Menopause Symptoms: What They Are, How To Treat Them, And How You Can Live Happily After Menopause

Menopause is a natural stage of life for women over 40, but how each woman experiences it varies from person to person. Some women do not hit menopause until they are past their 50’s. Others reach menopause in their early 40’s. About 70% of all women will experience menopausal symptoms that vary in severity and length. There are typical symptoms associated with menopause that include hot flashes, sweating during the night, and flushing. These are caused by hormone levels dramatically changing in a short period of time. This stage of life actually starts in the woman’s early 40’s, and goes from there.

Some women are lucky and do not go through menopause for very long. Their body transitions easily and then they live healthy and symptom free lifestyles. For most women though, menopausal symptoms require special treatments and can last until mid-50’ or until much later. The most common menopausal symptoms include hot flashes, night sweats, irregular periods until they stop completely, a sharp drop in sex drive, and vaginal dryness. The last two can affect the woman’s life much more than the others. Women are almost 100% unable to reproduce after menopause begins.

Treating menopause as soon as possible will help you live a comfortable life until the symptoms pass. There are various ways to go about relieving the symptoms and preventing more complicated problems that can arise out of menopause. There are so many menopause treatments out there, but you should aim for the natural ways to treat them first. Nobody wants to rely on chemicals for the rest of their life!

Menopause has many different symptoms and conditions that can develop. How do you know if they are different from ordinary conditions or a different cause? It’s simple. If you are suddenly noticing these things, they are likely attributed to menopause. If they seem like they have slowly creeped on you, such as with depression, then it is likely something else has happened.

Women going through menopause certainly have a lot to deal with. This can cause strain on family life and financial stressors. It is always important to realize the things you face and try to control them in the best manner possible. There are options out there for women, including support groups and online forums.

If you want to improve your symptoms or reduce the likelihood of them occurring then read on to learn more.

Hot Flashes and Cold Flashes

The majority of women with menopause or perimenopause will get hot flashes or cold flashes. These are sudden feelings of warmth that spread through the body. It can feel uncomfortable and cause dizziness sensations as well as flushed cheeks, which are quite visible to others. Hot flashes are normal and do not cause any problems. Some women even think that they make them look more attractive! Others wish that their cheeks were not as red.

Hot flashes occur because the body is lacking estrogen. This can happen to women at any age regardless of menopause, but for a healthy woman hot flashes only happen frequently during this period in life.  Women also stop producing estrogen at a different pace. Some will slowly ease into menopause, while others change over night. Women that undergo a hysterectomy are more likely to experience extreme hot flashes.

Cold flashes are the same as hot flashes, but where you feel chills or break out into a cold sweat during the night.

Most women going through perimenopause or menopause will use estrogen supplements to keep their levels from dipping low enough to cause hot flashes.

Night Sweats

Having night sweats may be one of the most uncomfortable symptoms of menopause. During the night women usually break into a sweat. This can be uncomfortable and disturb sleep patterns as well as your partner. Night sweats can also be smelly, as excessive sweat can leave behind on odor on blankets. To minimize sweating keep yourself cool at night and keep a fan on if possible.

When you have periods of night sweats then you should change your bedding often to reduce the build up of bacteria living on the sheets and blankets.

Irregular Periods

Women can go through their entire life with irregular periods, but they become common in menopause. This is similar to when a female first starts her menstrual cycle and periods are irregular. Short, completely absent, or periods that change abruptly are a natural symptom of menopause. This is caused by hormone imbalances, which of course happen during menopause.

Essentially, irregular periods are defined as anything that:

  • Is very short one month and lasts longer the next.
  • Heavy or light without consistency.
  • Very painful one month, but PMS free the next.
  • Skipping periods for more than one month.
  • Having longer than average periods.

Irregularities can be controlled by taking natural estrogen supplements as well. Overall, women should not worry about these types of things unless there is a history of ovarian or uterine cancer in the family. If you have irregular periods and cancer history in your family then getting regular check ups is absolutely required for your long term health and safety.

Drop In Sex Drive

Unfortunately women experiencing menopause will likely have a sharp drop in sex drive or libido. This is fairly common but not ALL women have this problem. Of course, it doesn’t need to be taken care of or treated unless women are having a serious problem with their relationship due to lack of sex. Women and men alike will experience different levels of sexual interest, but when something is noticeably missing, women should seek treatment. Once again, loss of libido is often chocked up to hormonal imbalances. All of which can be treated without the use of drugs – but rather natural treatments.

Tips for improving libido:

  • Try vitamin supplements to balance vitamin and mineral levels, as well as help hormones balance.
  • Exercise more frequently.
  • Find things that are stimulating regardless of what your “hormones” tell you.
  • Work with your partner or spouse to help increase your natural arousal. Try new things and be adventurous together.
  • Find out what interests you.
  • Try supplements for increasing libido. Look for only natural supplements of course.

Vaginal Dryness and Discomfort

As hormone levels drop and the body decides it no longer needs to reproduce, the vagina also loses its natural lubrication. Itching and irritation usually begin to happen as well. Estrogen levels dropping also result in the firmness of the vaginal walls and skin becoming weaker. It is natural for women going through this to feel older and less attractive.

You no longer need a strong or “lubricated” vagina, so your body simply decides it is time to stop producing all of that. Luckily there are very natural products available where women can get lubrication stimulants for their vagina. This will ease up on itchiness and chronic dryness, and will also help with sexual intercourse and enjoyment in that department.

It is natural for this to be emotionally upsetting. After all it is a BIG change that is occurring with your body. Be sure to relax and look for something that can make it a little better for you to deal with.

Women should NOT use douches to “cleanse” the vagina, particularly during menopause. This will only increase dryness. Instead, there are special “pearl” shaped lubricators that will increase natural moisture levels.

Eating a balanced diet and drinking plenty of fluids will also help to some degree. Do not expect miracles, since the body does what it does naturally.

Unbalanced Moods

When a female starts her menstrual cycle, moodiness and sudden tears are common. When a woman starts menopause, the same exact thing occurs. This emotional turmoil is caused by hormones going out of control due to bodily changes. They can become very severe in older women however. If you feel that your moods are too much to bear, then getting professional treatment is advised. Having a close friend or confidant will help immensely in controlling panic and mood swings.

If you are married it is important to make sure your husband empathizes and understands the things you are going through.

Fatigue and Lethargy

Fatigue is one of the top symptoms of menopause that women begin to experience from the early stages. Instead of just feeling lethargy during PMS, women start to feel it on a regular basis. Lethargy can make you feel slow, reduces productivity, and even results in weight gain. Long periods of chronic fatigue can lead to muscle and bone problems as well.

Drowsiness is quite different though. Fatigue is constant low-energy. Drowsiness is the feeling that you must sleep, but you feel better when you awaken. Fatigue will certainly impede on your work and family life, so be prepared to combat those feelings as soon as possible. Women can do a number of things to help treat fatigue naturally.

Fatigue can be treated through:

  • Vitamin supplements containing large levels of B vitamins.
  • Exercising regularly, even through those feelings of fatigue.
  • Using natural estrogen or menopause supplements.

Hair Loss and Increase of Hair on Face

Most women will lose some thickness in their body hair as well as hair on the scalp during menopause. However they are more likely to experience an increase in facial hair development. This is relatively easy to manage and one of the symptoms of menopause that women should not worry about as much. Taking extra vitamins and maintaining a healthy diet can prevent hair loss and decrease chances of facial hair development.

Increased hair on the face can be taken care of with laser hair removal, but this is expensive and can be painful. If your facial hair bothers you, simply get a gentle wax to remove the excess.

Sleep Disorders and Insomnia

Experiencing insomnia during menopause is a rather common problem that women face. This can be caused by sweating and hot flashes, as well as just general emotional and mental imbalances that lead to insomnia problems. You will find that most women going through the menopausal stage of life will also start to sleep less and less and appear to be awake at all hours of the day.

