‘Change of life’ is emotional

VIEW ON HEALTH

Tracy Staverman really didn’t have a penchant for wine until a weekend course with girlfriends helped her realize the difference between a Merlot and a Cabernet. Inspired by this discovery, she took an impulsive girls trip to Sonoma, leaving her husband, their twin teenagers as well as her elderly mom to fend for themselves for the weekend. They were none too pleased but figured it was an overdue break for the 44-year-old retail manager.

Then Tracy followed up her interest by enrolling in a culinary program. Next, she started salsa dancing. And then the problems developed.

“Scott thought I had lost my mind, doing all these crazy things,” says Tracy of her spouse. “At first he was supportive of my new hobbies but then it started taking away from him and he resented that.”

This lament is not uncommon particularly for the partners of women in this age range. For however cliché it may appear, the period of mid-life for a woman is often the time when she reasserts her identity. An identity that often lies in quiescence while priorities like child rearing and work take precedence. Some professionals liken it to a woman shedding her skin often in the wake of trauma, sorrow and years of accumulated stress.

“The physical changes that occur in women as they get older do have a psychological impact,” says Jeannine Klein, a developmental and social psychologist and Professor of Aging at UNLV. “It’s not unusual for a woman to recognize that her life is changing. Perhaps her children are older or leaving the nest. Economically she may be more settled. Now is the time she can concentrate on herself. Hormonal changes that occur for women during midlife are closely tied to physical changes related to cessation of menses. While we know hormones play a role, we haven’t been able to eliminate other influences.”

Indeed, the period before the cessation of periods is not so well known or even discussed. Yet, it represents a transition time encompassing prime mid-life years and much subtler symptoms than menopause. Perimenopause has often been described as puberty in reserve due to the emotional and physical flux it creates. And this 10 to 15 years before menopause is called the perimenopause, or “before menopause.”

Daliah Wachs, M.D., or “Dr. Daliah” as she’s known to the listeners of her radio program, has addressed the changes that happen to women during the perimenopause period. “Weight gain, mood changes occur. Fluctuations in hormones can make one testy, more irritable, labile — (crying) easily,” says Wachs. “(I) reassure (them) that what they are going through is normal. I also have the husband, partner in the room to explain to them the changes that will happen since many women feel pressured by their partner that something is wrong with them, when perimenopausal symptoms are natural.”

PUBERTY TO MENOPAUSE

Long before a girl has her first menses or period, her body is gearing up for this transition from girl to woman. Estrogen, the primary hormone responsible for menstruation, can be likened to a bossy big sister barking orders to her younger sisters — progesterone, follicle stimulating hormone and luteinizing hormone. Estrogen’s dominance stimulates a cascade of hormones directing a young girl’s body to prepare her for potential motherhood by releasing a mature egg. When conception doesn’t occur, a girl has her period, shedding the uterine lining, and the body once again prepares itself in what will become a monthly cycle.

During a woman’s reproductive years, generally considered between the ages of 18 and 40, she usually marries, has her children and raises them. However, a funny thing happens around age 40. Subtle changes in her body chemistry begin to occur. Early on, most are undetectable, but as the years progress, generally between 40 and 50, a woman may notice her periods have become unpredictable or very heavy. She might also notice that her mood has changed, replaced with a sense of urgency, irritability or anxiety. Family or close friends might be surprised she’s taken up sports or is learning a second language. The woman might speak her mind more, dress differently or change jobs or relationships. All of this is “normal,” say experts, although the degrees to which these changes occur vary significantly.

Estrogen levels don’t fall appreciably until after the last menstrual period. What is often more likely to occur is estrogen dominance and too little progesterone during the perimenopause. Perimenopause can occur as early as age 35 and last for 10 to 15 years before menopause starts. Menopause is when all menstruation stops.

For 44-year-old Frankie Newmann, the transition from her “wild” 20s to her more tranquil 40s is filled with lots of stories but little regret. “I feel more hopeful like I could do anything if I set my mind to it,” she says. “I feel I can accept situations if they are irrelevant in my life and in my family or if things are likely not to change regardless of how I feel about the situation. Just make peace with it. It is what is and move ahead.”

Men and women both go through physical and emotional changes during their lifetimes but women’s lifecycles are biologically designed to be a little more complex. Couple that with cultural expectations and one has an environment ripe for volatility. Klein explains, “Our society, with a strong push from the media, places heavy emphasis on young, thin and beautiful. Crow’s feet and laugh lines are natural and beautiful reminders of how we’ve enjoyed life but how many mid-life women lament how ‘wrinkled’ they’ve become. We need to start letting women see that they are beautiful, perhaps even more beautiful with life experiences.”

One aspect of aging that appears to be affected is the libido. Ironically, many women report having an increased sex drive though hearing about decreased sexual desire is far more common.

Newmann explains, “I feel very sexy. I seem to have more sexual urges now.” She attributes her good figure and health to vegetarian living, exercising, no drinking and religiously buckling her seatbelt — habits she didn’t always have but has learned to appreciate as she has aged.

