A Christian Perspective of Perimenopause and Menopause in Women Part 2
Perimenopause, is the time in which a woman's body makes a natural shift from regular cycles of ovulation and menstruation toward no menstruation and infertility, or menopause. As estrogen decreases, the 40ish woman is at higher risk of certain health disorders. Her bones, reproductive organs, breasts, and heart all become more vulnerable. During this period, bones start changing because they're losing estrogen and progesterone. Lowered estrogen levels puts women at higher risk for uterine, breast, or ovarian cancer, heart disease, and diabetes. The good news is that women can take many steps to reduce their symptoms without resorting to taking artificial hormones, which may be detrimental to their health. Making healthy lifestyle choices may help ease some of the symptoms of perimenopause as well as promote good general health as women age. Simply incorporating certain vitamins, minerals, herbs, and foods into the diet and making particular lifestyle changes can offset many of the annoying, uncomfortable, and sometimes painful effects of perimenopause. Some things you can do to make life a little easier are practicing good eating habits, getting enough sleep and exercise, and avoiding things like caffeine and alcohol. You should also avoid spicy foods and eat more soy foods. Do Kegel exercises daily to strengthen the muscles of the vagina and pelvis. Practice slow, deep breathing whenever a hot flash starts to come on. Remain sexually active if married, and use lubricants during sexual intercourse, if needed. If unmarried, or widowed, abstinence is recommended, due to the possibility of an unintended pregnancy or contraction of anSTD (Sexually Transmitted Disease).
Because the risk of osteoporosis and heart disease increases at this time, a healthy diet is important. Use a low-fat diet that's rich in fruits, vegetables and whole grains. Add calcium-rich foods or take a calcium supplement that also supplies vitamin D, which helps the body absorb calcium and helps protect against bone loss. Getting out in the sunshine also gives the body vitamin D. Take a good multivitamin, and drink plenty of water. If experiencing recurring yeast infections, lower sugar and starch intake considerably. Also avoid smoking, alcohol, and caffeine, which can trigger hot flashes, interrupt sleep patterns, and cause other problems. Regular physical activity helps prevent weight gain, improves sleep, strengthens bones and lifts the mood. Do some exercise for at least 30 minutes on most days of the week. Walking, jogging, swimming, and other strength building exercises are all beneficial. Gardening is also a wonderful way to get your sunshine and exercise some too.
Women are going through a lot of changes, and some of those are societal pressures like having parents, or grandparents to take care of, as well as children and grandchildren who need care. Having to care for and/or deal with the death of elderly parents, experiencing the "empty-nest syndrome" when children leave home, and the birth of grandchildren, places women into a new category of stress. Women in their 40s and 50s in this sandwich generation, have a lot more stress than most other times in their lives. Practiced regularly, stress-reduction techniques, such as prayer and meditation on God’s Word, can reduce stress and may be particularly helpful during the menopausal transition.
In addition to diet, exercise, and other lifestyle changes, many women moving toward menopause want alternative choices for treating their symptoms. Some women claim that herbal remedies help relieve menopausal symptoms. One popular alternative to conventional HRT is a synthetic hormone (derived from the Mexican yam) called tibolone. Some other botanical sources, referred to as phytoestrogens, mimic the effects of human estrogen and have similar results. Two of the more common remedies are Red clover isoflavone extracts and Black cohosh (Cimicifuga racemosa, also known as Actaea racemosa), which is a North American native plant. These options show some potential for treating menopausal symptoms while still being fairly safe. Black cohosh is an herb extract which is used to treat hot flashes and other menopausal symptoms. Overall, it appears relatively safe, but don’t use it if you have a liver disorder. Phytoestrogens are plant-derived compounds that have estrogen-like properties, which are generally extracted from soy, flaxseed, or red clover. They may be helpful for mild hot flashes and have a protective effect on bone density. They may also help decrease blood pressure and low-density lipoprotein (LDL or “bad cholesterol”). Be careful using phyotestrogen supplements if you have an increased risk of a disease or condition that's affected by hormones, such as fibroids, endometriosis, or breast, uterine or ovarian cancer. If you're already taking estrogen in another form, such as birth control pills, hormone therapy or tamoxifen, take further caution. Also, dehydroepiandrosterone (DHEA) is a natural steroid that's produced by the adrenal gland and may help minimize menopausal symptoms such as hot flashes, vaginal atrophy, sexual dysfunction and bone loss. Be cautious here too as high doses may cause problems.