Insomnia is much more common in women over 40 years of age, and can sometimes increase over the years until menopause ends or is controlled.

Often insomnia that lasts longer than a month is the type that is dangerous. Other levels of insomnia that are shorter lived are less harmful to the body. If your sleep problems go away relatively quickly then you shouldn’t worry about them. If they last for weeks at a time then you will definitely need treatment.

An excellent insomnia treatment is Valerian Root. When taken orally it allows you to sleep peacefully and without disturbances. Valerian comes in tea form and pills, as well as liquid. It is safe and has a high record of causing no harmful side effects.

Confusion and Concentration Problems

Menopause is usually when women start to become forgetful and confused about a number of things in their day to day life. This is usually a result of medications or stress from going through the big change. Women that do experience confusion should never let it go without treatment! You will need to see a doctor to consider quitting certain medications and increasing the intake of supplements such as Omega-3 fatty acids. This will preserve brain function and memory.

Memory loss, however brief, can be upsetting and stressful. It is best to start taking natural supplements to help your memory and try doing memory building tasks. Sudoku puzzles and other similar games are excellent for helping women with these types of symptoms.

Simply playing a memory game a few times a week or once a day can do wonders for the body and mind. Plus they are actually enjoyable! They also make good beside games to play before falling asleep.

Dizziness and Light Headedness

These are rather common symptoms and can be managed if you control the things that cause them. Spinning and dizziness are often caused by hormonal changes, hot flashes, and fatigue. To control them you must control everything else. If your dizziness is causing severe problems, such as falling and hurting yourself, then see a doctor for a remedy. Women are more likely to fracture or break a bone during menopause, so you want to prevent that as much as possible.

Gaining Weight

Weight gain during menopause is very common and due to hormone changes. If you are worried about weight gain, you can try exercising and eating healthier. It is never too late to change your habits and improve your health. Weight gain can be avoided with continuous exercise. Since your metabolism will no longer be as fast, you need to make dietary adjustments to account for your lowered metabolic rate.

Tips to Combat Weight Gain:

  • Exercise daily. Going for long walks can work wonders for your entire body.
  • Eat energizing high quality foods. Choose less processed meals. Avoid eating out.
  • Drink plenty of water, particularly if you exercise or live in an arid climate.
  • Don’t order what your husband orders. Get smaller meals and hopefully healthier meals. Married women tend to eat what “he eats”, so that leads to a lot of weight gain after metabolism levels dip.

Incontinence and Inability to Control Your Bladder

Being unable to control your bladder is embarrassing and a hassle to deal with. This is caused by a weakening bladder, and is fairly normal. Incontinence is only a problem if you wet yourself frequently or require diapers. In serious cases surgery may be the only way to control incontinence and a weaker bladder.

Internal muscles around the bladder get weaker as your estrogen levels drop, and can be increasingly weakened by childbirth, being overweight, no exercise, or certain types of surgery.

Natural ways to strengthen your muscles include:

  • Kegels, which strengthen the pelvic floor and vaginal muscles too.
  • Exercises involving the thighs, pilates has many moves to help with this.

Muscle Aches and Breast Pain

These types of pains are fairly common during menopause but should be monitored very closely as well. Pain and soreness of the breasts is common but you should be doing regular breast checks as well as getting mammograms and check ups. If you notice something suspicious in your breasts, lymph nodes, or any bodily muscle, see a doctor immediately. Women going through menopause are prone to cancerous tumors and benign lumps. The sooner you notice them and get checked out, the safer you can be.

Normal muscle aches are common however and usually nothing to worry over. You can take a multi-vitamin for women to reduce soreness and be sure that you are not lacking in potassium, a common mineral that women do not get enough of.

To treat muscle pains immediately try a warming massage oil to loosen the muscle and soothe them. Take warm baths with essential oils to help relax and alleviate some of the pain. If possible stretch more often to help reduce aches and pain in the body.

Osteoporosis

Menopause not only affects your hormones, but it also can affect your bones as well. Normally your bones are renewed on a regular basis, strengthened and become stronger. After a woman turns 30 her bones strengthen less and are not able to develop as well. It is extremely important for women in their 20’s to read this and understand it. The best way to help your bones and to prevent menopausal osteoporosis is by strength training and eating a healthy diet full of leafy greens.

Myths about Osteoporosis:

  • You need calcium to prevent it. This is largely false information. Dairy products and excess calcium can increase the rate of osteoporosis in women! Your body uses calcium to digest dairy, thanks to Casein, a protein found in cows milk. So essentially drinking milk or eating dairy is counter-productive to bone strengthening.
  • You should take calcium supplements. This is also false information. If your diet is full of leafy greens and other sources of quality calcium (think of tofu and plants), then you do not need a supplement.
  • Osteoporosis pills help. There are several studies that show osteoporosis pills will either keep the condition at a standstill, or actually DECREASE bone mass.

To preserve your bones and keep them strong and healthy throughout menopause, you MUST do the following:

  • Take an all natural estrogen supplement. Estrogen is responsible for calcium absorption in the body.
  • Exercise using weight bearing exercises. Squats, water aerobics, and other moves involve weights or your own weight will help immensely.
  • Avoid soda since the acid in sodas leech calcium from bones, making them more brittle.

Changes in Hair, Skin, and Nails

Women going through menopause will notice large changes in fingernails, hair, and skin. The fingernails become softer, or thicker. Some women have easily breakable nails that turn yellow or flake. Some women on the other hand develop very thick hard to trim nails. Nails are a portal to your health and what is going on in the body. Since menopause can cause a number of different conditions to develop, odd changes in the nails should be reported as soon as possible.

Of course it is no surprise that the skin would change during menopause. Women will start to notice their skin is drier, more wrinkles are developing, and the skin is sagging more. This is from less collagen being produced and the walls that support your skin faltering. It is important to take preventative measures to help your skin. Use a rich moisturizer with antioxidants. It is never ever too late to start a sunblock regimen. Protect your skin from harsh weather and sunlight, and cleanse your skin regularly. It helps to avoid refined sugar and smoking since both damage collagen.

The hair follicles on your scalp also become weaker and more brittle. Thinner and dull hair is a result of aging. Luckily there are many high tech products on the market that can help you keep your shiny thick hair for many more years to come. Process it less often and try using more natural products instead of your typical dye and perm jobs. There are a number of products on the market designed to help thinning hair and brittle hair. Anti-aging hair products can work wonders for aging hair.

Remember to always use sunblock on your entire body when you are in the sun for extended periods of time. The nails, hair, and skin, all need to be protected from sunlight.

Depression, Social Anxiety, and Panic Disorders

Women who are social and happy their entire lives can hit menopause and instantly become depressed and have social anxiety problems. This stems from body changes that may make a woman feel insecure, as well as depressed. Depression can appear at any time for anyone. If you notice that you feel more depressed than usual and you are unable to control your feelings of sadness, then you may have a need for treatment.

Signs You Are Depressed:

  • Withdrawing from loved ones, family, friends, and co-workers.
  • Giving away beloved possessions.
  • Not wanting to do what you enjoy.
  • Not taking care of your body like you used to.
  • Changes in eating habits, such as binging or restricting heavily.
  • Apathy and lack of concern for things you used to love.
  • Thoughts of suicide
  • Feelings of hopelessness or impending doom that lasts for weeks at a time.

Treatment Options for Menopausal Women:

  • Therapy, such as counseling.
  • Exercises like yoga or pilates. They relax the body and open up your mind to clear itself and empty out negative emotions.
  • Any type of physical activity outdoors.

Social anxiety is different from depression, but often includes symptoms like being afraid to go in public, feeling ashamed in public, not wanting to interact with friends, and feeling sweaty or panicked in public places.

Headaches & Migraines

Headaches and migraines are symptoms of menopause that many women will experience. Though headaches alone are rather common, women with menopause will usually experience them on a more severe level. Frequent headaches should be treated since it isn’t normal to seemingly have a “constant” headache or migraine.

