Embracing the beauty in life after 50
The kids have all grown up, they are out of the house and you have more time to yourself! This should be the best time of your life – and then menopause hits. Is this physiological phenomenon inevitable? Unfortunately, yes it is. Are you helpless to all of the changes you may experience with menopause? Absolutely not!
Menopause is defined as the absence of menstrual periods for 12 months. It is the time in a woman’s life when the function of her ovaries ceases. The average age of menopause is approximately 51, but it may occur as early as a woman’s mid 30s or as late as in her mid 50s. Usually, women tend to undergo menopause at an age similar to that of their mother. Some of the most common symptoms experienced during menopause include hot flashes, night sweats, and irregular periods. Not all women experience these symptoms, and the severity of the symptoms also varies.
The hormone estrogen, which comes from the ovaries, is responsible for the development and regulation of the female reproductive system. It also plays an important role in cardio-protection, as it helps regulate cholesterol and triglyceride levels. Estrogen is responsible for bone and skin health (including oil production, elasticity, thickness), as well as fat distribution. In the brain, estrogen also influences core body temperature and impacts memory. With menopause, we see a decrease in estrogen levels, therefore we see changes in all these body systems.
As one gets older, natural changes occur in skin. As the skin cells age, they become less able to carry on their normal functions. The skin becomes thinner as production of collagen and elastin, two vital proteins that allow skin to maintain its shape, decreases. Also the release of superficial dead cells begins to slow down, causing skin to appear dry and dull. These changes become even more pronounced in areas of the body that are usually exposed to the sun, due to the accumulated damage from sunlight. These natural changes in skin become accelerated when a woman reaches the peri-menopause stage, which often starts around the age of 45 and can last up to for 4 years. During this time, menstrual periods may begin to become irregular, and hot flashes may begin to be experienced. Once reaching menopause, the skin changes again. It becomes thinner, since there’s a relationship between collagen production, skin thickness, and lack of estrogen. Skin texture can also change, with a new onset of a “crepe” like appearance to the skin, due to a loss of collagen production. There is also fat loss under the skin, which can cause sagging around the neck, jawline, eyes and cheeks.
Fat distribution and weight gain
During menopause, women tend to lose the small waists they once had as fat starts to be deposited in their midsection. This hormonally driven shift in body fat distribution is called “visceral adiposity,” and besides being unsightly, it is actually dangerous to heart health. Several studies have demonstrated that menopause is associated with increased fat in the abdomen as well as decreased muscle mass in the body. This suggests that menopause plays a role in the transition from being pear-shaped (wide hips and thighs, with a smaller waist) to apple-shaped (wide waist and abdomen, with more weight above the waist). Excess weight in the abdomen raises the risk of many diseases, including heart disease, hypertension, type 2 diabetes, and even breast cancer. It can also bring on fatigue, and create a poor self-image.
Although the average woman gains only five to seven pounds during menopause, some women have a heightened risk for greater weight gains, dependent on their nutritional intake and level of physical activity. A decrease in muscle mass is generally observed with aging as individuals tend to be less active. Decreases in lean tissue will in turn decrease a woman’s basal metabolic rate (BMR) which is the rate at which the body burns calories at rest. When BMR is decreased, caloric needs lessen, so there isn’t a need to eat as much food. However, many females as they age do not change their dietary habits and continue to eat the same amounts.
During menopause changes are also seen in hair. It may appear to have decreased luster and growth due to hormonal changes. This can lead to thinning, breakage, and loss of hair. The thinning of hair is not necessarily due to increased hair loss, but due to brittleness, causing it to break somewhere along the hair shaft. Hormonal changes can also lead to growing hair in places not seen before such as facial ‘peach fuzz’ or even chin hair. It is estimated that up to 40% of women going through menopause will experience changes in their hair.
Hot flashes, Insomnia and Night Sweats
Hot flashes are the most common symptom of menopause, with about 75% of all women experiencing them. Hot flashes cause a sudden increases in core body temperature and increased heart rate and perspiration. Needless to say these symptoms can make sleeping difficult. According to the National Sleep Foundation, approximately 61% of menopausal women experience some type of insomnia due to hot flashes. During peri-menopause, estrogen levels begin to decline, setting off occasional isolated hot flashes, night sweats, and/ or temporary insomnia. These symptoms can become much more frequent and intense during menopause. Unfortunately, for some women, insomnia doesn’t end after menopause. In fact, studies show that it can become indicative of more serious sleep disorders in post-menopausal women including restless leg syndrome and sleep apnea.
Besides the aesthetic changes that we see during this time of life, some women also experience other symptoms like mood lability, and depression. Menopausal women may experience feelings of joy one moment, and sadness the next. Compared to before the onset of menopause, menopausal women are more than four times as likely to have symptoms of depression. Factors that impact the likelihood of experiencing depression include the availability of social support and being employed. Studies show that women with partners are 40 % less likely to experience depression compared to single women. Those that are gainfully employed have less than 50% chance compared to unemployed women. It has been further demonstrated that women with a history of severe premenstrual syndrome (PMS) may have more severe mood swings during menopause. Also, women with a history of depression seem to be more vulnerable to recurrent depression during this time.
