CHAPTER 10
Your Changing Body
MENOPAUSE, EXERCISE, AND AGING HAPPILY
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A personal note All my life I’ve been an athlete, or had an athlete’s mentality about keeping fit. Keeping a balance between my body and my mind was critical to my sense of self. As long as I trained, my body would respond to the goals I set. I never thought that would change. However, when I reached menopause, I discovered that my body had its own agenda. At first I felt betrayed. Once I understood what was happening, I did something about it. I continue to be fit and athletic. These were—and still are—the most important things I can do to keep my body and mind in balance and my sense of self intact. And you can do them too! |
One thing’s certain: the longer you live, the older you get. We joke about aging, feel depressed about it, and valiantly try to forestall the process. Very few of us delight in it. Yet getting older can bring some of the best years of our lives, offering possibility, freedom and insight we never had before.
Too many women feel that aging ends their attractiveness, usefulness, and capability. They fall victim to the myth that our youth-obsessed world and culture has passed them by. Bombarded by media images of sexy young models airbrushed to perfection, competition seems hopeless.
Since the average woman today can expect to live half her life after age forty, she needs to realize that there are benefits to aging. Shedding the pressures and expectations of youth allows you to be yourself, explore new territory (physical or mental), and unlock creativity. This sense of freedom can make you soar.
The secret to making your later years your happiest rests in two words: health and attitude.
You don’t have to stand by watching your health profile change beyond your control or recognition. Regular exercise helps you maintain your figure. The health benefits of regular exercise are nothing short of phenomenal: reduced risk of cancer, diabetes, high blood pressure and cardiovascular disease. Weight bearing exercises such as running and walking build and maintain bone, a key element in reducing the risk or severity of osteoporosis. And it’s been medically proved that bones and muscles respond positively to exercise at any age.
Embrace change in a positive manner instead of fighting it. You don’t have to be a victim. You can do more to help yourself than you may realize. Again, exercise—running and walking in particular—plays a crucial role. Sustained aerobic exercise (the kind that makes you breathe deeply and sweat) releases natural chemical mood enhancers called endorphins into the system, making you feel good and giving you a sense of optimism. It breaks the cycle of depression that often comes with aging by helping you to build a positive outlook about yourself and the future.
Valuable help is also available from the medical profession, organizations devoted to women’s health issues, books, magazines, and friends.
If you’re troubled by the changes in your body, start doing something about it now. Remember: fitness always gives you a positive hold on both health and attitude.
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A personal note You’ll never see a happier group of people than the ones I find in over-forty (or fifty, sixty, seventy, or even eighty) fitness groups. At my first World Masters Athletics Championships, I was stunned by the quality of the performances and the attitude of the athletes. None of the men or women wished he or she was twenty-five again. They were living totally in the present. Unconcerned about being younger, they enjoyed tough competition in their age groups and then had the energy to party like mad when the competition was over. |
Changes: What and Why
Aging alters the life you have been living in subtle and profound ways. Kids grow up and leave home, job retirement is on the horizon, illness or death may come to a spouse, partner, or friend, and you begin to experience physical and emotional changes. All of these work together in changing how you live.
Most of us find the physical changes particularly unsettling. For years we take our bodies for granted. Perhaps there are a few more lines and wrinkles that cause you to joke about giving yourself a facelift at fifty. Or you may feel less resilient and unable to do all the things you could just a few years before. But we rarely give serious thought to how our bodies have already been changing, even in our forties.
Then, in what feels like an instant, the wheels fall off and nothing about your body functions in the same way. We’re always surprised. (Speaking frankly, I was astonished! It was the reason I wrote this book!)
Most of these physical changes occur because of one big event: menopause. Shrouded for so long in mystery and myth, it is not surprising many women don’t want to say the word and just refer to it as ‘The Change’.
The Change
Menopause means your period stops, right? That’s what I thought. Periods end, another inconvenience is behind me. Wouldn’t it be great if it were so easy?
Even though menopause is a natural process, it is not a simple one. Cessation of the menstrual period is just one of many complex things happening to your body before, during, and after menopause. Many women bear the changes with hardly a ripple, but for millions of others, the physical and emotional transformations of menopause are devastating. Although I believe menopause should be embraced with happiness, and even honor, those are probably the last things many of us feel.