Headache triggers:

  • Stress
  • Alcohol consumption
  • Dehydration
  • Sweating without replenishing water
  • Irregular periods
  • Lack of exercise
  • Eyesight changes
  • Pollution or allergies
  • Diet, particularly one high in sugar

Women experience migraines will often get them due to decreasing vision or other problems. This is normal and is caused by estrogen levels going down during menstrual cycles or menopause. Hormonal induced headaches can be treated the same as any other. You may need extra strength pain reliever to truly relieve the pain however.

Oral Changes

Your mouth is the secret to what is going on in your body. Various gum and mouth conditions can tell a dentist or doctor if anything is wrong with your body. This is why doctors often check the mouth during a visit. Breath changes, gums bleeding and changes in tastes are all part of the menopausal transition. This type of symptom is not common. If you experience bleeding gums and breath related changes that are visibly different, not just from eating something, then you must see a doctor. This could be a sign of something much worse going on within your body and it needs to be treated!

Certain problems in the mouth can be signs of heart disease or kidney problems, both of which women over 45 are prone to getting. Always note dramatic changes immediately and investigate after you notice them.

Digestion Problems

Women going through menopause commonly experience digestion issues. This can be from gas to nausea. Women with a healthy diet full of fruits and vegetables and whole grains are not as likely to experience these problems. Women that do not eat healthfully will probably feel more stomach cramps, constipation, and nausea after eating food.

Dairy appears to be one of the things that menopausal women cannot digest as easily after going through the big change. You can switch to soy products or various other non-dairy milks and products. This will definitely help your system ease up on the discomfort and gassiness.

Constipation can be managed through eating more fiber and drinking more water. If that doesn’t work out then you can always opt for fiber supplements or stool softener. There is not anything else that can be used to help constipation if these options do not work out.

If you have continuous problems with your digestive tract there may be a bigger problem. Celiac disease, irritable bowel syndrome, and other conditions can be brought on by menopause and newly discovered after you hit a certain age. These should be treated by a doctor and managed with the appropriate diet. If left untreated, you will likely feel very uncomfortable after meals and not be able to tolerate certain foods.

Everything Else Caused By Menopause

Menopause is certainly a rough time for women that are aging and changing. It isn’t something to hate however, but instead embrace. This is a whole new part of life where you can do new things and explore the world around you. After menopause you are not old and useless – certainly not! There is so much more for you to do out there, as long as you are healthy enough to do it. Take this as your opportunity to skydive, travel to Europe, or even foster children.

Menopause is often treated as something negative, like it is the end of your world. While it isn’t pleasant it can be managed and treated until it is over. Evaluate what really bothers you and discuss those things with a doctor or a holistic health expert. Remember to always let your spouse know what is going on so that he or she isn’t confused or angry at your changes.

HRT and Breast Cancer

Whether or not HRT increases the risk of breast cancer is still unresolved. Studies suggest that five years of treatment is associated with minimal risks but there may be a small risk if HRT is continued for more than 10 years. Numerous studies are under way to evaluate the risk more clearly.

The possible effect of HRT on breast cancer should be considered against the background of a one in 12 lifetime risk of developing this disease, compared with a one in four risk of having a heart attack. A woman’s risk of hip fracture has been estimated to be about one in six – equivalent to the combined lifetime risk of developing breast, womb and ovarian cancer.

Other factors such as family his­tory and benign breast disease may also influence the risk of breast cancer, although these need not be a contraindication to HRT. Current medical research suggests that there may be a link between inherited genes and breast cancer. Therefore a positive history of breast cancer in a close relative may be an important indicator of your own increased risk of breast cancer.

An interesting point is that women who develop breast cancer while taking HRT appear to be more likely to survive than women who are not on HRT. This may reflect a difference in the type of cancer that evolves or could arise from increased detection of early cancers which would not normally develop. Only further research will reveal the true answer.

However, it is important to be aware of your individual risk; the more risk factors you have from the list, the greater your risk. If you are at high risk of breast cancer, have minimal risk of heart disease or osteoporosis, then you may decide against HRT. If you have severe men­opausal symptoms you might choose to take HRT for just a few years. The choice is very much an individual one, depending on your personal circumstances.

HRT for women treated for breast cancer

There are increasing moves to offer HRT to women who have been treated for breast cancer. The decision to start treatment is based on the individual merits of each case, but may be recommended if symptoms of oestrogen deficiency are particularly severe. HRT does not appear to interfere with tamoxifen, a drug used in the treatment of breast cancer and which has some properties similar to those of oestrogen.

Risks vs Benefits of HRT – How to Decide

For women having a difficult time through the menopause, the options for treatment are numerous. There are many other non-hormonal drugs available but none has proven to be as effective as HRT.

This does not mean that every menopausal woman should take HRT – many do not need any treatment at all.

Even if you are considering HRT, it is important to balance its favourable action on osteoporosis and heart disease against the increased risks of cancer. Overall, the effect of HRT is to reduce deaths in users by over 40 per cent. Obviously this figure is slightly meaningless in the sense that everyone dies eventually, but it does show that the life expectancy of HRT users is greater than that of non-users.

Facts and figures aside, your personal decision to take HRT depends on weighing your indi­vidual needs and requirements against any possible risks associated with the treatment. If the benefits outweigh the potential risks, then go ahead. If the balance is less clear, you may wish to discuss alternative options or seek the opinion of a specialist. Some women with obvious risks, such as a very strong family history of breast cancer, may still choose HRT if they are at risk of osteoporosis or suffer severe menopausal symptoms.

The important factor is infor­mation – without this it is impossible to decide which is the best path for you to take. Do not be afraid of seeking out information, and if you do not understand it, ask. Be careful to select the right sources as the amount of misinformation in the general press provokes confusion.

You can always try HRT for a few months and see how its suits you. Take it for at least three months before making your assessment, as it can take that long before your body settles down to the hormonal changes.

Remember also that there are several different regimens; if you started with tablets but find it hard to remember to take them every day, try the patches – you may need to try several different combinations before finding the one that suits you best. Similarly, the initial dose or type of oestrogen or progestogen may need to be altered if you experience side effects.

Do not feel that you have to persevere if HRT just does not suit you. There are numerous alternatives to HRT, but none is a substitute for a healthy lifestyle with a good diet and adequate exercise.

Side Effects of HRT

Side effects of oestrogen

Bloatedness, breast tenderness, nausea and vomiting are symptoms associated with high levels of oestrogen, and are not uncommon when starting treatment. If they have not settled after the first two or three months the oestrogen dose may need lowering. These symptoms are more common in women who start HRT while still menstruating and will tend to occur at times when their ovaries are producing normal amounts of hormones. As a result of this conflict of HRT and the body’s own production of hormones, women who start HRT before their natural periods have ceased are more likely to experience side effects and irregular bleeding than post­menopausal women.

Side effects of progestogens

‘Premenstrual’ symptoms affect up to 20 per cent of women receiving continuous oestrogen and cyclical progestogens. Breast discomfort, depression, nausea, irritability, fluid retention and headaches are notice­ably linked to the course of proges­togen. Altering the dose or type of progestogen can give relief, as can switching to the combined oes-trogen/progestogen patches which use much lower doses of hormones. If symptoms are particularly severe, the progestogen course could be taken every three months. Altern­atively the duration of the progestogen could be shortened, but reducing the course to less than ten days diminishes the protective effect against cancer of the womb and can provoke irregular bleeding.

Changing to a continuous combined HRT can also improve symptoms because, although the progestogen is taken every day, the dose is usually lower than for cyclical regimens.

Irregular bleeding

Unless the progestogens in HRT are synchronised with your body’s own production of progesterone, irregular bleeding can be a problem, particularly if you start HRT before the menopause.

Weight gain

Although many women are con­cerned that HRT will make them gain weight, studies show that HRT users put on less weight than do non-users after the menopause. A few women are sensitive to oral oestrogens, particularly if the dose is too high, causing them to retain fluid and gain weight.