As we age, the risk for having cardiovascular disease rises for both genders, but for women, those risks escalate after the onset of menopause. Why does this shift in heart health occur? Estrogen appears to have a positive effect on the inner layer of the arterial walls, helping to keep them flexible. When estrogen levels drop during menopause, arteries become stiffer. We also see detrimental changes in cholesterol levels. LDL cholesterol, the “bad” cholesterol, tends to increase while HDL, or the “good” cholesterol declines or remains the same. Triglycerides, which are other types of fats in the blood, also increase. All these changes can lead to high blood pressure and cardiovascular disease, and increase the risk of heart attacks and strokes. The hormonally driven shift in body fat distribution also increases the risk of cardiovascular disease. This occurs because visceral fat is the type of fat that is metabolized by the liver, which turns it into cholesterol that then circulates it in the blood. LDL cholesterol collects in the vessels where it forms plaque that serves to narrow the lumen of arteries and cause hypertension. Lifestyle factors can also negatively impact heart health. Women whose diets are high in sugar, trans fats, and salt have higher chances of heart disease during this time. Smoking and leading an inactive lifestyle also increase the risk.
For many women over 50, the white elephant in the room is the decline of sexual function that is frequently experienced. Sexual function is a paired response of both physiological and psychological functions. For both aspects, hormonal changes associated with aging play a vital role. Three hormones responsible for maintaining or heightening the sexual response are: estrogen, testosterone and progesterone. It is well documented the levels of these hormones decrease with age and many women become discouraged as they begin to experience associated menopausal changes. While, yes, this “changing of the seasons” has its consequences, it doesn’t mean pleasure with sexual activity has to cease.
One cannot go through the day without seeing at least one commercial for the everpopular medications used to treat the primary male complaint associated with aging, erectile dysfunction (ED). However, for women, there is only one available medication on the market for sexual dysfunction, and there is very little information on alternatives and advice to improve the sexual experience for women after menopause. Flibanserin (AddyiÒ) has been introduced in the United States and may have promise to assist, but this drug has some serious side effects and has significant restrictions by the Food and Drug Administration (FDA) for its use.
Understanding what is happening with sexual function as we age can assist females in making educated decisions on how to combat these issues. As stated earlier, there are both mental and physical responses during sexual activity. One physical aspect of sexual pleasure is simply a reflex: a touch or physical stimulus (sensory stimulus), which then activates a sensory receptor, that in turn produces an involuntary physical response (motor response). Many studies have shown that with aging, our bodies are less sensitive to sensory stimulus and therefore require more stimulus to produce a response. Clinically, this is defined this as slowed reaction time. Slowed reaction times are linked to a variety of hazards including increased falls, increased motor vehicle accidents, as well as a general decline in function. This phenomenon is also a problem for women during sexual activity. The body just doesn’t respond like it used to and sensory receptors need to be continually activated to keep them responsive. However, as women age and sexual function declines, many women choose to reduce or stop engaging in sexual activity. This is absolutely the worse thing to do from a reflexive standpoint. The old adage, “use it or lose it” holds true here. These sensory receptors will respond, it just may take a more consistent stimulus for a slightly longer period of time. There are over the counter aides that can assist with this stimulation. A simple external vibrator can provide the answer for many women experiencing this problem. Unfortunately, some women are reluctant to broach the issue with their partner as it might be taken as criticism that they can no longer do what is needed to give their partner pleasure. However, if the subject is approached from the standpoint that is has nothing to do with a partner’s ability and it is just a natural consequence of aging, external vibrators can be included as a valuable tool to improve sexual function and response. There are several external vibrators available on the market and those that have multiple frequency options seem to work best for providing variability to individual preferences.
Lastly, several drugs commonly prescribed for women over 50 can also negatively affect sexual function. One of the most common are the serotonin-selective uptake inhibitors (SSRIs) medications often prescribed for menopausal depression. An alternative to these SSRI medications that has less negative effects on sexual function is bupropion (ZybanÒ). It not only produces fewer sexual side effects than other antidepressants, but can actually help to alleviate sexual dysfunction. Although not indicated by the FDA for this use, many psychiatrists express it is the drug of choice for the treatment of SSRI-induced sexual dysfunction. Other drugs identified in the literature that may reduce sexual function are statins for treating high cholesterol levels, several medications used to treat hypertension (diuretics, beta-blockers, alpha blockers), H2 blockers for treating indigestion and gastric reflux, and benzodiazepines for treating anxiety and insomnia. With many of these drugs, there may be viable alternatives and these should be discussed with your primary care provider.
