Adolescence and menopause – both times of massive hormonal, lifestyle and emotional changes for women. And for those of us with teen-agers, we can find this time in our lives to be even more stressful than normal. What can we do to get along better with our adolescent daughters (and sons!) as we’re experiencing our own upheavals? After raising nine children, and doing almost everyone wrong, sometimes more than once, I offer a few suggestions:
Remember that they, too, are experiencing anxiety, depression, mood swings, increased irritability and inconsistent motivation. They feel as out of control of themselves as we do about ourselves. It’s frustrating for everyone and we always take out our frustrations on the ones we love the most, right?! Thank goodness our family is pretty forgiving otherwise none of my kids would ever speak to me again…
You have tools to help mitigate friction, tension and drama.
So, remember that menopause and adolescence are passages – not destinations. Enjoy the ride as much as possible using all the tools at your disposal: both medical and experiential. Yes, you’re older but you’re also wiser. Putting that wisdom to good use can yield satisfying results for you both.
A recent study by Rachel Rettner and published in Live Science showed that nearly half of all U.S. men have a genital human papillomavirus (HPV), and men aged 58 to 59 (the oldest cohort in the study) had the HIGHEST rate of infection. At the same time, according to this study, women’s infection rates are lower in older women than it is in younger women. Why would this be? Why don’t women know of this prevalence rate? What can we do about it and what does it mean for our health?
A HPV vaccine is available and effective but it is currently only recommended for younger men. This recommendation is failing to take into account a changing – and ageing – U.S. population. Both men and women are living longer, and are re-entering (pardon the pun) the dating world after divorce, spousal death or by the growing popularity of on-line, anonymous dating websites. Both men and women need to become more educated about HPV and other sexually transmitted diseases. We need to initiate more candid discussions with our health care providers, and we must become more open and honest in our conversations with current and potential sexual partners.
Just because we’re not fertile and in danger of becoming pregnant does not mean we can afford to be carefree with respect to sex. Transmission of sexually transmitted diseases can be prevented by regular utilization of condoms that are effective, easily obtained and easy to use. We teach our children to be vigilant in their sexual encounters; we need to start following our own advice.
Make an appointment with your OB/GYN and get tested for STDs, and discuss strategies with your doctor on how you can protect yourself and your partners. STDs aren’t just for women; HPV can cause genital and oral cancers in men, too. It may feel awkward at first to have these conversations, but we are too smart and have too many years left to live at the top of our game to be silent about safe sex. Our lives and our health depend on it. Talk to your doctor – and your partner(s) - today.
There are many choices when it comes to hormone replacement, and information you find on the internet can be confusing.
Let’s define some terms that are often used:
Bioidentical: Bioidentical hormones have the same chemical structure as hormones produced in the body by endocrine organs. Bioidentical hormones can be branded, or can be compounded by a pharmacist.
Compounded: a compounded hormone is made by a pharmacist according to a doctor’s prescription. The pharmacist takes estrogen or progesterone, usually synthesized from yams or soy, and mixes into the product requested. This can be provided in creams, gels, or capsules.
Estrogen and progesterone can be mixed with testosterone and DHEA.
Natural: generally a term not used in medical parlance, but meant to signify a drug that comes from a biologic source
Transdermal: There are benefits to using hormones that are absorbed directly into the bloodstream, and when hormones are applied to the skin, or placed in the vagina, they are absorbed directly into the bloodstream. When estrogen is ingested via the stomach, it passes through the liver. In the liver, coagulation factors are synthesized, and these can increase the risk of blood clots, strokes, and heart attack.
Synthetic: a substance made in the laboratory which has the chemical structure that mimics the hormone it is meant to replace. Norethindrone is a progestin which is used in oral contraceptives and is a type of progesterone.
SERM’s: Selective estrogen receptor modulators
This is an exciting and promising development in hormone research. Scientists learned the structure of the estrogen receptor and how it varies in different tissues of the body. The estrogen receptor is the site on the cell that accepts the hormone, and initiated the function that is required. For example, there is an estrogen receptor on the bone, and raloxifine is a SERM that attaches to the receptor and prevents bone loss, as estrogen would. The good news for this
drug is that it does not act as estrogen in the breast, or in the uterine lining. Therefore, there is no increase in endometrial cancer, and there is actually a decrease in breast cancer, as this drug acts as an anti-estrogen in the breast.
todays-news.htmlIn the Washington Post’s December 20, 2016 AGING WELL section, Bonnie Snyder Berkowitz wrote a great piece on how your body is changing as you age; you’re not a non-athlete anymore – just a different one. For competitive athletes as well as a general or occasional fitness striver, the changes can be addressed and largely mitigated. Her synopsis of the bad and the good follows:
So, we know the times are changing but we’re also getting educated on how to overcome these new challenges and get our lives back within our control, on our terms. And it’s never too late to start; menopause brings change and change brings opportunities. Let’s make the most of them and become our best selves yet. Good luck and let us know how you’re doing! -- JC
The North American Menopause Society published a practice pearl recently written by Dr. Soares of Queen’s University School of Medicine. Here is a synopsis:
Many women have experienced mood changes during times of hormonal change such as pregnancy, premenstrually, postpartum, and during the menopausal transition. During the menopausal transition, many factors also affect mood including health problems, medication use, vasomotor symptoms, sleep disturbances, and stressful life events.
When considering treatment for depression, several considerations are important.
The clinician must differentiate between a major depressive disorder and depressive symptoms such as low mood and decreased enjoyment of normal activities. Major depression has certain diagnostic criteria that are well documented.
Studies have shown that both depressive symptoms and major depressive episodes occur more commonly in the perimenopause and early postmenopausal years. Having had a previous depressive episode is a major risk factor for developing depressive symptoms with menopause.
There are many psychosocial risk factors that are contributory including: unemployment, low education, being African American or Hispanic, poor health, greater body mass index, smoking, low social support, history of anxiety, and multiple life stressors.
Risk factors include wider variations of hormone levels (vs. low estrogen), vasomotor symptoms, sleep problems, poor health, lack of social support, and life stresses which may all contribute to the timing of depression. Studies have demonstrated that sleep problems and distressing life events led to more persistent or recurrent depression. Prolonged perimenopause and surgical menopause seemed to have a higher relation to depression.
Antidepressant are the first line treatment, especially if the symptoms are severe, there is a history of multiple episodes of depression, or if a woman’s ability to function is impaired, or there is suicidal ideation. Trying a previously successful drug is a good start, but for women who have never been on an antidepressant, the SSRI’s and SNRI’s are often effective. When choosing an antidepressant, considerations should include tolerability ad side effects. Some of the antidepressants are more effective in eliminating hot flashes, while others may also be effective in reducing pain.
What about estrogen? Estrogen has benefits in enhancing mood because of its interaction with neurotransmitters. The benefit in reducing hot flashes and improving sleep may also be contributory to their antidepressant effect.
The clinical approach that I find helpful in my practice is to begin with an extensive history which includes menstrual cycle, previous history of depression, depressive symptoms, vasomotor symptoms, social history, and medical history. I determine if a trial of estrogen is a reasonable option. If a patient’s symptoms are mostly depressive, or if they have any contraindications to hormones, I will begin with an antidepressant. In some cases, I may prescribe both, but often sequentially rather than concurrently. That makes it easier to monitor benefits and side effects.