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Menopause: Is It Really for You?
by Marjorie Dorfman

Are you prepared for menopause? Is anybody? These and other searing questions may or may not be answered in the following article, but at least you will be able to chuckle about it.

Did you really think the days of pimples and zits ended when you left the high school auditorium and the night of the prom behind? Well, let me assure you ladies out there that those ugly little buggers are merely lying patiently in the world of I-told-you-so, like hungry alligators lurking in a leafy glade. They may return in even fuller force during middle age, bringing with them all sorts of undesirable companions. As our hormones rage in youth, they do so again in middle age, albeit with a last hurrah and a different, more mature attitude.

How did all this awful stuff happen anyway? Well, for one thing, people live longer than they used to. A hundred years ago a woman would more than likely be dead by the time menopause reared its unattractive, aging head. Living longer reaps many obvious rewards, but menopause isn’t one of them. The hormones, estrogen and progesterone, whose production is signaled by the pituitary gland, cause the lining of the uterus to thicken and shed. During childhood, so much is produced that these hormones allow for the onset of a young girl’s first menstrual cycle. (I remember when mine finally came at age 14. I over-heard my father tell my mother that " never had anyone waited so long for so little".)

During the teen years and early twenties, estrogen flows like water through young, nubile bodies. In the mid-thirties, for reasons unknown, levels begin to drop (an unpaid hormone bill, perhaps?) When a woman enters a transitional period called "peri-menopause," which can last up to four years, she is usually in her the mid forties. At this time, hormone levels (like some empires) rise and fall, leading to irregular menstrual cycles and irritable, deposed emperors. Monthly periods may be longer, shorter, lighter, heavier or may not occur at all. For some women, peri-menopause is a time of mild, barely noticeable changes, and for others it is a roller coaster ride of annoying, unpredictable symptoms. Each woman’s experience with menopause is as unique as her individual personality. Aside from irregular periods, other symptoms may include hot flashes, sleep disturbances, vaginal and urinary problems, mood swings and changes in appearance. (This may be the time to change your identity. If you do, make sure to pick someone who’s not going through the change!)

The classic signs of menopause are hot flashes. More than seventy-five percent of women experience them in some degree or another. For those who may not know, a hot flash is a sudden rush of warmth, usually over the upper body, that lasts anywhere from thirty seconds to five minutes. The face may become flushed and perspiration may occur. As the body cools down, there is often an accompanying chill. (There is nothing supernatural happening here, unless you consider getting older an occult phenomenon.) In short, these flashes are like being transported inside a freezer after standing over a roaring fire-place, with no stop in between for achieving room temperature or defrosting.

Insomnia can be a problem as well, affecting at least twenty-five percent of women during this difficult phase of their lives. The linings of the urethra and vagina thin out, and women become more susceptible to urinary tract infections and vaginal dryness. Fluctuating hormones may cause crankiness or mood changes. Weight gains, especially around the waist, are not uncommon at this time. Facial skin may wrinkle and become drier and hair may even thin a bit. Acne can come home again and facial hair may develop on your face. As long as there’s none growing on your chest or arms, I wouldn’t worry too much about it!

The body’s march toward menopause begins when the amount of estrogen and progesterone released by the ovaries begins to decline. For most women, it occurs between the ages of forty-eight and fifty-five, with the average age being fifty-one. It can occur before forty and sometimes as early as the late twenties in a small number of women. Current and former smokers (I fall into this category) experience menopause earlier than non-smokers. After menopause, all women are at higher risk for osteoporosis and cardiovascular disease (heart attack and stroke). This may be due to the loss of the protective effects of estrogen.

Menopausal symptoms can be annoying and uncomfortable (not unlike an unexpected visit from some relatives). To reduce the effects of hot flashes, dress in layers so that you can easily undress when you feel warm. Avoid abrupt changes in temperature. It is thought that spicy foods, hot beverages and caffeine expand blood vessels, triggering hot flashes. Regular exercise and avoiding stress (ha ha!) may also help. To get a better night’s sleep, stay in a cool room for about two hours before bedtime. Relax by taking a bath, reading a book or listening to peaceful music. Because your body is unable to lubricate itself, sexual intercourse may be unpleasant. An over the counter jelly purchased while wearing a mask and dark glasses can help.

During and after menopause, therapies to ease symptoms and reduce the risk of osteoporosis and heart disease may be beneficial. All of the following options cannot take the place of your doctor or other health care professional evaluating your need for them. A licensed physician should be consulted both for diagnosis and treatment. That being said, I will proceed to relate the treatments my non-medical research has uncovered. They include: Hormone Replacement Therapy (HRT), Raloxifene and Biphosphonates such as alendronate. What was that, you say? Allow me to elaborate.

As the name implies, hormone replacement therapy replaces the hormone, estrogen and often progesterone, which you lose after menopause. It alleviates the symptoms of hot flashes and vaginal dryness. It has also been shown to stem bone loss and may be linked to improved cardiovascular health. The other side of the scale is that HRT may increase the risk of breast cancer, although it must be said that current research points to accelerated growth in existing cancers. For many women the benefits of protection against osteoporosis and heart disease may outweigh the risk of breast cancer.

Raloxifine is called a selective estrogen receptor modulator (serm) and was first used as a treatment for some breast cancer patients. It does not ease menopausal symptoms, but for women at risk for Osteoporosis, it is an alternative to HRT therapy. It prevents bone loss, and some improvements in cholesterol levels may be seen. It may also protect against breast cancer, but as all things, has a down side as well. It has no effect on hot flashes. Biphosphonates help fortify bones against the process that causes bone loss. However, they provide no other benefit. They may be taken in conjunction with HRT. For prevention of cardio-vascular disease for women with high cholesterol, medications to lower it are also available. Take your pick. One from Column A or two from Column B?

Column C must also be presented, both for confusion and clarification’s sake. This involves the world of herbs and natural foods in the treatment of menopausal symptoms. Once again, no expert am I, but there seems to be some answers for some people here as well as everywhere else. They may be helpful but can only be an adjunct to medical treatment and can in no way replace it. Herbs and plants offer historical benefits and a botanical alternative for relief from the symptoms of menopause, such as headaches, nausea, irritability, bloating and hot flashes. These include among others: Chasteberry, Valerian Root, White Willow Bark, Ginger Root, Wild Yam, Black Cohosh and Dong Quai. Research on the benefits of each is readily available in health stores and related facilities.

What should we do? The answer, my friends, is not blowing in the wind, but lies within understanding who we are and what our medical history and tastes dictate. Somewhere there’s a way for every woman to go through menopause as painlessly as possible. Is it warm in here or is it me? I feel hot and then chilled. Oh, boy, I just remembered. I forgot to take my hormone replacement pill this morning. Now I suddenly feel like Î am on a roller coaster. Maybe I should take advantage of the feeling and live a little. I wonder if there’s time to run down to Coney Island and take a ride on their roller coaster as well. Wanna come along? Good luck!

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Copyright 2002