YOUR MENOPAUSE MADE EASY 

A really Positive Guide to the Menopause

By Anne Newbury

Introduction

Nothing is guaranteed to affect a women's emotional and psychological equilibrium more than the realisation that she is fast approaching the menopause.

Indeed, for many of us, the mere contemplation of the word is enough to arouse all manner of anxieties and fears. And who can blame us, when stories passed down from our mothers, or around by our friends, tend largely to highlight only the most gloomy, negative aspects of this unavoidable situation?

Listening to other's experiences; their grisly tales of embarrassing hot flushes, insomnia, rapid weight gain and declining looks and health, we cannot help but be filled with foreboding for our own future.

And the closer we get to middle age, the more likely we are to perceive the menopause as an unwelcome intruder whose appearance denotes an important demarcation line that, henceforth, will be a permanent reminder of the uncomfortable fact that our youth is now firmly behind us.

But, surprising as it may sound, your own experience of this perfectly natural event need be nowhere near as difficult or as negative as you may have been led to believe. For while it is certainly true that a large proportion of the ten million or so British women who are either approaching or currently going through the ‘change' are likely to suffer at least one or more of the uncomfortable, distressing, embarrassing and sometimes even painful symptoms commonly associated with it, it is equally true that a significant proportion of these could experience not only far fewer symptoms, but also a markedly less traumatic or difficult passage than they envisage.

How? Experts agree that, of all the many problems women both fear and perceive about the menopause, by far the biggest influence on their actual experience of it will be their attitude towards it. In other words, women who fear the menopause and those who believe that the only way to get through it is to ‘grin and bear it' in silence, are likely to experience a far more distressing and uncomfortable time, than those who approach it with knowledge, a positive attitude, and the courage to demand professional information, support, advice and medical intervention should the need arise.

Scientific research has shown that information is the key that equips us to cope. This applies to almost every aspect of our lives, as well as to virtually every situation that we are likely to encounter in our lives. Surveys conducted with hospital patients have revealed that patients who are given all the necessary details about their illness i.e. what caused it, how it will be treated, what side-effects to expect, etc. not only have a far better chance of recovery, but also recover far more rapidly, than patients who are left in the dark.

The aim of this app, therefore, is to provide you with everythingyou need to know about the menopause. It is filled with reliable information, valuable advice and a number of tried and tested self-help strategies to help you cope with every single aspect of the menopause, in order to ensure that your ultimate experience of it will be as painless, comfortable, pleasant and as positive as it can possibly be.

As with puberty, the menopause is an unavoidable fact of life. And just as some women's experience of puberty was more difficult than their peers, your own experience of the menopause is likely to be quite different to any other woman's. Not only because of the wide variation that exists in the physiological and hormonal patterns of our bodies, but also because of the different psychological reactions we all have to similar events.

In order to gain a full and true understanding of what happens during the menopause - and why - it is important to first understand what changes took place within your body at puberty, which marked the commencement of the cycle that the menopause will soon bring to an end.

HOW PUBERTY AFFECTS YOUR BODY

Although some women will have experienced an earlier or later puberty than average, the majority of women will have embarked on this important stage in their lives at some time between the ages of eleven and fourteen. Most of the changes that occurred at this time will have been triggered by the production of certain hormones. This process occurs when a part of the brain - the hypothalamus - tells the pituitary gland that it is time to start releasing a class of hormones known as gonadotrophins.

Gonadotrophins, in particular FSH and LH  (which stand for Follicle-Stimulating Hormone and Luteinising Hormone) stimulate the ovaries to start producing oestrogen and progesterone which, once they enter the bloodstream, have their own specific influences to play, both from a physiological point of view, and also from a psychological and emotional point of view.

Oestrogen has several roles to play. Apart from stimulating the formation of breast tissue and the growth of pubic and underarm hair, oestrogen affects the development of the special sweat glands known as the apocrine glands (which are sited close to the vagina, anus, naval and nipples) and also affects the way your body lays down fat deposits. Another function of oestrogen is to stimulate the ovaries to grow in order to produce even more of this hormone. It takes between one and two years for the ovaries to reach a size large enough to enable them to start producing eggs.

Once egg production starts, the two hormones which triggered off the whole process in the first place, FSH and LH will then prompt the ovaries to release the tiny eggs they have manufactured into the fallopian tubes. This process is termed ‘Ovulation'.

 Once ovulation takes place, the release of the egg will cause a tiny scar to form on the ovary, which in turn, becomes a small pink and yellow gland. This tiny gland - the corpus luteum - is responsible for the manufacture of progesterone, whose job it is to effect the necessary changes in the lining of the uterus to make it capable of receiving and feeding a zygote, which is the name given to an egg once it has been fertilized by a sperm.

 Once conception occurs, the cells of the zygote will undergo a rapid transformation by repeatedly dividing themselves while it journeys along the fallopian tube and down into the uterus. Implantation occurs when, after floating around freely in the uterus for between four and seven days, the zygote finally attaches itself to the endometrium (the mucous lining of the uterus).

 If conception fails to take place, however, an altogether different cycle of events will occur. Sometime around the 24th day of the cycle the hypothalamus will halt the flow or releasing hormone to the pituitary gland which, in turn, will reduce its own flow of follicle-stimulating and luteinising hormones to the ovaries. As production of these hormones diminishes, the ovaries will cut back drastically on their output of oestrogen and so restrict the flow of blood to the uterus. When this occurs, the cells begin to die, and the uterine lining, which is no longer needed, begins to shed itself in the process known as menstruation.

 This cycle of egg production and the shedding of the lining of the uterus will continue (interrupted only by pregnancy) for several decades until the last mature eggs have been produced and released. While it has been estimated that women are born with as many as 70,000 potential egg cells present in our bodies, fewer than 500 of these are likely to become mature eggs.

 As you can see from this brief explanation, there are many complex changes that take place within your body during each menstrual cycle. Not surprisingly, therefore, any disruption in this hormonal process can have far-reaching consequences upon a woman's body, as well as her psychological and emotional equilibrium.

