The Man's Guide to Menopause

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Hey, if she's going through it, you're going through it too. You might as well know the facts. Here they are

You've probably heard some nasty rumors about menopause. You know the ones: That it will turn your wife into a mood-swinging lunatic. That she'll bite off your head if you so much as blink at the wrong time-and any time is the wrong time. That sex becomes something other people do.

Well, guys, it's time to get the facts. We went to some of the country's top menopause experts to help turn you into a menopause expert too. Our guide answers your most burning questions. You'll learn what's happening, why it's happening, and-most important-how to help yourself and your partner survive this challenging time.

What is menopause, anyway?
Speaking biologically, it's simple. "It's the moment of a woman's final menstrual period," says Brian W. Walsh, MD, director of the Menopause Clinic at Brigham and Women's Hospital in Boston. And no, it's not one of those "Duh!" questions. Lots of women don't know that either.

Menopause occurs when a woman's ovaries run out of eggs, marking the end of her reproductive years. The average age for menopause in the US is 51.

But when you speak of menopause, you're probably referring to the "symptoms" that you've heard about. Those, including hot flashes, can begin as soon as the early 30s or as late as the mid-50s. They often begin during perimenopause-the sometimes lengthy period right before menopause-and continue through the postmenopausal period.

How long is it going to last?
The entire menopausal phase can last from about 1 to 10 years, depending on family history and certain lifestyle factors. Women who smoke, for example, may have an earlier menopause that lasts longer with more pronounced symptoms, says Dr. Walsh. That's because smoking lowers the body's level of estrogen, the sex hormone that plays a key role in regulating the menstrual cycle.

On the other hand, women who are overweight tend to have fewer symptoms. The reason? Fat tissues help convert other hormones into estrogen for a protective effect. As a result, estrogen levels typically don't fall as low. (This doesn't mean that you should encourage your partner to bulk up. Women who are overweight and have high estrogen levels are at increased risk of developing uterine cancer and breast cancer, says Dr. Walsh. Also, being overweight increases her risk for heart disease.)

Some lucky women, for unknown reasons, go through menopause without any symptoms. And most women, fortunately, aren't bothered much by them. In fact, in one survey of 750 women, the majority who were already menopausal or experiencing symptoms felt either neutral or positive about menopause.

So what's with those hot flashes?
Those red-in-the-face, sweaty moments are the most common menopausal symptom. Up to 80% of menopausal women will have these sudden surges of body heat that are caused by a drop in estrogen levels.

During a hot flash, the woman's inner thermostat-the part of the brain that regulates body temperature-becomes unstable and thinks that the body is too hot. To cool down, blood vessels dilate and send a rush of blood to the surface of the skin, typically on the face, neck, and upper body. As a result, the woman's skin becomes very hot and appears red. She may sweat and even feel an uncomfortable prickly sensation. The entire episode lasts anywhere from 5 to 15 minutes, although discomfort may linger.

Hot flashes can strike without warning at any time of the day or night. When hot flashes happen at night, they may awaken your partner from sleep. She may find herself drenched in sweat (hence the term "night sweats"). These nocturnal firestorms can cause insomnia, fatigue, and a range of related symptoms such as irritability, anxiety, poor concentration, and forgetfulness.

While you may feel helpless when your partner starts to flush, there is something you can do: Act as her "hot flash coach" and help her breathe through them, suggests Diane Wetzig, PhD, chief of psychology for University Hospitals Health System/ Laurelwood in Cleveland. (See "A Good Hot Flash-Quenching Exercise" on p. 152 for instructions.)

She does bite my head off sometimes. What's that all about?
You'd be cranky too if you suffered from hot flashes, night sweats, and sleep deprivation. Mix in some fluctuating hormones and the stress of this midlife transition time, and you've got a perfect setting for a blowup (or meltdown).

"Sleep disruption is the most profound thing that happens with menopause," says Prevention columnist Mary Jane Minkin, MD, clinical professor at Yale University School of Medicine and co-author of What Every Woman Needs to Know about Menopause (Yale University Press, 1996). "When someone isn't sleeping well, she may be a bit short at times. Guys need to understand that. They need to be supportive and, if necessary, encourage her to get help from a health care provider."

For some women, reaching menopause may serve as an unavoidable reminder that they're getting older, says Dr. Wetzig. They may worry about things such as wrinkles, weight gain, and graying hair. And they may feel less attractive, leading to feelings of insecurity and anxiety. For some, just knowing that menopause is approaching can be distressing because it marks the beginning of a new and unknown era.

But you can help, says Dr. Wetzig, by making it a point to reaffirm your partner's attractiveness and worth. "Tell her that you value the one-of-a-kind, marvelous woman that she is and that you look forward to growing old together."

