Overview | Facts and Information | Key Terms | Credible Sources of Information | Strategies for Evaluating Websites for Credibility14, 16 | References and Resources | Team Member Bios This site provides detailed information regarding menopause and aging. It has been created in part to enhance the Western Illinois University first annual Women's Health Fair.

Overview

Aging and menopause are extremely important processes in life that all women most go through. During this time many physical and psychological changes occur. Many women experience a loss in appetite, sexual drive, energy, hot flashes, as well as mental health issues.1 This webpage is designed to help women acquire knowledge and understanding of the changes that transpire during this time.

Through the use of humor, in this clip women discuss the physical and mental changes that take place during the aging process.




Facts and Information

Menopause is a mental and physical change that women experience mid-life. Women experience these changes differently and onset can occur at varying ages.

Menopause- Menopause is defined as the final menstruation period. When a women has lived twelve consecutive months without experiencing a menstrual cycle, she has undergone Menopause. Most women experience menopause between ages 40 and 60.
Perimenopause- The transitional phase prior to Menopause. During this time, women begin to experience bodily changes associated with the onset of Menopause. This stage may last several years.
Postmenopause- All the time after Menopause- the time after a woman's last period, when her ovaries are no longer active.

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Body changes related to Menopause and Aging

Changes in hormone levels8

  • Levels of estrogen, progesterone and testosterone change during perimenopause and menopause.
  • Estrogen promotes the growth and health of the female reproductive system.
    • Typically, estrogen levels decline during perimenopause
    • This decline occurs irregularly
    • Some women may increase a temporary increase in estrogen level

The table below provides information on these hormones and details the possible symptoms resulting from changes in hormone levels.





Estrogen
Progesterone
Testosterone
What does this hormone do?
  • Stimulates growth of breast tissue
  • Maintains vaginal blood flow and lubrication
  • Causes lining of the uterus to thicken during the menstrual cycle
  • Keeps vaginal lining elastic
  • Many other functions, including preserving bone
Prepares lining of the uterus for a fertilized egg and helps maintain early pregnancy
Although known as the “male” hormone, testosterone is also important to a woman's sexual health:
  • Plays a key role in a woman's estrogen production
  • Contributes to libido
  • May help maintain bone and muscle mass
How do menopause
and age affect this hormone?
During perimenopause, levels fluctuate and become unpredictable. Eventually, production falls to a very low level.
Production stops during menstrual cycles when there is no ovulation and after final menstrual period
  • Levels peak in a woman’s 20s and decline slowly thereafter. By menopause, level is at half of its peak.
  • Ovaries continue to make testosterone even after estrogen production stops
  • Testosterone production from adrenal glands also declines with aging
    but continues after menopause
What symptoms may result
from changes in hormone level?
  • High levels can result in bloating, breast tenderness, heavy bleeding
  • Low levels can result in hot flashes, night sweats, palpitations, headaches, insomnia, fatigue, bone loss, vaginal dryness
Lack of progesterone can cause periods to become irregular, heavier, and longer during perimenopause
Effects of testosterone decline are uncertain
*This table was adapted from information found at the North American menopause Association webpage.

Changes in the Genital Area

Shifting hormone levels may cause changes in the vagina.8
These changes include:
  • dryness in vaginal tissues
  • thinning of vaginal tissues
  • reduction in elasticity of vaginal tissues
  • inflammation
  • redness
  • itching
  • pain
If these changes become bothersome or persistent, they may be the result of a more serious condition; Atrophic Vaginitis, or Vulovanginal Atrophy.8 These conditions may occur in the early stages of perimenopause, or after several years of reduced estrogen levels. Many women who experience this may choose to take estrogen therapy to help offset unpleasantness.

Body Changes1,8


menopause-signs.gif
click on the following for more information on going through "The Change".

