Chapter 26

Boston Women’s Health CollectiveOur Bodies, Ourselves

“With the advent of menopause, children leaving home, or the decline of a parent, we come to the end of familiar roles and ways of being and begin a different way of life”

-page 528

Midlife is defined as ages 45 – 65Midlife is a time of emotional, social & physical

changes which for women includes menopauseMenopause defined as end of monthly bleeding 1 – 10 years prior to menopause a woman may

experience symptoms of “peri” (around) menopause which include hot flashes, irregular periods, more pronounced PMS

Menopause occurs at different times for women, the average age is 51

Menopause can be brought on earlier by smoking, or be surgically or chemically induced

Midlife is often a time of social changes including children leaving home, health decline of parents, and assumption of new roles including mother-in-law or grandmother

It can be a time of redefining oneself as nurturing roles shift providing more time and energy for achieving goals put on hold years earlier

Often comes with increased perspective on life and/or accomplishment, along with a new sense of self-pride and awareness

Many women in midlife enter the “sandwich generation” where they are caring for children and ailing parents

Divorce/separation after children leave home may occur creating further stress (or relief )

Transition can trigger emotional problems – or feelings restlessness associated with changes occurring emotionally, physically and socially

Physical changes including weight gain, loss of reproductive capabilities, wrinkles, thinning hair can create emotional stress in a society focused on youth and beauty

May be associated with “ageism” & discrimination due to age

Health changes related to decreased estrogen

production increase a woman’s risk for osteoporosis, cardiac disease, urinary incontinence, weight gain

With decreased production of estrogen/progestin women experience symptoms of “the change of life” while their body adjusts to hormonal changes

During perimenopause & menopause a woman may experience:

More severe PMS symptomsIrregular periods varying in occurrence, flow, durationHot flashes and night sweats Insomnia and sleep disturbances Vaginal dryness and/or pain with intercourseUrinary changes such as stress or urge incontinence and increased urinary tract infectionsIncrease or decrease in sexual libidoMood changes

Health related risks associated with decreased estrogen production include:

Increased risk of heart diseaseIncreased risk of fracture secondary to decreased

bone density and/or osteoporosis (only 15% of women are diagnosed w/osteo)

Decrease in lean muscle mass and increase in adipose tissue

What to do…. Aerobic exercise and weight bearing exercise help to

greatly diminish these risks and symptoms related to menopause

Sexuality (unlike fertility) continues throughout our lives

Post menopause women no longer need to worry about pregnancy or birth control providing more spontaneity

Vaginal changes in women post menopause put them at higher risk for contracting STI’s and HIV, (if not in a mutually monogamous relationship) hence “safe sex” practice is encouraged

Vaginal dryness and/or discomfort can often be remedied with OTC moisturizers or lubricants

For sexual dysfunction and or pain with intercourse medical intervention may assist

Hormone Replacement Therapy (HRT) available since 1960’s, generally uses estrogen in pill, patch, ring or cream form. Many also include progestin additive.

Widely prescribed when first available, but often associated with negative side effects – including increased risk of breast cancer and blood clots

Women's Health Initiative (WHI) 2002 published study confirming risks of HRT for breast cancer and blood clots. They also concluded women were more at risk for cardiovascular disease & stroke with HRT

Study tested only one regimen of HRT – leaving some questions remaining regarding efficacy and safety of HRT

HRT concerns have generated new drugs for providing benefits of hormone replacement without negative side effects

Selective Estrogen Receptor Modulators – SERM’s (Raloxifene/Evista®), Tamoxifen, help prevent bone loss and reduce risk of fx without stimulating breast or uterine tissue to become cancerous

Biphosphonates (Fosamax®, Boniva®) are another class of drug which help to prevent bone density loss

Herbal treatments such as black cohosh, red clover and soy are felt safe for short term (<6 mos) use

Exercise, well-balanced nutrition, and cessation of smoking, drinking or substance abuse can have dramatic results on the effects of aging and menopause

Aerobic exercise – walking, running, jogging, dancing, greatly improves stamina, cardiovascular status, and releases “feel good” endorphins

Weight resistance exercise – push ups, pull ups, squats, lunges, weight lifting, or water exercise help to increase load bearing on muscles & tendons thereby increasing muscle mass, and decreasing bone density loss

Many women in midlife are without health insurance and/or do not receive this through a spouse or employer

Midlife women without health insurance (if not disabled) must pay privately for coverage or seek employment that provides it

For older women needing insurance (<65), full-time work may not be an option and they may not meet poverty level for state Medicaid assistance

Affordable Care Act designed to provide more affordable insurance options for under privileged Americans through state wide insurance exchanges

Many support groups exist for women over 50, and provide an important source of information, sharing and networking.

In addition, several over 50 advocacy groups are campaigning to improve the status an image of older people in the U.S.

National Women’s Health Network provides women with updates on current research and findings

So when did I get here? As a woman who is officially in “midlife” I can tell you it has to be one of the best times of my life. I am more confident, self-aware, and love my new titles including “Mom-in-Law” and “Grandma”. I feel I’m at the top of my game mentally, and professionally, and no longer feel the need to put my needs on the back burner.

I found this chapter to be very informative and helpful in realizing some of the “restlessness” that comes with this age is normal.

A thought for discussion:

What are you experiencing if you are indeed in “midlife”. If you are not even close, where do you think you will be when you get there?

I wince at saying this for fear of sounding “old”, but time does go so fast. You really need to enjoy every minute of your life, and make the most of what God has given you.