate that to your partner.

So—explore your sexual parts! Get to know yourself and what feels good and where. Practice. Masturbate. You’ll probably discover that, rather than a full-on attack, a gentle tease, a buildup of tension, then backing off is both effective and pleasurable. Consider using a vibrator if you need more stimulation.

Now, have a little tutorial with your partner. How is he supposed to know this stuff if you don’t show him? Maybe he can show you what pleases him as well.

Next, broaden your definition of sex. According to sex therapist JoAnn Loulan, sex should begin with willingness and end with pleasure, with or without orgasm in between. Lots of intimacies count as sex—cuddling, kissing, touching. As long as it’s emotionally pleasurable and fulfilling and keeps the spark alive, it all counts.

Your mind can be the pink Viagra that everyone’s looking for. Harness your creativity and imagination. Fantasize. Read or watch erotica. Many women are gathering ideas from the latest 50 Shades of Gray series. (More on that later.) Or read this for our own list of movies that turn us on.

Finally, a few wrap-up thoughts:

  • Don’t compare. Your sex life is unique and sacred. There’s no magic number of times or ways to do it. At this stage of the game, we can do it any way we want.
  • Your partner is a lot more accepting of your body than you are, so let go of the self-criticism.
  • If you have a hard time loosening up and you can’t turn off that judgmental voice in your head, try a glass of wine with sex. (As long as alcohol isn’t a problem for you.) It’s a nice way to release inhibitions.
  • Take belly dancing. I still remember watching a friend who had learned to belly dance walk onto the dance floor with her husband. That woman had the roll of the hips down pat—it was sexy even for me to watch. You’ll develop some great musculature, and you’ll learn a truly female art form.

And most important: Have sex! However it works for you, just don’t stop.

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Herbs to Manage Menopause. Maybe.

Posted in Condition News, tagged , , , on July 12, 2012 |

Humankind has relied on medicinal plants for thousands of years. From that perspective, treatments like estrogen therapy (ET) are a flash in the pan.

And with insecurity about prescription oral ET because of rumored links to breast cancer and heart disease, are we back to leaves and roots?

Well, that’s an option. Maybe.

Many people choose nontraditional therapies, such as acupuncture, massage therapy, and homeopathy, either exclusively or in addition to traditional medicine. Botanicals—herbs and other plants—is just another of those nontraditional approaches. In fact, botanicals are still used in about half of the prescription drugs we take, according to an article in WebMD.

If you’re interested in trying botanicals for menopausal symptoms, like hot flashes, night sweats, and mood swings, here are a few options.

But first, a few caveats:

  • Herbs are drugs, just like pharmaceuticals. Don’t think that because they’re “natural” that they’re somehow safer or more pure. I often remind women that marijuana and cocaine are botanicals, too, so “botanical” does not always equal “healthful.” Botanicals can interact with other drugs, and they can cause side effects. If you have any medical conditions or are taking other medicines, do your homework and check with your doctor before taking any botanical.
  • Botanicals aren’t regulated. Dosages might vary and so might the quality and the efficacy of the remedy, depending on the manufacturer. So be sure to check the dosage you’re taking and buy botanicals from a reputable source.
  • There isn’t much credible research on the efficacy and long-term safety of most botanicals, so a lot of information is conflicting or based on hearsay from less-than-credible sources. For solid, current information, check out the National Center for Complementary and Alternative Medicine (NCCAM) website, which is maintained by the US Department of Health and Human Service.
  • No drug or botanical remedy replaces good health habits, like weight control, exercise, and a well-rounded diet.

So here’s the lowdown on the top botanicals for relieving some menopausal symptoms.

Black cohosh

Native Americans have used this member of the buttercup family to treat “female troubles” for hundreds of years. More recently, Germany’s Commission E, which is similar to our FDA, approved black cohosh for relief of menopausal symptoms. Remifemin is the commercial (and standardized) version of black cohosh. It’s also the version of black cohosh that’s been used in several studies.  As with most botanicals, however, the research is contradictory. It’s used to relieve hot flashes, night sweats, vaginal dryness and “other symptoms.”

