Changes After Menopause

The following changes do not begin until some years after menopause. Many women do not experience them. A few find that they start earlier. Most of the changes are a normal part of the aging process, and not due to estrogen withdrawal. The following descriptions of the reproductive organs as they move into extreme old age are a "worst case" scenario. It is not reading for the fainthearted.

Vulva Changes:
The vulva and its contents start to shrink. The plump tissue of the outer lips (labia majora) begins to disappear. The thin inner lips (labia minora) become very small. Pubic hair grows straighter and more scanty. In extreme old age, the vulva has a glazed or shiny look.
Vagina Changes:
The walls of the vagina become shorter, thinner, and narrower. There is a loss of elasticity, and the ridges flatten out. A reduced blood supply makes the lining less robust, with a risk of dryness, itching, and pain at intercourse. There is an increased risk of infection due to a change in the acidity.
Uterus Changes:
The uterus gets smaller as the walls get thinner. The lining still responds to estrogen if taking ERT. The oviducts cease to function; this appears to have no health effect.
Pelvic Floor Changes:
The whole support system can weaken as the muscles and ligaments become more flaccid. There is an increased risk of prolapse from the bladder, rectum, uterus, or vagina itself.
Bladder & Urethra Changes:
The walls become thinner and lose some elasticity. The tissue is more at risk of bladder infections and stress incontinence.
Breast Changes:
The gland tissue shrinks. The support ligaments lose some of their elasticity so the breasts droop. The nipples become smaller and flatter and can lose their ability to erect.
Changes in Men:
These are not so obvious because men do not have tissue moisture and plumpness in the first plaice. Nor do they lose their slight production of estrogen. There is a gradual decline in testosterone at abwout age 40. Later, the effects of estrogen can show through as male breasts and a general softening of the skin. The non estrogen-dependent effects of aging equally apply to the male genitals.

Perhaps the main difference between midlife women and men is that most men would avoid reading about the effects of aging!

Self-Care

A vagina which feels dry can be dampened with baby oil, or vegetable oil. Avoid the use of other lotions or creams; they interfere with the vagina's ecology and yeast can flare up. Love making and masturbation help to maintain the vagina's robust muscle tone. Do Kegels exercises daily. Itchiness can be soothed and relieved by applying bancha tea or Vitamin E oil topically to the vulva and vagina area. The risk of urinary and vaginal infections can be reduced by wearing loose cotton underclothes. A hot, moist environment encourages germs and infections. Keep the area as cool and dry as possible.

Some women report that they can reduce most of the symptoms of menopause by herbal therapies; others choose acupuncture. Vitamin and mineral supplements are another route. Vitamin E may help reduce hot flashes. Vitamin C, D, and calcium are essential for bone formation. Vitamin A deficiency has been associated with heavy bleeding. Magnesium and vitamin B complex may reduce edema, help with relaxation, and ease stress. Warning! Never take any supplements in high doses. They can be toxic. Also, they can interfere with the absorption of healthful nutrients in the diet.

Theory Land

According to a report in the Archives of Sexual Behaviour, there are clear-cut benefits to regular sexual activity. "It may help reduce or stop some menopausal symptoms. Women who maintain a consistent sex life are less likely to experience hot flashes. There is a close association between increasing irregularity of menstrual cycles, hot flashes, declining estrogen levels, and declining frequency of intercourse.

"Regular sexual activity might have a protective action against lowering hormone levels and therefore its absence is associated with the disruption of cycles. The discomfort of hot flashes and other associated symptoms might have an inhibiting effect on sexual behaviour...But the association between hot flashes and reduced frequency of intercourse may result from some common third variable."

Another theory concerns the hormones in a partner's ejaculate. These might be absorbed through the vagina walls and keep them more robust. It is suggested that this is why women who enjoyed love making before menopause continue to do so afterwards, and may be even more keen than before. It is an interesting theory because the male hormones in ejaculate contain prostaglandins, and an excess of prostaglandins can cause the uterus to contract with period cramps.

Yet another theory suggests that freedom from the risk of pregnancy heightens a sense of freedom in bed. This was a popular theory until a few women reported that the risk of pregnancy has been a sexual "turn on." Now it was gone, they were no longer as excited or keen.

Use It or Lose It?

