Menopause is not an illness, not a disease. It’s a life passage—a perfectly natural passage. It might be easy for the woman in your life. Or it might be difficult for her—and for you. The challenges of menopause vary from woman to woman. But if you would you like it to be as easy as possible for both of you, become better informed about menopause so you know what to expect and how to help.
A Recent Phenomenon
Medically speaking, menopause marks the end of a woman’s fertility. Her production of the female sex hormone, estrogen, gradually declines, and as it does, ovulation (egg release) and menstrual periods become less regular, and eventually cease.
Menopause is actually a fairly new phenomenon in human history, so we’re still learning about it. As recently as 1900, women’s life expectancy was around 48, so comparatively few experienced post-menopausal living. Today, women’s life expectancy is about 80, so most women live 30 years beyond menopause.
A Normal Life Passage
As women’s life expectancy increased, and menopause became common, medicine mistakenly considered menopause as an illness, something that needed to be professionally treated. But in the last 25 years, women’s health activists have reclaimed menopause for what it really is—a normal life passage into a new stage of life. In fact, for many women, menopause is the door into a promising new stage of life, one of productivity, wisdom, and increased personal fulfillment.
Takes Many Years
Mention menopause, and many men envision a brief period of time around women’s 50th birthday. Actually, menopause is a long, slow process that can take many years. It usually begins during a woman’s late 30’s as estrogen production in the ovaries begins to decline. During their 40’s, most women notice some menstrual changes—skipped periods, heavy periods, spotting between periods, periods lasting longer than seven days, or periods happening more frequently than every 21 days. After 45, most women notice the beginnings of the two major menopausal complaints: hot flashes and vaginal dryness, which become increasingly noticeable as they approach 50 and may last into the mid-50s.
But these generalizations about menopause obscure the fact that women pass through it individually. About 20 percent of women experience no physical changes other a gradual cessation of menstruation. About half of women notice mild discomforts. And some 30 percent experience considerable distress.
The Top Three Discomforts
- Hot Flashes. These sudden feelings of heat occur without warning and last from 30 seconds to five minutes. Usually, the face, neck, and chest are the areas most affected. Hot flashes often cause significant perspiration. They can strike during the day or at night. At night, they often disrupt sleep, and cause women to kick the covers off. The discomfort caused by hot flashes ranges from mild to severe. Noticeably uncomfortable hot flashes typically last for a year or two, though some women experience them for several years. The cause of hot flashes remains unclear, but it appears that the estrogen decline disrupts the body’s temperature-control center in the brain.
- Vaginal Dryness Causing Irritation and Pain on Intercourse. As estrogen declines, the mucous membrane that lines the vagina thins and women produce less natural vaginal lubrication. This often causes discomfort during intercourse, and may also cause irritation in everyday nonsexual situations.
- Emotional Upsets. The myth is that women become irritable during menopause. The truth is that emotional reactions vary tremendously. Some women experience no noticeable mood changes, while others become depressed, nervous, and irritable, with the possibility of insomnia as well. There’s no way to predict which women will experience menopausal emotional changes. But a history of significant premenstrual syndrome (PMS) or post-partum depression (PPD) suggest increased risk. Both PMS and PPD are emotional reactions to hormonal changes—and so are the emotional upsets of menopause.
Then there’s “surgical” or “chemical” menopause, sudden loss of estrogen production because of surgical removal of the ovaries (during hysterectomy or treatment of ovarian cancer), or chemotherapy (usually for breast cancer). Compared with gradual, natural, menopause surgical and chemical menopause tend to cause moderate-to-severe discomforts because they occur suddenly and all at once.
Because menopause varies so greatly among women, men need to inquire about it to understand how it affects the woman in your life. Ongoing communication not only provides valuable information, but it also shows that you care, that you’re thinking about your spouse and your relationship. Discussions of menopause can deepen your couple intimacy at a time when many women feel a need for reassurance that they are valued and loved.
Ask About It
Don’t wait for her to announce: “I’m having a hot flash.” If she’s over 40, raise the issue periodically. Let her know that you’re interested. Ask her to keep you informed of her passage through menopause and her feelings about it as the process unfolds.
