How can a woman cope with stress during menopause?

Answer 1

The term ‘menopause’ literally means the last menstrual period. The time leading up to this last period is referred to as the climacteric or peri-menopause and the time following menopause is referred to as post-menopause. However, the term ‘menopause’ is commonly used to refer to the time around the last period (both before and after). In this factsheet, we have endeavoured to use the terms most appropriate but do also refer to menopause in this general sense when suitable to do so.

Menopause is a normal event in life, characterised by hormonal changes, and in this way, is similar to life’s other significant hormone-related event, menarche (first period). It typically occurs in ‘mid-life’, between the late 40s and early 50s. Women who smoke tend to experience menopause around two years earlier than non-smokers.

With an average female life expectancy of 82, menopause signals the start of a life stage that may span 30 or more years. Rather than the beginning of old age, as it is sometimes presented, menopause is the beginning of a new phase in a woman's life that will bring different expectations, opportunities and experiences.

Premature and surgical/medical menopause
If menopause occurs before the age of 40 it is said to be early or premature. Approximately 1% of Australian women commence menopause prematurely (1). Premature menopause may be particularly distressing for younger women, especially if it impacts on their plans to have children. Because it is uncommon, symptoms may initially not be acknowledged as being menopausal.

Menopause can also be induced by either surgery (removal of the ovaries) or medical treatments like radiotherapy or chemotherapy. This type of menopause is usually referred to as surgical/medical or artificial menopause and is generally immediate with more severe symptoms.

What happens to my body at menopause?
The experience of menopause varies widely from woman to woman and from culture to culture. All women, however, undergo the same basic hormonal changes during menopause. A woman’s ovaries produce three types of hormones - oestrogen, progesterone and testosterone. These hormones play a vital role in menstruation, ovulation and pregnancy. During the peri-menopause, the ovaries' production of these hormones diminishes. This process is usually gradual, taking a number of years (unless the ovaries are surgically removed or affected by radiation or chemotherapy). The adrenal glands and fat cells continue to produce testosterone and a form of oestrogen in small amounts.

The degree to which each woman’s body responds to these normal hormonal changes varies.

25% of women do not have any problems with menopause and manage the transition without assistance
50% of women experience some menopausal symptoms, varying from mild to moderate
25% of women have more severe problems (2).
It is important to recognise that not all symptoms that women experience at this stage in life are related to menopause. Some are just part of the normal ageing process. Common menopausal symptoms include:

Hot flushes and night sweats – Hot flushes are characterised by feelings of heat that spread to the chest, neck, face or even the whole body and may be accompanied by sweating, nausea, heart palpitations, and flushed skin (3). When hot flushes occur at night they are referred to as night sweats. They can last anywhere from 30 seconds to five minutes or occasionally longer. Some women may only experience them infrequently but others may have many each day. Hot flushes and night sweats can be aggravated by stress, anxiety, alcohol, hot food and drinks, spicy foods, overdressing and a hot environment. Hot flushes and night sweats are thought to be caused by hormonal changes occurring at menopause.

Menstrual irregularities – Many peri-menopause women find that their menstrual cycle and/or flow changes. Some women will experience very irregular periods that stop and start with no apparent pattern. It is also common for women to get heavier, lighter or longer periods at this time. Women should note, however, that irregular bleeding can sometimes be a symptom of gynaecological cancers. Women experiencing irregularities may wish to consult their doctor in order to ensure the irregularities are menopause related.

Sleep disturbances – These are generally caused by night sweats with women often finding they are constantly adjusting their bedclothes to suit their body temperature. They may also have to get up and change their clothing or bedclothes following a night sweat. All of these interruptions can leave a woman feeling fatigued the next day. Some women also experience wakefulness without flushes and difficulty in getting back to sleep.

Genital changes - It appears that oestrogen plays a significant role in maintaining healthy vaginal tissue. The reduction in oestrogen levels at menopause can cause thinning of the vagina tissue and vaginal dryness. A woman may find penetrative sex painful due to the lack of lubrication and reduced elasticity of the vaginal walls. Changes in the vagina’s pH level (which keeps naturally occurring bacteria in balance) can also occur, resulting in bacterial infections (4). Women may also notice a decrease in fatty tissue in the vulva (ie. labia, clitoris and mons pubis, the mound covering the pubic bone).

Urinary problems – Changes in the vagina, urethra and bladder at menopause can make women more susceptible to urinary tract infections. Symptoms of a urinary tract infection include painful and frequent urination, feeling a need to urinate when the bladder is empty and a strong or unpleasant odour to the urine. The drop in oestrogen levels can aggravate existing pelvic floor muscle weakness resulting in incontinence problems.

Joint/muscle aches and pain – Peri-menopausal women may have morning stiffness and joint pains in the hands, knees, hips, lower back and shoulders. This symptom is commonly reported in menopausal women in Asia. The drop in oestrogen may be a contributing factor but the reasons for why this increases joint/muscle aches and pain are unclear.

