There are two important keys to dealing with menopause: a menopause kit and never sharing an office with “one of those skinny, young women who get cold all the time.”
That’s the advice of Willa Addison, a public health nurse with the Jackson County Health Department. Dr. Susan Kaarsberg’s advice was a little more direct. Talk to your doctor about estrogen therapy.” Many menopause symptoms can most easily be aided through the therapy, the doctor said, if your personal circumstances are right.
The two ladies presented a lecture entitled “Ima Hottie and the Seven Dwarves of Menopause” last month at the Women’s Health Conference at John A. Logan College. It’s a speech Willa has been refining for years, along with her personal menopause kit, a duffel bag full of tools for combating the symptoms of menopause.
The dwarves of menopause are not the friendly happy dwarves that rescued Snow White. Instead, of Dopey and Doc, the menopause dwarves are: Itchy, Bitchy, Leaky, Sleepy, Weepy, Forgetful and Sexy. Yes, Sexy.
Willa said that she wears the uniform of menopausal women, a sleeveless shell and loose over shirt that can be shed when necessary. “Thankfully, we live in a time when we can talk about menopause, not whisper with other women about ‘The Change’.”
The most common symptom of menopause is hot flashes. Some women, almost half of the women who have hot flashes, report them as being mild, a bit of discomfort with no sweating. “I don’t know any of those women,” Willa said. But the other half reports their symptoms as either moderate or severe. For those with severe hot flashes, the sudden sweats and rising body temperature are so bad that women must temporarily stop what they are doing.
So, from the kit, comes the fan. Always have a fan and don’t room with little skinny young people,” Willa recommended. And, a cool rag to wash the face and pressure points can help. And, reducing smoking, caffeine and spicy foods can help prevent hot flashes.
Dr. Susan explained that doctors are on the fence about whether estrogen therapy is a good or bad thing. Studies have pointed both ways, so any decision to start estrogen therapy needs to be thoroughly discussed with your personal doctor based on medical and family histories and severity of symptoms.
“There is nothing else that will help like estrogen, but there are risks, so you need to discuss those with your doctor,” she said. “In menopause, the ovaries have given out and estrogen production has ceased. Other options include hydration and exercise and some of the newer anti-depressants are showing to have some success in fighting the symptoms of menopause.”
Dr. Susan said homeopathic remedies including soy and black cohosh have their own risks. Soy mimics estrogen and has similar risks, and black cohosh, which has had questionable success, has been associated with liver damage, she said.
After their enlightening and sometimes humorous introduction of Ima Hottie, Willa and Dr. Susan went to work introducing the dwarves.
Itchy is a result of the drying of the skin, membranes and pretty much every part of the body. “Menopause even affects your eyes. Who knew?” Willa asked, drawing a huge bottle of lotion from her menopause kit, and recommending that women hydrate, hydrate, hydrate.
And, Dr. Susan added, use lubricant. With the loss of estrogen, women are facing lower sex drives anyway and those who overcome the lower sex drive may find sex is uncomfortable due to the lack of moisture. “Slather it on,” the doctor said, saying that lubricant can help keep sex enjoyable for menopausal women.
The Bitchy dwarf is the mood swings that come with menopause, the “inappropriate reaction” to events, irritability and a resurfacing of old issues. Willa said recent research has shown that emotional and mental stressor women believed were long since dealt with pop back to the surface during menopause and it is not uncommon for women to be “so mad I’m shaking.”
And, most women do not realize how bad it is, Dr. Susan said. Estrogen supplements and anti-depressants can help with the mild depression that often accompanies menopause, but some women face severe depression. Women need to realize that the symptom is normal and report it to their doctors, so they can discuss solutions.
Leaky is less directly related to the onset of menopause and more related to aging and the natural functions of the female body. “Age starts the body sagging and childbirth stretches us and all of that leads to leaking,” Willa said. Leaky dwarf tells us she “hasn’t had this many damp panties since I was 2.”
And those damp panties can lead to infections, Willa added.
The best answer, Dr. Susan said, is kegel exercises. To do kegel exercises, women sitting erect would try to tense their stomach muscles, drawing them toward the spine. Then, she should flex her muscles in a manner consistent with stopping the flow of urine. And, they should do it about 200 times a day to prevent leakage, she said.
“I have a male colleague who said why aren’t more women aware of this. It is such a good thing for all women,” Dr. Susan said. “So I asked him, have you tried it?”
The exercise can be done almost anywhere, but it isn’t easy and it has to be done daily to be effective, she said. Skip one day and it’s back to the beginning, she said.
Women also need to be able to differentiate a leaky bladder from an overactive one, she said. An overactive bladder needs medical attention. An overactive bladder can most easily by identified as an uncontrollable urgency, sometimes triggered by specific events, like putting a key in the door. Medication is available to help people with overactive bladders, she said.
Sleepy Dwarf is in large part a side effect of Ima Hottie and those hot flashes. More than 70 percent of women in menopause reported losing sleep at least one night a week, largely due to night sweats and hot flashes. Many women also develop restless leg syndrome and sleep apnea, Willa said.
The key to overcoming sleep issues is to use bedrooms for sleep and sex only, Dr. Susan said. Reading, watching television and other activities should be kept elsewhere. And, after 15 minutes of trying to sleep, women should get p and do something else rather than just continuing to toss and turn, she said.
“A lot of people are embarrassed by crying,” Willa said, which is a problem with Weepy dwarf. This little bugger sneaks up on you, she said, making you cry when all you really want to do is scream. Women in menopause should simply cry without apology, she recommended, and carry a hanky in the menopause kit.
The weeping is another expression of depression, Dr. Susan said. “When you can’t explain it, when it’s overwhelming, talk to your doctor,” she said.
The most frustrating of the dwarves, personally, Willa said, is forgetful. This can be devastating to women who are accustomed to overachieving. Multitasking becomes impossible, you lose the ability to prioritize, have trouble concentrating, space out more, have trouble remembering names and words that you want to use, and even have more difficulty explaining basic ideas, Willa said.
“This is one of the symptoms where estrogen is not as useful. Current studies indicate it might even exacerbate memory loss and early onset Alzheimer’s,” Dr. Susan said. Instead, women should do things to stimulate their brains, make lists, do crossword puzzles, and even consider the new video games designed to stimulate the brain.
And the most important thing not to let forgetful take away, Willa said, is the knowledge that menopause does not mean the end of you. Sexy dwarf tells us “If you had a good sex life before menopause, you can have a good sex life after menopause.”
As we have been told for years, most of the important impulses for sex drive come from between the ears, she said, and we simply need to take into account the physical changes in our bodies.
“I’ve been waiting my entire life for something on me to thin and it’s my vagina,” Willa joked. Seriously though, the thinner lining of vagina can make sex uncomfortable and mean women need more outside lubrication.
“They say if you don’t use it, you lose it,” Dr. Susan said, “And it’s true. It may be uncomfortable the first time you have intercourse, but the more you use it, the more comfortable it will be.”
Women who may be close to menopause should know there terms:
Pre or peri-menopause the period up to 10 years long before the beginning of menopause. Many symptoms including hot flashes can begin in peri-menopause.
Menopause occurs when the body goes one year without a menstrual cycle. This can be surgically induced by a total hysterectomy.
Post-menopause is the rest of your life afterwards.
Women who have had a menstrual cycle within the last year are still biologically able to become pregnant, even though they may be skipping monthly periods.
The average age for menopause is 52.
