Tranquilizers, Antidepressants, and Mood Stabilizers
If you suffer from serious postovulatory anxiety, mood swings, or depression, your doctor may prescribe any number of tranquilizers or antidepressants, especially serotonin reuptake inhibitors (SSRIs), which seem to provide at least some relief. Some work by elevating levels of neurotransmitters like serotonin and norepinephrine—chemicals in the brain that regulate personality, mood, sleep, and appetite.
Antiprostaglandin Medication
Probably the most painful symptom of both PMS and menstruation is uterine cramps. We now know that they are caused by imbalances in prostaglandins—chemicals produced in the uterine lining that increase prior to menstruation. Luckily, there are effective drugs such as Motrin that eliminate cramping.
PMS, Conventional Medicine, and Long-Term Solutions
You should keep in mind that there are always potential side effects whenever you take any drugs. And remember that while medications can be extremely useful in eliminating PMS symptoms, they will be effective only as long as you are taking them. Since PMS is known to often get worse with age (lucky us!), that could mean years on drugs or hormone therapy for women who are severely affected. Still, while the dietary suggestions and other natural alternatives may involve some sacrifice, at least you know that there are a number of choices that offer relief.
KEEPING SANE ALL CYCLE LONG
The reality of womanhood is that PMS is an unfortunate fact of life for many, and even a fairly debilitating condition for some. Like menstruation, it’s hardly an experience that most women would choose to have. But treatments exist, and you do have some influence in restricting its severity, if not achieving its complete prevention. Perhaps as important, you may have the ability through charting to pinpoint your own PMS pattern, allowing you to take preventive action in the days immediately prior to its usual arrival.
One small advantage of advanced warning may also be to alert your partner, who could be sensitized to the cyclical basis for your physical and emotional changes. By being attuned to your cycle, your partner can understand why, for example, you may be feeling depressed or premenstrually unresponsive, sexually or otherwise. Such knowledge on his part won’t make PMS go away, but with both of you sensitive to your cycle, it can help minimize its impact.
“The Brink of Madness,” PMS Attacks, by Steve Phillips, copyright © 1986 by Steve Phillips, used by permission of Ten Speed Press, P.O. Box 7123, Berkeley, CA
CHAPTER 22
Demystifying Menopause
Perhaps with education and proper perspective, we can look forward to the day when people will stop viewing menopause as a crisis, or even as “the change,” and see it more appropriately as “yet another change.” For living is constant change. That is its essence and its promise.
—DR. KATHRYN MCGOLDRICK, former editor-in-chief of the Journal of the American Medical Women’s Association
Menopause. The word itself evokes countless emotions in women—everything from dread and fear to excited anticipation and relief. But back in the day, the word wasn’t even uttered aloud. For some reason, it was a stage in a woman’s life that was simply not discussed in polite company. Perhaps a lot of the stigma formerly associated with menopause related to a woman’s primary role being defined as a mother, since it’s true that menopause signals the end of the biological potential to reproduce.
Luckily, things have changed considerably. Women’s roles have expanded dramatically, and society no longer defines a woman simply by her capacity to give birth. Today, many women are making the decision not to have children altogether, yet they still feel feminine and fulfilled.
Interestingly, there is a correlation between a woman’s age at menopause and that of her mother’s. In fact, studies show that if a mother went through menopause fairly early, her daughter may, as well. (See diminished ovarian reserve section.) Just knowing this one scientific fact may help women to better plan whether or when they might want to try to get pregnant.
Needless to say, the topic of menopause is so huge that I couldn’t do it justice in just one chapter. I would encourage you to read about it more thoroughly in any number of excellent books available today. The reality is that this topic and, more specifically, the associated issue of hormone therapy, represent a continually evolving body of knowledge that can make your eyes glaze over. So it will require serious research to make the most informed and best decisions for your own health.*
WHAT EXACTLY IS MENOPAUSE?
“I thought it was when women stopped having periods.”
“Isn’t it when women run out of eggs?”
“I think it’s when women reach about fifty.”
“It’s when a woman can finally enjoy sex without having to worry about getting pregnant.”
Actually, all of the above have kernels of truth, but I should first clarify a few terms, listed in the box below.
Menopause In the strict biological sense, this refers to the permanent cessation of menstruation resulting from the loss of ovarian follicular activity—it’s basically a mouthful to say “the final menstrual period.”
Premenopause In the context of menstrual cycles, it refers to the years leading up to menopause when the cycles start to change. But it can also simply mean anytime before a woman goes through menopause.
Perimenopause This refers to the years immediately prior to menopause through the first year after. Or, as I like to call it, “Good Times.”
Climacteric This is a dated term for the transition from the reproductive years to the nonreproductive state. It generally lasts about 5 years.
Change of life This is a somewhat euphemistic and also dated term used to include the emotional, intellectual, and obvious physical changes that a woman experiences during this transitional time.
Primary Ovarian Insufficiency This is now the correct term that refers to the loss of function of the ovaries before age 40.
Premature Menopause This term has now been replaced by the more accurate expression listed immediately above, and refers to the loss of function of the ovaries before age 40.
