Vasomotor flushes or hot flashes are characterized by sweating and an intense feeling of heat around the head and neck. Hot flashes can be problematic for several months, several years, or even 10 years or more. When they create sleep deprivation, depression can result.
In Nancy Pickard’s novel Twilight, the character Jenny Crain has a conversation with a friend about hot flashes. She says, “Jenny, I want you to know that hot flashes can be wonderful.” Jenny can’t believe her ears and she gulps. Her friend continues. “Really. This is the only time in my life I’ve ever been warm. I get up to go to the bathroom in the middle of the night, and my feet aren’t freezing. Sometimes I lie in bed and think, oh, this is so nice.”
Hot flashes or hot flushes are not magical changes. They can result when estrogen is low and an imbalance occurs. They are a way your body cools you off. The disruption in temperature control in your hypothalamus is associated with a sharp rise in blood levels of epinephrine, a potent stimulator of heart function. Some experts believe hot flashes and profuse perspiration are a result of an alteration in blood vessel control in the periphery of the body. This theory explains why women commonly report that their heart pounds. In fact, clinical measures show that heart rate does increase during a hot flash. Because the heart is beating faster, blood pressure can rise, and headache and dizziness can occur. While core temperature doesn’t increase, you could feel intense warmth throughout your upper body, with flushing of the neck, face, and chest, and in some cases, profuse perspiration followed by chills. The chills are your body’s way of trying to conserve body heat.
You could be part of the majority of perimenopausal women who suffer from hot flashes. Only about 15% to 25% of these hot flashes are severe or frequent (more than 10 a day). The duration of a hot flash varies from a few seconds to minutes. The average number of hot flashes is 10 a day, with the majority occurring at night, but frequency also varies from person to person and even in the same woman.
When pressed, the American Medical Association admitted that only 5% of women suffer any major menopausal problem, but because of increasing advertising and medical research paid for by drug companies, many women are being brainwashed into thinking that temporary discomforts are serious. Other experts believe that expecting problems at menopause can lead to actual difficulties. For sure, getting uptight about hot flashes can increase them because one of the common triggers for hot flashes is stress.
The medical community has not conducted any controlled prospective trials on the menopause experience of healthy women who exercise regularly, eat a proper diet, don’t smoke, and lead a healthy lifestyle. This is probably because the cultural focus in the United States is on menopause as a problem and even as a disease.
Some cultures where menopause is not a problem have been studied.Anthropologist Ann Wright found that traditional Navajos exhibited few symptoms, and unlike our society, postmenopausal women gained increased decision-making power and respect as they grew older. Her study suggested that menopause symptoms are related to psychological stress, not physical stress. Kung women in Africa have increased status after menopause. There isn’t even a word for hot flash in their language. Either Kung women don’t experience hot flashes or maybe they accept them as normal and don’t view them in a negative light. In contrast, 65% to 90% of American women can experience hot flashes, and a large number complain of vaginal dryness and loss of interest in sex.
Melatonin, a hormone secreted by the pineal gland, helps set your biological clock, which dictates the smooth running of your body on a daily basis. When this mechanism falls out of sync, insomnia is one result. Melatonin tends to decline with age. Recent evidence suggests that melatonin levels are lower if you’re overweight and postmenopausal.
Night sweats can interfere with efficient sleep patterns, and so can tight muscles, hot flashes, and other menopause changes. All can lead to daytime fatigue, irritability, memory loss, nervousness, and anxiety. Lack of vitamins and minerals can also interfere with sleep, as can emotional reactions.
Joint and Muscle Pain
Joint and muscle pain can be due to deficiencies in vitamins, minerals, or fluids. If you’re not eating foods that contain the vitamins and minerals you need or taking a good multivitamin and a good multimineral, and if you’re sweating a lot due to hot flashes or night sweats, you may need additional nutrients and water.
Memory Loss and Foggy Thinking
Memory loss and foggy thinking may be related to estrogen reduction, but they may not. Estrogen may stimulate the growth of nerve cells and increase the levels of acetylcholine, an important transmitter of nerve messages in the brain. One study showed that women who suffered surgical menopause and who were given estrogen after surgery had better scores on tests of memory and abstract reasoning compared to other women who were given a placebo (sugar pill).
Other experts maintain that memory loss and fuzzy thinking are part of normal development and are usually self-limiting. Studies have provided evidence that thinking and memory loss occur no more frequently at menopause than at other times in a woman’s life.
Some researchers have reported that both chemotherapy and tamoxifen (an antiestrogen drug with many adverse reactions) can cause fuzzy thinking. Researchers at Rush University Medical Center in Chicago found that forgetfulness is not caused by menopause. In fact, the hormone supplement industry was built partly on the premise that estrogen pills could keep women’s minds sharp. That idea has been challenged by this research. The participants were not taking hormone supplements, which were recently linked to an increased risk of dementia in older women. Instead, the women were given two standard memory tests every year and were followed for an average of a little more than 2 years. Scores declined only slightly for postmenopausal women but no more than would be expected with normal aging, according to Peter M. Meyer, the lead researcher and a biostatistician. The researchers claimed that if women are sometimes forgetful, it is probably not because of any harmful hormonal changes in their brains but because they are busy, distracted, and stressed out dealing with the ordinary pressures of midlife.