Does the "use it or lose it" maxim apply to the vagina? Maybe, when any muscle group is not worked over a long period of time, it atrophies. First, it loses strength and stamina. Then, and only after very prolonged time, it withers and dies. This is true for tissue, nerves, blood vessels, all the body organs, including the vagina. The more any tissue is exercised, the less risk there is of "disuse atrophy."

Midlife men have the same risk, only to a greater degree. A penis which is not regularly exercised will rapidly succumb to disuse atrophy. This rarely happens. The penis erects at night during REM sleep, and stays erect for 20 minutes or more at intervals during each night. Even in extreme old age, men without partners (and some with) masturbate to relieve sexual tension and because they enjoy the activity. By these methods, the penis is regularly exercised and kept healthy.

The same phenomenon occurs with clitoral erection. The vagina is not involved, though it may produce the sweating phenomenon during REM sleep; research is still needed. Be wary of indulging in excess sexual activity in order to avoid the risk of vaginal atrophy.
Keep in mind that other maxim: moderation in all things.

Neither menopause nor aging changes sexual desire of itself. Of far more relevance are the levels of activity before menopause, expectations of continuing activity, general state of health, and the presence of an. active partner. At midlife, a woman can find her partner has erection problems. She may be divorced, widowed, or otherwise on her own. Marriage to an older man carries a risk of early widowhood because men die five to seven years earlier than women. In some cases, and often cruelly, a woman can be abandoned by her spouse at midlife.

Sexual activity can improve after menopause if there have been troublesome periods, constant infections, or fears of unintended pregnancy. Self-pleasure (masturbation) is the natural outlet for women on their own. It is not unknown for a woman who has a selfish partner to become assertive and stop all activity if she perceives him as boorish and unloving. Could this new and feisty attitude be due to the effects of testosterone showing through?

According to one study, nearly half of the women involved said that they masturbated in their 50s. This fell to one-third at age 70 and over. Two-thirds of the men in their 50s masturbated; this fell to just under half at age 70 and over. Those having orgasms ranged from 83 percent of women in their 50s to 74 percent in their 70s and over. 91 percent of men had orgasms in their 50s; and 73 percent in their 70s and over.

Sex is like fine wine. It gets better with aging.

Exercise

If exercise is a loathsome thing
Dance, or frisk on a trampoline.

Apart from all the benefits of exercise already listed in this chapter, vigorous physical activity stimulates the production of endorphins. These are morphine-like compounds secreted by the brain. Endorphins are the body's natural pain-killers. They also provide sensations of a high, with enhanced self-image and self-esteem. Other benefits of exercise include:

Speeds up the metabolic rate for up to 24 hours afterwards.
Builds muscle which keeps bones strong and ligaments taut.
Burns fat for fuel and increases fat-burning efficiency.
Continues to burn extra calories after exercise stops.
Relieves symptoms of stress and can control depression.
Reduces the risk of heart disease and osteoporosis.
Relieves some symptoms of dysmenorrhea and PMS.
Tones up the skin and improves body outline.
Slows down the aging process.
Increases energy levels.

In short, if exercise could be bought and taken in tablet form like vitamin supplements, would you buy and consume it?

Fitness can be maintained by doing aerobic exercises for 20 minutes or more at least 3 times per week. The intensity of the activity should raise the heart rate to between 60 and 75 percent of the maximum heart rate. Average maximum heart rate is determined by taking 220 and subtracting present age. The target heart rate is the appropriate percentage of that rate. Women with a history of heart disease, who are over 45, or who are obese should not exceed 75 percent of their maximum heart rate. Consult a doctor before embarking upon an exercise program.

Warning! Avoid jumping, jogging, and bouncing if there is the slightest tendency to prolapse. "Jumping Jacks" can start urine leakage where none existed before. Bouncing adds nothing to the goals of aerobic exercise. It can overstretch the muscles and ligaments and hurt the knees. Try walking. Start slowly and gradually speed up the pace over a few weeks.

There has been so much emphasis on exercise that women who are disabled could feel dismayed. If confined to a wheelchair, or lying prone in bed, small weights can be lifted, stretching programs achieved, and isometric exercises accomplished.

One phenomenon of menopause is that many women believe they are now free of the physician's office. The risk of pregnancy is over, periods have ceased, all is well. And so it is. Keep in mind, however, that cancers and heart disease are to be guarded against after menopause. Regular mammograms, Pap smears, pelvic exams, breast screenings, and treadmill tests bring that greatest of all health benefits -- peace of mind.

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