By Henrylito D. Tacio
Vanessa, 48, wants to talk to a friend about some problems she’s been having lately: She can’t sleep, she frequently breaks out into sweats, and she often finds herself feeling happy one moment and upset the next.
Sexual intercourse has become painful, and every time she sneezes or laughs, she loses a bit of urine. In addition, her menstrual periods are erratic.
Insomnia, hot flashes, mood swings, painful intercourse, urinary incontinence, menstrual cycle changes. Sounds familiar? They should: They are the hallmarks of a major turning point in the lives of women—menopause.
Menopause literally means the “end of monthly cycles” (the end of monthly periods also known as menstruation). It comes from the Greek word pausis (“cessation”) and the root men– (“month”). As such, menopause is “the absence of menstruation for 12 consecutive months.”
In Western countries, menopause occurs most commonly at an average age of 51, with a typical range of 45 to 55 years of age. In some countries like the Philippines, the average age of menopause is much lower, about 44 years old. The reason for this is unclear.
To understand the physiology of menopause, think of what happens during a normal menstrual cycle. “At the beginning of the cycle, the body releases hormones that cause a follicle—a sac in the ovary that contains an egg and estrogen—to grow,” explains Sandra G. Crandall, a clinical and educational consultant, in an article, “Menopause Made Easier.” “As it matures, the estrogen is released, which helps prepare the uterine lining for implantation by a fertilized egg by thickening the walls with blood.”
When a certain amount of estrogen (the main sex hormone of women) enters the bloodstream, the body secretes a hormone that causes ovulation—the release of the mature egg from the follicle into the fallopian tubes. The ruptured follicle—called in medical parlance as “corpus luteum”—begins to grow and produce both estrogen and progesterone.
“If fertilization does not occur, the corpus luteum withers and dies, and estrogen and progesterone levels drop,” Crandall notes. “Without progesterone, the thickened uterine lining sloughs off and menstrual flow begins. Low levels of both estrogen and progesterone in the blood trigger a new cycle.”
Once a woman turns 40 or so, she enters the so-called perimenopause stage. At this time, “the number of follicles in the ovaries has diminished from some 400,000 at birth to about a few dozen,” Crandall informs. “As a result, these women start experiencing anovulatory cycles, in which no egg is released.”
As ovulation becomes more frequent, estrogen and progesterone levels decline. “The pituitary gland, in an effort to continue ovulation, secrets large amounts of hormones,” Crandall says. “This often causes periods to become even more irregular and bleeding to become heavy.”
These irregular menstrual cycles can continue for up to 10 years, although most women experience them for about four, according to some studies. Eventually, the ovaries stop responding to the body’s hormones and menstruation ceases completely.
“Menopause is not considered a disease, although doctors recognize a long list of symptoms women often complain about,” writes Vikkie Castro in an article, which appeared in a national daily. “To address these symptoms, doctors today recommend hormone replacement therapy [HRT] as one of the vital aspects in the care of elderly women.”
Although most Filipino women are still not aware of HRT, many women are now coming out to seek medical help. In fact, more women are starting to consult doctors about HRT.
One of Castro’s sources of information was Dr. Elena Gohu-Yu, of the Obstetrics and Gynecology Department of the Chinese General Hospital. This doctor strongly recommends HRT not only because it relieves the symptoms of menopause but because it also protects women from heart disease and osteoporosis.
“HRT is good for the skin and other organs such as the heart, preventing heart attack and stroke, the most common cause of death in elderly women,” Yu points out. “Numerous studies have already proven that the incidence of cancer through HRT is insignificant compared with the high risk of developing cardiovascular diseases without HRT.”
Recent studies have shown that a woman’s risk of cardiovascular diseases rises dramatically after menopause. “Before menopause, the ratio of heart attack is three males to one woman,” Yu points out. “After menopause, at 50 years, the ratio is two males to one female. But after 60 years, the ratio is 1:1, meaning that as women age, they are more likely to develop cardiovascular disease.”
Most women with menopause – about 80 percent – complain of hot flashes. “A typical hot flash lasts about 2.7 minutes,” explains Dr. Sadja Greenwood, author of Menopause, Naturally. “During a hot flash, your face and upper body feels as if it’s been shoved into an oven. Your face reddens and you sweat heavily as your skin temperature suddenly rises seven to eight degrees. It usually returns to normal in about 30 minutes.”
What women can do? Dr. Marilyn Poland, an American associate professor of gynecology and obstetrics at Wayne State University School of Medicine, tips: “When you feel a hot flash coming on, remind yourself of a couple of things: that hot flashes are normal, that they don’t last long, and that you are able to do something about them. Most times that positive mind-set can make the flash more bearable.”
They should not disregard drinking lots of water. “Don’t forget to refresh yourself with cool water or juice,” Greenwood reminds. “This keeps body temperature in check.” However, cut the caffeine. “Those caffeine-containing beverages stimulate production of the stress hormones that trigger hot flashes.”
While menopause may signal the aging of the reproductive organs, women can still have a happy life. “Vaginal dryness from a lack of estrogen decreases interest in intercourse during menopause,” Poland says. “A water-soluble lubricant, vegetable oils, and unscented cream or oil, are all good choices for lubrication,” Greenwood suggests.
Or couples may want to try new positions in intercourse to find the most comfortable, Greenwood says. “Touching can be especially important at this time,” she says and suggests more hugs and mutual massages for closeness and sensual pleasure.
Women going through menopause who continue to have intercourse on a regular basis (once a week or more) have fewer or no hot flashes compared to women who have sporadic sex, research shows. Dr. Norma McCoy, a professor of psychology at San Francisco State University, and Dr. Julian M. Davidson, professor of physiology at Stanford University, studied 43 women who were just beginning to enter menopause. They found that frequent sex helps moderate dropping estrogen levels, which reduces the occurrence of hot flashes.
McCoy believes that the high estrogen levels help maintain a healthy interest in sex and that regular sexual activity indirectly stimulates failing ovaries, which helps moderate the hormonal system and prevent extreme swings in the estrogen level.