While the end of menstruation is the classic sign of menopause, it is also the time when your ovaries stop releasing eggs, and there is a sharp decline in the production of estrogen and other ovarian hormones. It is the end of fertility. For some women these occur all at once; for others they happen gradually.
Perimenopause is the name for the transitional cycle leading to menopause that women begin to experience three to five years before their periods end. A variety of physical symptoms associated with menopause actually begin during perimenopause because of declining levels of reproductive hormones. These can include hot flashes and profuse sweating, intense feelings of heat followed by intense feelings of cold, and vaginal dryness.
The decline in production of estrogen during perimenopause can cause emotional ups and down that are very much like those experienced during adolescence. But many of us find these feelings more intense at this stage of life because they are bound up in conflicting feelings about aging, the loss of reproductive function, and the many other midlife changes that are taking place at this time.
As a result, it is often difficult to tell if your moods and physical state are due to chemical changes or happenstance. Are you feeling sad and useless because your children are leaving home or because hormonal changes are making you depressed? Are you feeling less sexy and attractive because you know intellectually you cannot reproduce or because chemical changes have altered your libido? Are you always tired because physical changes are affecting your sleep or because you’re in a plateau with your job? Chances are these feelings are due to a combination of these factors and the reasons can’t be easily delineated.
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A personal note I’m really saddened when I see menopausal women who, when depressed, turn to alcohol or tranquillizers. A daily run or walk sure helps! Plenty of depressed people experience an emotional lift from exercising, and plenty of psychiatrists treat their patients with exercise for that reason! |
What Happens During Menopause
Mother Nature didn’t intend for most animals, including us, to outlive their reproductive usefulness. Because of advances in medical science, this is the first century in history where the life expectancy of women is over age fifty. Not content merely to live past menopause, ours is the first generation of women who expect to continue to live healthy, active, even sexy lives after reproductive function is over. We are truly rewriting history!
Here are the basics. Women are born with ovaries filled with thousands of eggs. (Nature usually overcompensates; she wants to make sure that you can reproduce!) At puberty, the pituitary gland in the brain begins releasing follicle-stimulating hormone (FSH), causing the ovaries to release an egg every month. At the same time, the uterus builds up a lining of blood and nutrient tissue in anticipation of the egg being fertilized (pregnancy). Most of the eggs are not fertilized and are shed each month, along with the lining of the uterus, as menstrual blood.
As we age, our eggs age too and then die off. This occurs around age fifty. Stress, pollution, poor nutrition, and other factors may also contribute to the eggs diminishing and dying earlier. During perimenopause, our brain works harder, releasing more FSH to get the ovaries to continue to release eggs. The lining of the uterus may build up greater than ever, and menstrual flow is often extremely, and distressingly, heavy. Some periods are skipped altogether. Premenstrual syndrome (PMS), irritability, and moodiness can worsen or appear when you have never experienced it before. The hypothalamus gland of the brain, which regulates temperature, is also affected, sometimes causing uncontrollable rises in temperature and sweating known as hot flashes.
Eventually, the brain gives up when there are no more eggs, and the uterus also ceases its monthly build-up of its lining. Thus, there are no more menstrual periods, and at this point, the ovaries begin to cease producing the hormone estrogen. This is menopause, and this seems to be where real distress occurs. The lack of estrogen causes a chemical shift in the body, and for many the symptoms are very similar to drug withdrawal: headaches, night sweats, bad dreams, broken sleep or insomnia, chronic fatigue, depression, gastrointestinal upset, and, perhaps most frightening of all, temporary memory loss. It’s no wonder that many menopausal women (and their partners) think they are losing their minds. And it’s confusing because these are all also symptoms of extreme stress, which may be occurring anyway because of the other midlife changes we’ve discussed.
