Archive for Perimenopause
The Basics of Perimenopause’s Effects on Your Memory, Moods, and Productivity
Posted by: | CommentsAround a woman’s fortieth birthday she starts hearing jokes and innuendoes, or making them herself, about mood swings, depression, and memory loss. It’s not that long ago that the “change of life” was believed to turn women into nasty old crones or dimly aware, befuddled old ladies.
In reality, many of us finally hit our stride in our forties. We advance in our careers, start our own businesses, make a difference in our communities, and usually act as the anchor for our families. All of our talent, skill, and good intentions notwithstanding, we also can find ourselves unexpectedly sidelined by seemingly mysterious changes in our memory, moods, and energy levels. These changes are of varying intensity: for some of us, occasional forgetfulness, transient fatigue, or a “blue” day now and then will be minimally disruptive. But frequent memory lapses, chronic fatigue, and volatile mood changes not only make our days less productive but rack our self-confidence and leave us feeling like we don’t recognize ourselves.
For many of us, the timing of these mood changes, memory gaps, and energy shortages couldn’t be worse. Of course, there wouldn’t be a favorable time to blank out in a meeting or squint uncomprehendingly at a spreadsheet as Janice did, but in the midst of a career that is really taking off; sudden holes in memory or difficulty concentrating can threaten the gains you’ve worked so hard to achieve. Just when you need more energy than ever to move through your busy days, finding that simple tasks require monumental effort is discouraging. Moods that careen from anxiety to tearfulness to irritability, often without warning, can rattle your view of yourself and cause your family to tiptoe around you, wondering what’s wrong.
Many women in their forties don’t connect their experiences with a possible hormonal change. Many worry secretly that they just aren’t as sharp as they used to be, or that they just can’t cope with life’s pressures as effectively anymore. These symptoms, depression, anxiety, irritability, fatigue, mental fuzziness, can also be particularly hard to sort out because they feed on each other. The more tired we are, the harder it is to concentrate during the day, or the more likely it is that we will feel irritable and down. “Am I tired because I lay awake worrying last night? Or am I irritable because I had no sleep? Do I have trouble focusing because I’ve been feeling depressed?” I talk to many women whose perimenopausal anxiety or depression seems to produce still more worry: “What’s going on? Is there something wrong with me? Why am I feeling this way?”
I want to unravel the mystery surrounding perimenopausal memory changes, mood swings, and fatigue. We’ll take a look at hormonal influences on memory, mood, and productivity, and then examine ways to sort out the differences among biological and external variables affecting our recall, outlook, and energy. Most important, well look at ways of managing these changes so you can get on with your life with your customary energy, determination, and enthusiasm.
The Basics of Perimenopause – Planning Ahead for Healthy Heart, Bones, and Breasts
Posted by: | CommentsOnly recently has preparation become a watchword in women’s health. The generations of women who came before us didn’t start thinking about steps they could take toward having a healthy pregnancy until they became pregnant. Now, we advocate that women begin to prepare their bodies for pregnancy a full year before they would like to conceive by improving their diet, exercising, and taking essential vitamins. The same is true for perimenopause: whether you are at the beginning, middle, or end of your forties, the time is right to think about making your mature years healthy and enjoyable.
Most women are no strangers to planning ahead for milestones in our lives. We’ve picked out wedding and bridesmaids’ dresses in anticipation of getting married, polished our resumes before graduation, studied the want ads in anticipation of getting a new job, and decorated nurseries while waiting for babies to be born. Perimenopause is another time in our lives when preparation now pays big dividends later.
I’m going to review the healthy steps you can take to protect your heart, bones, and breasts during perimenopause. I’ll take you through a calm discussion of the risk factors for disease and what you can do to minimize them. Since women are living longer than ever now (our average life expectancy is nearly 80 years) and are in much better health than previous generations, you want to do everything possible to establish good health for yourself in the coming years, judge your risks, and make solid, carefully thought-out choices based on your individual needs.
Protecting Your Heart
I’m going to start with an overview of how estrogen impacts the heart. Up until the beginning of perimenopause, when our bodies start producing less estrogen, women have a distinct advantage over our male counterparts as far as the health of our hearts is concerned. Women have fewer cardiovascular problems early in life, probably because the “estrogen edge” helps keep our veins and arteries in better shape. But that changes as we get older, when heart disease becomes the leading cause of death among women.
In her book The Female Heart, Marianne J. Legato, M.D., observes that by age 60, women’s risk of heart disease is equal to men’s. After age 65, heart disease kills more women than men, nearly half a million each year. Research data show and I certainly observe this in my clinic that the majority of women mistakenly believe that cancer poses a greater threat to their health than heart disease. In reality, heart disease claims more women’s lives each year than any other disease, including breast, ovarian, and lung cancer combined. I cite this statistic not to sound an alarmist note but to focus on opportunities we have during perimenopause to pay equal attention to our cardiovascular health.