Fuzzy thinking can also be due to a sluggish thyroid, which in turn can be caused by deficiencies of zinc, selenium, and copper. As you age, your digestive enzymes and hydrochloric acid are reduced. Both are critical for the proper breakdown of food and the nutrition your mind and body need. All these situations can affect your ability to think clearly.
Bleeding during perimenopause can be erratic and scary. You think you’re approaching menopause, then suddenly you have a heavy-flow period.
Hormonal fluctuations lead to fluid retention, which affects circulation, reducing the amount of oxygen reaching your uterus, ovaries, and brain. Heavy marijuana use decrease the amount of hormones released, which can cause irregular bleeding.
Eating red meat and dairy products may cause or contribute to hormonal imbalance. Unstable blood sugar levels are an important factor, too. Food allergies, vitamin and/or mineral deficiencies, and depressed mood can also lead to hormonal fluctuations.
Think of your body as a unit. When one part gets out of sync, the whole process can get sidetracked. The more balance you can bring to your body, mind, and spirit, the easier your menopause will be.
Osteoporosis is one of the most common and disabling conditions affecting women after menopause. The amount of bone in your skeleton is a function of your genetic inheritance, how much calcium you take in, your vitamin D consumption, your peak amount of bone mass, your rate of bone mass loss, and what drugs and medications you take.
A 2003 study in the Archives of Internal Medicine examined the risk of bone fractures in more than 8,000 women over age 65. All of the women were taking some type of medication that affected the nervous system, such as the most commonly prescribed antidepressants. Over a period of 5 years, researchers found that the women had a significantly greater chance of sustaining fractures compared to women who didn’t take these types of drugs. When the data were broken down more specifically, women who took antidepressants were found to be 70% more likely to suffer disabling hip fractures. Researchers suspect that reduced alertness prompted by the drug use was to blame for the higher incidence of fractures.
Some experts believe the principal determinant of skeletal status is your ovary function. The precise way that estrogen influences bone remodeling is not known, but specific receptors for estrogens have been identified in cells of bone tissue.
Estrogen reduction may have a negative influence on your ability to use calcium. Calcium absorption through the intestine decreases and calcium loss from the kidney increases, resulting in an increased use of skeletal calcium to maintain calcium in the blood. Other factors that increase your risk for osteoporosis include:
• Taking glucocorticoids (cortisone, Decadron, Dexameth, Dexon, Cortef, Medrol, Delta-Cortef, Prelone, Deltasone, Orasone, Panasol, Meticorten, Aristocort, Atolone, Kenacort)
• High consumption of caffeine, animal proteins, and sodas
• Alcohol consumption
• Cigarette smoking
• Prolonged bed rest or lack of weight-bearing exercise
• Taking thyroid and/or parathyroid hormones
• Family history of osteoporosis
During the climacteric, women show a 2% to 5% loss in bone mass a year, but reduced estrogen is not the only factor involved because women lose up to 50% of their total bone mass before menopause. From the ages of 25 to 34, between 6% and 18% of women exhibit low bone density. Hip fracture rates are also high before menopause even occurs. Other factors that can lead to osteoporosis include smoking, excessive alcohol intake, a mother who suffered severe osteoporosis, lack of exercise, a high-fat, high-carbohydrate diet, never having given birth, feeling depressed, a history of ovulatory disturbances, low body fat, and deficiencies in calcium, magnesium, and other minerals.
Sex Drive Reduction and Intercourse Discomfort
It’s on the TV screen and in the movies. Sex is everywhere except in the bedroom. Sociologists at the University of Chicago asked 3,159 women and men chosen to represent the larger U.S. population about their sex lives. They found that 43% of the women and 31% of the men reported some persistent sexual dysfunction such as inability to become aroused or to achieve orgasm.
If you were interested in sex and enjoyed intercourse when you were younger, you’ll probably feel the same way after menopause. If you were never able to achieve orgasm, you may be able to now that you can relax and not worry about becoming pregnant. You may never have explored your body sufficiently or participated in enough foreplay to become aroused.
The opening to your vagina is shielded by the mons veneris (the fatty tissue at the base of your abdomen that becomes covered with hair at puberty), the labia (folds of tissue that extend downward on either side of the vagina), and the clitoris (located at the top of your vulva where the labia meet; it becomes erect when you’re sexually aroused). The external organs of generation in the female are the mons, veneris, the labia majora and minora, the clitoris, the meatus urinaries or opening to the bladder, and the opening to the vagina. The term vulva or pudendum includes all these parts. Between the clitoris and vagina is your urethra, a 11⁄2-inch passageway that leads to your bladder, where urine is stored.