HORMONES AND THEIR EFFECTS

 In addition to governing the reproductive cycle, oestrogen and progesterone are also responsible for the following:

 Oestrogen

  • Apart from working with another set of hormone-like substances (prostaglandins) to maintain healthy blood vessels, oestrogen also helps to control and maintain the supply of collagen, which is an important component of healthy hair and skin. Adequate supplies of collagen are vital to maintain the elasticity of the skin and the thickness of our hair.

 Progesterone

  • Together with prostaglandins and immunoglobulins, progesterone acts to improve the functioning of our immune system, and also helps the body maintain an optimum balance of salt and water.

Aside from these effects, the ovarian hormones also have a key role to play in influencing our mood and the state of our emotions at different stages of our cycle. For example, the feeling of happiness and optimism we often experience at the commencement of each cycle (just after our period ends) owes much to the high levels of oestrogen present in our bodies at that time. Conversely, the moodiness, irritability and generally out-of-sorts feeling associated with the PMS many women experience just prior to menstruation is, to a large extent, influenced by the lower level of oestrogen and higher concentration of progesterone present towards the end of our cycle.

Recent research has shown that, far from being ‘all in the mind', as some medical physicians believe, PMS is not only a very real condition, but it's cause is now known to be linked very closely to the levels of oestrogen and progesterone present in a woman's blood. The hormonal imbalance which tends to occur towards the end of the menstrual cycle can cause all kinds of problems from headache, backache, depression and migraine, to food cravings, skin problems, weight gain and extreme mood swings.

And the closer we get to the menopause, the more marked these hormonal imbalances are likely to be. For example, the less frequently we ovulate, the less progesterone our bodies will produce. Instead of shedding itself regularly, the endometrium, or lining of the womb, will go on building up until sufficient progesterone is available to precipitate menstruation. Thus, when menstruation does finally occur, which may happen after a delay of a few weeks, or several months, the flow of blood is likely to be far heavier than previously experienced.

Apart from causing irregular, unpredictable and probably more uncomfortable and lengthier periods when they do finally occur, this shortfall in progesterone can, in certain cases, either exacerbate any PMS symptoms that were previously experienced, or prompt their appearance for the first time.

Testosterone

Testosterone is another hormone which affects the female body. Although principally a male hormone, small quantities of it are produced by the adrenal glands and the ovaries from puberty onward. Unlike oestrogen and progesterone, however, our production of testosterone is likely to increase, rather than fall following the menopause. Although in most cases this increase is marginal, it does occasionally happen that a woman will produce rather more testosterone than her body needs. If this should happen, it could not only affect a woman's femininity, but also cause an increase in the growth of facial and bodily hair.

HOW THE MENOPAUSE AFFECTS YOUR BODY

Because there are very few outwardly physical signs, most women are not actually aware of the advent of the menopause until their periods have either been irregular for some time, or some other symptom associated with it (i.e. they start experiencing the odd ‘hot flush') begins to manifest itself. This is because the actual process itself takes many years to complete.

Consequently, many women in their late thirties and early forties believe that, so long as their periods are still regular, and no other outward physical changes are taking place, the menopause is still a long way off. Inwardly, however, it may well be a different story. Because a women's reproductive system does not grind suddenly and immediately to a halt (unless she has a hysterectomy which also involves the removal of the ovaries), great variations can take place in hormonal levels with little outward effect.

Eventually, however, certain changes will occur that you will not be able to ignore. The first of these is likely to be a change in the volume of menstrual blood. Some women experience heavier periods, some lighter, while others will experience a mixture of both over a period of months. Some may even find that their periods cease altogether only to reappear suddenly several months later. It is important to point out, however, that contraceptive measures should not be dispensed with, as although conception becomes increasingly less likely with each passing month, it is still technically possible to become pregnant. Witness the number of ‘surprise babies' that have been born to women in their 40s and 50s who thought their chances of motherhood had long since passed! Most experts are in agreement that you should not dispense with contraception until you have had at least twelve consecutive period-free months.

Apart from the above mentioned changes in your pattern of menstruation, the fact that your ovaries will still be producing oestrogen means that few other symptoms may occur at this stage. You may even find that a few years will pass before the symptoms associated with reduced oestrogen levels, such as hot flushes, vaginal dryness, night sweats or vague feelings of tiredness or general lethargy begin to appear.

Of course it is impossible to predict with any real accuracy how long your own menopause is likely to last, or even when it might begin, as there are so many variables to take into account. Despite all the research that has been conducted in recent years, the only factor to emerge that may be of some use in gaining an insight into both the timing of this event and the anticipated length of its duration, is that a certain similarity has been found within family groups. So, if your mother, grandmother, sister and aunts experienced a late, short menopause, it is reasonably safe to assume that this pattern may well repeat itself in your case, too.

SYMPTOMS OF THE MENOPAUSE

There are many symptoms associated with the menopause. Of these, some are fairly common and, therefore, are likely to affect a larger proportion of women. These include the following:

  •  Hot flushes
  •  Palpitations
  •  Night sweats
  •  Insomnia or changes in sleeping patterns
  •  Painful periods
  •  Heavier or lighter periods
  •  Changes in the condition, tone and texture of your skin and hair
  •  Vaginal dryness

 Other, less common symptoms include:

  •  Sexual problems
  •  Urinary problems
  •  Weight gain
  •  Changes in the density and structure of bones

While it is impossible to predict which particular symptoms are likely to affect you and to what extent, the following statistics compiled from research conducted in Great Britain and the United States may prove helpful, not only in providing you with some idea of what to expect, but also in allaying some of your worries and fears:

  • Around 15 per cent of women experience virtually no symptoms at all.
  • Around 10 per cent of women are likely to regard their symptoms as ‘severe' or even ‘very severe'.( Although it is important to add here that symptoms that may be regarded as ‘severe' by one woman, could well be dismissed as ‘insignificant' by another.)
  • The remaining 75 per cent of women are likely to experiencesome symptoms, but how severe these are likely to be will, of course, vary to a large degree.