Headaches

Fluctuating hormone levels can trigger migraine and headaches. These fluctuations are common with oral forms of HRT, particularly if you are not absorbing the drug for some reason. If HRT aggravates your headaches, switching to a non-oral form such as patches, gel or implants may solve the problem.

The Pros and Cons of HRT Skin Patches

Oestrogen

Skin patches provide a means of delivering the hormones directly to the bloodstream through the skin. As they do not pass through the stomach and the liver first, as tablets do, the required dose is much lower, reducing side effects. Patches are applied once or twice weekly, depending on the brand. They are generally well tolerated although some, particularly the older style patches containing alcohol, can cause skin irritation.

To use patches, remove the patch from its backing sheet and stick onto clean, dry skin, free from talcum powder, bath oils or body cream. The best site is the upper buttocks. Press the patch firmly on the skin for about 10 seconds, then run your fingers around the edges to ‘seal’ it. Keep the patch on when you have a bath or go swimming, although it can be removed temporarily for half an hour or so if you prefer – keep the backing sheet to stick the patch onto until you need it again.

Cover the patch when sunbathing and remove the patch if you are using a sunbed. When replacing patches, change the site so that you are not sticking the patch in the same place each time.

Oestrogen/progestogen combinations

Double patches are available either as separate pouches of oestrogen and progestogen or combined in a single patch. Use oestrogen-only patches twice weekly for the first 2 weeks of the cycle, followed by the double patches for the last 2 weeks of the cycle.

– Advantages of patches: The main advantage of the patches is that side effects are minimised because the dose of hormones is much lower than oral therapy. The hormones from patches are gradually released into the bloodstream producing minimal fluctuations.

– Disadvantages of patches: The disadvantage is that, at present, the doses of oestrogen and progestogen in the combined patches are fixed, so dose adjustments are difficult.

Occasionally, patches do not stick very well, particularly in hot, sticky weather, but you can easily remedy this by covering the patch with two inch surgical tape.

Although it is normal for the skin underneath the patch to redden, a few women develop a severe skin reaction that prohibits further use. Switching to a different brand can occasionally help.

The Pros and Cons of Tablet HRT

Oestrogen

HRT is most commonly prescribed in tablet form. If you have had a hysterectomy, only oestrogen treatment is necessary and should be taken every day, without a break, at about the same time. There are many different brands of oestrogen tablets available on prescription containing varying types of oestrogen. Some are fixed-dose regimens, others try to mimic the menstrual cycle by changing the dose over each 28-day course.

Progestogen

If you have not had a hysterectomy, you need to take a course of progestogen tablets, every month for about 10 to 14 days. They are available in calendar packs combined with the oestrogen tablets so you do not have to work out when to take them. They are also packaged separately so that they can be taken with the woman’s own choice of oes­trogen. If used in this way, one simple regimen that many doctors recommend is to take the proges­togens for the first 10 to 14 days of each calendar month, i.e. starting the 1st of March, 1st of April, etc. This has the advantage that you can adjust the type and dose of oestro­gen and progestogen more easily. As your ‘period’ should start around the middle of the month, your doctor will easily be able to tell if you have any irregular bleeding that may need further investigation. Women whose last natural period was more than one year ago can take progestogens continuously, every day, with oestrogen as a ‘no bleed’ regimen.

– Advantages of tablets: Tablets are easy to take and their effects are quickly reversed if you decide to discontinue treatment.

– Disadvantages of tablets: It is not always easy to remember to take tablets every day, and even more difficult to remember them when away from home. Forgotten tablets can trigger fluctuations in hormone levels and irregular bleeding. The higher doses of hormones, necessary to account for huge losses in the passage through the gut and lever, can increase side effects. Nausea is a more common side effect of tablets than other routes but can be minimized by taking the tablet with food or at bedtime. Rarely, oral oestrogens are so poorly absorbed that menopausal symptoms are not controlled and an alternative type of HRT is recommended.

What to Expect during HRT

At your follow-up visit, expect to give another detailed medical history relating to any changes in your symptoms, side effects, or any other problems that have developed in relation to your therapy. Your blood pressure should be measured and a general examination includ­ing your breasts and abdomen should be done at each visit. Pelvic examinations should be performed annually and a Pap smear should be done every one to two years.

Often, the question arises of whether or not to take an endometrial sampling (endometrial biopsy) as a means of screening for uterine cancer or correcting hormone dose. I feel that if you are taking your progestin in an adequate dose, and your bleeding pattern is normal, there is no reason for doing an annual sampling. However, if you are one of those women who take estrogen only, who have their uterus intact, and who do not take progestin for some specific reason (some women with their uterus intact refuse progestin because of its side effects), I would recommend having an endometrial sample every year. You should also anticipate having a baseline mammogram taken when you first begin therapy and an annual mammogram thereafter.

It is my recommendation that once you start HRT, you visit your physician at least every six months. If the examinations listed above are done, and no problems occur in the interim, you need only those biannual visits. However, if you experience any side effects such as breakthrough bleeding, you should report them to your physician and anticipate that an endometrial sample may be taken.

It is also important that your doctor closely monitor the amount of estrogen you are taking and its effects on you. This monitoring may require testing your blood estrogen levels and measuring your cal­cium levels to assure that you are not losing calcium, which can lead to losing bone. One way of determining calcium levels is with the urine calcium creatinine test. Bone density testing is a method of determining bone loss that is very important for women at risk for osteoporosis. It shows whether bone mass has been maintained or improved with therapy. If bone density test results show that bone loss is continuing, then the method and/or type of HRT should be changed.

The Pros and Cons of HRT Implants

Oestrogen

Small pellets of oestrogen, inserted into the fat under the skin, last for about six months. This simple pro­cedure can be done at your local surgery or in the hospital outpatient department. You are given an injection of a local anaesthetic to numb the skin before a small cut is made, usually in the lower abdomen. After the implant is inserted the wound is closed with a stitch or piece of tape. If you have a stitch, your doctor will remove it about five days later. If Steristrips were used, gently peel them off yourself after five days and cover the wound with a sticking plaster until it has fully healed. Try not to do anything too strenuous immediately after an implant insertion, because occasion­ally they fall out.

Testosterone

Testosterone is the male hormone but the ovary also produces small amounts. The precise role of tes­tosterone in women remains unclear but a few doctors recommend the addition of testosterone implants for women with sexual problems. There is some evidence that testosterone increases interest in sex, although some authorities dispute this. Oes­trogen replacement alone will restore poor libido caused by oestrogen deficiency but the option of additional testosterone is available for those who favour it.

Advantages of implants: The advantage of implants is that you do not have to remember to use HRT. They dissolve slowly and provide stable levels of the hormone with minimal fluctuations. The pellet fully dissolves after five to six months, when it needs replacing. Implants produce the highest levels of oestrogen, although these usually still remain within the normal premeno­pausal range. This has the potential advantage of stimulating a greater increase in bone density than other forms of HRT.

Disadvantages of implants: The main disadvantage is that, if this method does not suit you, it is virtually impossible to remove the pellet once implanted.

An occasional problem is that the implants last increasingly shorter periods of time after each insertion so that, for some women, menopausal symptoms return two or three months after the last implant. When oestrogen levels are measured, they are very high and it seems that these women have developed some immunity to the effects of the implant. The only way to treat this is to reduce the dose of the implant gradually and restore normal levels of oestrogen.

Women needing progestogens will have to take regular courses, as with other regimens. If you stop using implants, you should still continue progestogens until there is no bleeding. This can be up to two years or more after the last implant because implants continue to stimulate the lining of the womb long after their effects on menopausal symptoms have ceased.

What Are The Risks Of HRT?

If HRT is so effective why don’t more people take it? First, not everyone needs it; second, not everyone wants to take it; third, a small number of women should not take it; and finally, many women who would benefit from it are concerned about risks and side effects.

