Women and Menopause

07May
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Women and Menopause

If you want to understand the enormous hormonal changes with women and menopause at an average age of 50.5 years (we think it’s younger) it might help you understand why women from approx 44 years plus seem to be acting like loose canyons. Men should be warned about the massive changes in women in this age group as a lot of relationships in this age group seem to struggle. Men seem to be always making allowances for hormonal driven behavioural changes by women whether it’s PMT, Pregnancy or Pre Menopausal. It’s a juggling act of emotions that males have to deal with. Remember males at this age change to so why do we do it? Why have kids late in life…? Is it purely financial? Hope not…

“Because women are having kids later in life it is bringing about a crisis that they just don’t see or get! When they are in their mid to late forties and are pre-menopausal the kids are becoming teenagers and are going through adolescence. That’s one crazy hormonal driven household. Unfortunate husbands, poor kids. Society has been conned into believing this thinking by women having children late in life works. It doesn’t.” ~ Jack Jeddaman

With women and menopause, comes moodiness — that’s the common assumption, and it’s certainly the case for some women. But is it inevitable?

It’s hard to say exactly how much menopause contributes to changes in mood. Part of the problem is that traditionally, studies of women menopause have concentrated on a small group of women — those that are experiencing more than the usual degree of difficulty.

Researchers are now trying to get a more representative picture of the variety of women and menopause experiences. The Melbourne Women’s Midlife Health Study has spent the ten years following more than 400 women chosen from the general population. Every year, the women go through a series of tests that monitor their menstrual cycles, hormone levels, and general health, and answer questions about their moods, stress levels, and what’s going on in their lives.

So is it true that menopause makes you moody?

“We had a very careful look at this data,” says Professor Lorraine Dennerstein, psychiatrist and head of the study, “because we wanted to know whether depression was related to the menopause. And in fact we found it wasn’t: that as women passed through the menopausal transition, negative moods actually get less.”

“What we did find though, was that passing through the transition makes women a bit more vulnerable to stress. So if you’re unlucky enough to have a lot of hassles occurring, or interpersonal stress with your children or your husband or people at work, or if you lose your job at this time, it will be more difficult for you to cope.”

The study found that women of menopausal age were subject to many such stresses. For example, it’s often a time when aging parents require extra care, and grown children are still needing support. “People used to talk about the empty nest syndrome,” says Lorraine Dennerstein, “but far from being an empty nest it seems to be a revolving door, with people coming and going all the time — and let me tell you when they come and go they donít just come home by themselves, they often bring people with them, or pets and furniture, and when they go they tend to leave some of these things behind.”

Women with severe physical symptoms (such as hot flushes and night sweats) were found to have higher rates of depression, as did women with other health problems or a history of depression prior to menopause. So while depression can be a problem during menopause — as it can be at any time of life — menopause on its own does not actually cause depression.

The hot flush is the classic menopausal symptom — the most visible outward sign of underlying hormonal upheaval. Officially, menopause is defined as the time when the last period ends, but in reality, hormonal changes and menopausal symptoms often last for several years. These years are called the ‘menopausal transition’.

The brain mistakenly thinks the body is too hot, and puts into action heat losing mechanisms. The blood vessels in the limbs dilate, and skin temperature rises. “There can be just hotness in the face, or some women have total body heat,” says Sue Davis. “They go red, they start sweating, they’re dripping under their armpits … some women wake up several times a night drenched in sweat.”

Hot flushes typically last 3 to 5 mintues. They can happen as often as every hour, and can go on for years — with serious disruptions to work, sleep, and quality of life.

What about sex?

“That was actually fantastic. I had two children, and I didn’t want any more children, and it was absolutely wonderful not to have to worry about getting out of bed and get that terrible damn diaphragm that I used to use, and all the gunk that went with it … I felt liberated.”
— Peggy.

Another common assumption is that women after menopause aren’t interested in sex.

“That’s also a stereotype which simply isn’t true,” says Lorraine Dennerstein. The Melbourne Women’s Midlife Health Study has asked detailed questions about women’s sex lives, and identified the many and varied factors which may be responsible for any changes in their level of interest.

Menopause can cause vaginal dryness, which can be uncomfortable during sex unless more time is taken to reach arousal. But this is not necessarily a disadvantage, says Lorraine Dennerstein. “It could lead to the couple having more prolonged lovemaking, which could be very pleasant.” she says. “So it’s not necessarily a big problem as long as women know that there is something they can do about it.”

Lubricants, readily available at the chemist, are one option; oestrogen creams or oestrogen-filled vaginal rings (pessaries) are another.

Women who reported most satisfaction with their sex lives fell into two groups. “Firstly there was the group of women who were single and had met a new partner, and they would say this has transformed everything and they had a fantastic sex life,” Lorraine Dennerstein reports. “The other group were those who would say something like, my children have left home, my husband and I now have time to do a lot more things together, we’re going away for the weekend, having a lot more romantic dinners and so on — and their intimacy has improved.”

Where sex was less than satisfying, it wasn’t usually menopause that was to blame. The most important factor was how women felt about their partners. Says Lorraine Dennerstein: “If there are negative feelings towards the partner — anger or resentment going back perhaps over many years over many different things, that’s going to have a far more powerful effect at any stage of the woman’s life than the hormonal changes of the menopause.”

Hormonal factors may come into play for some women, particularly those for whom menopause comes early. But when it comes to sex drive, it isn’t oestrogen but testosterone that seems to help.

According to Associate Professor Sue Davis of the Jean Hailes Foundation, testosterone levels start to fall well before menopause: women in their early forties have about half the testosterone of women in their early twenties. But most women will still produce enough, says Sue Davis. For others, sex drive, energy levels, motivation, and muscle strength may suffer.

Those most likely to be affected by low testosterone are women who have never menstruated, those who go through menopause early, and those who have had their ovaries removed. In the latter group, Sue Davis says, “testosterone levels fall suddenly by 50%, and these women often complain of sexual dysfunction and fatigue that isn’t improved with oestrogen replacement alone.”

For women with low testosterone, a different form of hormone replacement may be the answer. Sue Davis has conducted trials of testosterone patches, and has found an improvement in libido, orgasm and sexual pleasure, with no discernible adverse effects. This treatment may be available to more women in the future.

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