What the above-mentioned statistics do not reveal, however, is how much information, advice, support and help was given to the women who took part in the above-mentioned surveys to help them cope with the symptoms and side-effects caused by the menopause.

For, as many women have already discovered for themselves, there are many new strategies and approaches available today, all of which have been proven to reduce significantly - and sometimes even banish altogether - the majority of symptoms caused by the menopause.

WHY THESE SYMPTOMS OCCUR AND HOW TO COPE WITH THEM

Hot Flushes

Intermittent hot flushes, which are estimated to affect between 50-85 per cent of women, are one of the most common symptoms of the menopause.

Some women have relatively few hot flushes, perhaps only once a fortnight or once a week. Others may find themselves experiencing these between once and several times a day. The severity of attacks also varies to a marked degree. A severe attack may leave you perspiring so profusely that the sweat trickles down your face, neck and back. Palpitations, nausea and sometimes even faintness, can also occur.

Although no one is entirely certain why hot flushes should occur, the most likely cause is thought to be due to hormonal disruptions which affect the hypothalamus's ability to control body temperature. In the normal course of events, the hypothalamus regulates our body temperature quite effectively. Nerve impulses transmitted along the autonomous nervous system send messages to the sympathetic nervous system telling it when to switch on our internal heating system, and when to switch it off, in order to maintain optimum body temperature.

This delicate mechanism is thought to be so sensitive that even a mild reduction in oestrogen levels can upset its balance, causing the wrong messages to be relayed. Instead of maintaining their normal level of activity, the blood vessels suddenly dilate, propelling more blood than normal to the surface of the skin. Apart from increasing the body's rate of ‘heat loss' through the pores, the increased amount of blood just beneath the surface results in ‘flushing' or reddening of the skin in the surrounding area.

Despite the fact that hot flushes are a perfectly normal occurrence, and not in the least harmful, they can be quite disconcerting. However, the good news is that their frequency and severity is only likely to be greater at the beginning of the menopause. Once the hormones begin to stabilise at their new levels, they will gradually become milder and less frequent until they eventually disappear altogether.

Self-Help Strategies-

  • Keeping a record of when the hot flushes occur may help you pin-point which time of day and in which particular situations they are most likely to occur. If you do find a common link, you can take steps to avoid that situation or to reduce your activities at specific times in order to minimise their effects.
  • Reduce your intake of tea, coffee, alcohol and spicy foods, and any other stimulants, as these are known to precipitate and exacerbate hot flushes.
  • Avoid heavy clothing, long-sleeved, tight-fitting outfits' with high necks and materials made from synthetic fibres, as these can promote sweating and trap perspiration. Wear natural lightweight fibres such as cotton and silk which have better ventilation properties. Short sleeve dresses and blouses with a V-neck will help you stay cool. In colder weather, several layers of lightweight clothing are better than one thick layer of a heavier fabric - this leaves you with the option to remove one or two layers when a hot flush occurs.
  • Don't spend all your time worrying when the next hot flush will occur. When they do occur, try to remain calm and relaxed - panicking will only succeed in speeding up your heart rate, thus adding to your stress and making the problem worse.
  • Avoid stuffy, smoky, over-heated rooms. If this is impossible try to manoeuvre yourself so that you're fairly close to a source of air-circulation, such as a door or window.
  • Sugar and tobacco are both known to promote perspiration. If you can't cut either or both out of your life entirely, reducing your intake can be a significant help.
  • Carry chilled water around with you (a thermos flash is ideal for this purpose), or a small, hand-held, battery operated fan.
  • Citrus fruits and ginseng contain small amounts of oestrogen - including these in your diet can help boost your supplies of this hormone.
  • When hot flushes occur, taking a cool shower will help lower your body temperature. If this is not practical, running your wrists under cold water for a few minutes should help achieve the same effect.

Palpitations

Hot sweats are often accompanied by palpitations, as the same mechanism often also results in speeding up the heart beat and pulse rate, so that it feels as if your heart is skipping a beat, or racing uncontrollably. While these can be rather alarming if you have not experienced them before, they should not automatically be interpreted as a cause for concern. However, if you are at all worried it's always a good idea to seek advice and reassurance from your GP. Most doctors are only too happy to check you over in order to both eliminate any other potential causes, and also put your mind at rest.

Self-Help Strategies-

  • Learning a few simple relaxation techniques can help you cope better with these.
  • In some cases, a few simple changes to the diet can do much to reduce both the severity and frequency of palpitation attacks.
  • Hormone Replacement Therapy can also be useful in eliminating these (and many other symptoms) altogether. This is discussed in greater detail in a later chapter.

Night Sweats

As their name suggests, night sweats occur in the middle of the night, often when you have been asleep for some time, only to wake up suddenly soaked in sweat. Once again, these are caused by the same mechanism that prompts their day time equivalent: hot flushes. However, where normal sweating usually takes place in the armpits, the palms of the hands and soles of the feet, perspiration caused by hot flushes and night sweats usually occurs on the forehead, neck, upper lip, face and trunk.

Self-Help Strategies

  • Leaving a window open in your bedroom at night will help you to remain cool.
  • Cotton sheets are both far more effective at absorbing moisture and keeping your body temperature down.
  • As with daytime clothing, using several thin layers of bedding is more practical and sensible then one heavy duvet or several thick blankets.
  • Avoiding hot, stimulant drinks such as coffee and tea and refraining from smoking immediately before bedtime can help reduce attacks, as can drinking a glass of water before you retire.
  • Keep an electric or battery -operated fan on your bedside table. Alternatively, use a bowl of tepid water and a sponge, and allow the water to evaporate on your skin, as this will help t absorb the heat. Don't be tempted to use cold water or iced water though, as this can only increase the over-heating effect that you are trying to combat.

