Perimenopause/Menopause
Your body changes at midlife, too. In your 40s, you enter a transition phase called perimenopause. During this time, the ovaries produce less estrogen.
Menopause is sometimes called "the change of life." The average age of menopause is 51.
Perimenopause and menopause are natural events.
Symptoms and Effects
Many changes of perimenopause are related to a decrease in estrogen levels. These changes may make you feel unlike your usual self.
Menstruation
In your 40s, increasing and decreasing hormone levels can cause changes in your menstrual cycle.
Hot Flashes
As you approach menopause, you may start having hot flashes. About 75 percent to 85 percent of perimenopausal women get them. These flashes are the most common symptom of perimenopause.
A hot flash is a sudden feeling of heat that rushes to the upper body and face. The skin may redden like a blush. You may break out in a sweat. A hot flash may last from a few seconds to several minutes or longer.
Hot flashes can happen anytime — day or night. Those occurring during sleep, called night sweats, may wake you up and leave you tired and sluggish the next day. Even though hot flashes are a nuisance, sometimes embarrassing, and may interfere with daily life, they are not harmful.
Sleep Problems
Perimenopausal women may have to deal with sleep problems. Night sweats may disrupt your rest. You may have insomnia (trouble falling asleep), or you may be awake long before your usual time.
Vaginal and Urinary Changes
As your estrogen levels decrease, changes take place in the vagina. Over time, the vaginal lining gets thin, dryer and less flexible. Some women have vaginal burning and itching. The vagina also takes longer to become moist during sex. This may cause pain during sex. Vaginal infections also may occur more often.
Bones
Once made, bone is always changing. Old bone is removed in a process called resorption, and new bone is formed in a process called formation. From childhood until age 30 years, bone is formed faster than it is broken down. After age 30 years, the process begins to reverse: bone is broken down faster than it is made. However, bone loss that happens too fast can result in osteoporosis. Osteoporosis causes bones to become too thin and weak.
To prevent osteoporosis, you should focus on building and keeping as much bone as you can before menopause. You can do that by getting plenty of calcium and weight baring exercise.
Cardiovascular Disease
Heart disease kills more women than any other cause of death. After menopause, a woman's risk of heart disease and stroke increases. Women who have not reached menopause have a far lower risk of cardiovascular disease than men. The estrogen produced by women's ovaries before menopause protects them from heart attacks and stroke. When less estrogen is made after menopause, women lose much of this protection. The risk of heart attack and stroke then increases.
Sexuality
Sexuality is an important part of life. Sex can give you a feeling of well-being and bring you closer to your partner.
Sexual Changes in Women
Your sex drive and sexual response may change in the perimenopausal years or beyond. As you age, sexual arousal takes longer. It's important to talk with your partner about what you're feeling and what excites you. You may need to spend more time on foreplay or try new positions.
When estrogen levels are low, vaginal tissue gets thinner and dryer. This may cause discomfort during intercourse. Water-soluble lubricants sold over-the-counter can help moisten the vagina.
Some postmenopausal women enjoy sex less than they used to because they feel self-conscious about wrinkles and other signs of aging. However, many women say their sex lives are better after menopause.
Sexual Changes in Men
Men take longer to get aroused as they age, just as women do. Their erections may become less rigid, as well. This is normal and should not affect sexual satisfaction.
Emotional Concerns
The constant change of hormone levels during perimenopause can effect a woman's emotions. Some women have mood swings, memory lapses and poor concentration. Some may feel irritable or depressed.
Lifestyle Changes
Losses, new demands and changes in routines are common at midlife. Your children may be entering their teen years — a time of challenges.
Today, many women wait to start a family until they are around 40 years of age. Becoming a new mother at midlife — no matter how joyful an event — is a big adjustment.
Women who have not had children or never married also face changes of midlife.
Despite these challenges, midlife often is still a rewarding phase of life.
How to Cope
The best thing you can do to get through midlife's rough spots is reach out for help. Talking with others is reassuring. If you open up to a friend, you may find she is facing the same fears and stresses.
If you are bothered by unsteady emotions or mental lapses, talk to your doctor.
Hormone Therapy
A major decision facing you as you enter menopause is whether to take hormones. For many women it is a confusing issue.
What Is Hormone Therapy?
With HT, you are given estrogen to replace the estrogen your body is no longer making. If you have never had a hysterectomy and, therefore, still have a uterus, you normally are given progestin, as well. This helps reduce the risk of cancer of the lining of the uterus that occurs when estrogen is used alone.
