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Understanding This Thing Called MenopauseWhat You Need to Know Right from the StartMy good friend Nadine hit me with a sobering thought this morning. We were headed to our local gym to meet Laura, Robyn, Tina, and few other friends for our regular "We're-not-getting-older-we're-getting-better" workouts when she decided to fill me in on the morning's news.
"I read in the paper today that between the year 2005 and 2030 there will be 1 billion women going through menopause . . . all at the same time," she said almost innocently. I wasn't quite sure if she thought this was a good thing or a bad thing. But I know what I thought: That's
waaay too many of us having hot flashes and mood swings all at the exact same moment. Talk about your weapons of mass destruction . . .
The funny part is, though, that despite what we have all been conditioned to believe or expect, it's not really
this thing called menopause that's going to change our lives in any kind of dramatic way. Because--and I'm speaking strictly in medical terms here--menopause is now clinically defined as not having had a menstrual period for twelve months or more. It is considered the official
end to your reproductive years--and for many women that also means an end to some of the most troubling symptoms associated with this time of life, including hot flashes, night sweats, moods swings, and those "touch me and I'll kill you" temper outbursts. And, in fact, as lots of women who have already passed through this transition will likely tell you, reaching menopause can seem more like a beginning than an end anyway--thestart of the second phase of your life. If you look at gals who have already opened the door for us--incredible, talented,
and, yes, gorgeous women like Diane Sawyer, Oprah Winfrey, Diane Keaton, Tina Turner, Cher, Suzanne Somers, Hillary Clinton--then you know that what's on the other side can be pretty spectacular.
But the getting there--ahhh, now that's a
different story. Doctors use the word
perimenopause, which technically means the years leading up to menopause--a period that can begin as young as thirty-five or as late as fifty, be as short as one year or as long as ten or more. My friends and I--well, we have coined an entirely different term to describe
this time zone. And if you've just rounded the bend past forty--and particularly if you are heading toward age fifty--it's likely you've got a few terms of your own to describe
this particular time of life. (Does the word
yikes! come to mind?) As you no doubt already know, it's the perimenopause years that can leave you wondering if anything about life is ever going to seem normal again.
*You pick up the phone to call a client--and while it's ringing, you've completely forgotten whom you've called.
*You wake up in the middle of the night warm and flushed and breathing heavy--and sex is the furthest thing from your mind.
*The bakery is out of rye bread--and you cry for forty minutes. In the store.
*You begin to wonder if it's possible to have PMS for forty-seven days in a row.
*You are convinced beyond any reasonable doubt that global warming has arrived--and it's hovering over your house 24/7.
*You go on vacation and without warning your period arrives--ten days early and heavier than you've ever experienced before.
If this all sounds a bit too familiar, then you probably know this can be a time that tries a woman's soul, tests her patience, challenges her resolve, and in many instances leaves her wondering why, after going through labor, giving birth, raising a family--and breaking through a glass ceiling or two along the way--she now has to put up with
this! Not to mention a partner whose testosterone levels have been dropping since
he hit thirty-five!
Before you get too discouraged, remember, there is an upside. With just a little bit of knowledge--and some patience and resolve--you can discover how to put that "kick" back in your engine, pick up speed, and head into the second half of your life, raring to go! How do you begin? For me, the best place to start was in discovering my new body--what's changed, what's different, and, overall, what I can come to expect from myself and my own slightly used biology, now and in the years to come.