In brief, the road to menopause is a decade-long continuum in which the average woman’s ovaries will gradually become less and less efficient until they eventually stop responding to the hormones that ultimately lead to ovulation. But it’s important to note that for some women, the process can start well before 40 years of age, and thus you could find yourself experiencing some of the classic menopausal signs discussed below, years before you thought you would.
Women with this condition, called Primary Ovarian Insufficiency (POI) but formerly called premature menopause, are often put on hormone therapy until about age 50, since the most serious symptom is diminished estrogen, which can lead to higher risk for health issues such as osteoporosis and heart disease. In addition, if you think you are going through POI and you would still like to get pregnant, I encourage you to read about your options here.
Regardless, menopause is a uniquely individual experience. Some women glide right through it, barely noticing any changes at all. Others have a harder time, often choosing medical assistance to cope with the challenges it presents. The only definitive statement that can be made is that menopause is when menstruation stops, which for the average woman is around age 51.
One day, you too may have the joy of passing the baton, as it were, to either your daughter or niece. I had that privilege when I was 55 and my brother Robert’s daughter, Sabrina, was 17. She and I were traveling together to visit one of my dear friends when I secretly packed a special gift to give Sabrina when the clock struck midnight on August 27th. It was at that moment that my charts told me that it had been a year since my last period, and I had now officially gone through menopause. It was time for me to pass on the metaphorical ceremonial tampon.
So while the two of us giggled and hugged, I happily handed her the symbolic red-ribbon-wrapped tampon. What made that night even more special was the fact that as the minute hand on the
clock passed over midnight, we celebrated five years to the day since she herself got her first period.
CLASSIC SIGNS OF IMPENDING MENOPAUSE
The most obvious way to tell if you are nearing menopause is by noticing the three classic signs that most women experience to varying degrees:
•menstrual cycle irregularities
•hot flashes
•vaginal dryness
Medical professionals refer to them as symptoms, but it makes more sense to refer to them as signs. After all, “symptoms” imply disease, and certainly menopause is nothing more than a natural passage of life. Many women have questioned the medicalization of menopause, just as they have insisted on natural approaches to birth control, getting pregnant, and childbirth. They want to perceive it as a healthful part of their lives—perhaps different, but with distinct advantages.
Gail Sheehy, author of the groundbreaking book The Silent Passage: Menopause, describes what it was like to educate people about this universal transition:
As I traveled around the United States giving lectures and appearing on TV and radio talk shows, the conversation about menopause had to be started up from scratch in each city. . . . Reactions from male talk show hosts were sometimes comical. “Menopause,” gulped a Cleveland man on the midday news. “Is that like—impotence?” “Um, no,” I murmured lamely. “. . . Baldness. Is that like Alzheimer’s?”
Menstrual Cycle Irregularities
One of the first signs of impending menopause is a change in your menstrual cycle. About 80% of women experience some kind of cyclic change, perhaps as early as about seven years before. Typically, women first find that their periods become heavier and more frequent as their cycles shorten. But eventually, their periods start to become lighter and less frequent as their cycles become longer and ovulation becomes more sporadic. These latter changes are due to ever-decreasing levels of estrogen.
If you find that your periods are getting unusually heavy, there are some practical tips that you may want to reconsider. Try to avoid excessively hot showers and baths whenever you’re bleeding. In addition, you should avoid alcohol and aspirin throughout the cycle, both of which inhibit blood clotting. But the best thing you can do is to maintain a lifestyle of steady and vigorous exercise, which will help adjust the hormonal imbalances that are causing the heavy bleeding in the first place.
Of course, irregular or heavy bleeding could be symptomatic of various medical conditions, including pelvic infections or even a uterine fibroid, which is a fairly common occurrence as women get older. Therefore, it’s especially useful during this time to continue charting and report any conspicuous abnormality to your clinician.
Hot Flashes
You may be one of the lucky few who manage to coast through menopause with no discomfort whatsoever. Unfortunately, though, the vast majority of women experience hot flashes at one time or another during their perimenopausal years. They can start while your cycles are still regular and often continue through to about two years after your last menstrual period. In some women, they may persist several years longer. The unpleasant episodes may last anywhere from a few seconds to a few minutes. They may occur once a week or even once an hour! Oh joy.
You may experience hot flashes as nothing more than the feeling you get when you’ve just stuck your foot in your mouth at a dinner party—that familiar passing warmth on your face or upper body. But you may also experience them as a drenching sweat accompanied by chills. In rare cases of extreme intensity, they may even occur with heart palpitations and feelings of suffocation. Many women describe feeling an “aura” just before—a distinct sense that they are about to have a hot flash. Some even feel anxious, tense, dizzy, nauseous, or a tingling in the fingers a few seconds in advance.
Researchers believe that hot flashes are caused by changes in the hypothalamus, the master gland in the brain that controls, among other things, body temperature and cyclical fertility hormones. These changes are a result of declining levels of estrogen, which, ironically, trigger the body to turn on a misguided hormonal cooler. In essence, then, hot flashes reflect an inappropriate lowering of the body’s natural thermostat.