The Basics of Perimenopause – Risks and Benefits Hormone Replacement Therapy
Posted by: | CommentsFor some of us, the risks of HRT may outweigh its benefits. Women who have had these conditions should be carefully evaluated before HRT begins:
- breast, uterine or other cancer stimulated by estrogen
- a family history of estrogen-dependent cancers
- abnormal vaginal bleeding
- chronic liver disease
- blood clots in the legs or lungs
The research on HRT and breast cancer is contradictory. Some studies have shown that HRT is not associated with an increase in the disease, but other data link HRT (both estrogen alone and estrogen and synthetic progestins combined) with a greater risk of breast cancer when taken for five years or more. The Harvard Nurses’ Health Study is often cited as showing that HRT raises breast cancer risk by 30 to 40 percent when taken for five years or more, and presents an even higher risk for older women. For some women, even a slight risk of breast cancer is unacceptable, Sharon felt that way, particularly since her mother-in-law was struggling with breast cancer. While she had no direct family history, seeing her mother-in-law’s situation made her feel very wary of anything that could increase her own risk of developing the disease. Other women decide that HRT’s potential benefits for them today outweigh the risks, particularly when their personal risk of heart disease is much greater than their risk of breast cancer. These women, like all of us, need to take care of their breast health by scheduling regular mammograms and examining their breasts every month.
There isn’t a single process to arrive at a decision about HRT, and unfortunately we don’t have neat answers to the question about breast cancer risk. It will probably be many more years before enough rigorously controlled long-term studies on HRT have been done to tell us everything we want to know. Until then, some women will give HRT a wide berth, preferring to rely on no drug remedies to keep their symptoms under control. Others will choose HRT, feel well when they are taking it, and be comfortable that, for them, the advantages outweigh the drawbacks. Each choice is personal ¡ªno blanket decision will apply across the board. Whatever you decide about HRT, you need to feel that you have had an honest dialogue with a health care provider, who knows your situation, and who is willing; to seek out the latest research and information about new HRT products as they become available and provide that information to you. Most of all, your decision needs to be made in the spirit of partnership with a professional who listens to and respects your views about your own health.
The Basics of Perimenopause – Managing HRT Side Effects
Posted by: | CommentsIsabel, who considered stopping HRT a birthday gift to herself, is an example of a woman on HRT for whom the “cure was worse than the disease.” Her situation doesn’t have to be yours. When an HRT regimen isn’t relieving your symptoms or is making you feel worse, it’s clearly not working. Then you and your health care provider will need to do some adjusting: you may have to change medications, switch to a different form of administration, or take less or more of a hormone.
“I’m fat since I started HRT,” Laura stated flatly. “I was never slender to start with, but now I’ve gone from a size ten to a twelve, and I’m barely fitting into those.”
Weight gain can be an unwanted companion of HRT, as the estrogen component of the regimen seems to slow down our ability to burn body fat. Laura’s concerns about her weight echo those of many women who are considering HRT. I explained to her that because our basal metabolic rate decreases during our perimenopausal years, it takes our bodies longer to burn the calories that we ingest, whether or not we’re on HRT.
Because Laura’s uterus was intact, her HRT regimen included a synthetic progestin, to prevent estrogen from stimulating abnormal cells in the uterus. One side effect of the synthetic progestin that Laura was taking can be weight gain. The Physicians’ Desk Reference (PDR), commonly used by physicians as a source of product information about drugs, says that among the potential reactions to Provera are “fluid retention” and “weight change (increase or decrease).”
Taking HRT doesn’t have to mean an automatic weight gain. Laura and I discussed the importance of choosing foods wisely and the benefits of getting enough exercise. Then we identified three options for adjusting her HRT:
- First, we would talk with her health care provider about switching her from synthetic progestin to micronized natural progesterone. If, after two to three weeks on this regimen, her weight gain, bloating, or both were still problematic, we’d go to the next step.
- Step two would be to change the type of estrogen she was taking. Laura was currently taking Premarin, which contains estrone and other estrogens that are unique to horses and that may have had a role in her weight gain. Changing to Estrace, which is estradiol, could help. Again, I recommended evaluating this regimen after two to three weeks.
- If there were still no improvement in the weight problem, the third step would be to lower the dosage of Estrace. Sometimes a smaller dosage of estrogen can provide the protection we want without contributing to weight gain.
The Basics of Perimenopause – The Arc Bends toward Maturity
Posted by: | CommentsHormonal shifts and variations appear to “bookend” the beginning and end of our fully fertile years, from our first signs of maturity as young girls, to where we are now, in our forties. During our perimenopausal years, we may be fertile some months (when we do ovulate) but infertile other months (when we don’t ovulate). These hormonal fluctuations are similar to those in a young woman who has just started her menstrual cycle but doesn’t yet ovulate every month.
Eventually, the ovaries’ gradual tapering off of estrogen and progesterone production stops altogether. With estrogen and progesterone no longer stimulating the production and shedding of the uterine lining, menstruation comes to an end. A woman is considered officially “menopausal” when she has not had a menstrual cycle for twelve consecutive months. Reaching this point in her hormonal landscape is usually a decade-long progression of gentle and gradual changes.
Today, women live more than one-third of their lives after menopause. We can look at perimenopause, then, as a key threshold, a time for us to give careful considersation to how we live while our reproductive functions change. We can take advantage of the womanly wisdom we have gained in getting to this point in our lives. We can call upon all of our understanding to make this part of our journey authentic, positive, and powerful. As we weigh our options, we need to look at the benefits our hormones provide in preserving our physical and psychological health, and make choices about how to achieve optimum health and vitality when our bodies no longer produce these substances.