Premenstrual Symptoms

If you were prone to suffering PMS before the menopause, it is highly possible that certain symptoms may intensify for a while until your hormones stabilise. Symptoms include bloating, anxiety, irritability, tearfulness, tender breasts, increased dryness or greasiness of the skin, a craving for chocolate, sugar and sweet foods, fatigue and sleep disturbances. While these can be uncomfortable and irritating, the following self-help tips will help you to manage them more effectively, and to minimize their effects.

Self-Help Strategies

  • You can help stabilise your blood sugar and avoid sugar cravings by eating several smaller meals instead of one or two larger ones.
  • Reducing your intake of salt will help reduce bloating and water retention.
  • Alcohol and caffeine can aggravate the symptoms of PMS. If you cannot avoid them altogether, try to reduce your consumption.
  • Make sure your diet contains sufficient calcium, magnesium, vitamin B6 and vitamin E, as these can help reduce and/or alleviate emotional symptoms. A list of natural sources is provided below:

Calcium - Milk, cheese, sardines, soya beans, salmon, peanuts, walnuts, sunflower seeds, dried beans, green vegetables.

Magnesium - Figs, lemons, grapefruit, yellow corn, almonds, nuts, seeds, apples, dark green vegetables.

Vitamin B6 (pyridoxine) - Brewer's yeast, wheat germ, wheat bran, liver, kidney, heart, cantaloupe, melon, beef, milk, eggs, cabbage, blackstrap molasses.

Vitamin E (tocopherol) - Wheat germ, soya beans, vegetable oils, broccoli, Brussels sprouts, spinach, enriched flour, leafy green vegetables, whole wheat, whole grain cereals and eggs. 

A good multi-vitamin and mineral supplement can provide you with additional insurance. If you prefer to take separate supplements, the following information may prove useful:

  • Dolomite is a very good magnesium supplement, as it contains a perfect balance of calcium and magnesium. But do be careful not to take magnesium after meals as it does neutralise stomach acidity. Women on HRT and pre-menopausal women still taking the Contraceptive Pill need larger amounts of magnesium.
  • B vitamins are synergistic - this means that they are far more effective when taken together, than when taken separately. When taking a B complex, do make sure that it contains equal amounts of B1 (thiamine), B2 (riboflavin) and B6 (pyridoxine). Around 50mg of each is a good balance.
  • Vitamin E is thought to help you look younger by slowing down cellular ageing. It can also help alleviate fatigue and water retention. Pre-menstrual women who take the Contraceptive Pill, and women on HRT need extra supplies of vitamin E. This vitamin should not be taken within eight hours of a supplement containing ferrous sulphate (inorganic iron), as this destroys vitamin E. Other forms of iron such as ferrous gluconate, peptonate, citrate or fumerate are safe to take with vitamin E.

Sleep Disturbances and Insomnia

It has been estimated that around 32 per cent of women are likely to suffer some disturbance in their normal sleeping patterns while going through the menopause. However, many experts feel that these may not necessarily be a direct result of the menopause itself, but rather, stem more from the anxieties created by the ‘change', or merely as a result of other changes that naturally take place at this stage, i.e. children leaving home (empty-nest syndrome), and worries about the physical signs of ageing.

Nonetheless, because long-term sleep difficulties and insomnia can be a rather irritating and debilitating experience, it is worth taking steps to do as much as you can to help overcome this problem.

Self-Help Strategies

  • Eating a banana, or having a milky drink at bedtime can help you relax. Similarly, a short soak in a warm (but not hot) bath containing relaxing aromatherapy oils can help you unwind and promote better sleep.
  • If you find yourself unable to get to sleep, don't lay awake tossing and turning and worrying about it. Use the time constructively to accomplish something else. There are many things we all want and mean to do, but rarely get around to. Reading a book, watching a late-night film, or catching up on your sewing or correspondence are just a few things that you can do uninterrupted in those quiet night time hours when the rest of the family are asleep. It's amazing how relaxed and sleepy you'll soon feel once you stop worrying and start doing something else.

Alterations in your Skin and Hair

One of the most common fears of women approaching or going through the menopause is the changes this will bring in their hair, skin and overall appearance. There is no doubt that a reduced oestrogen level causes changes in the collagen structure which ultimately will make some difference to the tone and texture of your skin, as well as the thickness and condition of your hair. Once again, however, it is important not to lose your perspective. Of course, ageing is inevitable, but there is much that we personally can do to preserve our looks.

Self-Help Strategies

  • Make sure your diet consists of sensible foods that contain all the essential nutrients, vitamins and minerals.
  • Making sure you always remove every trace of make-up before bed, and applying a good quality night time moisturiser to your face, neck and décolletage will help to keep your skin soft, supple and smooth.
  • Regular professional facial treatments will help to deep-cleanse your skin and deal with any problems such as dry, flaky patches, greasiness or spots that might crop up due to changes in your hormone levels.
  • Dry skin brushing on a daily basis will help exfoliate any dead surface skin cells that build up. This is also extremely good for the circulation, which is important for the proper transportation of nutrients to the skin cells. Adding moisturising lotions and oils to your body will aid in keeping your skin soft and supple.
  • Exercise is good for many reasons - not only does it help keep your bones strong and healthy, but it's good for the heart, the lungs, the circulation and your weight. It's also remarkably relaxing and energizing.
  • HRT can help counter-act and sometimes even reverse any loss of collagen - but this is not recommended for everyone. Do discuss your suitability for treatment with your GP.

Weight Gain

According to the experts, striving to maintain your pre-menopausal weight can do more harm than good. Falling oestrogen levels and slower metabolism will have some effect on the way your body lays down fat, but not every woman will necessarily put on weight - some even weigh less after the menopause then they did before. On the other hand, this isn't necessarily always a good thing, either. Surveys show that underweight women live shorter lives than those who are overweight. Moreover, faddy dieting and too much weight loss can have adverse effects on your skin. Women with plumper faces often look more youthful than their thinner sisters. And while you may not relish being a dress size larger, do remember that people notice your face far sooner than they notice your body.