When your partner gets cranky, try to keep your own spirits high, suggests Dr. Wetzig. Although bad moods can be contagious, it's far more productive-and harmonious-to find out what you can do to help ease her irritability and work through it together. But wait until emotions subside before opening talks.

"When your partner is no longer irritable, you need to say, 'Let's problem-solve. How can I help you?' You need to act, rather than react, to her irritable or anxious moods," advises Dr. Wetzig.

She's depressed too. Is that part of menopause?
The idea that menopause inevitably causes depression is largely a myth, says Sheryl Kingsberg, PhD, clinical psychologist and assistant professor in the department of reproductive biology at Case Western Reserve University School of Medicine in Cleveland.

"There may be a small group of women who experience mood changes because they're very sensitive to hormonal changes-similar to those who experience postpartum depression or premenstrual syndrome," says Dr. Kingsberg. "But this is not common, and I wouldn't always chalk up depression to menopause alone."

Figure that any depression is serious and may need professional help. "A partner is often the first to recognize the signs of depression and can encourage the woman to get treatment," Dr. Kingsberg says. "Don't try to comfort her by saying, 'It's okay. You're just experiencing that change.' That's not a just. Clinical depression is real and needs to be treated."

What's the scoop on estrogen replacement therapy?
Deciding whether to replace her diminishing estrogen supply may be one of the most difficult challenges that your partner faces during menopause.

Estrogen replacement therapy (ERT) has a lot going for it: It relieves hot flashes, so she'll sleep and feel better. It also relieves vaginal dryness, so intercourse will be more comfortable. ERT also prevents osteoporosis and probably prevents heart disease.

But it can have unpleasant side effects, including vaginal bleeding or spotting (when a progestogen is added to protect the uterus), breast tenderness, and bloating. And many experts believe that long-term use-more than 5 to 10 years-could increase the risk of breast cancer to a small degree. Also, ERT is usually not for women who've had breast cancer or a history of deep vein thrombophlebitis.

You can help by discussing the pros and cons at home before she meets with her health care provider. It might help to draw up a chart on which she can mark the pluses that she feels she can't live without and the minuses that she thinks she can't live with. Since there are many different kinds, formulations, and dosages of ERT that can eliminate or minimize side effects, she and her doctor should be able to find one that fits the bill. (To help with that decision, check out "Hormone Replacement Therapy Made Simple" on p. 120 in the June 1999 issue of Prevention.)

How will menopause affect our sex life?
Contrary to popular belief, a woman's sex drive doesn't vanish without a trace at the onset of menopause. However, it may decline, perhaps because of falling testosterone levels, says Beverly Whipple, PhD, professor at Rutgers University in Newark, NJ, and president of the American Association of Sex Educators, Counselors, and Therapists. Don't take it personally.

"This decline is not a reflection on the man himself or a woman's sexual desire for him," says Dr. Whipple. "Some women have decreased desire for any type of sexual activity, whether it's with a partner or self-stimulation."

And a drop in desire doesn't necessarily equal a drop in sexual satisfaction, adds Sandra Leiblum, PhD, professor of psychiatry and director of the Center for Sexual and Marital Health at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in Piscataway. While you may find yourself having sexual intercourse less often, there's usually no major change in orgasm or sexual satisfaction for the majority of women, says Dr. Leiblum.

Women in their menopausal years do experience some physical changes that can make sex unpleasant or even painful. The most common is vaginal dryness, which happens as estrogen levels fall, says Dr. Whipple. ERT can correct this, as can water-based lubricants such as K-Y Brand Liquid or Jelly or Astroglide, available at any drugstore. Avoid oil-based lubricants, which actually dry out vaginal tissues and may cause latex condoms to break.

Falling estrogen levels may also cause the lining of the vagina to thin, adding to a woman's pain or discomfort. Your partner may find relief from a prescription estrogen vaginal cream or ring. To boost her sagging sex drive, she can talk to her doctor about taking testosterone. This hormone, when given in doses small enough to avoid nasty side effects such as facial hair and acne, does help some women.

If intercourse is still too painful, get creative. "Sexuality is more than intercourse and the missionary position," says Dr. Kingsberg. "If partners are creative and communicate their wants and needs, they can have a better sex life than they did when their bodies were in perfect working order."

Do men go through menopause?
No, since menopause means the end of menstruation, it's definitely a girl thing. Although you may experience a drop in testosterone as you age, the change is far more gradual and insignificant when compared to the rapid drop of estrogen that women experience during their menopausal years, says Dr. Minkin. And while menopause marks the end of a woman's fertility, men can continue to make sperm and procreate into their 70s, even after testosterone levels have fallen. Just ask actor Tony Randall, a brand-new dad in his 70s.