  1. Loss of muscle tone- Estrogen helps maintain muscle tone. As estrogen levels decline, muscle tone decreases.
  2. Pelvic relaxation- Muscles in the pelvic area may loose tone, and the uterus, bladder and bowel wall may sag. Mild relaxation should have little or no noticeable symptoms. More serious cases will have noticeable symptoms requiring medical attention.
    • Factors that may contribute to development of pelvic relaxation include:
      • vaginal childbirth
      • multiple births
      • giving birth to large babies
      • obesity
      • chronic cough
      • chronic constipation
      • heavy lifting
    • Symptoms of pelvic relaxation:
      • Feelings of pain or pressure in the vagina, abdomen or lower back
      • Bladder control problems
      • Increased urinary tract infections
      • Increased difficulty with bowel movements
  3. Changes in breast tissue- Decrease in density of breast tissue are common.
  4. Skin changes- Loss of collagen due to reduction in estrogen may cause a decrease in thickness and elasticity. During this time, women may notice slight sags or wrinkles, and an increase in dryness. Some women may develop acne in periomenopause.
  5. Hair changes- Women may experience an increase or decrease of hair. Some women report hair in places that they did not previously notice hair; such as the face or chin. Others report thinning hair.
  6. Changes in weight and fat distribution- Menopause may play a role in changes of body shape; specifically retention of weight around the mid-section. While Menopause may play a role, age and lifestyle are the main cause of weight gain. Metabolism slows with age, and women tend to become less physically active with age, begining in their 40's and 50's.
  7. Hot Flashes- Temporary sensations of heat, especially in the upper body, and flushing. Hot flashes are usually relatively short in length, but occur at random intervals throughout perimenopause. Hot flashes may be experienced for a length of six months to five years or longer.
  8. Night Sweats- When hot flashes occur at night, they are often accompanied by excessive perspiration. These periods of heat and sweating during sleep are referred to as night sweats.

These body changes affect sexuality. Negatively interpreted changes in body size and shape can lead to reduced self esteem or self image. Hormonal changes may lead to loss of sex drive, while physical changes may make sex painful or less satisfying.

Sexual Problems Associated with Menopause/Midlife8,6

Women may experience the following symptoms during Perimenopause or Menopause related to their sexuality:
  • Decrease in desire
    • As hormone levels change, sex drive is altered. Most men and women report a decrease in desire with age.
  • Decrease in arousal
    • Vaginal changes and hormonal changes often affect arousal.
  • Decrease in response level or satisfaction
    • Vaginal changes may make tissues less sensitive, leading to a reduction in satisfaction from stimulation.
  • Pain with intercourse
    • Vaginal changes including loss of elasticity of vaginal tissues and decrease in lubrication may may intercourse difficult or painful.

Sex and Menopause/Midlife

This video briefly explains what occurs to the body during menopause and why sex becomes unpleasent to some women during this time.

Reproduction and Menopause

human-reproduction-female.gif
Click on the following picture for more information on how the female reproductive system works

Sexual reproduction is the means by which humans produce new offspring. Reproduction occurs via fertilization when an egg and a sperm fuse to create a gamete. In order for fertilization to take place, a process called ovulation has to occur. During this process, a follicle matures and expels its egg in the ovary. From the ovary, the egg travels through the oviduct where it fuses with a sperm to form a zygote.2,3

During menopause, women cease to ovulate, and their menstruation cycle stops. Hormones that are necessary for pregnancy are not stimulated. Ovaries no longer respond to follicle stimulation and luteinizing hormones. In order to get pregnant the task is not an easy one, but it is not impossible. Due to technological advances pregnancy is now possible for women after they have gone through menopause. The following are ways to make pregnancy possible in postmenopausal women if they which to become pregnant:
In vitro fertilization (IVF): Is the process by which the ova are removed from the ovary before normal ovulation occurs. A woman’s egg and her partner’s sperm are placed in a healthy medium that promotes fertilization for a specific time period. Once that period of time is up, the egg is then placed in another medium which promotes development. The egg is evaluated for development, if it is determined that the development process is on task then the egg is placed in the woman’s uterus by using a hollow tube which is inserted into the vagina and cervix.2,3

Gamete intrafallopian transfer (GIFT): This is an extremely efficient procedure and cost-effective. During GIFT the sperm and eggs are implanted into the fallopian tubes. This process allows the egg to finish the division process within the fallopian tubes. It is important to keep in mind that GIFT is a more invasive procedure than IVF.
Zygote intrafallopian transfer (ZIFT): During ZIFT the egg and the sperm are placed in test tube for the fertilization process. Complete fertilization does not occur within the test tube. The egg and sperm are removed at an early stage and implanted in the fallopian tube. The continuation of cell division occurs as the egg and sperm travel down the fallopian tube and are natural implanted in the woman’s uterus. 2

The following video details the story of three women which have made the decision to become pregnant later in life through the use of IVF.


