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Women Hit By Midlife Challenges

It is dubbed the midlife crisis, middle age spread era, the climacteric, the change of life or simply “the change” and has even inspired a play, Menopause the Musical.

The variety of nicknames for menopause reflects the diversity of ways in which women are affected during this major turning point in their life.

Most women have a relatively easy time making their way through menopause, some completely breeze through without a whimper but there are the unfortunate ones who are hit hard by unrelenting symptoms.

Internationally renowned gynaecologist Dr Elizabeth Farrell, who specialises in menopause and is a founding Board member of the Jean Hailes Foundation for Women’s Health in Victoria, said that the majority of women would have mild to moderate symptoms and could probably manage without any added therapy.

About 20 per cent of women would experience no symptoms.

“Their periods will stop and they will feel fit and healthy and nothing will be different,” she said.

Another 20 per cent would have severe symptoms which impacted on their quality of life and were the women who really needed to have treatment.

For women in their perimenopausal and early-postmenopausal years, the use of hormone replacement therapy was considered safe.

“But it is contrary to people’s memories,” Dr Farrell said.

“They still have the study published in 2002 in the forefront of their brains.”

That study, the Women’s Health Initiative, reported a slightly increased risk of stroke, heart disease and thrombosis in women on long-term combined oestrogen and progesterone HRT.

Dr Farrell said that for women going through menopausal symptoms, the use of HRT was acceptable if they had no heart disease risks and were fit and healthy.

Although the WHI study showed that in those women taking oestrogen and progesterone, there was a small increase in the risk of breast cancer after five years of use, Dr Farrell said most of those women had been on HRT before the study. This was because the average age of participants was 63 years.

Women on oestrogen alone had no increased risk of breast cancer after seven years. In community studies, including the Nurses Health Study, there was no increased risk in women on oestrogen alone until after 15-20 years, Dr Farrell said.

Dr Farrell, who is president of the Australasian Menopause Society and also the Asia Pacific Menopause Federation, said it was worth having a medical check to rule out other possible causes – such as high blood pressure and hyper-thyroidism – for hot flashes and sweats.

Although venlafaxine (an antidepressant) could be used to alleviate hot flashes and sweats, it also caused them in about 20-30 per cent of women.

Evidence suggested that women who were suffering from a dry vagina could first try lubricants but if these were not sufficient, they could use one of the vaginal oestrogen products fairly safely, Dr Farrell said.

These included oestriol vaginal creams or pessaries which should be used only about twice a week in the longer term.

Women who wanted to navigate menopause naturally, without any medication, could take certain steps, Dr Farrell said.

Anxiety and stress can be triggers for flushes and sweats. “Some of the things that are recommended are meditation and yoga,” she said.

“Acupuncture hasn’t been shown to be effective but hypnosis has been shown to be effective in some women and things like paced respiration, doing the deep breathing like you do in labour, and biofeedback programs can be helpful.”

Another hazard was a teenage daughter dealing with puberty at the same time her mother was going through menopause. “Sometimes a little bit of family counselling can help,” Dr Farrell said.

Gynaecologist Dr Margaret Smith, who established the first menopause clinic in WA and is a foundation member of the Australasian Menopause Society, said that hormone replacement therapy was now called hormone therapy because the aim was not to attain premenopausal levels of oestrogen but to give small amounts for a short time to ease the symptoms of menopause, such as hot flashes, without causing breast soreness.

But Dr Smith said while some effects of oestrogen deficiency could be relieved, others could last for years. These included loss of bone density, which could lead to osteoporosis, and lack of oestrogens in the vagina which can lead to painful intercourse and urinary tract infection.

Hormone therapy could be given locally into the vagina and did not raise the risk of breast cancer or cardiovascular disease, she said.

And while women who smoked or had high cholesterol, diabetes or hypertension had a slightly increased risk of heart attack and stroke, transdermal hormone therapy might be useful once the risk factors were treated and reduced.

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The Facts About Male Menopause

Have you noticed your father, brother, or partner acting strangely lately? Does he forget things, seem lethargic, or wake up sweating?

If so, he may be suffering from male menopause. While this likely sounds unbelievable to most women, more and more people are suggesting that male menopause really does exist.

Like female menopause, menopause in men seems to involve a drop in hormone levels around middle age. Often referred to with contempt as the “mid-life crisis,” men may really be suffering from a documented illness. So grab the man in your life and make him aware of what he may be facing when he reaches middle age.

What Is Male Menopause?

Male menopause, also called andropause, refers to a gradual decline in a man’s testosterone levels. Not all men will go through andropause and it is unknown why those that will, do. Testosterone is the male sex hormone that is responsible for creating and releasing sperm, initiating sex drive and providing muscular strength.

Hormone levels tend to peak around the ages of 15 to 18 in most males. Sometime during his mid to late 20s, a man’s hormone levels will begin to drop slowly. Usually, these hormone levels will remain at a healthy level, but some men will see their testosterone levels drop significantly by the time they are 40. By age 50, half of all men will experience a significant reduction in testosterone levels, causing a variety of uncomfortable ailments.

Causes Of Male Menopause

Male menopause can occur naturally in some men. More often than not, though, andropause is triggered by illness, depression, dementia, and obesity. Certain diseases that attack the heart and lungs also seem to affect the production of testosterone. Men who have had autoimmune diseases or cancer seem to be at an increased risk for low testosterone levels.

Andropause vs. Menopause

Menopause in men is not entirely similar to female menopause. Female menopause involves the complete decline of sex hormones. During menopause, your estrogen levels will decrease and then disappear, causing acute symptoms and the complete loss of fertility. Men will never lose their fertility completely during andropause. Testosterone will continue to be produced, as will sperm, permitting a man to have children well into his 80’s. For this reason, there is much debate over whether this testosterone drop should be referred to as the male “menopause.”