Self-Help Strategies

  • Before you consider embarking on a diet, do check that your weight is within the acceptable boundaries for your height.
  • If you do find that you need to lose weight, try drinking a glass full of water thirty minutes before each meal. Not only is it wonderful for the skin, but it will help to make you feel fuller and more satisfied when you do eat.
  • Take time over your meals - don't rush them. Eating slowly and chewing your food thoroughly will help you to feel more satisfied. People who are overweight often tend to bolt their food.
  • Exercising an hour before you eat can help suppress your appetite. Exercise will also help maintain and increase muscle tone.
  • Altering your eating habits, and switching your largest meal to an earlier time of day will give your body more time to burn up the calories.
  • Don't eat late at night.
  • Eating the same amount of calories per day, but dividing them up between several smaller, more frequent meals will help stop you feeling hungry. Eating also switches on the metabolism.
  • Never skip breakfast, even if you don't feel like eating first thing in the morning. Many experts agree that this is the most important meal of the day.

Painful periods

If you find that your periods become more painful once the menopause starts, do see your doctor. Although this does tend to happen in around 10 per cent of cases, and often is nothing to worry about, there a number of other possible reasons that can also cause this. It is important to rule out fibroids, endometriosis (which occurs when small pieces of the lining of the womb break away and attach themselves outside the uterus to the ovaries or other areas), and other infections.

THE EMOTIONAL AND PSYCHOLOGICAL EFFECTS OF THE MENOPAUSE

Apart from the common and easily identifiable physical symptoms that accompany the menopause, there are a number of other emotional and psychological symptoms associated with it. Before we go into these, however, it is very important to point out that many of these may also stem from, or be a natural result of, other changes that traditionally occur at this period of our lives.

After all, middle age often coincides with a number of other life events that sometimes give rise to feelings of inadequacy or depression. These may include:

  • Bereavement of a parent, or a favourite older relative.
  • A partner's retirement, work difficulties, fear of redundancy or your own retirement.
  • Children going off to college or university, or leaving home to get married can often leave you with the feeling that you are no longer needed quite so much.
  • A growing awareness that you are neither as fit nor as healthy as you used to be.
  • Changes in your own or your partner's sexual pattern and/or libido can often cause frustration and/or dissatisfaction.
  • Having to come to terms with the fact that, while you are still a long way from being old, it is not easy, and this sense of loneliness can have adverse consequences upon your confidence and sense of security.

Worries stemming from events such as these, coinciding as they often do with the advent of the menopause, can often lead many women to assume that their emotional and psychological problems are a direct result of the menopause itself. And while each individual's experience of the above situations will be quite different, I cannot stress enough how important it is to keep a sense of perspective, and to strive to maintain a positive outlook.

The Empty Nest Syndrome

Self-Help Strategies

  • Once the children leave home it can often be difficult to find a new role for yourself. Many women become so accustomed to regarding themselves as ‘mothers', and to putting their family's needs before their own, that they often forget that their own needs are important too. Do try to remember that you were a woman long before you were a parent; that you have many gifts, skills and abilities that may have been pushed aside or too long neglected simply because ‘the children came first'; and that, while you may still be a wife and mother, you are, always and have been, a unique individual in your own right.
  • Take up a new hobby, or re-discover an old one. Pick up the threads of long neglected friendships. Hone long forgotten working skills by updating your training. Sign up for a college course in something that you have always wanted to study. Think seriously about returning to work - don't worry that you may not have been employed for several years; your maturity, coupled with the managerial and budgetary skills you would have acquired over the years will be useful to any business. If you are interested in helping those less-fortunate than yourself, voluntary work is always available. Any one of the above-mentioned options will boost your confidence and self-esteem.

 Fear of Ageing

Self-Help Strategies

  • Do what you can to help yourself in terms of exercise, looking after your skin, paying attention to your weight etc., and then do your best to forget about the fact that you are getting older. Ageing is an inevitable fact of life - worrying about it will not alter that fact. If anything, it will only succeed in making you feel worse. Accept the maxim that age is a state of mind.
  • Remember that others tend very much to regard us as we regard ourselves. If you place a high value upon yourself, make the most of your physical attributes and retain a positive, confident attitude, others will not only automatically place similar values upon you, but will find you far more rewarding company than if you are constantly bemoaning your lost youth and, consequently, attract a miserable, despondent air.
  • It helps considerably to recognize and accept that both your partner and your peers are ageing too. Thus, not only will they be more forgiving of your (real or imagined) shortcomings, but will very likely be suffering from their own insecurities, too.
  • Acceptance of the inevitable won't altar anything, but it willmake it a lot easier to cope with and to handle on a daily basis.

Fear of Incontinence

Incontinence - the involuntary loss of urine - is a subject few women like to discuss. Yet, surprisingly, this is something that affects far more women than you are probably aware of.

There are several types of incontinence, and several reasons why it occurs. The two most common, and the most easy to cure, are Stress Incontinence and Urge Incontinence.

Stress Incontinence is the name given to a condition which is characterised by small involuntary leakages of urine that occur when you cough, sneeze, laugh or indulge in some form of heavy exercise such as jogging or aerobics. It had been estimated that as many as 90 per cent of women are likely to suffer this at some time in their lives. It is very common to experience some temporary weakening of the bladder muscles following childbirth or gynaecological surgery. This often disappears once the woman is back up on her feet and exercising normally. If the problem persists, pelvic floor exercises can help restore the strength and elasticity to your internal muscles. Practised regularly they can help prevent the problem recurring in later life.

In addition to improving bladder control, practising these exercises regularly can have a surprisingly beneficial effect on your sex life, as the band of muscle which helps control the bladder lies within and circumnavigates the vagina.