It's Not Your Mother's Menopause--But Nobody's Told Your Ovaries
One of the really great things about being in perimenopause today--as compared to when your mom or grandmother went through it--is that it really doesn't signify much, except an aging of your ovaries. Indeed, thirty or forty years ago "middle-aged" was considered "elderly"--with women resigned to living out the second half of life in frumpy print dresses and low-heeled shoes. Well, it's not your mother's menopause! Today turning fifty comes with a whole new attitude--not to mention a whole new look--with high-achieving, high-energy gals from all walks of life proving that the face of aging is definitely changing. And, with a few shots of Botox and a bottle of moisturizer, the future can look pretty darned good! Unfortunately, your ovaries don't quite share in that same youthful enthusiasm. No matter how young you look or feel or act, when it comes to your reproductive system . . . well, let's just say you're lucky your ovaries are on the inside of your body. Because the truth is, they are aging, and that fact is pretty much responsible for most, if not all, of the perimenopause symptoms you are or will soon be experiencing--including the common symptoms like hot flashes and night sweats and mood swings, but also the less discussed problems such as dysfunctional bleeding, memory loss, insomnia, and more.
Before you can fully appreciate all that changes as your ovaries age, it's important to understand a little something about how they work in general--and how they control hormonal activity during all the phases of your life. In this respect, much of their activity revolves around the production of estrogen and progesterone. During your peak reproductive years--from your teens to your mid-thirties--the vast majority of the estrogen in your body, and pretty much all of your progesterone, is the direct result of what's going on in your ovaries. The other two hormones that matter most are FSH, short for follicle-stimulating hormone, and LH, short for luteinizing hormone. While both are manufactured in the brain, their primary activity is to stimulate the ovaries.
The other key players on your reproductive team are your follicles--tiny sacs within each ovary that contain the biological makings of an egg. At birth you have several million follicles already in place, just waiting for puberty to jump-start your hormones and allow the reproductive process to begin. When it does, a tightly wound network of action and reaction begins, and it all plays out something like this:
*As each monthly cycle starts, estrogen levels are relatively low--something which your brain readily senses. When it does, it begins to producing the chemical FSH. As the name (follicle-stimulating hormone) suggests, a rise in FSH stimulates the follicles inside your ovary to grow and eggs to begin developing, which makes estrogen levels rise.
*As this occurs, your ovaries send another message to your brain to initiate the production of LH, a hormone that encourages the release of your developing egg--a process known as ovulation. The sac in which the egg developed--known as the corpus luteum--is left behind, and it begins producing progesterone. Together, estrogen and progesterone help create a thick, spongy lining inside your uterus in anticipation of a newly fertilized egg.
*If that egg isn't fertilized and no pregnancy occurs, levels of estrogen and progesterone drop sharply. This, in turn, causes the newly thickened uterine lining to shed, leaving your body in the form of menstrual blood. After it does the whole cycle begins again--and a month later, you get another period.
That's the way it goes, month in and month out, for pretty much most of your reproductive life. As you begin to age, however, some of these steps begin to change. As early as age thirty-five, for example, your cycle may go from the average twenty-eight-day schedule to twenty-four or twenty-five days. While doctors don't understand why, older women seem to ovulate within ten or twelve days of their last period, instead of the customary fourteen, thus shortening their cycle. Eventually--usually between age thirty-five and forty--you will stop ovulating every month. Although it sounds like the several million follicles you are born with should last well into your nineties, they don't. As you age many begin to die off. The follicles that do remain are getting "older"--and they don't respond to hormonal stimulation quite as readily. So, while in your peak reproductive years you were probably ovulating every twenty-eight days, and doing so ten or twelve times a year, once you hit age forty, you are probably ovulating just six to eight times a year--and the older you get, the fewer eggs you "hatch," so the less frequently you ovulate. The end result here: Your estrogen levels begin to fluctuate, sometimes dramatically.
This is even more true if you are overweight, since fat cells can convert other hormones into estrogen--causing your levels to be double or even triple that of a thin woman. While holding on to more estrogen may seem like a good thing, here's the glitch: When you are not ovulating, your body fails to produce progesterone--and without this hormone your estrogen levels become dominant. This not only leads to a whopping case of PMS (one reason you have so many mood swings and crying jags and may even experience depression during perimenopause), it also causes another, potentially more serious problem to occur--a condition that doctors call "dysfunctional bleeding." You probably know it as "irregular periods"--you miss one cycle, or even several, and then you're hit with an exceptionally heavy bleed. Or your periods may come closer together or further apart, or your bleeding can sometimes be a lot lighter than you experienced in the past, or much heavier. Regardless of the form it takes, doctors report that up to 90 percent of all women experience some form of dysfunctional bleeding during perimenopause (see Chapter 3 for more on this subject).
