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Your Changing Body
A Head-to-Toe Guide
One thing that I have learned about getting older is that every womans experience is unique. For some, it can come with a tremendous sense of freedom—freedom from menstrual periods, childrearing responsibilities, and worries about unintended pregnancy. For others, it can be filled with feelings of sadness, anxiety, shame, and loss—the loss of our fertility, our femininity, our figures, and our looks.
Likewise, theres a lot of variability when it comes to the physical and emotional side effects. Approximately 75 percent of women report some troublesome symptoms, but the type and severity can vary drastically from one to the next. For example, some women are plagued by night sweats and insomnia, while others never have a single hot flash or lose a wink of sleep. Some start noticing a change in their periods as early as their thirties, while others continue having regular menstrual cycles until theyre well into their fifties.
I have to admit that before I started working on this book, menopause was a bit of a mystery to me. I really didnt know what to expect, or how it might affect me, and that was just fine. I vaguely remember my mom going through it, though I didnt realize the significance at the time. And of course, when youre younger, its the furthest thing from your mind. But now that Im on the brink of perimenopause myself, I realize that its important to understand whats happening to my body. After all, knowledge is the key to staying healthy and getting through the changes that lie ahead.
Demystifying Menopause
Literally speaking, menopause is the time in your life when you stop having menstrual periods. Meno comes from the Latin word meaning “lasting a month”; pause comes from the Greek word with the same meaning. In other words, a pause in monthly events. But it really isnt an event that occurs suddenly, without any warning, as the definition implies. Rather, for most women, its a change that happens gradually over a period of years.
The first stage of menopause, known as perimenopause, is when the changes and symptoms typically start. During this time, your ovaries begin producing less estrogen and progesterone—hormones that play important roles in ovulation and menstruation. Estrogen causes the endometrium (the lining of the uterus) to start to thicken in preparation for a fertilized egg. Progesterone prepares the lining of the uterus for the implantation of a fertilized egg. If a fertilized egg does not reach the uterus, the endometrium is shed as a menstrual period.
As their estrogen and progesterone levels drop, most women notice their menstrual cycles becoming irregular. You may skip a period, or experience lighter, heavier, shorter, or longer flows than usual. This shift in hormones also affects other organs and systems in your body. The result can be disturbing side effects including hot flashes, headaches, mood swings, and forgetfulness. It also may cause problems such as achy joints, urinary incontinence, and vaginal dryness.
Throughout perimenopause—which can start as early as your thirties and last up to ten years or more—your levels of estrogen and progesterone continue to decline until your menstrual cycle stops for good. Once twelve months have passed since your last period, youve reached menopause. On average, this stage occurs between ages fifty and fifty-one, but it can also happen much sooner or later. Youre likely to go through menopause around the same time that your mother, grandmother, or sister did, give or take a few years.
In the final stage of menopause, which is called postmenopause, those hot flashes and other menopausal symptoms usually begin to ease up. But unfortunately, now that your body is producing less estrogen, your risk of heart disease, osteoporosis, and breast cancer is higher—which is why its more important than ever to take care of yourself and make any necessary lifestyle changes to stave off these deadly diseases.
For most women, menopause is a natural biological process that occurs with age. But it also can be caused by surgery to remove the ovaries and certain medications and treatments, such as radiation and chemotherapy. These are typical reasons for menopause in women under age forty. Low levels of estrogen and damage to the ovaries can also cause early menopause.
In previous centuries, few women lived beyond menopause. But today, with a life expectancy of 79.7 years, we experience at least one-third of our lives after menopause. By 2020, the number of American women older than age fifty-five is estimated to be 45.9 million, compared with 31.2 million in 2000. As our life span improves, so does the accepted wisdom about menopause. Rather than being the beginning of the end, I like to think of menopause as the end of the beginning.
But Wait, Arent I Too Young for This?
A few years ago, when my good friend Carolyn, a forty-one-year-old real estate broker, didnt get her period, she started to panic. Her menstrual cycles had been regular since puberty. Shed never skipped a period except at age twenty-four, when she was pregnant with her twins. You could set your clock by her menstrual cycles, she often joked.