It is imperative to find out the facts before you decide about any form of treatment. Women’s magazines often prove to be the most important source of information on hormone therapy but they do not always get it right. In one questionnaire more than 50 per cent of women expressed an opinion that HRT increased the risk of heart attacks, strokes, breast cancer and cancer in general. Furthermore, many women starting HRT discon­tinued treatment within the first three months because of side effects – return of ‘periods’, feeling bloated, weight gain, nausea, breast tenderness and headaches.

What many of the magazines do not discuss is all the benefits of HRT -relief from menopausal symptoms, and reduction in risk of fractures, heart attacks and strokes; although cancer can occur, the risk needs to be put into perspective. Similarly, many of the side effects experienced settle down after the first few months of treatment or respond to simple adjustments of dose or a change of hormones.

It is also important to have realistic expectations; if HRT does not work, it may be because the dose of hormones is too low but it could be that oestrogen deficiency is not the sole cause of all the symptoms.

All these problems need to be addressed before starting HRT to ensure that treatment is not discon­tinued for the wrong reasons.

Cancer of the womb (endometrial cancer)

Early HRT treatment schemes were associated with a fourfold increase in the risk of endometrial cancer. Oestrogen replacement therapy thickened the lining of the womb, which could subsequently turn cancerous. Although the survival rates of this special type of cancer were very high (99 per cent at five years) the risk of developing cancer increased with each year of oestrogen use.

A breakthrough in research showed that ‘opposing’ the oestro­gens with the addition of proges­togen cycles created a ‘period’ which effectively removed the lining of the womb and any potentially cancerous cells.

Further studies have confirmed that an adequate dose and duration of treatment with progestogen reduce the risk of endometrial cancer at least to that of non-HRT users, if not lower.

Ovarian and cervical cancers

Both these cancers are more common than endometrial cancer but there is no evidence that HRT has any beneficial or detrimental effect, nor is having these cancers a reason to withhold HRT.

Venous thrombosis (blood clots in veins)

Modern diagnostic techniques have meant that more cases of venous thrombosis are accurately identified. For many years it has been believed that HRT is associated with little, if any, increased risk of venous thrombosis. However, recent research using these new techniques suggests that women taking HRT who have a family history or past personal history of venous thrombosis, who are overweight, immobile or who have severe varicose veins, may be more likely to develop blood clots in the veins than women who are not taking HRT.   This risk appears particularly to affect women just starting HRT and, like all other risks, should be balanced against the benefits of long-term treatment.

Making the Most of HRT and Nonhormonal Therapy

You should not rely entirely on hormones or other medications to enhance the quality of life after menopause. It is within your power to take very practical measures that can prevent or alleviate many of the symptoms that occur.

For example, there is a natural approach to take against osteoporo­sis. Remember that osteoporosis is preventable if you can control two main processes. First, you can develop as much bone as possible during your first forty years, before menopause. Second, you can reduce the rate of bone loss that may occur after menopause.

Success in doing these things often requires some changes in life­style that call for dedication and persistence. But, studies have shown conclusively that an inappropriate diet, lack of weight-bearing exer­cise, and heavy cigarette smoking contribute to loss of bone. If you are willing to make a few changes in your lifestyle, you could protect your skeleton.

There is still the problem of hot flashes and the question of whether, they can be alleviated without drugs. Hot flashes are one of the most disabling symptoms of menopause. They can interfere with the quality of a woman’s life and even with her ability to function. There is no doubt that HRT remains the most effective method known for dealing with this symptom.

For women who cannot tolerate taking estrogens, or who are not medically permitted to take HRT, the fact that nonhormonal medica­tions are not generally effective can be a desperate medical dilemma. Biofeedback training may provide some relief in such cases. With this process women learn to control and manipulate various body mech­anisms, such as heart rate, blood vessel diameter, and muscle tension, which are usually controlled without your awareness by your autono­mous nervous system. Research in biofeedback training is still in its early stages, but we hope that in the future it may offer a nonpharmacologic means of reducing the discomfort of hot flashes.

Work continues as well with progressive relaxation training, a fairly recent method for learning how to relieve stress and tension through practiced relaxation, which may bring some relief. While new tech­niques are under study, you can try other minor changes in your lifestyle to reduce the severity or the number of your hot flashes. Changing the kind of clothes you wear may help. Give up heavy sweaters and try layering clothing instead. Alter your activities when­ever possible to reduce stress. Attempting to gain some conscious control of your hot flashes through relaxation therapy may be produc­tive. A good relaxation therapist can teach you how.

Avoiding Cardiovascular Disease

As we will discuss later, the use of estrogen in HRT does appear to be associated with a distinct reduction in the risk of cardiovascular disease. Other factors can also be employed to reduce the incidence of this disease.

Other ways of combating heart disease without estrogen include stopping smoking. Smoking is the most harmful of all habits and probably the most significant cause of coronary heart disease. Another method is gaining control of the stresses in your life and working toward reducing your negative responses to them if you cannot elimi­nate the stresses themselves.

Enhanced Well-Being

Exercise also produces this special feeling of well-being. Often termed “runner’s euphoria” or “swimmer’s high,” athletes some­times cite this sense of well-being as one of the benefits of pursuing their sport. Many people start an exercise program, lose interest, and drop out. Quitting is most likely to occur during the first three months of an exercise program, which is a shame, because most studies show that the mood-enhancing effects of exercise develop strongly after three months of regular exercise. After several months, you usually achieve physical fitness as well. If you hang in there, you can expect to feel better, enjoy all of your activities more, combat exhaustion from work, and perhaps relieve menopausal discomforts.

Menopause and Hormone Replacement Therapy

Hormone replacement therapy (HRT) does exactly what its name suggests – it replaces the hormones that a woman’s body ceases to produce after the menopause.

Eternal youth

HRT has been touted as an ‘elixir of life’, a magic potion that can reverse the effects of ageing, keeping a woman young forever. HRT is not the answer to eternal youth, but it can make many women feel younger. Successful treatment of exhausting hot flushes and sleepless nights restores energy. In turn, feeling better means it is easier to take regular exercise and follow a healthy diet, both of which have their own benefits.

Critics are sceptical that the menopause requires any medical intervention and see it as a natural event that should run its own course. This is fuelled by the fact that not every woman becomes severely oestrogen-deficient after ‘the change’. Although the ovaries are the main source of oestrogen, the adrenal glands produce small amounts and oestrogen is also formed in fat. These extra-ovarian sources are insufficient to restore fertility but may be adequate to prevent the development of severe menopausal symptoms.

Fear of cancer, particularly breast cancer, is another cause for concern but studies suggest that the risks are minimal if HRT is taken for less than 10 years. Even then, the evidence for increased risk is controversial.

Many women accept these risks once they realise the benefits of HRT, although some find it hard to cope with a return of monthly ‘periods’ and the regular pill taking that many regimens require.

Progesterone protection

Although oestrogen replacement effectively relieves the symptoms of the menopause, it is not without its problems. Doctors noticed a sudden increase in cancer of the lining of the womb, the endometrium, that was clearly linked to treatment. The oestrogen was stimulating growth of the endometrium resulting in the formation of potentially cancerous cells. In a percentage of women, true cancer developed but in a form that, in most cases, responded to treatment. Fortunately, a simple means of prevention was found -a 12-day course of synthetic progesterone (called progestogens) taken each month ‘opposes’ the oestrogens creating an artificial bleed similar to a ‘period’, which expels any cancerous cells. Women who have had a hysterectomy are not at risk of endometrial cancer and can safely take ‘unopposed’ oestrogens.

Refuting myths

Many of the fears associated with HRT are due to its effects being confused with those of the oral contraceptive pill. In fact, they are entirely different.