I've heard that some menopausal women make major life changes. Is this true? Should I worry?
Don't blame hormones if your wife suddenly takes up bungee jumping or another extreme extracurricular activity. Although it's tempting to chalk up midlife changes to menopause, they're not necessarily related, says Dr. Kingsberg.

Many personal and professional changes may coincide with this time in a woman's life. Children may leave home or move back in after a stint at college. A parent may become ill, thrusting your wife into a caregiver role. Or your partner may be contemplating a career change or a return to school. At the same time, she may be thinking of her own mortality, as the lines in her face deepen and the gray hairs become too numerous to count.

Just the knowledge that menopause is imminent can cause mixed emotions for your partner, says Dr. Kingsberg. "For some women, it's very freeing to know that she's moved into a life stage where she no longer can reproduce. For others, it's a loss."

All of this can put a strain on even a strong marriage-or accentuate the weaknesses in one that's not so hot. Now's the time to enhance your relationship, says Dr. Leiblum. Get counseling if you need it. Since you're going to have more time-and privacy-for sex, fix whatever's wrong in bed too.

Whether you like it or not, time is running out. "If you're going to spend the last third of your life with a long-term partner," says Dr. Leiblum, "it should be a rewarding, rather than disappointing, time."

How can I help?
Learn more about the physical and emotional aspects of menopause, suggests Dr. Kingsberg. Read more articles like this one, look over any information that your partner brings home from her doctor's office, and even consider going to appointments with her-if she wants you to come along, that is.

Why do you need to know about menopause too? "So you can be a help rather than a hindrance. She won't have to worry that you won't understand what she's going through or that you'll be critical of her," says Dr. Kingsberg.

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What Men Want You to Know
When it comes to menopause, or rather, his wife's menopause, Dick Roth wrote the book on it-literally. In his 1999 survival guide, No, It's Not Hot in Here: A Husband's Guide to Understanding Menopause (Ant Hill Press, 1999), Roth shares his own observations from a uniquely male perspective.

"I wish the advice had been there for me in the beginning. I could have used a handbook to learn the basics," he says. Prevention put this question to Roth: What do husbands really want their wife to know as they make their way through menopause together? Here's what he had to say:

Be patient with me-I'm still learning how to communicate.
"We're all going to be somewhat poor at communicating at first," says Roth. "I learned a lot through trial and error. I started out expressing my feelings very vehemently. That didn't work. Then I didn't say anything. That didn't work either. Finally, I learned how to communicate in a way that works for my relationship."

Let's talk later, after tempers have cooled.
Sometimes we try to talk things over when one or both partners are on the verge of losing their temper. "Wait until emotions die down and rationality returns," he advises. The best time? Whatever works for you and your partner, says Roth, who prefers to talk things over in the morning when he's fresh and free of distractions.

Tell me what you really want.
"Many of us would be more than willing to help if we knew what our partner wanted," says Roth. "Do they want help around the house? Do they need a back rub? The problem with guys is that we're not good at asking. So instead of waiting for the guy to volunteer and getting mad when he doesn't, the woman needs to be direct and ask for what she wants."

Let me know what kind of mood you're in before I say or do something stupid.
"Reading someone else's feelings is an acquired talent," says Roth. "If you're not good at it, it really helps to be told. It comes back to communicating with each other."

Don't forget that I have feelings too.
"We [men] are going through some changes of our own and coming to grips with the fact that we're getting older," says Roth. "I want my wife to take the time to understand me and the changes that I'm going through. And to understand that this passage is not just about her. It's about us."

PHOTO (COLOR): So that's why she gets those hot flashes...

PHOTO (COLOR): FYI: Hot flashes can strike without warning at any time of the day or night.

PHOTO (COLOR): FYI: When someone isn't sleeping well, she may be a bit short at times. Guys need to understand that.

PHOTO (COLOR): FYI: There may be a few women who experience mood changes because they're very sensitive to hormonal changes.

PHOTO (COLOR): FYI: "You need to act, rather than react, to her irritable or anxious moods," says Dr. Wetzig.

PHOTO (COLOR): A Good Hot Flash-Quenching Exercise - Breathe in slowly through your nose for 5 seconds, then exhale fully, through the mouth, for 6 seconds. Hold the exhale for 2 seconds, then repeat until the hot flash subsides.

PHOTO (COLOR): FYI: Since you're going to have more time-and privacy-for sex, fix whatever's wrong in bed too.

PHOTO (COLOR):

PHOTO (COLOR):

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By Julie A. Evans

Contributing editor Julie A. Evans is currently concentrating on new motherhood rather than menopause.

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