It occurred to her that she could be pregnant, but she quickly banished the thought from her head. Not only are she and her husband careful when it comes to birth control, shed just finished reading an article on how difficult it is for women to get pregnant after age thirty-five. Then she had another intrusive thought. What if she had cancer?
She quickly dialed her gynecologists number. He didnt seem concerned. “It sounds like youre showing the signs of perimenopause,” he told her. Carolyn was stunned. She was approaching menopause? She told herself that it couldnt be possible. She was in great physical shape, training for her second marathon. At work and at home, she felt sharper and more energetic than ever. It was that simple. She was too young for menopause.
Carolyn remembered all too clearly how weepy her own mother was when she went through menopause. She would have a hot flash at the dinner table and then lie on the kitchen floor to cool off. Her mother often felt faint and dizzy and complained about it for years. Carolyn didnt feel anything like that. Not even close.
Carolyns doctor suggested that she start keeping track of her periods in a diary or on a calendar. He also asked her to note if her flow was heavy or light or lasted longer than usual. He asked her to come in so he could run some routine tests. Thats when he took a complete history and ran blood tests to rule out other conditions such as pregnancy and thyroid disorder.
He also did a blood test that measured levels of FSH (follicle-stimulating hormone). Produced by the pituitary gland in the brain, FSH helps regulate the growth and development of our eggs and follicles. However, in menopause, those eggs and follicles dont develop. So the pituitary gland releases more FSH, hoping to push the ovaries into action. This is why a high FSH level may be the first clue that youre approaching menopause.
Sound simple enough? Well, there is a catch. During perimenopause, your FSH levels can fluctuate wildly as your estrogen levels wax and wane—from month to month and even from day to day. So your doctor may need to do more than one FSH test to attain useful information. Even then, the results may be misleading. The bottom line: The only way to know for certain that youve reached menopause is if youve gone twelve consecutive months without having a period.
If, like Carolyn and me, youve been noticing changes in your menstrual cycle, or experiencing symptoms such as insomnia or hot flashes, I recommend scheduling an appointment with your ob-gyn or primary-care doctor. Keeping a diary to track changes in your menstrual pattern is also a good idea, so you can see when and where changes occur and share them with your health provider. Ive been doing this ever since I was in college on the advice of my gynecologist. To this day, I record the start date of each period in my Filofax. You might also want to write down how many days it lasts and whether its light or heavy.
Keep in mind that not all bleeding irregularities are caused by perimenopause. As noted earlier, abnormal menstrual cycles can be a sign of thyroid disease, uterine fibroids or polyps, or even cervical or uterine cancer. To pinpoint the exact problem, your doctor will probably order a blood test to check your FSH level and thyroid. You may also be advised to get a Pap smear, a transvaginal ultrasound, or an endometrial biopsy, depending on your symptoms.
If your physician suspects perimenopause, however, he or she may order certain screening tests, including ones to measure your cholesterol level and bone density. If youre experiencing any unpleasant or unusual side effects—no matter how embarrassing they seem—youll want to mention them and ask about possible treatments. Be sure your doctor knows your medical history—including whether you or any of your immediate family members have had heart disease, osteoporosis, or breast cancer.
Managing Your Menopot
Im a very active person, and always have been. Because I exercise so much, I rarely have trouble maintaining my weight. That is, until recently. Now that Im in my forties, my body is changing. Even though Im eating the same amount that I used to, my pants are getting tighter, my hips are getting wider, and Im gaining weight around my middle. Recently, I even popped the snap on my favorite jeans.
Sadly, I suspect Im a victim of middle-age spread. And Im certainly not the only one. According to some estimates, the average woman gains ten to fifteen pounds during her menopausal years. Most of this comes on slowly, about a pound a year after age thirty-five. Wait—were supposed to be gaining wisdom with age, not weight!
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“Menopause takes one into the territory that can be a victory for the bigger Self. But the Ego can pay a huge price.”
—Molly, age fifty-three
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For years, some experts believed that hormones were to blame for the added pounds. But new research suggests that our sedentary lifestyles and overeating are the real culprits. As we get older, many of us start becoming less active. Consequently, we lose muscle, which causes our metabolisms to slow—so our bodies burn fewer calories. Over time, this can add up to extra inches, especially if we dont curb our eating habits.