Soy

While not an herb, per se, soy is one of those few plant-based substances that can only do you good. As a source of isoflavone—an estrogenlike hormone—it might relieve menopausal symptoms, although the North American Menopause Society stops short of recommending it due to inconclusive evidence. However, soy is known to control cholesterol and to help prevent osteoporosis, besides having several other health benefits. In any of its many forms—tofu, soy milk, roasted soybeans—it’s safe and good for you.

Chasteberry

Fruit of the chaste tree, which is native to central Asia and the Mediterranean, chasteberry has been used for menstrual and menopausal symptoms for millennia. While it might be more effective in treating menstrual problems, the jury is still out on how it works and how effective it is on menopausal issues. While it doesn’t have serious side effects, it might affect hormone levels. It might also suppress sexual desire (thus the basis of its quaint name), so if you’re experiencing that side effect of menopause, this isn’t the herb for you. It’s also knows as “monk’s pepper” for its libido-suppressing qualities.

Dong quai

Sometimes called the “female ginseng,” dong quai is another of those ancient remedies with conflicting and unproven results. Some sources unequivocally praise its ability to relieve hot flashes and night sweats; others that it has no benefit beyond placebo.

But everyone agrees that one side effect is increased sensitivity to sunlight, so be more vigilant about using sunblock if you take it.

Evening primrose

Evening primrose is a pretty North American plant with yellow flowers that blooms, as its name suggests, in the evening. Oil from its seeds is extracted to make the botanical remedy. It has few side effects, but it apparently isn’t very effective at treating menopausal symptoms. Maybe plant the seeds in your garden and enjoy the pretty flowers?

Ginseng

Not long ago, ginseng root was touted as an herbal tonic for everything from memory problems to erectile dysfunction to a general energy booster. It would be hard for any substance to live up to such hyperbolic claims, and ginseng doesn’t. “Research results to date do not support health claims associated with the herb,” states the NCCAM fact sheet.

As a magic bullet for menopause? Not so good.

It’s fairly innocuous, and might have some health benefits, but it isn’t the miracle cure it was cracked up to be.

St. John’s Wort

Another of those old-time remedies that has recently made a comeback as a sedative and treatment for mood disorders, such as anxiety and depression. While it may—or may not—be beneficial (a large NCCAM study found it no more effective than a placebo), it definitely has some powerful side effects.

St John’s Wort interacts negatively with a host of medications, including other antidepressants. It has a long list of side effects, including sensitivity to sunlight and sexual dysfunction. Yikes!

Have you tried any of these or other botanicals? How have they worked for you?

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Bad News for Smokers: More Reason to Quit!

Posted in Condition News, tagged , , on June 11, 2012 |

About one in five women smoke. If you’re part of that 20 percent, I’m sure you’ve heard all the warnings and finger-wagging about the health hazards of smoking. Maybe you’re tired of hearing about all that bad stuff.

Well, unfortunately, here’s more bad news.

Just view this post as informed consent rather than yet another attempt to scare the bejeesus out of you. You can ignore it—just don’t say we didn’t tell you.

Several recent studies on smoking and menopause have found that not only do smokers enter menopause early by about a year or two, but also that menopausal symptoms, such as hot flashes, are more intense.

The more you smoke, the greater your chances of early-onset menopause. (Your odds are more than double, according to a 2007 study of 2,000 women in Oslo, Norway.) Researchers think that smoking may affect hormonal levels or the secretion of enzymes related to hormones. It may also activate certain genes that trigger the onset of menopause.

Early menopause is troubling because it’s linked to heart disease and osteoporosis. In fact, a team of researchers in Boston have hypothesized that smoking rather than early menopause may be to blame for the rise in heart disease they see in post-menopausal women.

