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A fun and fabulous health guide for living well at midlife—no prescription required!
Menopause can be a difficult and confusing timebut it doesn’t have to be. Your Perfectly Pampered Menopause has the answers that make the difference, with a clear-cut plan that shows you how to look and feel better now than ever before.
Culling advice from leading medical experts, award-winning reporter Colette Bouchez dispenses the latest news on everything from hot flashes, insomnia, and dysfunctional bleeding to incontinence, bone health, weight control, and more. She explores the latest buzz on HRT, natural hormones, and the newest prescription drugs, as well as the latest in natural and traditional care for a truly comprehensive guide to midlife health.
But she also brings you advice from top beauty and lifestyle experts and clues you in on everything from anti-aging skin and hair care to the hottest news in midlife nutrition (including an anti-hot-flash diet!), divine new relaxation techniques, optimal exercise and dieting secrets, and putting the kick back into your sex life!
With this complete guide to taking care of yourself now and in the future you'll discover how midlife can be the best time of your life!
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About the Author
An award-winning medical writer for the New York Daily News, COLETTE BOUCHEZ has more than twenty years of journalism and medical research experience. Her weekly consumer health column is syndicated by The New York Times, and she is a feature writer for WebMD.com. Her previous books include Your Perfectly Pampered Pregnancy (Broadway 2004), The V Zone: A Woman's Guide to Intimate Health Care, and Getting Pregnant (95,000 copies in print). She lives in New York City.
Read an Excerpt
Understanding This Thing Called Menopause
What You Need to Know Right from the Start
My 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. Becauseand I'm speaking strictly in medical terms heremenopause 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 yearsand 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 anywaythe start of the second phase of your life. If you look at gals who have already opened the door for usincredible, talented, and, yes, gorgeous women like Diane Sawyer, Oprah Winfrey, Diane Keaton, Tina Turner, Cher, Suzanne Somers, Hillary Clintonthen you know that what's on the other side can be pretty spectacular.
But the getting thereahhh, now that's a different story. Doctors use the word perimenopause, which technically means the years leading up to menopausea 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 Iwell, we have coined an entirely different term to describe this time zone. And if you've just rounded the bend past fortyand particularly if you are heading toward age fiftyit'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 clientand 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 heavyand sex is the furthest thing from your mind.
*The bakery is out of rye breadand 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 arrivedand it's hovering over your house 24/7.
*You go on vacation and without warning your period arrivesten 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 familyand breaking through a glass ceiling or two along the wayshe 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 knowledgeand some patience and resolveyou 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 bodywhat'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 MenopauseBut Nobody's Told Your Ovaries
One of the really great things about being in perimenopause todayas compared to when your mom or grandmother went through itis 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 attitudenot to mention a whole new lookwith 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 experiencingincluding 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 generaland 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 yearsfrom your teens to your mid-thirtiesthe 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 folliclestiny 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 lowsomething 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 egga process known as ovulation. The sac in which the egg developedknown as the corpus luteumis 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 againand 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. Eventuallyusually between age thirty-five and fortyyou 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 yearand 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 estrogencausing 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 progesteroneand 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 occura 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 irregularitiesparticularly the up-and-down action of estrogenis also setting the stage for a number of other malfunctions, bodywide. That's because estrogen receptorscells that need estrogen to functionare 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 lossall 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 feeland 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 dayand sometimes even hour to hourmaking 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 kitparticularly 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 symptomsbut particularly dysfunctional bleedingwith 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 controlregardless 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 youone 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 sweatseven the condition of skin and hair can help predict your true perimenopause status.