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Menopause
Menopause
is a natural physical transition that every woman experiences as she
ages. It is often loosely defined as the final cessation of menstruation
in a woman's life. This implies an abrupt and complete transition,
although the actual process is typically quite gradual. While most women
undergo this change between the ages of 48 and 52, some women stop
menstruating as young as their late thirties or early forties, and
others continue to menstruate into their mid-fifties. The process
leading up to menopause begins with a slow-down in the function of the
ovaries, generally about five years before the last menstrual period,
and additional physical and emotional changes continue for several years
after the last period. During this time, there is a change in the
hormonal balance, with a decrease in the amount of estrogen produced by
the ovaries. Finally, there is such a low level of estrogen production
that periods become irregular, eventually stopping altogether. As the
menstrual cycles cease, the level of progesterone also decreases.
Together, these hormones influence and regulate a number of physical and
emotional functions, and with changing levels of both, many women
experience more than just the cessation of menstruation.
Menopause sets in motion
a number of physiological changes that may impact a woman's sexual
functioning. The decreased levels of estrogen and progesterone during
and after menopause cause the lining of the vaginal walls to thin and
become more rigid. In addition, the production of vaginal lubrication
drops off, contributing to discomfort during intercourse. Estrogen
replacement therapy helps to counter these changes for many women, but
risks may outweigh the benefits for women with cardiovascular disease,
breast cancer, or uterine cancer in their histories. Estrogen
suppositories or creams, which contain much lower doses of estrogen and
are used over much shorter periods of time, are another option for
maintaining the viability of the vagina. For women who cannot, or prefer
not to use estrogen treatments, water-based vaginal lubricants
effectively alleviate vaginal dryness at the time of intercourse.
Menopause need not signal
the end of a woman's sexual interest or activity, as was assumed to be
true in the past. It is not the loss of estrogen, but the beliefs and
attitudes about sex and menopause, or aging, that seem to be important
to sexual desire and activity. In recent years it has become clear that
not only does interest in and capacity for sex continue well beyond
menopause, but that many women report an increased enjoyment of sex
because worries about unwanted pregnancy are no longer a concern.
Some women experience
this as a smooth transition with little physical discomfort, while
others experience many uncomfortable accompanying symptoms such as hot
flashes, night sweats, mood swings, irregular heavy bleeding,
osteoporosis, and vaginal dryness (which may lead to painful sexual
intercourse). As many as 80 percent of women going through menopause
experience some negative physical reactions. Women experience worse
symptoms if they are undergoing severe emotional stress or have certain
dietary habits that include excessive caffeine, sugar, or alcohol
consumption. Hot flashes are one of the most uncomfortable problems that
menopausal women complain about. While most women experience hot flashes
lasting two or three minutes, others last longer, even up to an hour.
Roughly 80 percent of women going through menopause experience hot
flashes, and for about 40 percent of those women the symptom is so
distressing that they seek medical attention.
Some women have noticed
that drinking coffee or alcohol can at times bring on hot flashes. Some
women find relief from certain symptoms with the help of hormonal
replacement therapy, in which various regimens of estrogen, progesterone
and androgens are taken. In addition to the hormonal treatments, other
remedies that have been found helpful for the depression, irritability
and anxiety experienced by some women include the use of tryptophan (an
amino acid that has a calming effect, also naturally occurs in hot milk,
beef, tuna, chicken, eggs and spinach), mild herbal teas (such as
camomile and valerian root, taken at bedtime), regular exercise and
relaxation.
As with any health issue,
menopause is yet another life experience that is eased with good
self-care, exercise and a healthy diet. Whole grains, legumes,
vegetables, fruits, seeds and nuts, smaller portions of meat and
unsaturated oils are all preferable to a diet laden in salt, sugar,
caffeine, alcohol, dairy products (other good sources of calcium include
green leafy vegetables, beans, peas, soybeans, fish, carob, and chicken
stock made with bones), and fats.
Premature menopause can
result from a variety of causes. One of these is the surgical removal of
both ovaries as part of a hysterectomy to treat ovarian cancer or other
cancers of the reproductive system, severe endometriosis,
life-threatening infections, or to protect women from perceived risk of
future cancer. About 5 percent of all women inherit a tendency toward
early menopause from their mothers and are born with thousands fewer
eggs than most women. Others inherit an autoimmune disorder in which
their own immune system destroys healthy ovarian cells for as yet
unknown reasons. These women tend to experience an earlier onset of
menopause and range of symptoms than seen in the majority of other
women.
The unpleasant side
effects of going through menopause may be amplified by the meanings that
menopause has for a woman. Some may see menopause as a sign of getting
old; others may grieve the loss of their childbearing years. This phase
of life may occur at the same time as other significant life changes:
children may be entering college, parents may be getting older and may
require more care, and women may begin to experience significant losses
of relatives or spouses through death. The experience of menopause may
be eased by viewing it in the context of other stresses that might be
occurring in a woman's life. Often allowing one to grieve the losses
that are being experienced will paradoxically offer some relief to the
adjustment to this normal phase of life. Finding someone supportive to
talk to, such as someone older who has successfully made this
transition, may be helpful. A holistic approach that addresses the
physical, medical and emotional challenges that accompany menopause will
ease the transition into what can continue to be a very enjoyable and
rewarding time of life.
Male menopause is a
relatively recent concept referring to a kind of emotional or
psychological crisis that occurs for some men during their 40s, 50s or
early 60s. Because men do not menstruate, menopause is a somewhat
inappropriate term for this male phenomenon. It is also referred to as
mid-life crisis. Male menopause or mid-life crisis typically manifests
itself as symptoms of depression for no obvious reason, intense
reflection on the direction one's life has taken as well as on what the
future holds, and perhaps some personality and behavioral changes that
may put a strain on relationships.
Just as estrogen
production diminishes in women during menopause, so does testosterone
production in males during this stage of life. The physical consequences
are much less dramatic for men than for women, but some men do
experience changes. These include taking longer to achieve an erection,
less strongly felt ejaculation, and a longer refractory period (after
ejaculation, the time it takes for a man to be able to ejaculate again).
Most men also experience gradually declining levels of strength and
endurance. On the other hand, ejaculatory control is likely to be
increased, and the man remains fully able to cause a pregnancy.
Furthermore, regular physical conditioning can combat much of the
decline in strength and endurance.
For some men, the
physical changes of mid-life signal a threat to their masculinity and
virility, setting in motion psychological distress and behavioral
changes. There are those men who experience mid-life as so threatening
that they seek to prove their youthfulness, strength and virility by
seeking out multiple sexual encounters, perhaps with younger partners,
or by participating in strenuous physical activities.
Not all men experience
male menopause, and of the men that do, only about 25 percent are
profoundly affected. The duration of a mid-life crisis is highly
variable. It may be concentrated into a few months, or it may last up to
several years. Generally, having a supportive and understanding family
and being able to discuss the ongoing concerns of mid-life will help men
negotiate this sometimes troubling time without major residual problems. |
Sex