Tracy explains that she too has enjoyed a greater sexual desire that she attributes in part to impatience with waiting for everything to be “perfect” and that her body is fine just the way it is. With a hearty chuckle she says, “Life is too short to tip toe. I have become wiser and push to enjoy all life has to offer and appreciate friends and family more.”

Experts believe renewed libido is due in part to feeling protected from pregnancy. Though the prospect of pregnancy is diminished as a woman ages, she should not be cavalier about her chances of conception. Wachs says, “Women can get pregnant up until menopause (early 50’s). Birth control over age 40 may have risks but low dose birth control for individuals with no contraindications such as blood clots, smoking, liver disease, etc. are helpful. Bioidenticals are nice but usually gynecology manages those.”

As a woman’s body ages, however, there is a range of symptoms with which to contend. One is low libido which can occur in the 30s, says Wachs, as well as sexual dysfunction, bladder issues, depression, menstrual irregularities, hot flushes and mood swings.

Laura is a 42-year-old mother of six. “People laugh when I tell them I have six kids or tease my husband about how lucky he is but the truth is, I don’t always feel so in the mood. Sometimes I’m too tired and often I just don’t have the desire though I surely love him very much. Other than that, I’m very happy with my life right now. I’d like to have more free time though.”

For 46-year-old Dawn O’Neil, getting older means she works harder to keep weight off and has become increasingly cranky particularly around her period.

Dawn says, “When I was younger I didn’t suffer from PMS at all. As the years have gone on, the symptoms have appeared and it seems like the time frame grows much longer for having those symptoms every month. It’s also harder to keep my weight stable. I exercise more but I don’t seem to keep the weight off, particularly around my waist!”

According to the American College of Obstetricians and Gynecologists, many changes of perimenopause are related to the decrease in estrogen levels that can be treated with hormone therapy. Some changes are simply related to aging. On occasion mood changes including depression are due to a woman’s lower serotonin levels and can be treated with antidepressants as well as counseling. A healthy diet and regular exercise are also basics of good health for any age.

For 57-year-old Pamela, going through menopause was much easier than going through perimenopause. She recalls, “I remember thinking, ‘boy, I’ve really lost my mind. I was going through a divorce and opening my own business. It seemed perfectly reasonable to me at the time that that’s what needed to be done but looking back I could have been a little more diplomatic. But I don’t regret any of the decisions I made either.”

For many perimenopausal women, being unapologetic can stress relationships, particularly with partners.

Tracy’s husband, Scott, recalls a friend who got divorced when his middle-aged wife simply packed her bags and left the house. “He was in shock and I kept thinking that that could be Trac. She was doing all these new things too,” says Scott.

The truth is that Tracy, as most women in this situation, had no intentions of leaving her husband or upsetting her family. “I was just enjoying learning new things,” says Tracy. “I felt like now was a good time as any and I wasn’t getting any younger!”

Klein indicates that women today are part of the “sandwich generation” in which they’re dealing with raising their children empty nest syndrome as the kids move out, careers, attempting to plan their retirements, relationships and care giving for aging parents. This can cause more than its fair share of insecurity with family members particularly spouses.

“In my own research into women and aging, I’ve found this to be more like the ‘splintered generation’ because of the push-me/pull-me effect of all these life factors. You don’t just feel caught up in a triple-decker club sandwich you are seeing your life stretched almost to the breaking point and the recovery process ends up reknitting you into an even stronger individual.”

Socially when folks feel “invisible”, they sometimes create a visibility through their actions. Klein explains, “The big phenomenon right now is the cougar, a woman over 40 dating a much younger man. An AARP survey in fact found that more than a third of single women over 40 are dating much younger men.” Then there are social groups just for the aging female.

“Visibility of women has always been a social phenomenon but it becomes increasingly more an issue as we get older,” says Klein. “As we near the end of our reproductive years and nature catches up, we tend to get put back into the shadows. The Red Hat Society is one social group created just for women, specifically those over 50, to celebrate aging gracefully and have fun doing so. Their ubiquitous red hats were selected specifically to tweak the notion that women have to be ‘invisible’ as they get older.”

But for the millions of American women in the perimenopause period, there is great optimism and hope. Middle-aged women are joining gyms at twice the rate of male peers and enrolling in college full-time more often too. More adventure travelers are women in their 40’s. They’re less likely to be afraid of making changes and researchers are finding they’re even better at coping with past traumas to the degree they may finally be able to finally fight the demons of substance abuse more easily.

Psychoanalyst Carl Jung believed that middle age people outgrow all pretenses of who they are “supposed” to be and are more willing to take risks. As these individuals are also contending with death of parents or empty nests, they gain a sense of liberation that fuels an accelerated journey of self-realization.

But gaining liberation for the mid life woman often comes down to the basics and totally normal biology. While women may feel they’re becoming less desirable, the truth is middle aged women have much to be hopeful about and certainly statistics demonstrate they’ll live longer and more robustly.

It all comes down to basics, however, as Newmann says. “My family and friends mean more to me than they ever have. I make more time for them in my life and tell them I love them and how they make my life more fulfilling. They complete me.”