The oral contraceptive pill contains high doses of synthetic oestrogens which are up to eight times more potent than the natural oestrogens used for HRT. These high doses are necessary to prevent the ovaries releasing an egg each   month, producing a contraceptive effect. A disadvantage of synthetic oestrogens is that they make blood more sticky, increasing the risk of clots and thromboses in veins and arteries, which can lead to heart attacks and strokes. In contrast, natural oestrogens have minimal effects on blood clotting, and the dose used for HRT is equivalent to the amount produced in the body during the normal menstrual cycle. Natural oestrogens reduce the risk of clots in arteries, so heart attacks and strokes are less likely to occur. The risk of a clot in the veins (venous thrombosis) in a woman taking HRT is the same risk as she would have during her re­productive years, although this is greater than for a postmenopausal woman who is not using HRT.

Because of these important differ­ences, women who were unable to take the ‘pill’ can safely take HRT.

Unfortunately many myths surround the use of HRT and misinformation abounds, even within the medical profession. Research shows that women obtain most of their information from non-experts, especially the media, so it is not surprising that there is so much confusion about HRT.

Exercise for a Healthy Heart and Strong Bones

The value of exercise cannot be overemphasised. Regular exercise reduces the risks of heart disease and, by strengthening bones, can prevent fractures.

It is never too late to start exercising – one study showed that an 80-year-old man gains the same percentage improvement in muscle strength as a 25 year old. Further­more, it is better to start taking exercise when you are older than to have exercised regularly when younger and given it up. It is not just the heart and bones that benefit from regular exercise; muscle strength and power also improve making falls less likely and, if you do trip, you have more strength to hold on to something. Reassess your need for drugs such as tranquillisers, hypnotics or alcohol, all of which affect judgement, making you more likely to trip or stumble.

Although the ideal recom­mendation for exercise is 20 to 30 minutes of brisk activity, three times a week, it need not be as daunting as it sounds. The easiest and most convenient exercise is walking, as it works against gravity and therefore puts greater beneficial stresses on the bones. Start gently and gradually increase the distance. Stretching exercises increase the suppleness of your muscles but have little effect on bone. Swimming is excellent if you have joint problems as it does not put great strain on joints, but getting into a pool of cold water on a winter’s day does require a great deal of motivation!

Exercise as a daily routine

The main reason why people fail to take exercise is simply lack of time so try to incorporate exercise into your daily routine. Walk or cycle to the shops instead of taking the bus or car; if it is too far, then get off the bus one stop earlier, or park your car further away from the shops. Ideally, find a companion to exercise with. If you feel up to more formal exercise, go ahead but it is very important not to overdo it in the early stages as, particularly if you get overtired, you are more likely to give up. Always warm up and cool down gradually to prevent straining muscles and avoid vigorous exercise if you have an infection.

Remember, an exercise pro­gramme should be maintained for life, not just for the next few weeks or months.

Lifestyle changes to prevent heart disease

Many of the risk factors for heart disease can be reduced by simple lifestyle changes:  losing weight, stopping smoking, modifying diet and taking more exercise.

Lifestyle changes to prevent osteoporosis

Again, adequate exercise and a healthy calcium-rich diet help to keep brittle bones at bay. Effective prevention of osteoporosis starts early, however, preferably in child­hood and there is plenty that you can do to protect your children. They need exercise, a good diet, and should be warned about the hazards of smoking.

Peak adult bone mass is reached around the ages of 25 to 40. The peak for men is 25 to 30 per cent greater than for women, placing women at more risk of osteoporosis. Bone loss starts shortly after the peak, starting earlier in women than in men, and is accelerated by the menopause.

Facts about Food and Lifestyles

Eating is social; it’s pleasurable; it’s soothing. All cultures use food to celebrate the special occasions of life. Food, in our society, is less synonymous with our body’s survival than it is with the concepts of celebration and reward.

At midlife, you should be seeking a balanced life and beginning a lifestyle that will enhance and ensure your good health. You are looking forward to living longer and living better. Therefore, it becomes necessary to create a balance between overindulgence in food and quasistarvation, and to create within this balance room for the celebrations of life. It is time to replace both the Rubenesque image of the too well-rounded female of the seventeenth century and Tom Wolfe’s image of the “social x-rays” of the late twentieth cen­tury. In order to foster long-term health, a dietstyle has to be practical and useful.

The Menopause Dietstyle means the end of yo-yo dieting, in which you can’t win for losing. With each upswing of the diet yo-yo your body becomes comprised of more fat and less muscle. It is a metabolic fact, proven time and time again. Here’s how your metabo­lism sabotages you. Let’s say you go on a strict diet and you lose twenty pounds quickly. Of the twenty pounds you’ve lost, fifteen pounds were fat and five were muscle. Once off the highly restrictive diet, you regain the weight, faster than the last time because your body has slowed down its metabolism in order to make the most of the very few calories you have been allowing it. It cannot handle the sudden in­crease in postdiet calories. Now that twenty pounds regained is com­prised of about eighteen pounds of fat and two pounds of muscle. Each time you yo-yo you become fatter. It’s a no-win, or perhaps we should say, a no-lose weight situation.

To make matters worse, medical research has demonstrated that as a woman ages, her percentage of body fat goes up and the percentage of lean body mass or muscle tends to go down. Women often decline in size following menopause. It is lean body mass or muscle mass that is shrinking. As much as 10 percent to 20 percent can be lost through the aging process alone. This percentage increases substantially for the longtime yo-yo dieter. Statistics show that a decrease in size plus a decrease in exercise requires a substantial decrease in the number of calories you eat as you get older, if you want to keep from gaining weight. You must exercise to keep and build lean muscle mass and to fight the body’s natural desire to store fat.

Benefits of the Menopause Dietstyle

When you incorporate the Menopause Dietstyle into your life, your entire being benefits. It is not a quick weight-loss diet. It is a wonderful beginning with no end in sight. It makes allowances for mistakes and transgressions, and it enables you to celebrate with a gourmet meal on occasion knowing that you can face yourself, your family, your friends, and your scale without having to face the music tomorrow!

Studies are just beginning to show that better nutrition, increased weight-bearing exercise, and HRT that is appropriate for you may work to arrest the decline in bone mass that puts women at risk of osteoporosis in midlife and later. Such studies also show the benefits of supplemental calcium in the diet. Earlier we believed that bone loss was permanent, but new studies point toward a more hopeful path for women with osteoporosis. Thus, as women grow older, the balance between the various food groups—carbohydrates, proteins, and fats— the types of calories eaten, and the nature and amount of exercise to offset calorie intake become increasingly important. Calories are en­ergy, and regular exercise doesn’t just burn more calories when you are doing it; it also gears your body to burn more calories for hours afterward.

Appropriate nutrition is a natural pathway toward healthy bone. Bone requires a healthy foundation of protein, in which minerals— especially calcium—are deposited. Successful bone-building requires a diet of well-balanced foods containing adequate calcium.

If you are premenopausal, you need at least 1,000 milligrams of calcium per day. After menopause, your need rises to 1,400 milli­grams daily. The average woman in the United States between the ages of forty-five and sixty-five receives far too little calcium: between 460 and 650 milligrams per day. You need to double that amount.

Research is underway to study whether increasing calcium intake during the formative adolescent and young adult years will increase the amount of bone in the later reproductive years. The facts are not in, but it appears that there are no disadvantages to trying that ap­proach.

There have been no studies that prove that a decrease in osteoporo­sis-related bone fractures can result from dietary changes alone. Nor. can calcium supplements alone reduce the incidence of fractures. Mak­ing new bone requires the presence of estrogen in your system. This process is enhanced by adequate weight-bearing exercise and a good diet that provides the right amount of calcium. Diet and exercise alone will not prevent bone loss!

Are Men’s Problems Complicated by Women’s Menopause?

We live inside our own mind and body and look out from the inside. It may be that the only time a man looks at his own outside or studies his mirror image is early in the morning when he shaves. Yet, what of his partner who sees him as he is? What of their relationship, which may be significantly altered by his aging? Perhaps the man returns home in the evening and to his wife he looks tired and slightly puffy; he needs a shave, and although the gray in his hair lends distinction, she sees him and knows him as the age that he is, which is fine, because she is aware of her aging appearance as well. He, in contrast, may perceive his wife’s appearance only in relation to her age and how she looks. He may never relate it to his own aging self. When he does, it shocks the daylights out of him!

