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By
Dr David Delvin.
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THE
MENOPAUSE - MALE AND FEMALE
The word 'menopause' fills many people with unease - or even fear. But the
best way to deal with the menopause is to understand it.
In this article, we're going to look at two things: the MALE menopause and
the FEMALE one. First, let's deal with the blokes:
THE MALE
MENOPAUSE
So let's talk about males - briefly. Why 'briefly'? Because there is
actually no such thing as a 'male menopause'.
Are you surprised by this? After all, the newspapers talk glibly about men
having a 'menopause' - particularly if a 40-ish or 50-ish guy suddenly
goes off the rails and runs away with his secretary.
But in fact, the word 'menopause' actually means 'stopping
of the periods'. And - as you may have noticed - us chaps don't
have them!
A few doctors - notably those with lucrative private practices - have
tried to promote the idea that males have an 'andropause' -
meaning a time when male hormone levels fall off very suddenly. But in
reality, what happens with most guys is that their hormone levels decline
very, very gradually over several decades. So a man's hormone output is
most unlikely to drop off suddenly in his forties - unless somebody
castrates him. Fortunately, this is very rare!
THE FEMALE
MENOPAUSE
Now the FEMALE menopause is a totally different matter. Every woman must
expect that she will go through it at some time - usually between about 46
and 54.
HOW BAD IS IT?
Well,
the fact is that a surprising number of women sail through it with no real
problems at all. Others have a really rotten time. It's vitally important
for husbands, partners, families and friends to realise that if a woman is
having a difficult menopause, then life can really be hell for her. So she
needs all the sympathy and help and love that's going!
WHAT HAPPENS AT
THE MENOPAUSE?
OK, now let's just be clear about what actually happens at the menopause.
What goes on is this. The woman's output of female hormones drops off
quite suddenly - often dramatically! (In the case of a person who has an artificial
menopause - caused by having her ovaries removed surgically - the change
happens overnight.)
A major effect of this drop in hormones is that the woman's periods stop.
To find out how they should stop, please see the next section. Other
striking effects which may occur (and which may cause a lot of distress)
are:
Hot flushes (known to Americans as 'hot flashes')
Sweating attacks
Vaginal
dryness - which inevitably causes sexual discomfort.
These three symptoms can now be successfully treated - as we'll see in a
moment.
WHAT SHOULD
HAPPEN TO THE PERIODS?
But first, let's just explain what should happen to your periods - because
there's a lot of misunderstanding about this. Many women have grown up
with the idea that when you reach the menopause, you should expect
horrendously heavy menstruation or 'flooding'. This isn't so. Heavy
bleeding is abnormal, and usually indicates some other problem.
In fact the periods should finish in THREE ways:
1. They stop suddenly, and never return.
2. They get less and less in amount, and gradually stop.
3. They get further and further apart - and gradually stop.
Anything else needs checking out by your GP or gynaecologist. In
particular, bleeding which occurs AFTER your periods have stopped needs
urgent investigation.
PSYCHOLOGICAL/EMOTIONAL
PROBLEMS AT THE MENOPAUSE
Understandably, quite a few people do run into psychological problems at
the time of the menopause - particularly depression, anxiety and
stress-related illnesses.
These problems are often related to feelings that your reproductive life
is at an end (which is nearly always true), that your sex life is at an
end (which is complete nonsense!), and that you are less attractive (which
is unlikely to be the case). Naturally, women who are going through a
difficult menopause tend to worry that their partners will leave them.
They often fret that their children are now growing up and leaving the
home, and that they will lose touch with them (the 'Empty Nest Syndrome').
If you're having emotional problems, please don't hesitate to see your GP
and get some help. You may need medication - such as anti-depressants -
for a short while. DON'T bottle things up: do talk to your partner and
your friends about your feelings - and see a counsellor if necessary.
HORMONE
REPLACEMENT THERAPY (HRT)
HRT 'makes good' the deficiency in female hormones. It is
now used by hundreds of thousands of women to combat the symptoms of the
menopause, and particularly the three major symptoms mentioned above: hot
flushes, sweating attacks, and vaginal dryness.
But can I make one thing clear? It is idiotic to make sweeping
generalisations about HRT - because there are many different types of it.
In Britain at the moment, there are more than FIFTY HRT
preparations on the market!
So anything I say here about HRT is on a general guide - for more specific
information, please talk to your GP, gynaecologist, or Menopause Clinic.
In particular, please remember that there are some women who shouldn't
take the hormones - particularly those who have had cancer of the breast
or certain other cancers.
There are several different methods of giving HRT:
VAGINALLY.
Hormones given directly into the vagina - as creams or pessaries or rings
- will replace the missing female hormone called 'oestrogen' and defeat
vaginal dryness, thus making sex a lot more comfortable.