In addition, the same hormone imbalance that is causing your bleeding irregularities--particularly the up-and-down action of estrogen--is also setting the stage for a number of other malfunctions, bodywide. That's because estrogen receptors--cells that need estrogen to function--are distributed throughout much of your body. They are found not only in your female organs, such as your breasts, ovaries, and uterus, but also in your brain, liver, digestive tract, urinary system, blood vessels, skin, bones, and even your central nervous system. In fact, estrogen stimulates the production of proteins that help maintain the healthy function of a good number of organs and systems.
What's more, these hormone receptors also act like little "docking stations"--welcoming in and accepting the estrogen that floats through your bloodstream. When the receptors in any system of your body receive the proper amount of this hormone, they can direct that system to work as it should. The end result is that you feel great. But what happens when, as hormones levels get wonky, there just isn't enough estrogen to go around? Some of those receptors are left "empty"--and that means many systems in your body don't work as they should. And you can begin to feel the effects bodywide. Not only can you experience the classic hot flashes, night sweats, and mood swings, there can also be headaches, joint aches and pains, fatigue, sexual dysfunction, even memory loss--all the result of hormones that have run amok. Later in this book you'll learn even more about how your "dancing hormones" affect the way you feel--and bring on a variety of symptoms.
1, 2, 3, Testing . . . For Menopause: What You Should Know
Since it's clear that the basis for menopause is changes in various hormone levels, many women wonder if a simple blood or urine test could validate their reproductive status and, at the very least, help verify where they are in the menopause process. For many years doctors believed that blood tests for either estrogen or, more importantly, FSH (follicle-stimulating hormone)
could reveal a woman's current reproductive status. This, however, is not the current line of thinking. Why?
While an elevation of FSH around the third day in any menstrual cycle can be a predictor of
fertility, doctors now know that unless you're trying to get pregnant, this test is not likely to tell you much. That's because hormone levels continue to rise and fall so dramatically during the entire course of perimenopause, getting a clear and accurate reading is almost impossible. Medical studies that have attempted to do so found that levels fluctuate dramatically from day to day--and sometimes even hour to hour--making it nearly impossible to draw any kind of solid conclusion. In fact, the older a woman gets, the less reliable an FSH test is.
The same is true for estrogen and progesterone tests. Levels, in fact, can fluctuate so widely, even during a normal cycle, that the tests won't really tell you much. Needless to say, most experts agree that this caveat also applies to home hormone tests, many of which are available on the Internet, and in drugstores nationwide. What's more, there is another caution to consider if you do decide to try a home test kit--particularly if you are using it to nail down the reason behind your dysfunctional bleeding.
While a self-administered test might give you
some clue to your hormonal status, it can't tell you
anything about other possible causes for your symptoms, particularly dysfunctional bleeding. It won't, for example, give you even a hint if fibroid tumors or polyps are part of your health picture or if you are experiencing a potentially dangerous buildup of uterine tissue cells (see Chapter 3). For this reason it's important that you check out any abnormal symptoms--but particularly dysfunctional bleeding--with your doctor before spending your money on a home test or jumping to any perimenopausal conclusions about your health. And for heaven's sake, don't stop using your normal method of birth control--regardless of what your drugstore test tells you. The truth is, unless you have not had a menstrual period for one full year, you can still get pregnant!
The bottom line: Regardless of what is available in the way of testing, most doctors believe that the most reliable information about your menopause status comes directly from you--one reason why so many physicians now rely heavily on the self-reporting of symptoms to make a diagnosis. This includes not only cycle irregularity but also hot flashes, memory problems, fatigue, mood swings, night sweats--even the condition of skin and hair can help predict your true perimenopause status.
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