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A personal note In 1999 I read in the New York Times about a recent study that showed elderly people who walked, or even strolled, three miles a day, lived seven to ten years longer than their sedentary counterparts. I’ve always said I didn’t care if I lived longer, I only wanted to live better! But this study stunned me, because it is clear that if people can live ten years longer, they are actually experiencing a better quality of life for more years overall. |
Coping with Menopause
Fortunately, most of us can weather these changes with equanimity, because we know they are temporary, but for others they seem overwhelming. One place to turn for help is your gynecologist. Although some women believe that doctors incorrectly characterize menopause as a disease to be treated rather than as a natural part of the aging process, many women need specific relief that’s available now only from their doctors. There is also a great deal of evidence that medical intervention—along with your own health and fitness program—can help prevent many problems and risks associated with aging. My personal experience is that a daily walk or run can be physically and emotionally lifesaving, and this is a simple, easy, and even discreet decision that puts you back in control of your body. Like menopause itself, the solutions that work for you may be varied and complex.
Osteoporosis and Heart Disease: More Transitions
Osteoporosis
Although most of the common symptoms of menopause eventually can be overcome by braving them out, the danger of osteoporosis and heart disease is quite different. Osteoporosis is often called the ‘silent disease’ because there are no specific symptoms to treat. It occurs when there is a loss of bone density, thinning of bone tissue, and in severe cases, the growth of small holes in the bone. The combination of these changes results in bones that are thinner, more porous, and more breakable.
The link between osteoporosis and menopause is the fact that the cessation of estrogen production can cause loss in bone density in a short period of time. Women can lose up to 20 percent of their bone mass in the five to seven years after menopause, making us more susceptible to osteoporosis. The risk is highest for thin white women who smoke and/or drink excessively, have a family history of osteoporosis, didn’t drink enough milk as teenagers, and for women who enter menopause early. At the present time, one postmenopausal woman in three is developing or already has bone loss and which, in severe cases, is a problem that results in millions of fractures and thousands of deaths each year.
Bones strengthen at any age with use, but the sooner you begin to exercise the better it is for your future. But exercise alone may not be enough to forestall osteoporosis. Lack of estrogen is devastating for bones, and there is evidence now that medical intervention early in menopause can greatly reduce the risk of fractures.
To find out your risk of osteoporosis, include a baseline bone scan to measure bone density in your regular check up. Increasing calcium intake or taking newer drugs—such as Fosamax—specifically designed to increase bone mass or prevent further deterioration may be ways of forestalling further bone loss, but they are not without risks or side effects. Weight-bearing exercise, such as walking, running, and strength training, is also critical for keeping bones strong, without risk. In addition, exercise improves co-ordination and helps prevent the falls that are so dangerous to women suffering from the disease.
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A personal note Many women lash out at the medical community for not treating menopause ‘naturally,’ as if doctors are some kind of patriarchy dictating the terms of our bodies to us. I believe that part of a positive attitude about menopause allows us to take the best from both worlds. |
Heart Disease
Some women seem virtually immune to heart attacks when they are young. Heart attacks are mostly a man’s disease until women become menopausal. Then, postmenopausal women have the same rates of heart disease as men. Heart disease is the number one killer of women; it kills more than all the cancers combined. Estrogen may protect women from heart disease, and when estrogen stops, cholesterol levels rise; the cholesterol is more likely to adhere to the arteries as they become narrow and less elastic. Blood clots also form more easily.
Therefore, it used to be believed that replacing the hormone estrogen artificially (HRT—Hormone Replacement Therapy) would protect against heart disease. This is not true. HRT may be useful to some women for other menopausal symptoms, but definitely not for heart disease where, in some cases, it may be dangerous.
Running and walking are ideal in helping post-menopausal women prevent heart disease because they not only increase cardiovascular capacity but also help expand major arteries. But exercise alone may not be enough for women at risk of heart disease. As I said at the beginning of this book, this is a time for a thorough medical check-up to find out what your health status is, including blood tests to determine your risk of heart disease.
For women with increased risk factors such as high LDL (the ‘bad’ cholesterol) levels, your doctor may recommend drugs called specific reductase inhibitors (statin drugs). For women with high blood pressure, other medications may be prescribed.
We now know that prolonged use of oral HRT increases the risk of heart disease by a small amount. If you are taking HRT for menopausal symptoms (such as hot flashes, for instance) and medications for cholesterol or blood pressure, then after discussion with your doctor you may decide to stop HRT. It’s all about balancing risks.