In one study, researchers examined the weight of 485 women ranging in age from forty-two to fifty. They found that the women gained an average of about five pounds over a three-year period. The weight gain occurred regardless of whether the women were going through menopause—an indication that declining estrogen levels werent a major factor.
Hormonal changes can, however, affect where our excess body fat is stored. As estrogen levels drop and we begin producing more of the hormones androgen and testosterone, the storage site of fat shifts to our abdomen. In her book Fight Fat after Forty, Pamela Peeke, MD, MPH, former senior scientist at the National Institutes of Health, refers to this phenomenon as a “menopot.” Even if youve had a flat belly all of your life, you may suddenly find your waistline expanding.
I dont know about you, but Im not ready for a menopot! The good news is, we have the power to do something about it. By exercising and eating right, we can stave off those excess pounds, as well as shed the weight that we've already gained. My Fit and Sexy for Life program combines walking and strength training to burn fat and build muscle, which is the key to a supercharged metabolism. Ive also included special abdominal exercises to firm and flatten your belly and keep the menopot at bay.
Is Anybody Else Hot in Here?
My childhood friend Marie, now the owner of a small gift and novelty store in a Pennsylvania suburb, got her first taste of menopause in the form of a heat wave—and not the tropical kind. She just got hot, for no apparent reason.
Ever since Marie was a teenager, her periods were irregular, so she didnt notice any changes in her cycle at first. The hot flashes, however, caught her attention. Shed be watching television or doing inventory at her store, when out of the blue, shed break into a sweat. The first time it happened, she was ringing up a picture frame for a customer. Suddenly her face turned bright red, and she began sweating so much that the hair around her face was soaked. She had no idea what was happening. Neither did her customer. The kind woman asked Marie if she should call 911 or bring her some water. The flash lasted for about three minutes. Marie was so embarrassed that she didnt charge the woman for the frame.
As time went on, her flashes became more frequent—sometimes occurring three or four times a day. Marie had to give up coffee and tea because they seemed to trigger her flashes. She also said good-bye to spicy foods. As much as she loved curry and chimichangas, they proved to be catalysts for her flashes.
Hot flashes like the ones that Marie describes affect as many as 85 percent of all perimenopausal and menopausal women. They can last anywhere from a few seconds to several minutes, and can occur multiple times throughout the day. Theyre characterized by a sudden feeling of warmth or intense heat, mostly on your head, neck, and chest. While their cause isnt completely understood, theyre believed to be the result of a sudden change in your hypothalamus—the part of your brain that regulates temperature—which is brought on by the loss of estrogen. When your hypothalamus mistakenly thinks that your body is overheating, it starts a chain of events to cool you down: your heart beats faster, your blood vessels dilate, and your sweat glands start pumping.
Hot flashes can be mild: a feeling of warmth that comes over you, then quickly disappears. Or they can be intense: your heart starts racing, your face turns bright red, and perspiration starts pouring down your face. Flashes can be preceded or accompanied by a racing pulse, dizziness, anxiety, headache, or nausea. They can seem to come out of nowhere, or they can be triggered by stress or things such as spicy food, red wine, and coffee—just as Marie discovered. They can happen at any time of day, but theyre most likely to strike in the morning and evening.
Hot flashes can also hit during the wee hours of the night. In a survey by the National Sleep Foundation, more than a third of menopausal and postmenopausal women reported suffering night sweats as they slept. On average, the hot flashes occurred three days per week and interfered with sleep five days per month, according to the survey of 1,102 women, ages thirty to sixty. When they disturb your sleep, night sweats can make you even more tired, irritable, and downright hard to be around.
Hot flashes tend to be more intense among women who have had induced menopause (through surgical removal of their ovaries or ovary damage caused by certain drugs or radiation), as well as women who have an early natural menopause (before age forty). Women who are obese are less likely to develop hot flashes, because some estrogen is available from their fat stores. Very thin women tend to fare worse. (But dont think this is an excuse to hit the cookie jar!)
Hormone therapy (combined estrogen-progestin or estrogen only) is still considered the most effective way to treat severe hot flashes. In fact, research shows that it can reduce hot flashes by up to 90 percent. But there are also other tactics—including exercise and avoiding triggers such as coffee—that can help.