Some of us will find that a combination of lifestyle changes and complementary or alternative remedies takes care of the majority of the physical and emotional changes that occur during perimenopause. For others, a different eating plan, a new exercise routine, or vitamin or herb supplementation alone just won’t be enough. Those of us who have a family history of heart disease, osteoporosis, breast cancer, or depression face other choices about making the years ahead our healthiest. There is no single path through perimenopause and the years beyond that is right for all women, but we do share a destination, a healthy, productive and fulfilling way of life.
The basics of importance of self-care in preparation for perimenopause
Posted by: | CommentsA Decade of Self-Care
Self-care in the forties is very different from what we did or didn’t do in other decades. The old bromides about eating well, exercising, and taking vitamins are completely retooled with new energy, excitement, and creativity. I see a subtle distinction between self-help and self-care, although some might say I am splitting hairs. Self-care places a very healthy and essential emphasis on how we can more fully appreciate and respond to the changes we are going through, taking body, mind, and spirit into account. In our forties we have rich opportunities to embrace change, perhaps more than in any other time of our lives. During this transition, we develop a powerful and integrated philosophy of how to take care of ourselves.
We’ll look at nurturing and caring for all of ourselves: making conscious decisions to halt our busy pace, seeking relaxation and calm in new ways with ourselves and with other women, moving our bodies in ways that let us enjoy our strength and power, and eating combinations of foods that have a particular ability to nourish our changing nutritional needs. The richly varied textures of life in our forties give us nearly limitless ways to revitalize our bodies and spirits.
Meditative Moments During A Decade of Self-Care
Making perimenopause a positive time starts with slowing down long enough to enjoy it. This philosophy flies in the face of the way some women live when they first come to see me with concerns about their perimenopausal changes. Their lives are relentlessly busy, and although the thought of moving at a more deliberate pace can be intriguing, it is also a bit frightening. Connie is the quintessential do-it-all type of woman, holding down a responsible job, coordinating her three children’s schedules, volunteering as a Sunday school teacher, and regularly stopping by her parents’ home to check on them and bring them books, food, flowers. Now, at 48, the apparent seamlessness of her life was starting to unravel, at least in her eyes.
“I’m having trouble keeping control of my moods,” she told me. “There are days when I wake up feeling either depressed or irritable, and the first thing my husband or kids say to me completely rubs me the wrong way.” Connie’s use of the word control was significant, she went on to say that she was struggling not to let her family, friends, and coworkers know that anything was troubling her.
I explained that hormonal shifts could certainly have a role in the mood changes that were alarming her, but I also pointed out that her heavy schedule could contribute to her feelings of being cornered, resentful, or anxious.
“When was the last time you took any time for yourself?” I asked her. “Have you had the chance recently to do something meditative that would replenish and restore you?”
“Well, we did take a vacation last summer.”
“Did you plan and organize the whole trip?”
She nodded. The trip had been fun but not exactly restful, she said. Most of the time had been spent on the go, with visits to relatives and long outings every day. “I felt responsible for everything on the trip,” she admitted. “I know it sounds strange, but I even worried about the weather.”
When I meet a forties woman like Connie who hasn’t had a quiet, restorative interlude in her life for a long time, I usually ask her to think back and remember a time (it can be as far back as childhood) when she felt thoroughly relaxed and content. A lot of women wrinkle their brows as they concentrate, because the feeling of being calm or contemplative rather than rushed and busy seems like a very vague memory.
“I used to go fishing with my dad when I was a child,” Connie said. “I remember that as such a peaceful time. Sometimes we didn’t even talk much, but the silence was very companionable. The sun would filter through the canopy of trees over the stream, and everything was very quiet. I always felt kind of dreamy.”
Connie and I talked about what it would take for her to revisit the tranquility of that time by the stream with her father. “More and more women are fly-fishing as a hobby,” I said. “Maybe your next vacation could include some fishing, if you would enjoy that again.” In the meantime, since summer was months away, we looked at some immediate steps Connie could take to apply the brakes ever so slowly on the hectic pace of her life.
In our forties we can make our own meditative moments when and where we choose. As some women do, you might want to practice meditation that involves sitting quietly and repeating a favorite word or phrase to empty and calm your mind. At the same time, you can create a vision for yourself that pleases and soothes you. Until Connie could actually get some time away, I suggested that she try taking a few moments to visualize herself beside the shimmering stream where she spent summer days thirty years ago, calling back that calm and safe feeling. “It’s best if you can carve out a specific time to visualize yourself in a peaceful place,” I suggested.
With women like Connie, who have programmed their thinking to believe that unless they are accomplishing something or getting things done, they are wasting time or being unproductive, the act of stopping and taking time for ourselves doesn’t always feel comfortable at first. “But you are accomplishing some extraordinarily important things, physically and emotionally,” I said, seeing Connie’s raised eyebrows when we talked about meditation and visualization.
“You help your heart by making a conscious decision to reduce your stress, that helps lower your cholesterol. Your body will put out less Cortisol, the stress hormone. You’ll give yourself a chance to call upon your internal resources, the power at the very center of your being.