Listen To Her
Be emotionally available for her. If she doesn’t experience significant menopausal discomforts, she may not have much to say. But if she does, she may need to discuss things during her menopausal years, repeatedly and at length. Invest your time and energy in listening to her experiences and feelings. Menopause marks a significant personal change, and as such, it means a change in your relationship. Be ready for it. Be there for her.
Gently Correct Her Misconceptions
This brief discussion doesn’t make men experts on menopause. But men aren’t the only ones in the dark about this passage. Many women are more familiar with menopause mythology than with the facts. Just because a woman’s friends have had a rough passage doesn’t mean that she will. You might suggest—or better yet, buy—a book for your spouse that contains good information, for example Women’s Bodies, Women’s Wisdom by Christiane Northrup, M.D., (Bantam, NY, 1998, $24.95), which contains an excellent discussion of menopause, including both mainstream and alternative approaches to dealing with it.
Dealing With Hot Flashes
Until a few years ago, many doctors automatically prescribed hormone replacement therapy (HRT) for hot flashes. It works, but it’s also problematic (see below). Fortunately, there are several other helpful treatments men:
* Diet. In China and Japan, few women experience hot flashes. The reason? Their diet is rich in soy foods, notably tofu. Tofu and other soy items (but not soy sauce) contain plant estrogens (phytoestrogens, specifically isoflavones), weak versions of human estrogen. They may be weak, but in the body, they act like estrogen. Many studies show that soy foods help relieve hot flashes. For example: Italian researchers gave 104 menopausal women either 60 g of soy powder or the same amount of a placebo, and asked them to keep diaries of their menopausal symptoms. After three months, those taking the soy reported significantly fewer hot flashes. Men can encourage women to try soy foods. Men can also signal a willingness to eat them. Tofu itself is bland and tasteless, but it quickly acquires the flavor of anything cooked with it. Add it to soup, pasta sauces, or casseroles—just about anything.
Men might also signal a willingness to eat less meat. Andrew Weil, M.D., a professor of medicine at the University of Arizona, notes that vegetarians “often glide through menopause with little discomfort.” That’s because, in addition to soy, many other plant foods also contain phytoestrogens, among them: peanuts, cashews, almonds, wheat, corn, oats, apples, green beans, garbanzos, and carrots. You don’t have to become a strict vegetarian. But the woman in your life may benefit if you signal a willingness to eat less meat and include a few more meatless meals in your menu plan each week. You might begin by replacing one meat meal a week with a hearty vegetable-bean soup.
* Supplements. Studies since the 1940’s have shown that vitamin E helps relieve menopausal complaints. “Women in my practice have had excellent results using vitamin E to treat hot flashes,” says Shari Lieberman, Ph.D., a clinical nutritionist in New York City. Dr. Lieberman recommends 800 IU of vitamin E a day. (Vitamin E also reduces risk of heart disease, the leading killer of postmenopausal women.) Men can encourage women to take this vitamin.
* Relaxation Therapies. Stress makes any discomfort more annoying. It also makes hot flashes feel hotter. Several studies show that deep relaxation cools hot flashes. At Harvard’s Mind-Body Medical Institute, researchers led by Judy Irvin, Ph.D. asked 33 menopausal women to record the intensity of their hot flashes. Then the women were divided into three groups. One did nothing extra. Another engaged in recreational reading. The third listened to relaxing visualization audiotapes daily. After seven weeks, only the women in the relaxation-tape group noted any decrease in hot-flash intensity.
Men can encourage women to incorporate a relaxation program into their lives.
* Exercise. The more a woman sweats, the fewer hot flashes she’s likely to experience. Researchers at the University of Newcastle, in Australia, surveyed 220 women over age 40 about their health, moods, and lifestyle. Some exercised regularly; others did not. The more the women exercised, the less likely they were to feel bothered by menopausal hot flashes, night sweats, and mood swings. The researchers expected exercise to help only those who were not taking hormone replacement therapy. In fact, even those on hormones said regular exercise helped ease their passage through menopause. A Swedish study came up with the same findings. The researchers surveyed 900 women about their menopausal symptoms and exercise habits. As exercise increased, menopausal symptoms decreased. Women who exercised at least a half hour a day generally reported the fewest, mildest hot flashes.