Perimenopause is a natural stage of life, and does not necessarily require any kind of medical treatment. But in some cases where the physical, mental, and emotional effects of perimenopause are significant enough to disrupt the everyday life of the woman experiencing them, medical therapy may be needed. Some women may seek medical attention for the more severe perimenopausal symptoms, but most just tolerate the changes or don't experience symptoms severe enough to feel the need to go to a health practitioner. Because symptoms often come on gradually, women may not realize the symptoms are connected. As they go through the menopausal changes, their body's production of estrogen and progesterone varies. These hormonal swings are the root cause of the changes their body is going through during perimenopause. Women need to be reminded that perimenopause is a normal time in a woman's life, though she may not feel very normal during that time. Irregular periods are characteristic of perimenopause, and most of the time, this is perfectly normal and nothing to worry about. But if bleeding is very heavy, or accompanied by blood clots, and you’re changing tampons or pads every hour, your period lasts longer than eight days, bleeding occurs between periods, or periods come regularly less than 21 days apart, you should see your health practitioner. Some causes of abnormal bleeding include hormonal imbalances, birth control pills, pregnancy, fibroids, blood clotting, or cancer. Signs such as these may indicate an underlying gynecologic problem that needs diagnosis and treatment. Any blood flow that happens during postmenopause, even just spotting, should be reported to a doctor. The cause may be minor, but the possibility of endometrial cancer needs to be checked for.
If sex drive decreases dramatically, seeing a counselor or therapist may help you and your partner work through this issue. You may only need vaginal lubricants, if vaginal dryness is a problem. Another treatment that may be needed is antidepressant medications for mood swings or depression, but these symptoms are often caused by a lack of sleep. Some women take oral contraceptive pills to ease perimenopausal symptoms, even if they don't need them for birth control. These hormone treatments of combined estrogen and progestin can help keep their periods regular plus ease other symptoms as well. Many women experience relief after taking these low-dose pills, or using the skin patch, vaginal ring, or progesterone injections, but not without risks. Progesterone may cause sedation so it must be taken at bedtime. Synthetic progestins may cause irritability and mood changes in some women. As a strong pro-life Christian, I personally choose not use these hormonal methods, as they can cause spontaneous abortions of a fertilized egg.
After menopause, hormone replacement therapy (HRT) medications, as well as over-the-counter plant estrogens and herbal remedies are often prescribed by health practitioners to replace the higher hormones in the pill. In addition to relief from hot flashes, HRT can alleviate vaginal dryness, improve sleep quality and joint pain. It is also believed to be effective for preventing bone loss and fracture. HRT refers to the use of estrogen plus progestin for a woman who has an intact uterus, or estrogen alone for a woman who has had a hysterectomy. HRT therapy is provided as tablets, skin patches, gels, skin sprays, or subcutaneous implants. Intravaginal estrogens come in the form of a ring or pessary, and in the form of creams. Several major studies have questioned the health benefits and risks of HRT, including the risk of developing breast cancer, heart attacks, strokes, and blood clots. Current guidelines condone the use of HRT for the treatment of hot flashes, but state it should not be used for longer than 5 years. If a woman has a uterus and decides to take estrogen, she must also take progesterone to prevent endometrial cancer (cancer of the lining of the uterus). If she does not have a uterus, progesterone isn’t necessary. Women taking HRT should have a baseline low risk for stroke, heart disease, blood clots, or breast cancer. Using a lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream rather than a pill) may be more healthy for some women. Women should having frequent and regular pelvic exams, Pap smears, breast exams, and mammograms, to discover problems as early as possible.