You’ll build your energy supply back up. Your mind will feel less cluttered because you’ve made room to think creatively, calmly, and insightfully.”
Other women have told me they “don’t know how” to relax. In fact the ability to relax is inborn. Every time your body returns your pulse, blood pressure, breathing, heart rate, and adrenaline levels to normal after a stressful incident, you are practicing your innate ability to relax. Sometimes in our forties we just have to retrain ourselves a little to tap into this capability. “Think of taking time to meditate and relax as a different form of discipline,” I suggested to Connie, as I often do to women who seem anxious about dedicating time to themselves.
You can start by deciding on one soothing thought or image, as Connie did, seeing herself quietly waiting for fish to pull on her line. Think of the place you would most like to be, and place yourself there for a few moments each day. For Cherie, it was a remote beach in western Ireland she once visited. Doreen made a mental tour through her grandmother’s sprawling and comfortable house in the South, long since sold. Ariel insisted that she couldn’t think of any image that was relaxing to her at first, but then her face slowly broke into a smile as she said, “I went to Europe one summer when I was in college. I visited the oldest church in Paris on an afternoon in the middle of the week, when it was about a hundred degrees out. Inside it was dark and cool, and there was nobody there. The idea that people had been praying there since the twelfth century was very moving to me, even though I’m not mat religious myself. Maybe I should think of myself inside that ancient church once in a while.”
The methods for creating stillness and quiet in our minds certainly aren’t limited to meditation or visualization. But I often recommend that women consciously take a few quiet moments to reactivate their relaxation response, even if it has lain dormant for years as they charge through life. The activities we can enjoy in our forties, alone or with other people, can also be very meditative and replenishing. Sometimes it’s just a matter of putting our own creative spin on something we’ve always enjoyed.
Pat has loved to read ever since she was a child, but she recently changed her reading list. “I kept up with a lot of professional literature and journals,” she told me, “and if I had time to read anything else, it would be history or biography. A friend of mine gave me a book of Jane Kenyon’s poems for my birthday, it sat on my shelf for months because I hadn’t read poetry since high school English class. My friend never asked me how I liked it, but one day after we had talked on the phone; I took it out and read one of the poems. I just loved it! I finished that book, and then I started reading other women poets, all different voices from different eras. Now I usually read a poem or two before I go to bed. It’s a very peaceful way to end my day.”
There can be a meditative quality to gardening, sewing, cooking, writing, painting, sculpting, whatever you choose. In fact, your forties can be the perfect time to exercise your creative energy by rekindling former interests or discovering new ones. For several years Andrea had let gardeners take over the care of her flowers because she no longer had time for all the upkeep they needed. When she decided to take more time for herself, she reclaimed one flower bed and dug it up, replanting new flowers in different colors and varieties. “The gardeners know not to touch that section now” she said. “It’s mine. Even though it’s a small patch of our yard, I could spend hours out there. I had forgotten how much I love turning the dirt over, and how excited I get when the first tender shoots start to come up. I just didn’t realize how different it is when someone else does the gardening for me. I always get pleasure from looking at our flowers, but I’m so glad I’ve started taking care of some of them myself again.” I like Andrea’s story because it richly illustrates how we need to take care of ourselves in our forties, doing things differently, quite literally planting new seeds, reacquainting ourselves with pleasure in simple and meditative ways, and not allowing others to experience our pleasure for us.
The Basics of Perimenopause – New Hormone Test Options
Posted by: | CommentsWhile FSH can be measured only in blood, the technology to measure estrogen, progesterone, testosterone, and other hormones using saliva samples is now being applied in very innovative ways. First, let me explain how saliva testing differs from blood testing of hormones.
Saliva testing gives a reading of only the unbound or “free” form of the hormone molecules. This is important because only the free hormone molecules can actually act on cells in the body. The free hormone level is probably only two to five percent of the total amount of the hormone in the body, according to experts at Aeron Lifecycles, a California laboratory specializing in saliva testing.
Blood testing, on the other hand, measures both the free and the bound” hormone molecules and it doesn’t always distinguish between the two. As the name implies, bound hormone molecules remain bound and cannot act on cells. So the blood-test level of a particular hormone doesn’t tell us how much of that hormone is available to affect processes in the body. This means that a woman whose blood test shows her to have a normal hormone level could actually have either more or less than the amount of free hormone that her body needs.
Saliva testing appears to be much more accurate in measuring estrogen, progesterone, testosterone, and other hormones. These tests are starting to be used by some physicians to adjust hormone replacement dosages. In some cases women and physicians use information from saliva testing to make decisions about other forms of treatment for perimenopausal symptoms. With Janice, Sharon, and Mary, saliva testing resulted in two very important outcomes. First, the results brought them some peace of mind by confirming that their symptoms were not “all in their heads.” Second, the objective measure gave them and their health care providers a solid indication of which areas most need attention.