Men can help by encouraging women to take the time to exercise several times a week. Better yet, exercise with the woman in your life: Take walks together. Go for bike rides. Swim. Take a yoga class. Join a gym. (Exercise also helps prevent osteoporosis and heart disease, which become major health issues for women after menopause.)
* Herbal Medicine. A Native American herb, black cohosh (Cimicifuga racemosa), helps relieve hot flashes. This herb contains phytoestrogens, so it’s a natural alternative to hormone replacement. In Germany, where herbal medicine is considerably more mainstream than it is in the U.S., a black cohosh extract, Remifemin, is very popular. Several studies show that Remifemin compares favorably with conventional hormone therapy. Remifemin is available in many health food stores. Follow the label directions. Or buy tincture of black cohosh and follow the package directions. If the woman in your life is unfamiliar with Remifemin or black cohosh, you might offer to buy one or both for her.
Dealing With Vaginal Dryness
If you don’t already use a sexual lubricant, start now. Lubricants substitute for lost natural vaginal lubrication and usually eliminate menopausal women’s discomfort during intercourse. Saliva is rarely enough. Many menopausal women simply cannot enjoy intercourse without a commercial lubricant. If you object to lubricants as “artificial” or “an interruption,” you would do well to reconsider. For menopausal women—and this can mean women over 40—lubricants often mean the difference between enjoying intercourse and not. Sexual lubricants are available over the counter at pharmacies.
In addition, the phytoestrogens mentioned above—soy, other plant foods, and black cohosh also help replace lost estrogen and preserve natural vaginal lubrication.
Dealing With Emotional Upsets
A T-shirt proclaims: “I’m Menopausal. Watch Out.” For some women, menopause involves significant irritability and blues. Others notice few, if any, emotional upsets. Many women find that the diet, exercise, and relaxation approaches to hot flashes also help them minimize mood swings. A kind man with patience also helps
Dealing With Changes in Sexual Interest
The myth is that as menopause progresses, women lose interest in sex. For some women, this is the case. However, other women notice an increase in sexual interest, especially if they leave unsatisfying relationships and embark on new ones. Surveys show that the majority of women experience a decline in libido, but continue to be interested in affirming their relationships through lovemaking.
Men involved with women who experience decreased libido during menopause may have to adjust to a situation they don’t care for. You may have to renegotiate your sexual frequency. See the article: “You Never Want To.” “You’re Insatiable.” Overcoming Desire Differences.
One nice thing about menopause is that it marks the end of the need for birth control. But don’t rush this. Even though a woman has periods infrequently, if she still has them, she’s still ovulating, and might become pregnant. Keep using birth control until she hasn’t had a menstrual period for several months.
The most controversial aspect of menopause is hormone replacement therapy (HRT). Space here does not permit an exhaustive discussion, but briefly, HRT involves trade-offs: prevention of menopausal discomforts, but increased risk of breast cancer. For many years, physicans believed the increased breast cancer risk was offset by a reduction in risk of heart disease, which kills many more women than breast cancer. But according to the latest research, HRT may not help prevent heart disease.
There is no blanket advice about HRT. Each woman must choose for herself in consultation with her physician based on her own personal and family medical history. Currently in the U.S., a significant majority of menopausal women do not take HRT.
HRT raises very confusing issues, issues many women feel a need to consider over time and discuss at length. Invite the woman in your life to use you as a sounding board. Be willing to discuss HRT—not just once, but several times as she weighs the pros and cons. Remind her that she can always change her mind later—stop it if she doesn’t like it, or start it if she wishes.
If a woman opts for HRT, she’ll get better results if she also incorporates the other suggestions in this article into her life.
The Promise of Greater Intimacy
Bottom line: When men are willing to focus on issues raised by menopause, discuss them, and be there for the woman, the couple is more likely to emerge from this life passage feeling close, content, and more intimate.