Urge Incontinence is something that often occurs later in life. This condition is characterized by the experience of sudden and frequent urges to rush to the toilet to pass water. These may occur several times throughout the day, and sometimes during the night. The cause is often due to a combination of factors resulting from the reduction in oestrogen levels brought on by the menopause. What happens is that, as the oestrogen levels drop, some shrinkage may occur in the vagina, uterus and cervix. In turn, this may affect both the bladder and the urethra (the tiny pipe through which urine is transported from the bladder to outside the body). A reduction in hormone levels may also create a certain laxity in the pelvic floor muscles through which the urethra passes. When this occurs, the external sphincter muscle becomes weaker and less efficient at controlling the flow of urine.

Distressing and embarrassing as incontinence undoubtedly is, the wisest course of action is to pluck up the courage to discuss this problem with your doctor at the earliest opportunity, if only to reassure yourself that no medical treatment is required. Provided that there is nothing medically amiss, the following exercises may be all that is required to restore both your dignity as well as normal function to your bladder.

Self-Help Strategies - Pelvic Floor Exercises

  • First, locate and identify the muscle that controls the flow of urine. You can do this quite easily the next time you need to pass water. Once the flow of urine has begun, try squeezing the muscles around your bottom and vagina to see if you can stop the flow. If your muscles are weak they will have little effect. If you experience a slight lessening or cessation in the flow of urine, you will know that you have located the correct muscles.
  • Squeeze Technique 1: Squeeze your muscles and try to hold the contraction for three seconds. Relax the muscles for one second, and then repeat this process six more times. This exercise should be carried out at least three times each day. It can be done at any time, not just when you need to pass urine, although obviously you will be able to assess what effect it is having when urination is taking place.
  • Squeeze Technique 2: Squeeze for one second, let go for one second and continue doing this for at least 20 ‘squeezes'. Repeat this exercise at least three times daily. Once you become quite adept at doing this, try increasing your speed.
  • Squeeze Technique 3: This exercise is quite hard, but once you've mastered the two techniques described above, it should not take long before you can build up until you are accomplishing this with relative ease. Squeeze and hold the contraction for 10 seconds. Relax for 5 seconds and then repeat the exercise five times in quick succession. Try to achieve at least three sets each day.

OSTEOPOROSIS AND THE MENOPAUSE

It has been estimated that as many as 50 per cent of women will suffer a bone fracture as a result of Osteoporosis. This condition, which is characterized by a weakening in the strength and amount of bone tissue, is one that not only can have potentially disastrous consequences on the health, longevity and quality of a sufferer's life, but one that we women are especially prone to contracting. And our chances of contracting it increases significantly once we have passed the change of life.

It is easy to see why women are especially at risk, when you consider that approximately one third of our bone tissue is formed from collagen, while the remaining two thirds is made up of minerals, the primary component of which is calcium. As the female hormones, oestrogen and progesterone affect both the manufacture of collagen, as well as our bones ability to accept calcium, it is not surprising that a reduction in the levels of these hormones could have such potentially serious consequences on our health.

And while there are enormous variations in the amount of bone loss that inevitably will occur with age, there are a number of established factors that can increase the risk and exacerbate the effects of osteoporosis. These include:

  • Race - Descendants of Northern Europe races are more prone to osteoporosis than people of African or Mediterranean origin.
  • Colouring - Fair-skinned people have a higher risk factor than those who are dark-skinned.
  • Low Body Mass - The smaller and lighter you are, the less overall bone mass you have to lose, thus the greater risk of osteoporosis.
  • Lifestyle - High intakes of tobacco, alcohol and caffeine and a sedentary lifestyle can increase your risk.
  • Age at which the menopause begins - An early menopause, regardless of whether it occurs naturally or as a result of surgery, increases the risk.
  • Illness - Certain illnesses, such as anorexia, rheumatoid arthritis, thyroid problems and diabetes requiring insulin treatment will be higher risk.
  • Drugs - Steroids, cortico-steroids, thyroxin and calcium deficiency can also increase your risk.

  The good news is: just because you may fit into one or several of these categories, this does not necessarily indicate that you will automatically develop osteoporosis to any serious degree. What it does mean, is that because your risk factor is higher, you would be well advised to take whatever steps are necessary in order to reduce this.

Medical science has now perfected a number of screening techniques to help identify those whose bones have a reduced mineral content, which may be available within the NHS to certain high-risk patients. If you are at all concerned about this condition, your GP may be able to arrange such a screening, or alternatively, provide you with reassurance on this matter.

Once bone mass has been lost, it is virtually impossible to replace. Thus, as no actual cure exists to date, the only method of avoiding osteoporosis - or, at the very least, minimizing your risk factor - lies in the preventive measures outlined below.

Self-Help Strategies

  • Replacing or supplementing your oestrogen and progesterone levels during the menopause can help prevent or reduce bone loss. But if your risk factor is high, you may need to continue HRT treatment long after the menopause, so do discuss the advisability of this with your GP, as there may be other factors present in your case that would need to be weighed up against this.
  • Reduce your intake of caffeine, tobacco and alcohol, and increase the amount of exercise you take. Do not use more than a teaspoon (5g) of salt per day as this can increase the amount of calcium lost through the kidneys.
  • Ensure that your diet contains the recommended amount of calcium. If this is difficult, or you are uncertain about the level of calcium you may be ingesting from your food, take a supplement. RDA (Recommended Daily Allowance) figures are given below:

Pre-Menopausal Women - 1000mg (milligrams) daily

Menopausal Women - 1200mg daily

Post-Menopausal Women - 1400mg daily

If you opt for obtaining your calcium via a supplement do be careful to read the label to ensure that it contains a sufficient amount of elemental calcium. 600mg of calcium carbonate, for example, does not mean that you will be getting the full 600mg, as this equates to 40 per cent, or 250mg of calcium. Whereas a 600mg tablet of calcium lactate contains just 13 per cent (88mg).