The implications of saliva testing are very, very exciting. To begin with, it is allowing researchers to measure significant patient-to-patient variations not only in baseline hormone levels but in the way hormone supplements are absorbed and metabolized in different dosage forms (oral estrogen versus estrogen in cream form, for example). The work being done by Aeron Lifecycles and Madison Pharmacy Associates shows not only that the form of hormone supplement that a woman takes can make a difference but that, in the case of hormone creams or patches, where they are applied on the body also affects her hormone levels. For instance, applying very small amounts of progesterone cream to the hands produces significant changes in progesterone levels (as measured in saliva), as opposed to applying it elsewhere on the body, such as on the breasts, abdomen, or inner thighs.
The more precise measurement of hormones through saliva testing could potentially lead to radical reductions in dosages of hormone replacement therapy, to dosages that are 50 to 75 percent lower than current standards. Mary’s situation is one case in point. She was taking 200 mg of natural micronized progesterone a day during the luteal phase of her cycle, but when her physician saw, from saliva testing, that her estradiol levels were less than 0.5 pg/ml, he agreed that supplementing her with a type of estrogen as well might relieve her symptoms of sleeplessness, waning sex drive, and vaginal dryness.
Mary’s doctor told me that he normally starts his patients out with 1 mg of Estrace or 0.625 mg of Premarin (both are types of estrogen) and a type of progesterone. But he listened carefully as I talked about estriol, the “weak” or “forgotten” estrogen that can often be used in small amounts (0.5 mg vaginal suppositories, two to three times a week) as a first line of intervention for perimenopausal symptoms of estrogen deficiency.
I faxed him an article about estriol from the Journal of the American Medical Association, and he called me back at the end of that day. We discussed adding estriol vaginal suppositories to the 200 mg of micronized natural progesterone Mary was taking daily. (She would take 0.5 mg of estriol in vaginal-suppository form two days a week all month long, but progesterone only from day 13 of her cycle until she got her period.)
He expressed concern about the fact that this low dose of estriol does not provide the cardiac and bone protection that is supplied by the more potent forms of estrogen, an issue of particular concern since Mary’s father died of heart disease in his midfifties. However, Mary’s cholesterol, blood pressure, triglyceride, and lipid levels all look normal. For now, her cardiac profile indicates that the first steps she could take toward avoiding her family history of heart disease would be to work on some of her lifestyle issues, notably her eating and exercise patterns. And although she is taking micronized natural progesterone to minimize some of her mood swings, it provides the added health benefit of building bone mass, offering her important protection against osteoporosis later in life.
If the trends revealed by the preliminary research on saliva testing continue, and if the early findings and anecdotal examples are borne out by further controlled study, we may find that it is possible to restore a woman’s estrogen, progesterone, or other hormone levels to normal physiological ranges with significantly lower dosages of hormone supplements. Currently, if a woman chooses to take HRT, customizing her regimen can sometimes be a hit-or-miss affair. The standardized dosages are either too high for some women and produce unwanted side effects, or else they are too low to adequately relieve symptoms. Saliva testing could allow us to be much more precise in developing individualized treatment plans. It’s exciting to think that one day we will stop thinking in “standardized” ways about women’s hormonal health.
Another breakthrough that may come about as a result of saliva testing is the ability to measure the effects of plant-based substances, such as soy and black cohosh, on hormone levels. While these substances have estrogenic properties (they are sometimes referred to as phytoestrogens), we’re not sure about their pathways in the body or their effects.
Phytoestrogen plants vary tremendously in their potency and in their ability to bind to receptor cells in the body. It may be that in the future saliva testing will provide some of the key answers we’re looking for about the therapeutic potential and possible side effects not only of phytoestrogens but what we now call “traditional HRT” as well.
Right now, we don’t know all there is to know about measuring hormones through saliva, but this emerging information has certainly commanded my attention. I also appreciate the fact that saliva testing is convenient and private, you do it at home using small plastic containers provided by the laboratory, and then mail the containers to the lab for analysis. The lab mails the results to you and your health care provider.
You may be interested in measuring your hormone levels with saliva testing, but your health professional may not yet be familiar with this tool. It is reasonably well accepted among physicians that women’s hormone levels vary, so you might approach the discussion from the standpoint that you want information about your baseline levels in order to gather more information about yourself, or to help you decide about any treatment for perimenopausal symptoms. Ideally, baseline hormone testing would be done fairly early on in your perimenopausal transition. Then if you decide to use any intervention to manage your symptoms, follow-up testing is an option to measure your results, using the baseline values as a comparison.
The Basics of Sensuality and Intimacy During Our Forties and Perimenopause
Posted by: | CommentsThe forties are a time when we can make sense of shifting and sometimes conflicting attitudes about sexuality, by seeking full expression of our sensuality. Sexuality is just one of many pleasures we give and receive. Voluptuousness in our forties makes the true definition of the word come alive, indulgence of luxury, enjoyment, and sensual pleasure.
“What do I know from indulgence or luxury?” Bonnie asked me. “I have too much to do, and not enough time or money.” That was my point exactly, the frenetic busy-ness of many of our lives keeps us away from ourselves, from the expression of our sensual side.
“Maybe we’re defining things differently,” I said to Bonnie. “I don’t mean luxuries that have to be expensive, or indulgence in a negative sense that’s lazy or selfish. I’m talking about luxuries like having time to yourself, or having intimate, meaningful time with someone you care about, where the goal is to be together, without expectations about getting something done.”