The process that takes place in your body during sexual intercourse remains the same no matter what your age. It consists of four stages:
1. Excitement. In response to touch, visual images, or fantasy, cells in your vagina and nearby glands begin to secrete lubrication fluid, and your heart rate and blood pressure may rise. The clitoris fills with blood and enlarges, your nipples become erect, and your breasts may increase in size. Your vagina lengthens and expands while the fleshy lips that surround your vaginal entrance swell. You may develop a rosy flush that begins over the upper abdomen and spreads over the breasts.
2. Plateau. Tissues in your vagina continue to swell. Your clitoris retracts under the folds of tissue that surround it.
3. Orgasm. If orgasm occurs (and it doesn’t happen each time you have intercourse) a series of intense and pleasurable contractions takes place in the muscles of your vagina, uterus, and sometimes your rectum. The number of orgasmic contractions ranges from 3 to 5 per minute to 8 to 12 per minute.
4. Resolution. In the next 30 minutes, muscle tension decreases and the swelling of tissues subsides. Your heart rate and blood pressure return to normal.
While age doesn’t alter these steps, reduced interest in sex and intercourse discomfort after menopause can be related to vaginal dryness, irritation, and thinning, which can be due to decreased estrogen levels. Depression and anxiety can also interfere with sexual interest. During the climacteric, thinning of the walls of the vagina can lead to dryness, infections, burning, itching, pain with intercourse, discharge, and occasional bleeding unless you take steps to counter these changes.
Once you’ve reached menopause, you should report any bleeding that you have to your health care practitioner. Uterine bleeding after menopause could be a sign of fibroids, a hormonal imbalance, or noncancerous growths in the lining of the uterus, among other health problems.
As estrogen decreases, vaginal secretions are altered in quantity and composition. The possibility of vaginal infection increases because your normal protective lactobacilli that assist with digestion decrease, permitting overgrowth of organisms from the vagina and surrounding area. Burning and irritation can be caused by a chronic discharge because of the change in the composition of secretions. Itching can occur because of the thinning and inflammation of the vagina.
The cells of the vagina and urethra contain high concentrations of estrogen receptors. Within 5 years of estrogen decrease, changes occur in the vagina, urethra, and bladder. Since estrogen increases blood flow in arteries, when estrogen decreases, there is a decrease in blood flow to the vagina and vulva, resulting in atrophy of the vaginal walls, flattening of lubrication glands, and loss of water-retaining ability. These changes can reduce lubrication and shorten and narrow the vaginal wall, which can lead to pain during intercourse.
Between 30% and 50% of women complain of a problem in one or more aspects of sexual functioning, probably due to reduced vaginal lubrication, atrophy of the vagina, and frequent infections. In a study of 887 menopausal women, pain during intercourse was the most common sexual problem, followed by decreased sexual desire, partner problems or dysfunctions, vaginal spasms, and lack of orgasms. The researchers found that the lower the level of estradiol, the greater the discomfort during intercourse.
Low estradiol levels correlate with decreased blood flow to the vagina. This makes vaginal engorgement, which is necessary for comfortable sexual intercourse, impossible. A catch-22 syndrome can develop: discomfort with intercourse, apprehension about intercourse, decreased frequency of intercourse due to fear of pain. Women who stop having intercourse, whether it’s due to loss of sexual desire, discomfort during intercourse, or another reason, develop even more vaginal thinning than women who continue to be sexually active.
Some experts claim that loss of interest in sex is not related to estrogen levels and shouldn’t necessarily occur at menopause. They present statistics to show that more than 40% of menopausal women report no decline in sexual interest. Less than 20% report any significant decline, but women who’ve had oophorectomies, hysterectomies, chemotherapy, or radiation usually have a loss of interest in sex.
Wrinkles are largely due to cross-linking of proteins. You can reduce them by retarding oxidative damage and free-radical destruction. Dehydration is another cause of dry skin. If you don’t drink enough water, your skin can look dry and saggy. Skin thickness declines just as bone density does after menopause. To have beautiful skin, you must eat healthy foods and drink enough water to feed your skin, and use products that protect it.
Urinary symptoms can include difficulty urinating, frequent and urgent urination, frequent nighttime urination, dribbling of urine, and frequent urinary tract infections. Some experts claim these symptoms will worsen over time.
Other experts claim vaginal and urinary complaints are highly individual and subjective. A physician’s diagnosis of atrophic vaginitis may not always be accompanied by symptoms and vice versa. Urinary frequency and bladder infections sometimes are associated with vaginal thinning and thinning of the urinary apparatus but not always.
If you don’t exercise daily and don’t watch what you eat, it is easy to gain weight after menopause because you are losing muscle—another reaction to hormonal changes. Don’t talk yourself into thinking weight gain is okay. Being overweight puts you at risk for even more chronic conditions. Obesity contributes to high blood pressure, which is a significant and independent risk factor for heart disease.
Being overweight is also a significant factor in diabetes, which accelerates the laying down of fat in your blood vessels and decreases blood flow through the heart. High blood pressure, obesity, and diabetes often occur together and can contribute to an overall high-risk profile postmenopause.