Feel like the old you – only better!
There is no doubt the menopause can bring about signs and symptoms that are both aesthetically unappealing and pose a danger to health. However, women experiencing menopause do not have to succumb to these changes. Many of these signs and symptoms can be attenuated through lifestyle modification.
A sound nutritional plan like the Mediterranean Diet that includes eating whole grains, fruits, non-starchy vegetables, and lean protein can assist in losing some of the midsection fat that accumulates during this time. Other tips for better heart health and weight loss:
• Stay away from processed foods and fried foods -they are usually high in hidden sugars and calories, and have low nutritional values.
• Keep a food diary to help you assess the types of food that you eat.
• When you eat out, skip the bread basket and take half the serving home.
• Eat smaller amounts, but more often. This assists in keeping metabolism up.
• Eat foods high in fiber, as it serves to help you feel full and assists in weight loss.
Furthermore, a diet that includes foods high in antioxidants, selenium, protein, zinc and tryptophan can also help with depression. Salmon, turkey, non-starchy vegetables and fruits have shown to boost dopamine and serotonin levels.
Eating nutritiously can also help with the changes we see in the skin and hair. Vitamin E, Omega 3 and essential fatty acids are important for healthy skin and hair. Foods like avocadoes, tomatoes, nuts, seeds and oil-rich fish like salmon, mackerel and sardines are a wonderful choice. It’s also important that you drink plenty of water and stay away from sugar in soft drinks and fruit juices.
Other things to have healthier skin and hair include using a good body and face moisturizer that contains Vitamin C and other antioxidants to help neutralize free radicals, which accelerate aging and wrinkling. A gentle exfoliator used at least once a week also helps refine the skin’s texture. Use shampoos and conditioners that moisturize the hair and scalp and don’t forget to protect your skin from sun damage by wearing a sunscreen daily.
You can also add a daily supplement to your routine. Three are a variety of multivitamins on the market that target the specific needs of women aged 50 and older. These supplements include vitamin D and Calcium to help maintain bone strength, and Biotin for healthy hair. Furthermore, according to the Institute of Medicine, older adults do not absorb up to 30 percent of the vitamin B12 in their food. Women over age 50 should be sure to get adequate amounts of vitamin B12, whether it comes from fortified foods, a multivitamin supplement or a combination thereof.
Daily exercise can assist with most of the signs and symptoms of menopause. It can prevent weight gain, strengthen muscles and bones, decrease fatigue, reduce the risk of heart disease and type 2 diabetes, and boost mood and self-esteem.
To assist with weight control, aerobic activity (use of large muscle groups while keeping heart rate elevated) is vital. Activities like walking and jogging are important as they are weight bearing in nature and can assist with bone health. In a study of 60,000 postmenopausal women, walking at a rapid pace four or more times per week resulted in a lower risk of hip fractures, compared with those who didn’t walk as much. Strength training should also be included twice a week in your routine. Strength training exercises will help to build bone and muscle strength, burn body fat, and rev your metabolism which helps with weight loss.
Hormonal replacement therapy (HRT) is used to assist with the problems seen with sexual function. Women should be highly encouraged to find a gynecologist that specialized in women’s health over 50 to discuss the risks/benefits of HRT. Additionally, there is a relatively new drug available, ospemifene (OsphenaÒ), which is targeted to improve one of the common complaints post-menopausal women express, vaginal dryness. OsphenaÒ acts similarly to estrogen on the vaginal epithelium, building vaginal wall thickness. This may be a good alternative for women who cannot or choose not to participate in traditional hormone replacement therapies. Additionally, there is a new non-drug treatment available to help combat vaginal dryness and as well as improve the tissue thickness and responsiveness during sexual activity, called vaginal rejuvenation. This clinical procedure is marketed as the Monalisa TouchÒ and it is available in the Ark-La-Tex area. Monalisa Touch is a CO2 fractional laser treatment designed specifically for the vaginal mucosa that works to reduce the symptoms of vaginal atrophy.
Hormone replacement therapy is also used prescribed for women to relieve hot flashes and other bothersome menopausal symptoms. However, not all women can be prescribed HRT. Factors that a physician will take into account before prescribing HRT are the female’s familial and personal medical history. Women with a medical history of heart attacks, cardiovascular disease or blood clots are not candidates for HRT. Menopausal hormone therapy risks may also vary depending on the type of hormone prescribed, its dosage and route of entry into the body (transdermal, oral) as well as the current age of the female it is prescribed for. However, physicians prescribe HRT for short periods of time to healthy women to decrease menopausal symptoms without significantly increasing their risk of cardiovascular disease.
In summary, menopause is a natural part of life that can bring about unwanted changes in appearance, function and health. However, changing your diet, exercising, as well as talking about your symptoms with your physician and significant other can assist in diminishing the symptoms and signs of menopause as well and improving your health and quality of life.