The awakening of your sensual side can happen through whatever combination of touch, smell, taste, sound, and vision you choose. Maureen enrolled in a sculpting class at a community college, intending to take some time for herself and to ease her stress level. But she found that kneading and shaping the clay, rolling it beneath her fingers, pounding it with her fists, was a sensual experience that left her not only more relaxed but energized at the same time. Andrea, who started gardening again after a long hiatus, had a similar sensual experience as she worked the warm soil and breathed the scent of the peonies and dahlias. “When I was growing up there was an older woman in our neighborhood who used to garden at night. She grew potatoes in straw. Everyone claimed that she gardened in the nude, although no one had actually seen her,” Andrea told me. “I don’t know what made her come to mind recently. I probably hadn’t thought about her for twenty-five years. But there’s something very appealing about the idea of gardening on a warm night with no clothes on. I just might try it.”
Sheila created a ritual for herself that soothes her and enlivens her senses: she listens to a favorite Bach piece, lights some soft candles, and bathes in scented oil. Afterward she dresses in an outfit of soft fabric and subtle colors she loves. She sometimes performs this ritual before meeting a friend at a cafe or museum, but she often does it just to relax by herself at home or before going somewhere alone. “I feel like I really own my body when I’m finished,” she says. “My blood is humming, and my mind is refreshed.”
Mindy delights in touch, smell, and taste when she devotes a Saturday each month to baking and freezing loaves of crusty whole-wheat bread. “I play out lots of emotion as I shape the dough,” she said. “The smell fills the whole house, and when the bread is done, I cut a thick heel for myself and have it with tea. My family looks forward to those Saturdays as much as I do.”
I often talk with women in their forties who yearn for a kind of intimacy and closeness that is nonsexual, for more expressions of caring from their husbands or partners. I always ask what these expressions of caring would look like, or what would define such intimacy. I get a range of responses, some of which are completely unrelated to sex:
“Being hugged, tenderly kissed and held, not just as part of making love.”
“Reaching for my hand in public.”
“Whispering something loving to me instead of just pressing up against me when he wants to have sex.”
“Calling me once in a while during the day to ask if there’s anything he can do on his way home, or just to say he’s thinking about me.” “Listening to me if I’m upset. Just being able to say what’s on my mind is so much more helpful than being told ‘It will be okay,’ or worse, ‘Calm down.’”
“Planning an evening out, getting the tickets, making the reservation, whatever, getting the babysitter, so all I have to do is show up and enjoy his company. We never get out unless I arrange everything.”
My next question is always the same: “Have you asked for any of these things?”
“Well, not exactly,” Helene told me. She was the woman who wished her husband’s show of desire were a little more expressive than pressing against her. The parallels aren’t exact, but in some ways achieving the intimacy we seek is similar to getting the health care we need: both depend on our knowing what we want and asking for it, very specifically, without being critical or apologetic. “The next time your husband initiates sex without a word, can you say something like I’d be so happy to hear you tell me you love me’?” I asked.
Sometimes demonstrating the kind of closeness we would like him to show us helps too. I suggested that Aileen take her husband’s hand often in public instead of waiting in vain for him to be publicly affectionate toward her. She was gratified when he reciprocated, stealing an arm around her shoulders or waist. Corinne also decided to take the lead: she picked up the phone and called her husband for a brief hello while he was at work a few times. “The first time, he barked, ‘what’s wrong?’” she said. “Now he seems genuinely happy to hear my voice. The other day I asked him to call me if he got a chance, and he did. We don’t talk long, but the tone is always very warm. I love that. Before we started talking occasionally during the day, it seemed like our discussions were all business.”
Deepening your intimacy with your partner requires a certain clarity about what you expect; it also means you have to take the time, apart from chores, bills, jobs, children, in-laws, and other “business,” to focus on your commitment to the person you care about without distraction. But our sensuality and passion are expanded in our forties, it becomes more than sexual feelings or acts, more about intimacy with others, involving a show of tenderness and trust born of confidence about our own strengths and needs. Our definition of romance matures: a spray of roses or a bottle of champagne seems less romantically charged than an evening spent intertwined on the sofa.
As you both adjust to physical changes during your forties, you and your partner can also use your broadened outlook on romance to your advantage:
- Plan regular, quiet, intimate times with your partner when the rest of the family is elsewhere, and the phone, television, beeper, and computer are turned off.
- Listen to favorite music together, or if one or both of you plays a musical instrument, perform a recital just for your mate.
- Take a look at photographs of your early days together, and describe your memories to each other.
- Read aloud to the person you love, or ask him to read to you as you cuddle. Short stories or poems are well suited for one session, but you might even decide to read a novel together in installments, one section at a time.
- Find a comfortable place to stretch out, and massage each other’s feet. Revel in the sensuous, comforting touch.
- Talk about the time when you met and were getting to know each other. It’s lovely to tell, and to hear about, the characteristics that drew you to each other.
You may have slowed your pace, yes, but you’ve also deepened your appreciation of the many meaningful ways you can be together with someone you love. Intimacy is there for you in your forties, waiting for you to recognize what it is and move deliberately toward it.