In addition to entering menopause early, women who smoke have more severe menopausal symptoms, and now a group of researchers from the University of Pennsylvania have specifically linked the severity and frequency of hot flashes to smoking and to genetic variations that control the metabolism of estrogen and the body’s response to environmental toxins.

In a 10-year study of 300 women, half of whom were African-American, smokers overall were about twice as likely to suffer from more severe and frequent hot flashes than nonsmokers. But with certain genetic predispositions, the African-American smokers were 84 percent more likely to suffer from intense and frequent hot flashes, while the white smokers were 56 percent more likely.

In an article for WebMD Health News, Dr. Margery Gass, executive director of the North American Menopause Society said, “I don’t think most women who smoke know that they are at risk for earlier menopause and more severe menopause symptoms.”

But now you know.

So if you suffer from hot flashes, and you smoke, you have one more reason to consider quitting.

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Q: Why do I feel premenstrual all the time–at 50?

Posted in Questions...and answers, tagged , , on November 28, 2011 |

Breast discomfort, bloating, acne, and cramps are all symptoms associated with perimenopause, I’m afraid. If your periods are irregular but still happening, what’s going on is that your ovaries are not quite done producing hormones, but the fine-tuned system of regular ovulation is winding down. Some chaotic and unpredictable hormone shifts result, contributing to the symptoms you’re experiencing.

What you describe sounds perfectly normal and will likely continue to some degree until menopause, when most of these symptoms will subside. Menopause is defined as 12 months without a period, and the average age for menopause is 51. It shouldn’t be too long a wait!

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Great Expectations

Posted in The Good Stuff, tagged , , , on January 5, 2011 |

A woman born in 1850 could expect to live just past her 40th birthday. A woman born in 1900 was likely to make it to 50—assuming she survived the flu epidemic of 1918 and other hazards. I looked up this life-expectancy data to help me understand why we have so little shared understanding of how menopause affects women.

We think of biology as something that changes very slowly, if at all. Since the beginning of time, we think, girls have menstruated, grown up into women, entered perimenopause, and then, at some point, achieved menopause. And then…

This is where the big change (no pun intended!) has happened. Our life expectancies have increased dramatically. Only 100 years ago, it was typical for women to die before they reached menopause. Our generation, in contrast, will live a third of our average-75-year lives post-menopause. Our granddaughters (born in 2000 or later) could be post-menopausal for closer to half of their 80-year-plus lives.

A third of our lives post-menopause? That’s good reason to make sure we women know that menopause is not the end of our sex lives. Sex is good for our health: it bolsters our immune systems, releases good hormones, helps protect (like other exercise) against heart attack and stroke, burns calories, relieves chronic pain.

Sex is good for our mental health, too, protecting us against depression and stimulating feelings of affection and intimacy. And sexuality is part of our identities, part of what we are.

Sex is part of a life that is not just longer, but happier.

It’s a research report I read recently that’s brought all this to mind. Most of the REVEAL (Revealing Vaginal Effects at Mid-Life) study participants said they weren’t aware of all the effects of menopause—on their vaginal tissues, in particular. Eighty percent of the participants who experienced painful intercourse said they’ve “learned to live with the vulvar and vaginal symptoms… as a normal part of getting older.” And 61 percent of those women felt it was “still taboo” to acknowledge menopause symptoms like painful intercourse.

Live with this for a third of our lives? Give up on—or suffer through—an aspect of who we are and what makes us happy? I don’t think so.

I often use a reading glasses analogy: When, as a part of aging, our eyesight is less acute, we get reading glasses, or a stronger prescription, or bi- or tri-focals. We joke about the type size on menus, and we ask for more light in the restaurant. We don’t give up on seeing! There’s too much of life still before us.

We need to understand the changes that are affecting us. We need to know there are ways to compensate—as with reading glasses—so that we can maintain our sexuality. And we need to let go of the notion that our health and happiness for a third of our lives is somehow a “taboo” subject to talk about—with our partners, our friends, our health care providers.

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