For women who already have heart disease, you definitely should NOT take HRT.
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TIP Here are two sure-fire ways to lower your cholesterol naturally and nutritiously; they may not lower it enough to satisfy your doctor, but some of us have had great results. The first is to eat oatmeal every day. This can be in porridge, oatmeal muffins made with fruit juice and not oil, breakfast muesli, whatever. For some reason the oats absorb fats in your gut and you excrete them. The next is a 150 year old time-honored health tip: ‘An apple a day keeps the doctor away’. Try natural remedies and exercise before you take drugs. |
Dealing with Menopause: Weighing Choices and Risks
Today, women can reverse some of the unwelcome side effects of menopause by taking hormonal supplements to replace the estrogen their bodies no longer produce. These hormones can be administered orally, by a time-release adhesive patch, implant under the skin, creams, vaginal tablets or suppositories. But these options are not without some serious drawbacks. Physicians have debated the pros and cons of estrogen supplements for decades.
Like genetic engineering and other advancements in medicine, hormone replacement therapy is an attempt to improve on nature’s design. When it first became popular several decades ago, women were given rather large doses of estrogen daily, a one-size-fits-all approach later found to result in a nine-fold increase in the risk of uterine cancer. To protect the uterus against cancer, the regimen was changed to cyclical hormone therapy, which meant lower doses of estrogen for twenty-five days of the month, plus the synthetic hormone progestin (progesterone) for the last ten of those twenty-five days, and nothing for the last five days.
Cyclical hormone therapy more closely mimics a woman’s natural cycle, which means that menstrual bleeding often continues for years beyond menopause. In addition, when progestin is given, some women have enough side effects—such as bloating, depression, and irritability—to convince them to abandon hormone treatment.
It is now known that there is a small increased risk of breast cancer when HRT is used, particularily for a prolonged period.
Lastly, many women gain weight taking estrogen. An informal survey among my friends estimates four to seven pounds, which is not a terrible price for feeling better, but it is annoying for those of us who try to keep fit. Maintaining an exercise program of walking and running substantially helps in preventing further weight gain.
All drugs have risks and side-effects. Weigh your choices carefully.
Advances in Hormone Replacement Therapy
There are now many choices available in hormone therapy: different dosages, different hormone combinations, and different methods of administering them. This means that replacement therapy can be better tailored to individual needs. Especially promising are the compounds known as SERMs (Selective Estrogen-Receptor Modulators), so-called ‘designer estrogen.’
Estrogen initially was viewed as something that would affect a woman’s bones, breasts, heart, and uterus in the same way, that is, as a single molecular switch that, in effect, turned on all over the body whenever the hormone was taken. But scientists testing the drug tamoxifen on women with breast cancer discovered something unexpected. Because tamoxifen was supposed to turn off the estrogen switch, a woman with breast cancer would take it on the theory that starving breast tissue of natural estrogen would help shrink or prevent tumors. It was naturally assumed that if there was no estrogen going to the breasts there would be none going to the bones either, meaning that the bone quality in women on tamoxifen would not be good. In fact, the women’s bones were fine. Tamoxifen was turning off the estrogen switch in the breasts but was acting just like estrogen in the bones, suggesting the possibility that estrogen didn’t work the same way in every cell. This, in turn, gave rise to potentially being able to build compounds that would be tissue selective.
Researchers currently believe there are many estrogen switches in the body and that turning them on or off depends on the type of the estrogenlike compound that is taken. There is a second generation of SERMs now in development that potentially will act like estrogen in the heart and the bones, but block the harmful effects of estrogen in the breasts and the uterus. In the conceivable future, women worried about raising their breast cancer risk may have the option of taking a different kind of hormone that doesn’t affect their breasts, or that may protect against breast cancer.
In short, women have always had to make their decision based on a comparison of risks and benefits, but now the risks and benefits are changing because more selective compounds are coming along that will offer alternatives.
If your menopausal symptoms are difficult to cope with, hormone replacement therapy may be an option. If you are a typical woman you could be facing up to half your life without the benefits of estrogen, so you should seek out an appropriate health professional with whom you can discuss your particular requirements. You have a lot of choices, many of which are risk-free.