Skin/hair changes –With age, our skin becomes thinner and less elastic. These changes are accentuated at menopause as oestrogen appears to play an important role in maintaining the skin. Women may notice a change in the skin’s texture and tone and an increase in the appearance of lines. They may also find their skin is dryer or oilier than before, or a combination of both. Some women report a crawling sensation which is similar to ants running over the skin. This is called formication and while its exact cause is unknown it appears related to changes at menopause. Women may experience an increase in facial hair and thinning of hair on the scalp, related to a change in balance between oestrogen and the male hormone testosterone. Thinning of the pubic hair can also take place.

Others – There are a number of other symptoms commonly attributed to menopause including depression, forgetfulness, anxiety, irritability or other mood changes and weight gain. Whether depression is directly associated with menopause is still a subject of controversy. However, it does appear that some women may find the menopause transition (like other transitions such as puberty and pregnancy/childbirth) increases their vulnerability to developing depression. Menopausal symptoms such as hot flushes and night sweats and related sleep disturbances may result in some women experiencing forgetfulness, mild anxiety, irritability and mood changes. Weight gain is not actually associated with menopause but rather with a natural decrease in metabolic rate that occurs with age and a more sedentary lifestyle (5). Menopause does, however, appear to be associated with a redistribution of weight from the hip and thigh area to the abdominal area.

Post-menopausal women have an increased risk of a number of health conditions, in particular osteoporosis and cardiovascular disease, because of the inherent hormonal changes.

Osteoporosis – This is a condition characterised by the loss of bone density resulting in fragile bones that are at risk of fracture. A woman’s bones generally reach their peak bone mass by her mid-20s, dependent on factors such as genetic disposition (ie family history), diet, calcium availability and exercise. After the age of about 35, the natural process of bone reabsorption becomes greater than bone formation, resulting in net bone loss. At menopause, this bone loss is accelerated due to the reduction in oestrogen (thought to play a significant role in slowing down the process of bone reabsorption). The highest bone loss occurs immediately after menopause for 5-10 years.

It may be useful to think of bone mass functioning like a bank. If there is a good initial deposit of bone (peak bone mass), then there will be more bone from which withdrawals (bone loss) can be made. If a woman does not achieve an adequate peak bone mass and/or does not maintain strong bones throughout her life (by eating a calcium rich diet and participating in weight-bearing exercise) she is at risk of osteoporosis. Women who think they may be at risk of osteoporosis can have a bone density test. Dual energy x-ray absorptiometry (DEXA) is the most accurate way of measuring bone density.

Cardiovascular disease – The oestrogen produced by the body protects women from cardiovascular disease by increasing HDL levels (‘good’ cholesterol) and lowering LDL levels (‘bad’ cholesterol) as well as increasing the flow of blood through the body. The drop in oestrogen levels that occurs with menopause, therefore, is thought to contribute to an increased incidence of cardiovascular disease in post-menopausal women. Lower levels of oestrogen, however, are not the sole cause of cardiovascular disease. Other contributing factors include a family history of cardiovascular disease, smoking, excess weight, sedentary lifestyle, high blood pressure, diabetes and stress (6).

What cultural, social and emotional factors influence menopause?
A woman’s experience of menopause is influenced not only by her own personal emotions and attitudes but also by wider factors such as the role and status of women in society. Understanding how all these factors interrelate and impact on menopause can assist women to come to terms with changes occurring at midlife.

In some non-Western cultures, menopausal women generally do not report suffering from common symptoms such as hot flushes. It has been suggested that these differences could be related to dietary patterns. Other explanations are that in these cultures older women’s contributions receive more recognition and ageing is regarded more positively. Conversely, women in these cultures may not be able to discuss topics such as menopause as openly as in Western cultures.

In our society, ageing, especially in women, is not always valued and there is pressure on older women to maintain a youthful appearance. Representations of older women are limited and when they do occur they are often negative or stereotypical. This can all impact on how a woman perceives and experiences menopause.

While some women report feeling greatly relieved to cease menstruating, others report a sense of loss. For women who saw menstruation as a symbol of femininity and womanliness, its end may lead them to question their female identity. Other women may find it difficult to accept the loss of reproductive ability. Even for women who have made a well considered decision not to have children (or more children), the loss of the capability and option may trigger feelings of sadness.

Women may also find menopause a time to reflect on the past. They may look at their past and present relationships, choices about children and work satisfaction. Some may experience regrets about certain decisions or unfulfilled dreams. Reflecting on past events and exploring choices made throughout life can prove difficult for some women.

A range of other life circumstances often occurring at midlife can impact on menopause. For women whose focus has been on family, adult children leaving home can result in feelings of emptiness and a loss of purpose. Conversely, adult children remaining at home or returning to live in the family home can be a significant source of tension. Women at this age more also be responsible for caring for elderly relatives or experience the loss of loved ones. Long term health problems like diabetes, high blood pressure, high LDL cholesterol and arthritis can all arise at this time.