SKIN PATCHES
Hormone-containing skin patches can be used either on their own - or
combined with tablets. The point of using a skin patch is that the hormone
goes directly into the blood stream - without having to go through the
stomach and pass through the liver. This reduces the chance that the HRT
will cause nausea.
IMPLANTS
Not all that much used in the UK, these are little 'pellets' of hormone,
which are inserted under the skin through a small cut.
TABLETS
In the UK, this is still the commonest way of taking HRT. There are THREE
main categories of HRT tablet:
1. OESTROGEN-ONLY
HRT. Nowadays,
this should only be used by women who have had a hysterectomy - because of
the risk of causing womb cancer.
2. COMBINED
SEQUENTIAL HRT.
This type of treatment includes a second hormone - to protect the womb.
You will usually get a period every month.
3. COMBINED
CONTINUOUS HRT.
This treatment also contains two hormones. After the first few months,
you'll probably have no periods.
ADVANTAGES TO HRT
Quite apart from relieving menopausal symptoms, HRT has certain health
benefits. It helps ward off osteoporosis (thin bones - a common condition
which causes so many fractures). It may help protect you against heart
attacks and strokes. It seems to give a lot of women a feeling of
well-being - and many claim they look better too.
DISADVANTAGES OF
HRT
Like any other medication, HRT can cause side-effects, such as nausea,
tummy upsets and sometimes weight gain. Full details from your doctor or
clinic - or the leaflet in the pack.
More importantly, there is almost certainly a slightly increased chance of
breast cancer with most forms of HRT. And the type of HRT described above
as 'Oestrogen-Only' can sometimes cause cancer of the womb.
IMPORTANT NOTE: OUR KNOWLEDGE OF HRT IS CHANGING CONSTANTLY, AND
TODAY'S INFORMATION WILL SOON BE OUT OF DATE! FOR UP TO DATE INFORMATION,
YOU MUST RELY ON YOUR OWN DOCTOR OR CLINIC.
(MENOPAUSE
FIRST)
Q. I am 51, and my
doctor has suggested a test to see if I am menopausal. My symptoms are
tiredness - plus periods happening about every three weeks. How accurate
is the test - and what is involved?
A. It's just a simple blood test. The lab will check the level of
several female hormones in your blood sample - and then advise your doc as
to whether you seem to be going into the menopause or not. As you're still
having periods (though rather frequent ones), my guess is that you're not
yet very far advanced into the 'change'.
Q. I've been really
'down' ever since I reached the menopause 10 years ago. Will HRT cure my
depression?
A. Probably not, ma'am. But it may make you feel rather better in
yourself. However, depression usually requires treatment with
anti-depressants plus perhaps counselling.
Q. Does one take HRT
for LIFE? I'm 62, and I feel really great on it! Can I continue it into my
70s and beyond?
A. That isn't often done in the UK - though it is in America! I reckon
that you just need to see how things go. By the time you reach 70, we'll
know an awful lot more about the risks and benefits of HRT. Meantime, good
luck!
Q. I had my womb
removed some years ago. So can I take HRT with complete safety?
A. No: nothing in life is COMPLETELY safe. Obviously, the fact that
you've had a hysterectomy means that HRT can't give you womb cancer. But
there is a slightly increased risk of breast cancer - as mentioned above -
plus other possible side effects.
NON - MENOPAUSE
QUESTIONS & ANSWERS
Q. My husband had a
triple bypass 7 years ago, and since then has refused to consider
lovemaking. I guess he is nervous, but in fact while he was in hospital
the doctor told him he could resume. I think it has now become a 'mind'
matter rather than a physical one. Is this common? I feel very isolated
and rejected.
A. I'm sure you do, ma'am. I'm so sorry to hear about all this. It is
actually very possible that your husband has become impotent and - like so
many older males - doesn't dare tell his wife about it. I think you should
ask him about this.
If he IS suffering from impotence ('erectile dysfunction'), then it
would probably be quite easy to treat the problem - for instance, with
Viagra (which at the present moment is considered OK for guys who've had
by-passes).
Other than that, I can only suggest that you implore your husband to come
for counselling with you - to Relate or a sex problems clinic. I do hope
he'll agree, because it's quite unfair to leave you so frustrated and
rejected. Why should you be forced to go without sexual fulfillment?
Q. I'm a man of 68,
and I want to take up jogging. But my wife is worried that this could be
bad for the heart. What do you think, doc?
A. Jogging is generally BENEFICIAL for the heart. But I have to admit
that there is always a TINY risk of exercise provoking a heart attack.
Best thing is to see your GP, who can rapidly establish whether you would
be at any great risk if you go running.
And when you start jogging (as I expect you will), please make sure you
take it EASY to start with. Have a great time.
© 2000, 2001Dr David Delvin/Retirement
Matters Ltd. All rights reserved.
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