“Maxine’s Crabby Road,” 2001, reprinted with special permission from Hallmark Licensing, Inc.
There are several practical things you can do to make life easier while going through what may be a transition over several years. You should try to wear clothes made of either cotton, fibers that allow you to breathe, or wicking fibers often found in athletic wear, because the key is literally to stay cool. Among the most exciting products on the market are the countless new items that allow you to remain comfortable for up to several hours at a time (for example, cooling bandanas you can wear around your neck or forehead). And obviously, it’s best to avoid hot weather, or at least have continual access to cold water.
As with everything else, get plenty of vigorous exercise and maintain a well-balanced diet, including lots of fresh fruits and vegetables. Many women find relief from including soy-based products in their diet. Soy is a naturally occurring plant compound that mimics estrogen. You should, however, be wary of some of the hype surrounding it. And you might want to limit it to only a few times a week because it can block the absorption of needed nutrients. The ideal forms reduce that drawback and include tofu, tempeh, and miso. (Of course, if you are like my colleague, you too may exclaim, “Tofu? Yuck! I’d rather have hot flashes!”)
The most commonly prescribed medical treatment for hot flashes is hormone therapy (HT). By replacing the estrogen that has plummeted to such a low level, HT is nearly 100% effective in eliminating them. However, HT is controversial and not without its side effects and potentially serious risks, as discussed here.
Finally, many women who chart may find a pattern to their hot flashes. Recording them can help you feel more in control, by allowing you to be psychologically prepared for when they return.
Vaginal Dryness
One of the most commonly experienced and least discussed effects of menopause is the drying of vaginal tissue, again due to progressively dropping estrogen levels. Women are typically too embarrassed to talk about it, feeling that it must be their unique problem. But, in fact, most women find that their vaginas take longer to become sexually lubricated as menopause approaches. Some may even feel irritated by the type of stimulation that they previously found pleasurable.
While menopause can definitely lead to vaginal dryness, there are practical things you can try to keep your vagina lubricated, including taking more time for foreplay and using water-based lubricants. If you still find that you have vaginal dryness that makes intercourse uncomfortable or even painful, you may want to try estrogen therapy in cream form. This should relieve dryness or soreness in the vagina, usually within a week or two. Creams are often recommended over pills because they don’t pose as many side effects or health risks as oral medications do. However, be aware that many clinicians believe that any time you use estrogen, you should balance it with progesterone.
Confusing Irregular Cycles with a Pregnancy
Keep in mind that unless you chart your cycles, menopause may make you think you are pregnant when you are not. The reason for this is that you may seem to skip periods (which, as you should know by now, are just very long cycles). In fact, “missed periods” may be normal during this transition, though they could also be a sign of pregnancy. If you are charting, there are two ways to tell the difference between the two:
•You are likely pregnant if you have more than 18 consecutive days of high temps above the coverline, especially if you also experience tender breasts and nausea. (However, you’ll need to confirm it with your doctor. Home pregnancy tests are unreliable during premenopause due to fluctuating pituitary hormones.)
•You are probably not pregnant if your temperature pattern shows consistently low temps, or a delayed ovulation that indicates that you are merely having a long cycle. These extended cycles become increasingly likely if you are experiencing hot fl
ashes and vaginal dryness.
A WORD ABOUT MENOPAUSE AND OVULATION PREDICTOR KITS
A tempting way to detect if you are still ovulating is through one of the many ovulation predictor kits widely available. But you should know that these kits can be especially unreliable if you are indeed nearing menopause. The reason for this is that premenopausal women tend to have exceedingly high levels of LH that don’t necessarily trigger ovulation.
In addition, using the kits to detect menopause is impractical since a woman may ovulate so sporadically during this time that it would be nearly impossible to pinpoint when to even use them. Because they usually only come in 5- or 9-day supplies and cost from $20 to $50 or more a kit, you would be spending a pretty penny to verify whether you’re still ovulating. Charting is cheaper, easier, and simply more accurate.
HORMONE THERAPY (HT)
These days, it isn’t raging hormonal imbalance that drives a postmenopausal woman berserk. It’s raging medical debate. Some 30 to 40 million American women want a definitive answer on estrogen, and instead, they’re getting the daily odds.
—ELLEN GOODMAN
Few issues in medicine evoke more confusion and contradictory reactions than hormone therapy. Should menopausal women take artificial hormones or not? Are bioidenticals the way to go? The debate is often extremely heated, and ultimately inconclusive. The bottom line is that there is no ideal answer. Each woman’s situation is unique, and will have to be thoughtfully discussed with her own physician.
Part of the controversy over HT stems from the fact that when it was first prescribed, in the 1930s, not much was known about its potential long-term effects. It wasn’t until years later that it was discovered that the type of estrogen therapy then being practiced would increase a woman’s risk of uterine and breast cancer. In the 1970s, research showed that women who took estrogen were several times more likely to develop cancer of the endometrial lining than those who did not.
Taking Charge of Your Fertility Page 33