Estrogen often is prescribed as a pill, patch or gel, you apply to your skin. Another alternative is an Estrogen vaginal ring, oral contraceptives (birth control pills) also contain estrogen and progestin, but in higher doses. During perimenopause, oral contraceptives offer birth control and help regulate the menstrual cycle. They may be used during perimenopause before HT.
Benefits of Hormone Therapy
One benefit of HT that women are likely to notice right away is the relief from symptoms. For about 98 percent of women who take estrogen, hot flushes are relieved.Estrogen also treats vaginal dryness and irritation. Women who take estrogen have fewer urinary problems, such as infection and incontinence.
Hormone therapy also has been shown to help keep bones strong, which helps prevent osteoporosis. However, it only protects bones for as long as you use it.
Risks and Side Effects
As with any treatment, HT is not risk free. Estrogen therapy causes the lining of the uterus to grow and can increase the risk of uterine cancer. However, adding progestin lowers the risk of uterine cancer to less than that in women who do not take HT.
In women who take HT, spotty bleeding may occur. It’s important to notify your doctor if this occurs.
There is an increased risk of breast cancer in women who use combined hormone therapy. The increase appears to be small, but increases depending on how long a women takes hormone therapy. Hormone therapy also modestly increases the risk of heart attack, stroke and blood clots.
Eat a Healthy Diet
Eating a healthy diet will help you look and feel better. It also will lower your risk of osteoporosis and heart disease.
Exercise
Making exercise a part of your life can pay off in many ways. Exercise can help you lose weight and keep it off. Aerobic exercises help protect against heart disease and diabetes, and weight-bearing exercises help prevent osteoporosis.
In short, exercise makes you look and feel better.
Maintain a Healthy Weight
Weight gain is not so much a result of meno-pause as of middle age. About one in four women aged 35 to 64 years is overweight. Metabolism slows as you age, so your body takes longer to burn up the food you eat. Women have about 25 percent body fat, compared with 15 percent for men. This extra fat makes it easier for women to gain weight and harder to lose it.
Don't Smoke
Women who smoke shorten their lives by five to eight years. They also increase their risk of osteoporosis. Smoking doubles the risk of heart disease and cancer of the cervix and vulva in women, and multiplies the risk of lung cancer 12 times. Even the children of smokers can be affected by being exposed to secondhand smoke.
Limit Alcohol Intake
Drinking alcohol poses special concerns for women. A woman who drinks the same amount as a man is affected more. This is because her body contains less water to dilute the alcohol and her stomach has less of the key enzyme that digests it. When you drink, the alcohol slows your reflexes and affects your judgment and memory. One important reason why perimenopausal women should watch their drinking is that alcohol interferes with bone growth and calcium absorption.
Get Regular Health Care
Routine health care, even if you're not sick, can help detect problems early. It also gives you and your doctor a chance to talk about ways to avoid problems later in life.
Do Self-Exams
Throughout the year, there are exams you can do yourself to find possible problems early. One of these is the breast self-exam. Being familiar with the usual ridges and bumps in your breasts may make it easier for you to notice any changes.
Checking your entire body for skin changes also is a good idea.
Use Birth Control
Although your menstrual periods may become erratic as you get closer to menopause, pregnancy is still possible. Even having other signs of perimenopause, such as hot flushes, does not mean you can't get pregnant. About 75 percent of pregnancies in women older than 40 years are unplanned.
Get Preconceptional Counseling
If you are planning a pregnancy late in your childbearing years, be aware that the risk of problems increases with the woman's age. A woman younger than age 50 years should take 0.4 mg of folic acid daily if she is planning a pregnancy. It's also important to receive preconceptional counseling.
Having a first child near or after age 40 years is not rare. Women who get pregnant in their 40s can have safe pregnancies and healthy babies.
Practice Safer Sex
Everyone who is sexually active is at risk of getting an STD. Some STDs, such as syphilis or chlamydia, usually can be cured. Others have no known cure. Among these is acquired immunodeficiency syndrome (AIDS), a life-threatening disease caused by human immunodeficiency virus (HIV).
The best protection from STDs is for a couple to have sex only with each other.
There was a time when no one talked about menopause; it was a mystery to most women. Today, you can find a wealth of information on the topic. Talk with your doctor and learn as much as you can. That way, you can look ahead to the next stage of life with confidence. For more information, visit www.knowmenopause.com.
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