Until recently the most widely used estrogen preparation worldwide in postmenopausal women was oral conjugated equine estrogens. Conjugated equine estrogens are produced from the urine of pregnant mares (horses). Premarin is one example, either alone or in Prempro, where it is combined with progestin. It is not uncommon for women to experience side effects with progesterone or progestin therapy. For many years women had been advised by numerous doctors and drug company marketing efforts that hormone therapy with conjugated equine estrogens after menopause would reduce their risk of heart disease and prevent signs of aging, but a controlled trial by the Women's Health Initiative found that women undergoing HRT had an increased risk of breast cancer and heart disease. When the Women's Health Initiative of the American National Institute of Health announced that HRT treatment increased the incidence of breast cancer, heart attacks and strokes, this led to a sharp decline in HRT prescriptions around the world, which was followed by a decrease in breast cancer incidence. As a result, many women have now discontinued equine estrogens altogether, with or without their doctor's knowledge.
Adverse effects of HRT, like this, appear to vary according to the formula and dosage. Needless to say, a woman and her doctor should carefully review her situation, her symptoms, and her risk before deciding whether the benefits of HRT or other therapies outweigh the risks. Until more is known about the risks, women who elect to use HRT are generally well advised to take the lowest effective dose of hormones for the shortest time period possible, and to question their health practitioner as to whether certain forms might pose fewer dangers of clots or cancer than others. As with any medication, there are risks and benefits, and each woman should decide what’s the right choice for her. Talk to your doctor about your specific symptoms and needs for treatment. Many women choose not to treat symptoms through pharmacology at all, but instead find ways to cool off quickly (wearing loose clothing with natural fibers, or easily removable, lightweight layers) as well as mechanical means to cool off such as fans, drinking ice water, and staying in cool rooms. Avoiding hot flash triggers such as hot drinks, spicy foods, etc., may also help some women avoid the use of hormonal medications.
Many women arrive at their menopause transition years, like myself, without knowing anything about what they might expect, or when it might begin, or how long it might last. Very often a woman has not been told in any way about this stage of life, either by health practitioners, or from her older female family members, or from her social group. As a result, a woman who happens to have an eventful perimenopause with a large number of different effects, may become confused and worried, wondering if something abnormal is happening to her. There is a strong need for women to share more information with each other on this topic. Individual Christian counseling or support groups can sometimes be helpful for depressed, worried, or confused women, who may be passing through what can be, for some, a very challenging time of change.
While most women seem to have a negative view of menopause as a time of decline, some believe menopause gives them a sense of freedom, when they can do things they never could before. Many women experience the final passage to menopause as a time of liberation and self-discovery. Generally speaking, women raised in the Western world, now live long enough that about a third of their life span is spent in post-menopause. For some women, the menopausal transition represents a major life change of social, psychological, and spiritual significance. Although the changes that surround menopause is fairly well recognized by most women, the social and psychological effects of those changes are more often ignored and not generally discussed in the social context among women. Though perimenopause and menopause may be the end of one part of a woman’s life; it can also the beginning of another. Menopause, for Christian women, can be seen as a new opportunity to experience life and create fulfilling avenues of service for God’s work. They can use their newfound freedom to go on mission trips, to serve their local congregation as godly teachers, to help in community service projects in the Name of Christ, and many other things. The sense of joy and well-being is a sure reward for those who may not want to just stop and do nothing. Life after menopause can be the best years of a Christian woman’s life!
For more information
National Institute on Aging
Phone: (800) 222-2225, (800) 222-4225 (TTY)
Internet Address: http://www.nih.gov/nia/
Food and Drug Administration (FDA)
Office on Women's Health
Internet Address: www.fda.gov/womens/menopause
The North American Menopause Society
Phone: (800) 774-5342
Internet Address: http://www.menopause.org/