Taking positive action
There are a number of strategies that can assist women to achieve a smoother transition through menopause. As with all stages of life, following a healthy diet and exercising regularly will improve physical health and promote feelings of wellbeing. Women can:

Eat a well balanced diet - Metabolism slows with age which means a woman needs to eat less kilojoules or participate in more physical activity to avoid putting on weight. A well balanced diet, combined with regular exercise (see below) will assist women in maintaining a healthy weight. Women can include low fat, high fibre foods rich in phytoestrogens and calcium. Phytoestrogens are naturally occurring compounds found in plants that are similar to the female hormone oestrogen (7). Foods rich in phytoestrogens (eg. soy, soy products and linseed) may assist in relieving hot flushes. Maintaining an adequate calcium intake will help to slow bone loss. Women up to the age of 54 require 800mg of calcium daily, while women aged 55 and over need
1 000mg a day (8). Women should also ensure they get adequate amounts of Vitamin D which assists in the absorption of calcium. Most women should achieve sufficient amounts of Vitamin D through normal, safe sun exposure.

Exercise regularly - Regular, weight-bearing exercise (exercise which is done on the feet such as walking, jogging, dancing) can help slow bone loss. Aerobic exercise (exercise which increases the heart rate) is required for cardiovascular health, and strength and flexibility exercises are useful in maintaining muscle tone and keeping the body’s joints, ligaments, muscles and tendons mobile. Exercise has also been found to reduce stress and depression, improve sleep and assist in maintaining a healthy weight.

Stress management – Stress management strategies are beneficial at menopause as stress can interfere with the proper functioning of the adrenal glands. The adrenal glands assist in the production of oestrogen after menopause so it is important they work effectively. Activities as yoga, relaxation and/or meditation, Tai chi and regular exercise are good examples of stress management strategies. They all help relieve built-up tension and have a calming effect on the mind.

Making sex comfortable - If dryness and thinning of the vaginal tissue has made penetrative sex uncomfortable, a water based lubricant such as KY jelly or even saliva can be helpful. Other strategies such as taking more time, using massage and sexual aids and including sexual activities which are not focused on penetration can also be helpful. Local hormone replacement therapy (in the form of a cream or pessary placed in the vagina) can also assist (see HRT section).

Pelvic floor exercises – These exercises strengthen the pelvic floor and can assist women who experience stress incontinence. Stress incontinence is characterised by the leaking of a small amount of urine with exertion (eg. while coughing, sneezing, laughing, lifting heavy objects or during physical activity). The exercises are designed to work three different parts of the pelvic floor muscles: the muscles that control urine flow; the muscles that control the anal sphincter (muscles around the anus); and the muscles that surround the urethra and vagina. As some women have difficulty locating the appropriate muscles and performing the exercises correctly, seeking assistance from a health care provider (eg. physiotherapist) to learn the correct techniques is often recommended.

Trial alternative therapies – A number of ‘alternatives’ are said to be beneficial for relieving menopausal symptoms, particularly hot flushes. Alternatives commonly used by women include dietary phytoestrogens, phytoestrogen supplements, natural progesterone, wild yam creams and herbal medicine. It should be noted though that, scientific studies supporting the effectiveness of these alternatives in menopause are currently limited. For more information, refer to our Alternatives to HRT factsheet.

Trial HRT – Women who experience moderate to severe menopausal symptoms may wish to trial hormone replacement therapy (HRT). HRT is an effective short-term treatment for menopausal symptoms like hot flushes, night sweats and vaginal dryness. HRT should not be prescribed for the prevention of disease (eg. cardiovascular disease). Women trying to decide whether to take HRT need to discuss their individual risks and benefits with their doctor. Women taking HRT should review this with their doctor annually.

Give up smoking – Smokers are more likely to experience menopausal symptoms than non-smokers. Smoking increases the chances of hot flushes and night sweats, menstrual irregularities, ageing of the skin as well as cardiovascular disease, osteoporosis, lung problems and cancer. Women looking to quit smoking can use a number of strategies to help them succeed including nicotine replacement products, support from a health practitioner, family and friends, alternative therapies and/or a quit smoking program.

With appropriate support and chosen strategies to assist, menopause can be positively as a transitional time, offering opportunities for challenges, rewards and greater personal growth.

Answer 2

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Answer 3

OH DEAR I AM HAVING LOTS OF PROBLEMS WITH THIS PMS THING. WHAT I AM DOING TO RELEIVE ALL THESE STRESS IS...I DO WALK 30 MINS. EVERYDAY, I LOOK THINGS POSITIVELY IN FACT, WHAT I WANT IS HAPPY SUBJECTS AND WE HAVE TO SMILE AND LAUGH THATS THE REMEDY.
YOU CAN PING ME AT pea_1208 my yahoo messenger i will tell you more

Answer 4

I suffer from severe PMS, not exactly PMDD, and I take 200 mg of Zoloft and 150 mg of Wellbutrin everyday, and it keeps me sane 24/7. I am looking forward to menopause, because it can't be worse -- I hope!

Answer 5

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Answer 6

i have a magnet on my fridge, which is my motto, since i'm only 32 and in surgical menopause....."i used to care, now i take a pill for that"

Answer 7

I went on a low dose of zoloft to help take the edge off. Also cut back on caffiene, drink lots of water, and try to get excersise. If all else falls.....just SCREAM!!!! good luck :)

Answer 8

meditation
yoga
spending a lot of time with your choice of nature - place - like the woods / castles / beach / canyon - teke your pic.