The Basics of the Changes In The Mirror During Perimenopause – Skin Changes
Posted by: | CommentsThe first perimenopausal change my grandmother wrote about in her diary some sixty years ago was the fact that her skin looked different, somehow “older”. For many of us, skin changes get our attention before other signs or symptoms of perimenopause appear. A smooth, unlined look gives way to a face that has broken into a million smiles and been knotted in worry over a million problems, huge and small.
First, let’s look at some facts about our skin. The largest organ of the human body, the skin covers nearly seven square feet and includes three layers: the outside layer (epidermis), middle layer (dermis), and bottom layer (hypodermis). This impressive organ accounts for approximately 16 percent of our total body weight and has a remarkable ability to regenerate and heal itself, shedding the surface layer of dead skin cells every day and the outer layer about every twenty-four days.
As we age, fat in the hypodermis starts to disappear, which results in the skin being less soft. No one talks about how wonderful a baby’s hypodermis is, but in fact the healthy layer of fat that babies have to protect them accounts for their marvelous velvety skin. At the same time that the hypodermis is changing, glands in the skin’s middle layer, the dermis, produce less sebum, a fatty secretion that lubricates the skin and keeps it supple. The dermis is also where collagen, elastic like substance, is produced. The mechanism that controls collagen production isn’t fully understood, but estrogen is believed to play a stimulating role. As our estrogen levels wane, we have less collagen in the dermis. The top layer, the epidermis, undergoes fewer cellular changes than the two layers beneath it, but we wrinkles on our skin when the layers no longer fit together.
Our skin also takes longer to replenish itself in our forties. The epidermis has been exposed to sun, wind, or pollutants in the air for more years. When the outer layer of skin is replaced more frequently, as in younger women or in men who remove the outer layer of skin by shaving daily, the skin has fewer lines and perhaps more of a glow.
Skin care in the forties doesn’t have to be about expensive cosmetics or so-called antwrinkle creams, although the occasions) facial is good for your skin as well as your stress level. When I see women who want to know what to do about wrinkles, dry skin, or coarse facial hair in their forties, I generally make the following recommendations, in this order:
- Joy is the first essential ingredient for healthy and beautiful skin. A woman who radiates happiness in her forties is going to look magnificent, whether she has a few lines in her face or dozens. If you have to search your distant memory to think of the last time you did something that made you truly happy, do whatever it takes to change that now
- Rest is next, sleep actually wakes up our skin. We’ve talked about the hormonal influences on perimenopausal sleep disturbances, and ways you can get a more restful night’s sleep. But if you’re shortchanging yourself on sleep because you’re trying to get more things done on a daily basis, remember that the sleep deficit can show up in sallow, unhealthy-looking skin.
- Feed your skin. As your hormonal balance changes, you can help restore and stabilize that balance by emphasizing foods that have estrogenic and progesterone like influences in our bodies. Meals focusing on fresh fruits and vegetables, soy protein, and whole grains will nourish your whole body, and that will show in your skin.
- Hydrate your skin with plenty of water, at least two quarts a day. Alcohol, on the other hand, has a dehydrating effect and can make the skin look flushed or puffy.
- Regular exercise will increase your circulation and bring a healthy glow to your face. You can also help maintain smooth, toned skin using facial massage or acupressure. Acupressure involves applying gentle, firm pressure to key points on the face to stimulate circulation and reduce tension. This practice is based on the Chinese principle that essential energy, or chi, must flow in even, sustained movements through the body’s channels, called meridians. By stimulating chi, acupressure can invigorate the face or any other part of the body. You may decide to teach yourself to do simple facial acupressure or consult a trained acupressurist.
- It’s not new information that the sun is very damaging to our skin, but many women are surprised when I tell them that even full sunblock doesn’t fully protect them from the sun’s damaging rays. Many women I know have a false sense of security if they’ve layered on SPF 30 sunblock, thinking they can now spend time in the sun with impunity. But dermatologists now advise using sunblock as only one part of the armament we need against the sun, other skin-shielding tools should include a hat and sunglasses.
-If the hair on your upper lip and chin has gone from fine and downy to dark and coarse, your testosterone may be out of balance with the estrogen and progesterone your body is producing. During perimenopause, testosterone levels decline slightly. It’s not so much the amount of testosterone that is significant, but its ratio to estrogen and progesterone.
Testosterone is an androgen, or male sex hormone. Our ovaries produce it, although in significantly smaller amounts than are found in men. During our fully fertile years, the amount of estrogen and progesterone in our bodies may be sufficient to mask testosterone’s masculinizing effects, such as coarse facial hair. When the balance changes, increased facial hair or acne can result. Some women choose to have their testosterone levels measured along with their estrogen and progesterone levels. Increasing your estrogen and progesterone levels and bringing them back into balance with testosterone, by means of either lifestyle changes or hormone replacement therapy, can lessen coarse facial hair growth.
- Be a wise consumer when it comes to skin products. Many anti-wrinkle and anti-aging preparations are quite expensive, and claims that they remove toxins or rejuvenate cells are false. You have more control over how your skin looks through what you eat and drink and how you feel. If you have a budgeting choice between something that will supposedly make you look better outside, like a skin cream or cosmetic, and something that will replenish your spirit, like a concert, a massage, or a day off for a drive and lunch somewhere gorgeous, I vote for the latter.
