Living with menopause

| May 1, 2008

In-Depth Report

Menopause: Managing the change of life

What is menopause?

Menopause and your life

Symptoms associated with the menopause transition

Menopause and healthy living

Hormones and disease

Treating menopausal symptoms

Living with menopause

Menopause messages
Aging well

Glossary

Resources

Living with menopause

The average lifespan for women in the United States is approaching 80 years. Some women will spend four decades in their postmenopausal years. The experience of menopause is highly individual and it is sometimes a nonevent. Whatever your personal script, you can look at menopause as an opportunity to assess your health and lifestyle factors that affect your health, and to take steps to plan the future you want.

Diet, exercise, and proper medical care, as outlined in this report, are important steps toward a lifetime of good health. But good health is more than just the absence of disease. Midlife women can enhance their quality of life by maintaining social support, reducing stress and anxiety, and taking time to relax and pursue the activities they enjoy. Some doors are clearly closed, but others can open. The menopause transition can be navigated and most women discover what Margaret Mead called "postmenopausal zest." For women who struggle with this time, there is help available, from friends, clinicians and educational sources.

Menopause messages

Here are a few take-home messages about menopause:

Keep in mind that the menopause transition is part of a process that can take years to complete. Symptoms can begin in your 30s and continue well beyond your final menstrual period.

Remember that menopause is a normal part of being female with some big pluses. Most women love not having periods and the ups and downs that go along with them. It is also an opportunity to take stock — to consider where you are and what you want going forward, in terms of both your health and other aspects of your life.

When periods become irregular, or if you are very blue or irritable, see your physician to rule out such medical conditions as thyroid disease, uterine cancer, or depression. These conditions can mimic those of menopause.

Menopause is a time of many life transitions for most women. You may be seeing children leave home, caring for aging parents, changing career status, dealing with marital problems, or simply coming to terms with the aging process itself. Talk with friends, inform and care for yourself, or consider counseling if these events become overwhelming.

If you are among the 10% of women with very troublesome symptoms, talk with your clinician about you options... You can also try over-the-counter products marketed for menopausal symptoms, but inform your clinician so both of you can be alert for side effects and drug interactions.

Think of menopause as a time for renewed energy and commitment to good health.

Age 50 is a reference point many health organizations use in recommending additional screening tests for diseases of later life, including cancer, heart disease, and osteoporosis. Ask your doctor what screening tests are appropriate for you.

Aging well

The following tips can help smooth the transition through your midlife years and help you find satisfaction, new meaning, and new interests in the process.

Shift gears and attitude. Embrace the idea that older women can be fit, active, and attractive through midlife and beyond. Age has its benefits. Explore them through an existing support group, or start one of your own.

Become an educated health consumer. Maybe you've never had time to keep up with health and medical information. Now is a good time to read up on what you've been missing. Check the Internet, libraries, books, and newspapers. Ask your doctor or a local women's health center for a recommended reading list and Web site addresses with reliable information (see "Resources").

Develop new interests. Consider refocusing your career or taking more time to pursue your other interests by reducing your work hours. Take a class or join a club.

Plan for your financial future. If you haven't saved much for retirement, make it a priority. Understand your employer's pension or retirement savings plan. Protect your savings by diversifying your investments. Seek help from a reputable financial planner if you're uncertain about how to invest your savings.

Share your experience and wisdom. Mentor young people in your professional field or social circle. Do volunteer work. Teach an adult education class.

See the world. Travel opens your eyes to new places and cultures. If you are married, it can add a new, exciting element to a marriage that may have become routine. If you are single, take a friend or join a group if you don't want to go alone. If your budget or time is limited, visit places closer to home or travel off-season.

Be computer savvy. Never got into the computer world? Computers and the Internet are not going away, and you may be losing a great opportunity to stay in touch with your children, grandchildren, friends, and relatives. Try an adult education class in your community.

Take up a new sport. Have you always wondered why so many people are fascinated by hitting a small ball into a hole? Find out. Take up golf, tennis, dancing or any other physical activity you've been curious about. All activity is good for your heart, muscles, and bones, and you might meet some new friends, too. Start gradually when beginning any new sport, and consult your doctor if you have any health conditions.

Dust off old dreams. Did you put away your paints or guitar to raise children? Get some new art supplies or sheet music and explore your talent all over again.

Find a spiritual community. Many of you will already have a spiritual community. But if you don't, this is a good time to consider developing one.

Screenings, tests, and immunization schedule
Screening, test, or immunization	Frequency/comments
Blood pressure, height, weight	Periodically from age 18.
Obesity screening	Periodically from age 18. Adults whose body mass index is 30 or above should be offered intensive counseling and behavioral interventions.
Cholesterol testing (total cholesterol and HDL cholesterol)	Every five years from age 45. Screening should start at age 20 if risk factors for heart disease are present. National Cholesterol Education Program guidelines recommend testing everyone starting at age 20 and every five years thereafter.
Pap smear	Every three years until age 65. Many organizations recommend that Pap tests be performed annually until two or three consecutive tests are normal before lengthening the screening interval to three years. The American Cancer Society (ACS) recommends screening until age 70. Pap tests may be discontinued in women who have had a total hysterectomy for benign (noncancerous) disease. There is insufficient evidence to recommend for or against the routine use of new screening technologies (e.g., liquid-based cytology) or HPV screening.
Tests for chlamydia and other sexually transmitted diseases	Discuss testing with your physician depending on your risk factors.
Mammography, clinical breast exam for breast cancer	Mammogram, with or without a clinical breast exam (CBE), every one to two years from age 40. Women ages 75 and older should discuss mammography with their physicians. There is insufficient evidence to recommend for or against a CBE or breast self-exam, although both may be prudent. The ACS recommends a CBE annually for women over age 40 and every three years for women ages 20–40; it also recommends monthly self-exams for women ages 20 and older.
Colorectal cancer screening	From age 50, using one of the following: Fecal occult blood testing (FOBT) every year or flexible sigmoidoscopy every five years, or both Dual-contrast barium enema every five years Colonoscopy every 10 years. Begin screening earlier in people who have a first-degree relative diagnosed with colorectal cancer before age 60.
Skin cancer screening	The U.S. Preventive Services Task Force makes no specific recommendation about skin cancer screening. The ACS recommends a skin check every three years for people ages 20–40, and annually after age 40.
Osteoporosis screening	Bone density testing starting at age 65. Women ages 60–64 with risk factors, especially low body weight (less than 154 pounds), smoking, glucocorticoid use, or a family history of hip fracture should speak to their physicians about earlier testing.
Alcohol misuse, tobacco use	Discussions and counseling as needed from age 18.
Vision testing	For women ages 40–64: eye exam every three to five years. For women ages 65 and older: eye exam every one to two years.
Tetanus-diphtheria vaccine (Td, Tdap)	Td once every 10 years from age 18. Substitute at least one Td vaccine with the Tdap (includes the pertussis booster).
Pneumococcal vaccine	Once at age 65.
Influenza vaccine	Yearly from age 50.
Zoster (shingles) vaccine	Once at age 60 or older.
Experts make different recommendations, which can be confusing. Discuss these with your clinician, as you may have specific health issues that warrant a different screening schedule.