Living through "The Change" Gracefully
by Roberta Lee, MD (topic expert: health)

Most women will live one-third of their lives - after menopause. An understanding of the body's changes during this phase of life can ease the transition, and equally important, better prepare you to maximize your health. There are many choices available to women. Menopause is only one of several stages in the reproductive life of a woman. The transition into menopause is divided into four stages known as:

1. Premenopause -this is the time of "normal" reproductive function in a woman.
   
2. Perimenopause - means "around menopause". This stage represents a transitional stage of two to ten years before the period finally stops. It is typically experienced by women from 35 to 50 years of age. This stage of menopause is characterized by hormone fluctuations.
   
3. Menopause - represents the end stage of a natural transition in a woman's reproductive life. Estrogen and progesterone production decreases permanently to very low levels. The ovaries stop producing eggs. Natural pregnancy cannot be achieved in this stage.
   
4. Postmenopause - refers to a woman's time of life after menopause has occurred and begins when 12 full months have passed since the last menstrual period.

Common symptoms in menopause

1. Hot flashes, flushes, night sweats and/or cold flashes, clammy feeling
2. Irregular heart beat
3. Irritability
4. Mood swings, sudden tears
5. Trouble sleeping through the night (with or without night sweats)
6. Irregular periods; shorter, lighter periods; heavier periods, flooding; phantom periods, shorter cycles, longer cycles
7. Loss of libido
8. Dry vagina
9. Crashing fatigue
10. Anxiety, feeling ill at ease
11. Feelings of dread, apprehension, doom
12. Difficulty concentrating, disorientation, mental confusion
13. Disturbing memory lapses
14. Incontinence, especially upon sneezing, laughing; urge incontinence
15. Itchy, crawly skin
16. Aching, sore joints, muscles and tendons
17. Increased tension in muscles
18. Breast tenderness
19. Headache change: increase or decrease
20. Gastrointestinal distress, indigestion, flatulence, gas pain, nausea
21. Sudden bouts of bloat
22. Depression
23. Increase in allergies
24. Weight gain
25. Hair loss or thinning - head, pubic, or whole body; increase in facial hair
26. Dizziness, light-headedness, episodes of loss of balance
27. Osteoporosis (after several years)
28. Changes in fingernails: softer, crack or break easier

There are many things that can be done to age well during these transition years, but exercise is the number one intervention that all women can do to keep themselves healthy. Aging is often hastened by lack of exercise. Exercise works to stimulate growth of the skin, lungs, digestive tract, nervous system, and helps to control body fat.

What's more, postmenopausal women who exercise regularly are about half as likely to develop diabetes as their more sedentary counterparts. And the prevalence of diabetes might be prevented if overweight women took off pounds as a result of increased activity. In 1986 investigators mailed a questionnaire to 41,000 older women between the ages of 55 to 69. The objective of the study was to analyze the effect of physical activity on their risk of developing diabetes over the next 12 years. Women who regularly engaged in any physical activity were 31% less likely to develop diabetes during the study period than women who did not exercise regularly. Women who exercised more than four times per week had half the risk of diabetes compared with women who never or rarely exercised moderately or vigorously[1].

The most important aspects of physical activity to preserve are

1. Aerobic capacity- walking, jogging, running
   Builds cardiovascular health by making the heart work.
   
2. Flexibility - stretching
   Preserves balance-important for reducing the risk for falls.
   
3. Muscle tone- weight training
   Preserves strength another important preventive measure that reduces the risk of falling.

In the next column we will discuss safe alternative therapies for different symptoms commonly encountered in menopause

1. "American Journal of Public Health." January 2000; 90:134-138.