For efficient absorption, calcium needs to be taken in conjunction with vitamin D. Conversely, however, too much vitamin D will increase the amount of calcium your body excretes. If in doubt, ask your doctor to prescribe this in the correct form and quantity, or alternatively, seek the advice of your pharmacist who should be knowledgeable in this area.

Of course, by far, the best natural source of calcium is found in food. 100g of cheddar cheese, for example, will provide you with as much as 800mg of calcium, while 100g of the following food will provide you with the quantity of calcium listed  next to it:

  • Whole Milk - 702mg
  • Semi-Skimmed Milk - 729mg
  • Milk Chocolate -220mg
  • Muesli - 190mg
  • Sardines (in oil) - 550mg
  • Tinned Pilchards - 300mg
  • Raw Broccoli - 100mg
  • Dried Figs - 280mg 

 THE FACTS ABOUT HORMONE REPLACEMENT THERAPY

While there is no doubt that Hormone Replacement Therapy (HRT) has been a boon to millions of women who have or are presently going through the menopause, it is important to know the facts about this form of treatment as it is not suitable for every case.

The purpose of HRT is to replace the hormones that your body is no longer manufacturing, or is producing in more limited supplies. As we now know what these hormones do, it is easy to see why replacing them can help not only to guard against osteoporosis, but also reduce the severity of many of the other symptoms associated with the menopause.

The following facts about HRT may help you decide whether this would be a suitable form of treatment in your own particular case:

  • Around 15 per cent of women are likely to develop the following symptoms as a result of taking HRT: headaches; migraine; weight gain; oedema (fluid retention); PMS.
  • HRT is inadvisable in cases where the following conditions exist: breast cancer; endometrial cancer; pregnancy; where certain types of breast lumps are present; undiagnosed vaginal bleeding; and severe thromboembolism.
  • HRT treatment may be considered inadvisable in certain other cases. These include: fibroids; varicose veins; diabetes of the gall-bladder or liver; benign breast disease; certain particular types of thrombosis, and where there is a history of endometrial hyperplasia.
  • Contrary to popular opinion, smokers can have HRT treatment. However, as smoking does destroy oestrogen to some extent, it would be advisable to cut down or quit.

While HRT can be enormously beneficial in helping to alleviate many of the unpleasant and distressing symptoms associated with the change, it must be stressed that, firstly, it is not to be regarded as either a ‘youth' pill or a panacea for all ills, and secondly, while it may well relieve many symptoms, it does not necessarily follow that it will alleviate all of them.

Symptoms that generally respond well to HRT treatment include the following:

  • Hot Flushes
  • Night Sweats
  • Vaginal Dryness
  • Genito-Urinary symptoms
  • Skin Problems
  • Certain psychological problems resulting from hormonal imbalance i.e. depression.

More importantly, HRT can be especially valuable in preventing osteoporosis, and/or in reducing the rate of bone loss, as well as in reducing the risk of cardiovascular disease.

Chief among its drawbacks is the fact that the version predominantly prescribed today (combining oestrogen and progesterone) will produce monthly bleeding. And while many women may find this uncomfortable, particularly if they have not had a period for many years, many others are prepared to accept this as being a very small price to pay in return for the many other benefits that HRT treatment affords them.

Another drawback is that you may have to try several different levels of dosage before you find one that is most suited to you. The length of time you may be taking HRT will also vary according to the reasons you are taking it. Women who are taking to relieve normal menopausal symptoms may only need to take it for around two to three years. Long-term treatment lasting five years or more is usually only given to women who are at high risk of developing osteoporosis or cardiovascular disease, as well as those for whom the menopause has arrived at a relatively early age, either due to natural causes, or as the result of a hysterectomy.

Whatever your reasons for considering HRT treatment, it is always best to acquaint yourself with all the latest research that is available with regard to what it does, how it works, what side-effects it can cause, what risk factors are attached to it and which risk categories, if any, you fall into.

Once you have this information, you should then take the time to discuss thoroughly every aspect of HRT treatment with your own GP, and also talk to other women who have taken HRT in order to find out what it did for them and how it made them feel. While it will not necessarily affect you in the same way, it is always useful to find out about other people's experiences, and to hear how HRT worked in their particular case.

When every single question has been answered to your complete satisfaction, you will then be in a position to decide for yourself whether HRT is likely to have any potential benefit for you.

Lastly, do be guided by the advice of your own GP. If he or she has sound medical reasons for denying you this treatment, do be sure that you find out precisely what these are. Very few GP's would deny their patients any form of treatment that would be beneficial to them. On the other hand, if you are not entirely convinced that HRT would benefit you, don't allow yourself to be pressured into trying it by anyone else, or to allow anyone else, including your GP, to make the decision on your behalf. If in doubt, seek a second opinion. After all, not only is this your right, but it is your body that will be affected by any decisions that will ultimately be made.

SEXULALITY, LIBIDO AND SEXUAL PROBLEMS

While research has proven that most couples tend to make love less frequently as they get older, it is important to stress that this is not necessarily connected with the menopause.

Men, it has been found, reach their sexual peak between the ages of 18 and 25, while for women, the sexual peak is often attained much later. This has been borne out by numerous surveys which reveal that a man's ability to make love frequently starts to decline in his 30's. By the time they reach their 40's, many men find not only that they simply cannot recover as quickly as they did when they were younger, but they actually desire intercourse a lot less frequently.

Women, on the other  hand, tend to experience the reverse, with many reporting that the older they get, the more their libido increases.

Although the statistics do not necessarily indicate the norm, it might reassure you to know that one study conducted in America revealed the following surprising information:

  • Of those women over the age of 50 who were surveyed - 88 per cent reported that they were still sexually active; 73 per cent reported they enjoyed sexual activity at least once a week; and 47 per cent reported that they were still enjoying masturbation.
  • Of those women over the age of 60 who were surveyed - 63 per cent were reported as still enjoying intercourse at least once a week, while 37 per cent were still enjoying masturbation.
  • Of those women over the age of 70 who were surveyed - 50 per cent were still enjoying intercourse at least once a week and the same percentage quoted above were still actively engaging in masturbation.