Other Views, Other Choices
Some women decide to take replacement hormones for the two to three years needed. Once they have passed through menopause and the more disturbing menopausal symptoms cease, they discontinue taking these hormones. Most prefer to do nothing. Like athletes, they just ‘gut it out’ until the phase passes.
Many women question the wisdom of tampering with the body’s chemistry and are against treating a natural passage in life as a ‘medical problem’. Others fear that hormone replacement therapy will increase their risk of developing breast or uterine cancer, or will promote the growth of a pre-existing cancer, or have a distrust of drugs in general.
Are exercise and diet alone enough to offset any damage menopause may precipitate? And what about homeopathic remedies, natural supplements, Chinese herbs?
There are physicians, practitioners of alternative medicine, and authors of health books who believe that exercise and a good diet are all that matter, that medicine cannot help us if we do not first help ourselves. This line of thought may inspire people to take themselves in hand, which is all to the good. But it does not acknowledge how sophisticated and powerful medicine has become.
Women should, without question, exercise, eat properly, and take charge of their lives. We should all learn to listen to our bodies and make our own choices. But there are going to be times when that won’t be sufficient, when what we learn and what we accomplish don’t begin to compare to what we don’t know and can’t do. That’s the time to consult physicians and allow medicine to help. Medicine is too complex to be reduced to the language of self-help.
Most experts agree that the best approach is for each woman and her doctor to review her risk factors and family medical history, talk about her concerns, and the therapeutic options available. Then, together, come to an informed decision.
Whatever the decision, there is every good reason to tailor a fitness and nutrition program for yourself. Even if diet and exercise alone cannot replicate the benefits of medical intervention, they can enhance it.
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A personal note I took HRT for several years to help me regain control of my life. Menopause hit me broadside! One day I was fine, the next I thought I had a severe illness. I felt depressed, forgetful and indecisive. My hot flashes were unbearable and my skin crawled. The only time I felt normal was when I ran, but even I can’t run twenty-four hours a day! While HRT worked like magic in relieving these symptoms, I hate taking drugs and justified or not, blamed headaches, bloating and weight gain on HRT. After five years, I quit taking HRT figuring by then, the menopausal symptoms had mostly passed. For a few months, they returned in a diminished version and then eased out of my life. Now I’m monitoring my bone mass and my heart pretty carefully. I figure we learn more every day and soon we’ll get it right. In the meantime, my run still continues to be the day’s salvation, the time when no matter what else, I feel like I always did… maybe just a little slower! |
Tips for Dealing with Hot Flashes, Night Sweats, and Other Signs of Aging
- HOT FLASHES AND NIGHT SWEATS. Wear clothes in layers to peel off quickly. Keep a fan nearby. Drink hot liquids slowly, or replace them with iced drinks. Reduce your intake of alcohol. End each shower with a cool rinse. Keep natural fibers against the skin—this includes all-cotton sheets. Keep a window open for cool fresh air at night. Have a couple of very thin blankets on the bed rather than one heavy one. Make blankets easy to kick off.
- FACIAL HAIR AND ACNE. With a lack of estrogen to inhibit it, the male hormone testosterone comes on strong, encouraging sprouting facial hairs (just where you don’t want hair!) and often acne. HRT can treat this, but so can waxing, plucking, and topical acne treatment medications. As when you were a teenager, keep your hands off of your face.
- DRY, THINNING HAIR. Just where you do want hair, the same testosterone works in reverse on the top of your head. Massage your scalp with oil and treat hair carefully.
- DRY SKIN AND SCALY LEGS. Lots of lotion. If you are pale, add one of the new self-tanning creams to legs for healthy appearance. Massage body with lotion to get circulation going and bring blood to skin surface. Don’t stay in a hot shower or bath too long. Put a humidifier in your house, or preferably in each room.
- WRINKLES. Stay out of the sun, always use a sun block, and moisturize several times a day with a quality product.
- SAGGING MUSCLES AND STIFF JOINTS. In addition to the programs and exercises described here, you could try regular massage therapy and/or take up yoga, pilates, or water aerobics at your local community center, yoga center, or health club.