Some people seem to think that appearance is the main attraction for men, whereas women seek sensitivity and intellectual depth. Often, in some mature relationships, the wife sees her husband as powerful and bright. When the husband sees his aging wife, however, he may see in her changed appearance a reflection of his own altered image and see the enemy—old age—approaching. This perception is not the wife’s fault; it is merely a fact of life. Sometimes a man leaves his wife, and the only explanation he can give her is, “When I’m with you I feel old.” It’s a tragic response to years of loyalty and commit­ment, yet the need to run surges forth from deep within the man. It is comprised of unexpressed fears and emotions that have been buried so deep within him for so long that even he cannot tap their source. In an odd way, and without knowing why, his answer may be close to the whole truth.

What else about his partner reminds him of change that is scary? Apart from her somewhat changed external appearance, there are behavioral changes that occur in direct relation to her body’s bio­chemical changes that may also influence his perception. The thinning of her vaginal lining and painful intercourse may begin to intrude upon their sexual relationship. Changing bed linen or clothing in the middle of the night becomes the result of sweaty hot flashes instead of steamy sex. Add the fact that the man may be having an increasing problem with obtaining and maintaining an erection. Imagine the hesitation he feels at even trying to have intercourse with his wife when he realizes that she is enduring discomfort. They both know that sex should be enjoyable, not physically or emotionally painful. So he may just stop trying to relate sexually to her, and she may not object.

Meanwhile during the male’s daily activities at work or at play, if he is exuding the charisma of money or power, he may attract younger women. They make him feel good by subconsciously enabling him to project a longer and healthier future for himself. With problems at home that he doesn’t understand or relate to, he enters into a relation­ship that he did not initially chase or choose.

It is fair, then, to say that one part of the male’s awareness of the problems in his life is triggered by a woman’s menopause. This is not to lay responsibility on a woman for a man’s crisis, but it is to say that a woman’s changes in midlife are noticed by a man, and he cannot help but begin to examine the changes that are occurring in his own life at this time.

Sadly, much of the marital disillusionment, discord, and dissolution that occur when otherwise good marriages become shaky, around the time of menopause, are fully preventable. The problems must be recognized for what they are. You can work through the problems once you understand them, rather than abandoning the relationship or continuing the infidelity. The solution to the problems lies in open, honest communication.

Who Benefits from HRT?

There are two main reasons why you may wish to take HRT. First, you may want to obtain relief from hot flushes, night sweats, sleepless nights, depression, painful intercourse, bladder problems and other symptoms of the menopause. However, you do not need to have symptoms to benefit from HRT. The second, and probably the more important, reason to take it is the protection that it provides against increased risks of osteoporosis and heart disease associated with post­menopausal oestrogen deficiency.

HRT for menopausal symptoms

These often rapidly respond to HRT, sometimes within a few days, although it can take longer for the hot flushes to settle down. It does not matter which type of oestrogen replacement you take, providing the amount is sufficient to relieve symptoms.

Protection against osteoporosis and heart disease

About 15 years after the menopause, fractures and heart attacks increase because oestrogen levels are insufficient to have a protective effect. Ideally, substitute protection against these conditions needs to start as soon as the levels of oest­rogen fall.

This will be around the age of 50 for the natural menopause but may be earlier if you have had a hysterectomy or an early menopause.

Risk factors for osteoporosis

– Age

– Alcohol intake

– Bed rest

– Caffeine intake

Diet lacking in calcium

– Early menopause

– Family history

– History of amenorrhoea

– Lack of exercise

– Little exposure to daylight

– Number of years since menopause

– Number of pregnancies

– Oral contraceptives

– Previous fracture(s)

– Racial origin: white women are more susceptible than black

– Smoking

– Thyroid overactivity

– Use of oral steroids

Risk factors for heart disease

– Age

– Alcohol intake

– Diabetes

– Early menopause

– Family history

– High blood pressure

– High cholesterol

– Lack of exercise

– Number of years since menopause

– Oral contraceptives

– Personality

– Previous heart attack

– Smoking

Doctors currently recommend between 5 and 10 years of treatment with HRT for therapy to be of sustained value. Longer-term use would probably provide greater protection, but this needs to be balanced against an individual’s tolerance of HRT and associated risks.

The decision whether or not to take long-term HRT can only be made by assessing the balance of your individual risks versus possible benefits. The benefits of HRT will depend on your personal circum­stances, and your individual risk of fractures or heart disease.

Menopause and AIDS – Tips and Advice

We are in a new age with a new problem. The advent of AIDS has changed sexual mores drastically. The fact that medical science does not have the answers to this devastating illness is distressing and makes our ability to advise anyone on how to avoid AIDS extremely difficult. If you are in a monogamous relationship with no outside sexual con­tact by either partner, you have no cause for fear. But if you are not sure of that, or if you wish to enter into a new relationship, we understand the real possibility of danger that gives rise to your fears.

Evaluation of epidemiologic information about AIDS suggests that women currently in the perimenopausal or postmenopausal years show an extremely low incidence of AIDS. This finding may apply to the group as a whole, but how do you interpret it as an individual? With great caution!

Because men and women are both fearful of AIDS, they are willing to talk about it. Communication between you and your partner-to-be is of paramount importance. You need to discuss your sexuality and sexual history and raise the question of a meaningful, honest, one-to-one relationship that you hope will last, at least for a while. Allow your relationship to develop, and when sexual activity becomes a possibil­ity, do not hesitate to discuss your fear of AIDS.

The simplest way to be sure that your partner is not going to infect you is for both of you to have an AIDS screening test. It does put an end to spontaneous first-time sex. But, if it is going to reassure you as you develop a longstanding monogamous relationship, then have the test done. The chances of receiving a positive result are very low; the chances of reassuring you are extremely high.

Without AIDS testing, and the knowledge that your partner is going to remain faithful to you alone, there are other steps that should be used in all future sexual encounters. Safer sex will not only help prevent exposure to AIDS but will help safeguard you against the whole range of so-called sexually transmitted diseases (STDs). Safer sex allows all your usual activities and feelings, as long as there is no exchange of body fluids. It essentially means using condoms during vaginal and oral sex with any partner that has not been proven to be free and clear of AIDS, and avoiding direct contact with any body fluids.

This new sexual environment places a new and heavy responsibility on you. Only you can ask the right questions of your potential sexual partner. And you must ask! Your health and your life may depend on it. Otherwise, your only alternative at this time is to choose celibacy, which may not be your preference. We suggest that you ask the right questions, insist on honest and open answers, and only then permit the relationship to move forward sexually.

Menopause and Masturbation

In the absence of an acceptable partner, masturbation is a reasonable and appropriate source of sexual enjoyment as well as a method of releasing sexual tension. At midlife and thereafter, women may choose this form of sexual release as the shortage of available men gives way to the general shortage of men in an aging population. Masturbation may also be the sexual outlet of choice, over and above available partners. Masturbation is also a good way of getting started for women who, because of estrogen depletion, experience arousal too slowly to begin sexual activity at the same time as a mate. It is also a loving way to express sexuality for men or women during the illness of either partner or in instances when the desired amount of sexual activity differs for each partner.

There is no right and no wrong when it comes to sex. Society’s very recent acceptance of individual sexual preferences has also lifted the taboo on masturbation. Just as children need to be assured that there is nothing wrong with masturbation, so older persons need to know that it is not an improper activity for them. Although there is less disapproval of masturbation today than in prior times, there is still significant discomfort with the issue. However, if we agree that sexu­ality is basic to life, then masturbation must be included as one of our natural sexual outlets. According to one study, nearly half of the women questioned indicated that they masturbated in their fifties, and this amount decreased to about one-third of the women at age seventy and over. Two-thirds of the men involved in this study masturbated in their fifties and this amount dropped to 47 percent at age seventy or greater. Those achieving orgasm ranged from 83 percent of the women at age fifty to 74 percent when they reached their seventies and beyond. In their fifties, 91 percent of the men reached orgasm. At age seventy and later, 73 percent of the men who masturbated reached orgasm.