Evidence enough that sexual activity is definitely not the exclusive preserve of the young! 

Continuing a satisfactory sex life during and after the menopause is, therefore, not only clearly possible but, if anything, it can become even more satisfying once a woman is relieved of the fear of unwanted pregnancy.

Sexual Difficulties

Prior to the menopause, much of the oestrogen produced by your body will have been utilised by the vagina, uterus and cervix. As oestrogen levels fall, the natural secretions that help lubricate these areas can start to dry up. Moreover, the lack of oestrogen can also cause the surface tissues, or the lining of these organs, to atrophy and shrink.

Not only can this cause the vagina to shorten, but the shortfall in blood supply to the tissues may also result in them becoming weaker and thinner.

Lack of oestrogen can also influence acidity levels in the vagina which, in turn, may cause some reduction in the secretions that help keep this area lubricated. This can result in a certain amount of pain and discomfort during intercourse.

While vaginal dryness is quite a widespread problem, it is also a remarkably easy one to overcome with the aid of artificial lubricants - such as KY Jelly - that can be purchased over the counter at most pharmacies and drug stores. (Ordinary petroleum jelly is not a good idea, as this is not water soluble. It has been known to stick to the vaginal walls, which can make it difficult to detect infection.)

Hormone Replacement Therapy (HRT) can also provide a solution to the problem. Alternatively, if your GP deems you an unsuitable candidate for HRT, there are one or two proprietary brands of pessaries available without prescription (REPLENS is one) which can be applied locally. These contain small quantities of oestrogen, sufficient to stimulate increased vaginal lubrication.

However, before treating yourself with either a locally applied form of oestrogen therapy such as REPLENS, or a vaginal lubricant such as KY Jelly, it is always a good idea to discuss the problem with your GP in order to reassure yourself that your vaginal dryness is not due to any other potential cause.

The question of their own sexual attractiveness and desirability is also one that frequently plagues and concerns women as they get older. Here again, it is important to stress that one should keep a sense of perspective. After all, if your partner loved and desired you before the menopause, there is no reason why this should change after it, unless you yourself have changed. 

Similarly, it will help enormously if you can accept that looking good and being desirable do not necessarily equate with being ‘young'. Unlike our mother's generation, the society we have created not only refuses to accept that women over 40 are ‘past it', but actively encourages us to make the most of mature years. The blue rinses and crimplene dresses of our parent's generation have gone. Fashion no longer makes such great distinctions between age, and we have numerous choices that were denied to women who reached middle age in the 50's and 60's.

Thus, today, as never before, the many charms of the ‘mature' woman are becoming increasingly attractive to men of all ages. There can be no better evidence of this then the rising number of women who are enjoying highly successful and rewarding relationships with men who are younger than themselves.

The fact is, a woman's age is far less important to a man than her personality and character. And the confidence and maturity that come with age are both highly attractive and seductive attributes in their own right. Why else would women such as Felicity Kendall, Joan Collins, Glenn Close, Meryl Streep, Helen Mirren, Joanna Lumley and many other famous females over the age of 40 still consistently top of the charts of the world's most attractive and desirable women?

As far as sexual fulfilment and pleasure is concerned, the statistics related above are a clear indication that there is no earthly reason why you shouldn't go on enjoying a fulfilling sex life for many years to come.

The pelvic floor exercises described in the section on Incontinence can be of enormous benefit in helping overcome problems resulting from slack vaginal muscles. When these exercises were originally developed, the gynaecologist who invented them - Dr. Alfred Kegel, of the University of Southern California - had little thought beyond helping the millions of women worldwide whose lives were reduced to misery due to Stress Incontinence. No one was more surprised than Dr. Kegel,  when he found that he had unwittingly stumbled upon a method that significantly improved and increased every woman's ability to attain, and enjoy, satisfying orgasms whenever she wants.

Apart from experiencing a total cure of their incontinence problems, a significantly large number of Dr. Kegel's patients also reported that, not only were they experiencing a marked increase in vaginal sensation as a direct result of practising his exercises, but many who had previously felt little or no sensation at all during intercourse were suddenly beginning to achieve orgasms far more easily and frequently. Moreover, many women who previously had neverexperienced an orgasm were suddenly and miraculously attaining this highly pleasurable peak of sexual experience for the first time in their lives!

 CONCLUSION

In conclusion, it is important to reiterate that how you experience the menopause will very much depend upon how you perceive its approach. Thus, it might help you to remember the following:

  • The menopause is not a fearful disease. Rather, it is a natural and wholly inevitable stage of our life cycle; one that every woman, provided she lives long enough, will one day face.
  • The menopause does not automatically signal deterioration, pain, ill health, senility, the loss of your looks or the end of your femininity.
  • The menopause is not an obstacle that must be overcome with gritted teeth. You don't have to let it turn your life upside down. It is neither a drama, nor a psychological crisis.
  • If unwelcome symptoms arise, there is much that you, personally, can do to help you control, alleviate and cope more effectively with these. The most important thing is to not allow any symptoms or side-effects to disrupt or interfere with your normal enjoyment of life.
  • The menopause is not the end, or even the beginning of the ending of anything. But it could and should be the beginning of a whole new, and equally enjoyable, way of life.
  • If you approach the menopause with knowledge, understanding, information and a positive attitude, you will not only smooth significantly your passage through it, but you will discover that, as with many other natural changes that occur in our lives, every loss is equalled by a gain. In the case of the menopause, the losses it brings can be more than compensated by the advantages that you will gain.
  • The maturity and confidence that come with age bring far more pleasure than the insecurities of youth.
  • When you are freed of the fear of pregnancy, it is amazing how much more relaxed, enjoyable and fulfilling your lovemaking will become.
  • When you are freed of the responsibility of having young children to raise, it is amazing not only how much wider your options become, but how much more accessible pleasures that were previously denied to you also become.
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