- VARICOSE VEINS. Wear support hose and keep feet elevated as much as possible. Discuss options for vein removal or shrinkage with your doctor. Exercise is important to keep blood circulating. Severe varicose veins are more than an appearance problem; they are a health hazard as they can often form blood clots.
- COLD HANDS AND FEET. Except when you are out running or walking and may want synthetic socks, wear pure wool socks and gloves and keep moving. Running or walking is the perfect way to keep in motion and increase circulation.
- GAS AND BLOATING. Eat smaller meals more frequently. Keep moving; don’t sit in one place for a long time. I recommend having a teaspoon of ground flax seed with your breakfast cereal or in a smoothie, or following your evening meal with a dose of Metamucil.
- GUT CRAMP. Replace tight belts and waistbands with soft elastic; avoid constrictive panty hose and girdles. Avoid getting famished and then eating rapidly, especially while wearing tight panty hose. Again, I recommend ground flax seed or Metamucil to keep gut expanded to avoid kinks and cramping. Keep regular with exercise, lots of water, and bran products. Wait an hour to run or walk after eating.
- HEAVY MENSTRUAL FLOW. Wear a tampon, heavy pad, and black tights. Since the worst flow usually occurs on day one of your period, you may want to make this your day off from running or walking.
- HEARING LOSS. Avoid loud places, wear ear plugs on airplanes, and try to avoid restaurants and other public spaces with loud background noise.
- DIMINISHED VISION/IRRITATED EYES. Get your eyes checked regularly, particularly for glaucoma. Use artificial tears and lubricants. Wear sunglasses in bright light. Use adequate lighting when reading or working at the computer. Get someone else to drive at night or call a taxi. Get your cataracts fixed when you need to; for many, this procedure is nothing short of miraculous.
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STRESS INCONTINENCE. The muscles in your pelvic area may start to weaken. Do crunch sit-ups, practice sucking your abdomen in and holding it for a count of five several times a day, and especially practice Kegel exercises, which are designed to strengthen bladder function and vaginal walls.
- Contract the vaginal area as if you are stopping a flow of urine.
- Tighten the muscles a little and count to five.
- Tighten them a bit more and count to five.
- Tighten them as much as you can and count to five.
- Slowly release. Repeat five times.
Do Kegels several times a day.
Drink cranberry juice, try to urinate before exercise, wear dark tights or shorts. Don’t be self-conscious about wetting yourself; if you are in dark shorts nobody can see, and if you are all sweaty, you are all wet anyway! - DIMINISHED BLADDER CAPACITY. Do your Kegels and drink most of your fluid during the day so you can sleep through the night.
- DIMINISHED LIBIDO. Feel good about yourself, exercise to raise endorphins and to strengthen and maintain your own body image, spend more time with your partner doing fun things, read erotic literature, paint the bedroom pink and turn down the lights. If this doesn’t work, read up on herbal supplements—some women swear by them. Naturally, talk to your doctor if you want to consider possible drug treatment. There are remedies (and possible side effects) in mild testosterone therapies and creams.
- PAINFUL SEX/DRY VAGINA. Lubricants help a lot—like Astroglide or KY lubricant—but frequent sex is the best remedy to keep a thinning and shortening vagina flexible and lubricated. If all else fails, HRT may also help. Particularly useful and effective is estrogen cream, which is inserted with an applicator. This is a messy product, but it is good because you don’t have to take HRT all the time, or orally. The cream can be used only when you need it.
Final Thoughts About Change
Eventually, we’ll come out the other end of menopause happy and wise. Maybe we’ll even discover the ‘postmenopausal zest’ that we keep hearing about. We’re living beings; therefore we’re always changing. It’s important to realize that exercise and activity can not only help you through these changes but also can be the start of the whole new life that this era opens.
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A personal note I’m not sure ‘zest’ is quite the word I would use for my post-menopausal years! I think I would call it controlled but powerful energy … energy that I am surprised to have after feeling a bit low for a few menopausal years. For sure, however, I consider these years some of my best in terms of direction, productivity and accomplishment. That is a pretty zesty feeling to have at 67! |