Mutual masturbation is another way to enhance your sex life when you want to, or when other possibilities are limited because of illness or injury. It involves each partner giving each other pleasure until such time as they are both ready to join in whatever way is possible for them.

The techniques for masturbation are as varied and individual as what brings you satisfaction and pleasure. Do not be afraid to experi­ment. Self-experience and self-pleasure are valuable safe sex tech­niques. You do not actually need to have sexual relations with another person to feel sexually fulfilled.

In the study by Masters and Johnson that we mentioned earlier, it was found that each of the female volunteers masturbated differently. So you need to try and see what feels good to you. You may use your fingers and hands in caressing motions in whatever position feels best. Some women stroke or press, covering their entire genital area, whereas others find that stimulating the clitoris feels best. Hands and fingers can provide intense stimulation by stroking and rubbing the external genitals, by the fingers’ gentle thrusting motion in the vagina, or by a combination of both. There is no preferred way of self-stimulation; only personal preferences apply.

Vibrators also provide stimulation and excitement to many sensitive areas of the body and can be used in many ways. They come in both electric and battery-operated models and in shapes as different as women are unique. They also sidestep the old taboo of not touching oneself for women who find it is a lingering problem. These are available for purchase in pharmacies and most department stores, as well as offered in catalogues too numerous to mention.

Jacuzzi jets or hand-held shower heads playing directly on the clito­ris can offer sexual pleasure, and for some women so does the crossbar of a bicycle or the back of a horse when riding. Do not be afraid to try to seek sexual pleasure by yourself or to engage in a satisfying fantasy life that may stimulate you in different ways by “dream” imaging. Erotic books, movies, and videotapes may also be used to heighten your sexual excitement. Just remember, there would not be so many erotic items available if they were not in use. If you are not sure of how to start your process of experimentation, there are many good books available that offer specific instructions and techniques for masturbation, such as L.G. Barbach’s, For Yourself: The Fulfillment of Female Sexuality (New York, Anchor/Doubleday, 1976) and Sex Is Not Simple by Stephen B. Levine (Ohio, Ohio Publishing Co., 1988). You can also try to find a support group for women that deals with sexuality.

Finding the Right Treatment Regimen for Menopause

There have been many changes in the way we prescribe estrogens and progestins. These methods are referred to by doctors as treatment regimens or treatment protocols. They range from taking the hormones alone to taking them in various combinations with another hormone; from taking them continuously to receiving treatment in cycles that involve time on and off the medication. Learning about the various regimens and why and how we select them can help you understand why you may be taking hormones every day, whereas your best friend takes them cyclically.

Cyclic Regimen

Estrogen used alone, either cyclically or continuously, has been as­sociated with an increase in the risk of uterine cancer. For this reason, we add progesterone or progestin. (The progestin inhibits the growth stimulation of estrogen.) The combination of estrogen and progestin, taken cyclically, is the most popular method of HRT today.

The cyclic treatment most frequently prescribed works in accord with the calendar month. You take estrogen from the first through the twenty-fifth day of the cycle, adding progestin for the last twelve or thirteen days of the estrogen therapy, and then stop both medications for the final days of the month. Withdrawal bleeding may occur at the end of the month during the pill-free days.

There are three cyclic methods popularly in use in the United States today:

– You take estrogen tablets on days one to twenty-five of the month and add progestin for approximately twelve days (days fourteen to twenty-five). ,

– You use the estrogen patch, changing it twice weekly for twenty-five days and take oral progestin on days fourteen to twenty-five.

– You take one of the other estrogens and progestins in equivalent doses and cycle twenty-one days on and seven days off therapy.

These methods have one thing in common: About two-thirds of those women who have their uterus intact will experience a period during the treatment-free days. The amount of bleeding usually lessens over time and, after several years, may disappear altogether.

Continuous Therapy

Continuous therapy involves the uninterrupted use of estrogen. Re­cent prescribing trends have moved away from the interrupted, or cycled, use of estrogen, which actually rests on little scientific founda­tion.

Continuous estrogen with intermittent progestin has become the most popular U.S. method of continuous therapy. It works this way: You take estrogen continuously, either as a daily tablet or as a skin patch changed twice each week. You take progestin on the first twelve days of the calendar month.

More than two-thirds of women with an intact uterus will, on this regimen, experience bleeding. Bleeding, however, should occur only after the twelfth day when the progestin is stopped and last until around the sixteenth day. If bleeding occurs before the ninth of the month, it may suggest that the dose of the progestin is too low and should be adjusted. Bleeding starting after the sixteenth day should be considered irregular and reported to your physician.

Combined Continuous Therapy

Combined continuous therapy is a more innovative method of hor­mone replacement. This therapy involves daily doses of estrogen combined with low daily doses of progestin. The combined continu­ous method attempts to avoid that most unpopular side effect of HRT, withdrawal bleeding, that usually occurs with cyclic therapy. Variable results of this therapy have been reported in recent medical literature.

Endometrial sampling (biopsy) is often required, which generally shows a mixed pattern of estrogen and progestin in the uterine lining. Most women do not like the irregular bleeding and stop taking therapy. Those who continue usually find that they stop bleeding after approximately six months.

Is it worth it? Further research is necessary in order to answer this question. It seems likely that this form of combined continuous ther­apy may become very popular in the future. The main hesitation in prescribing it now is the risk of giving the body too much progestin, with a possible risk of heart disease or breast disease as a result.

Continuous Progestin Therapy

Progestin only, taken continuously, is a form of therapy for women who cannot take estrogen because they have had breast or uterine cancer, or because they have severe fibrocystic breast disease. Women take it either daily in pill form or in monthly intramuscular shots.

Progestins help to prevent osteoporosis. Their protection of bone, however, is not as good as that of estrogen. The major disadvantage of progestin-only therapy is that it may increase the risk of heart disease.

Menopause and Cosmetics

The skin becomes lighter and its texture changes somewhat as you age. Thus, makeup that has always looked good on you may look odd. Either it is too dark or too light or too bold. You should experiment with color. A good way to begin is to schedule an appointment with a professional makeup artist. (Makeup artists are usually available at the cosmetic counters of department stores.) With­out explaining in detail what is bothering you, see what makeup products and colors they choose for you.

For makeup to work for you, it all has to work together. Midlife is usually not the time for makeup extremes, even if you could get away with them in your younger years. The natural look is beautiful and makeup should serve as enhancement, not camouflage. Consumers spend billions of dollars a year on cosmetics. If you support this large industry, make sure you are buying what is right for you. Learn what it is that you are putting on your face and whether it is good for you.

We suggest that you stop buying cosmetics on impulse and buy only what suits your coloring. Once you have determined your look, buy into it. There are many looks to work toward in the years before “fiftysomething.” Some women who have passed that mark, like ac­tress Joan Collins, can still wear the darkest hair, the lightest skin, and the reddest lips. For others, a softer palette creates a quite different, yet equally attractive, face.

No amount of cosmetics can cover poorly cared-for skin. Begin cosmetic application with a clean face and a good moisturizer. We have a friend who prides herself on wearing only powder, light lip­stick, and a touch of mascara most of the time, and she looks terrific. We have another who can’t leave home without false eyelashes and a complete paint job. She looks good, too. They have chosen to make up in a way that makes them look and feel good. You choose for yourself what works for you. If you do choose a full range of makeup, be sure you know how to apply it artfully. Study yourself in daylight and in lamplight. The effects of your makeup change in different lights. You may find you need a lighter hand during the day.

However you feel about cosmetics and their use, if you use them, use them to your best advantage. That professional lesson we men­tioned earlier can work wonders for you in helping you to pick your image and enhance it with makeup.