The Basics of Suffering From Perimenopause – Desperately Seeking Sleep
Posted by: | Comments“I don’t have time to be tired,” Colleen burst out in frustration one day in my office. “For me, absolutely the worst part of this time in my life has been the loss of energy. I never wake up feeling like I’m ready to go. I’m in a fog. Then, even though I go to bed early, I don’t sleep well. I’m exhausted many days by three in the afternoon. Being tired so much of the time really gets in the way of doing what I want to do,”
During perimenopause, sleep, or lack of it, is a big part of the mood swings, mental blurriness, or absentmindedness that can disconcert us. If you lie awake listening to the clock tick or sit in front of the television bleary-eyed, watching your third infomercial at three-thirty A.M., you’re not alone. Chances are, thousands of women in their forties are also lying awake, wondering how in the world they’re going to think straight, function, and have energy when their day starts in three short hours.
Sleep deprivation caused by perimenopausal insomnia can shorten your temper, drain your energy, and trigger a flood of tears because you’re just too tired to deal with anything, from a small inconvenience to a major problem. Night after sleepless night takes its toll, physically and emotionally, leaving you longing for a good night’s sleep much as a starving person yearns for food. The relationship between loss of sleep and feeling short-tempered, out of it, or anxious during the day is complex, sleeplessness doesn’t directly cause your wavering moods, but it certainly is a major contributing factor.
Humans spend more time sleeping than any other species on earth, yet sleep researchers still don’t know exactly why we sleep. While most sleep research has been done on men, one European study revealed that women actually need more sleep than men, up to an hour and a half more per night. Why, then, when we’re in our forties, do so many us have trouble getting a decent night’s rest?
The reasons are varied, complex, and interrelated. Some women’s sleep is disturbed by hot flashes at night, called night sweats. We can wake up soaking and have to change our nightclothes and bedding. By the time we’ve done all that, we’re wide awake.
Surges in follicle-stimulating hormone are linked to hot flashes and night sweats. Remember FSH? This hormone often works overtime during the forties, urging our bodies to release eggs from our ovaries as if to meet a reproductive deadline. Instead of a monthly pulsation of FSH levels, perimenopausal women may have arbitrary spikes in this hormone, which is believed to have a vasodilating effect. FSH opens the capillaries beneath the skin, blood rushes into them, and we heat up.
When an FSH surge occurs at night, we can awaken feeling uncomfortably warm. Some perimenopausal women experience both night sweats and hot flashes during the day, others have only one of these two symptoms, or neither. Researchers still aren’t exactly sure why the trigger for night sweats and hot flashes varies from woman to woman.
Another possible culprit in perimenopausal sleep loss is serotonin, the neurotransmitter (brain chemical) that plays a strong role in governing sleep patterns and mood. Estrogen boosts the production of serotonin in the brain, and it may also keep serotonin from being reabsorbed by other cells, so its effects last longer. As our bodies manufacture less estrogen during perimenopause, serotonin may also be in short supply (or it may act for shorter times in the brain), producing wakefulness or restless sleep.
Estrogen’s effects on the brain are very similar to the effects of certain antidepressant medications on mood, medications like Prozac, Paxil, and Zoloft also block cells from reabsorbing serotonin. At least one study has shown that estrogen acts more quickly than antidepressants in slowing down serotonin reabsorption. Ironically, some women who take a serotonin-enhancing medication such as Prozac to combat their feelings of depression or anxiety are also battling one of the medication’s side effects, insomnia.
The hormone melatonin, produced by the pineal gland in the brain, also strongly influences our sleep and waking cycles. You’ve probably heard or read about melatonin, it’s widely available over the counter and has been alternately called a miracle hormone with anti-aging properties and dismissed as hype.
Here’s what we do know about melatonin. Our bodies produce less of it as we get older, and some people find 3 to 5 mg of it very effective in counteracting jet lag (which is really short-term insomnia). As a short-term sleep aid, melatonin may be useful to break the cycle of insomnia, but I’m not comfortable recommending that perimenopausal women use it for long periods of time. My concern is that we run the risk of “programming” our bodies to expect higher-than-normal levels of melatonin so that over time, we could have difficulty sleeping if we haven’t taken melatonin. Moreover, some over-the-counter melatonin products contain amounts of this hormone that are significantly higher than what our bodies produce, up to a hundred times the amount. As with any hormone supplement, be it an over-the-counter product or a pharmaceutical-grade medication, the concept of putting a large amount in our bodies isn’t one that most of us feel comfortable with.
The good news is that your sleepless nights don’t have to go on forever, and you don’t have to buy under-eye concealer by the case to hide your dark circles. There are several steps you can take on your own to help regulate your sleep cycle. If night sweats are waking you up, try these simple techniques:
- Regulate the temperature in your room. Make sure it isn’t too hot or cold.
- Wear lighter nightclothes, thin cotton instead of flannel.
- Use several light wool or cotton blankets on your bed rather than a heavy comforter. It’s easier to pull down one light blanket if you get too warm.
- Spicy food, caffeine, and alcohol seem to aggravate hot flashes and night sweats in some women. Eat lightly in the evening, and if you’ve been relying on a glass of wine to help you sleep, try chamomile tea instead.