What Are the Symptoms Of Male Menopause?

Male menopause symptoms are very similar to those experienced by women during menopause, only much less intense. Common menopause symptoms include hot flashes, night sweats, fatigue, muscle and joint aches. Men also suffer from emotional symptoms like mood swings, irritability, depression, and listlessness.

Sex and menopause in men is also an issue of concern. The most common symptom experienced by men with low testosterone is a diminished sex drive. 80% of men with documented andropause complain of low libido and an inability to maintain a strong erection. Like women going through menopause, men can begin to feel like they no longer enjoy sex. If this is the case, a visit to the doctor can really help men to feel more in control of their physical and sexual wellbeing.

Treatment Options

Men often do not seek treatment for andropause. A lot of men feel uncomfortable speaking about their symptoms and, in the past, doctors haven’t taken men’s menopause seriously. Signs of menopause in men can also be difficult to diagnose. Thanks to new studies, though, doctors have become more aware of this problem and are beginning to realize the importance of treatment.

The primary treatment for andropause is Testosterone Replacement Therapy (TRT). Like estrogen replacement in women, testosterone replacement aims to bring hormonal levels back up to a healthy level. Once testosterone levels are increased, most men begin to experience fewer symptoms. Unfortunately, testosterone replacement doesn’t always work well to combat erectile dysfunction. Because this is such a severe symptom for most men, other treatments for erectile dysfunction should be investigated.

It is important for men to understand what is happening to their bodies as they age. Andropause does not affect all men and its symptoms have varying degrees of severity. However, if you know someone who is affected by andropause, encourage him to talk about his symptoms with a doctor.

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Study Finds Positive Change In Menopausal Experience

White women are becoming more optimistic about menopause, with many seeing it as an opportunity to rethink their lives and redefine themselves, a new University of Texas at Austin national study shows.

This is just one of the positive changes in the way women across different ethnic groups are experiencing the change of life, the School of Nursing research found. The study also found women are getting support from their family and friends and some even mentioned relief and benefits when going through menopause.

Past studies have shown that white women, in particular, were concerned about menopause as a “harbinger of physical aging taking them away from society’s youthful ideal,” said Dr. Eun-Ok Im, the La Quinta Motor Inns Inc. Centennial Professor in nursing. “Most of the white participants in our study say they try to be humorous and laugh — to boost their inner strength and motivate themselves to go through the hardships during the menopausal transition.”

Im’s four-year study, funded by a $1.2 million National Institutes of Health grant, looked at ethnic differences in menopausal symptoms reported by Whites, Hispanics, African American and Asian women. The study was done via a Internet survey among 512 women and included equal numbers of mid-age (40 to 60 years old) participants from each ethnic group.

“A possible reason for the positive changes in the way white women look at menopause might be that the recent women’s health movement has educated women to accept menopause as a normal developmental process, allowing them to refocus on themselves,” said Im.

Results of her research were published recently in the Western Journal of Nursing Research.

African American, Hispanic and Asian women already reported being more optimistic and positive about their menopause and menopause symptoms than white women.

In Im’s study, black participants cited they were raised to be strong and accepting of a natural aging process. They perceived that — compared to other difficulties in their lives — menopause was just another part of life to endure.

Getting support from family and friends during the menopausal transition is especially new to the literature on the menopausal symptom experience of Hispanic women, said Im.

“An interesting new finding, however, is that minority women prefer support from those who are of the same ethnicity,” she said.

Minority participants also expressed their need for more information and educational programs, which Im sees as an additional encouraging sign. In the past, ethnic minority groups rarely talked about menopause with others and hardly ever said they wanted more information about the change of life, she said.

Im’s study supported research that found significant ethnic differences in the total number and severity of menopausal symptoms.

Some of her findings on differences include:

• Black women had a slightly higher percentage of hot flashes at 67.8 percent with white women at 64.4 percent and Hispanic women at 52.5 percent. Only 26.1 percent of Asian Americans said they experienced hot flashes.

• More white women (60 percent) took some kind of treatments for menopause symptoms. These included antidepressants and alternative medicines like herbal remedies, chiropractic, meditation, acupuncture and dietary supplements.

• African American women — 54.6 percent — experienced weight gain compared to 33.3 percent for Asians, 45 percent for white and 50.8 percent for Hispanics.

• Whites reported higher percentages of racing heart, headache, fatigue, sleeping difficulty, breast pain, increased crying, depressed feelings, upset, grouchy feelings, difficulty in concentration, forgetfulness, breathing difficulty, ankle swelling, cold hand and feet, stomach pain, muscle and join stiffness.

• Whites, Hispanics and African Americans reported about the same numbers of bloating while Asians only reported 23.4 percent.

• Whites, Hispanics and African Americans reported about the same percentage of mood swings — above 50 percent — while Asians reported only 32.4 percent mood swing symptoms.

• Asians reported muscle and joint stiffness and neck and skull aches as frequent symptoms of menopause. Findings strongly suggest there are sub-ethnic — Chinese, Korean, Indian Filipino — differences in the menopausal symptom experience of Asians, and more studies are needed in this area.

The research also found few women (in all ethnic groups) reporting positive experiences with their physicians when they consulted them about menopausal symptoms.

Im believes her findings will work to eliminate ethnic biases and inequity in menopausal symptom management and promote culturally competent care for menopausal women. Earlier research about menopause has mostly been with white women, she noted.

“The increasing ethnic diversity of our population requires health professionals to practice with greater cultural competence,” Im said.

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