Interventions

Relief for Vaginal Discomfort8
There are many methods available for women who experience vaginal pain, dryness and discomfort. As the genital area changes with age and during Perimenopause and Menopause, many women will experience pain or irritations, especially with intercourse. The use of lubricants, moisturizers and low-dose vaginal estrogen applications will often help alleviate these symptoms.1206661_25957521.jpg

  • Lubricants- Vaginal lubricants work by reducing the friction associated with thin, dry genital tissue. They are applied to the vagina and vulva before sex. Lubricants are not absorbed into the skin, and provide temporary relief from vaginal dryness and related pain during sex. Women who only experience vaginal dryness during sex may consider using lubricants. Lubricants can be water-based, silicone-based, or oil-based.
  • Moisturizers- Vaginal moisturizers reduce friction that sex can cause as a result of vaginal atrophy. Moisturizers are absorbed into the skin and cling to the vaginal lining in a way that is similar to natural secretions. Moisturizers are applied regularly, not just before sex, and their effects typically last a few days. Moisturizers maintain vaginal moisture and acidity, they are particularly appropriate for midlife women who are bothered by symptoms of vaginal dryness outside of sexual activity. Women who regularly use moisturizers may still choose to use lubricant before sex.
  • Low-dose Vaginal Estrogen Applications- Estrogen products designed for vaginal application effect estrogen levels in the genital area only, and restore vaginal blood flow and improve the thickness and stretchiness of vaginal tissue. These products act to reverse the thinning and dryness of vaginal tissues rather than just providing the temporary relief that lubricants and moisturizers do. Low-dose vaginal estrogen is appropriate peri- and postmenopausal women who do not get sufficient relief from moisturizers or lubricants. Vaginal estrogen may be applied using a cream, vaginal ring or tablet placed inside the vagina. Each form has similar effects, and all have very low incidence of unpleasant side effects.

Hormone Therapy1,8
Hormone therapy that effects hormone levels throughout the body may be appropriate for those who do not receive sufficient relief from lubricants, moisturizers and vaginal applications of estrogen, or for those who experience other unpleasant symptoms of menopause, such as night sweats or hot flashes.

Hormone therapy can be taken in the form of a pill (ingested), through the skin (patches or creams), or through use of a vaginal ring.


Hormone therapy products contain either estrogen alone or estrogen and progesterone.
  • Estrogen alone is used only for postmenopausal women who have had a hysterectomy (surgery to remove the uterus) because taking estrogen by itself raises the risk of uterine cancer.
  • Adding progesterone protects against the risk of uterine cancer, so estrogen/progesterone therapy is used for postmenopausal women who still have their uterus.

Mental Health and Menopause


As stated earlier, menopause occurs over multiple years and because of this some women will be facing physical and emotional changes throughout several years, until they finally reach menopause. The fluctuation of the physical and emotional changes may create mental health issues that should be assessed and treated.12

Mental Health Issues Include:


  • Depression
  • Mood stability
  • Increased Stress Level
  • Low Self-Esteem
  • Anxiety
  • Anger
  • Irritability

Menopause and Mood Changes:


Women may experience a wide range of feelings, from anxiety and discomfort to release and relief, upon menopause. Most adapt to the changes and continue to live well and remain healthy through these transitions.

The most prevalent mental health disorder associated with menopause is depression. This heightened prevalence is associated with the woman’s loss of their ability to bear children.

Symptoms13



The symptoms of depression in menopause are:
  • Two or more weeks of depressed mood,
  • Decreased interest or pleasure in activities,
  • Change in appetite,
  • Change in sleep patterns,
  • Fatigue or loss of energy,
  • Difficulty concentrating,
  • Excessive feeling of guilt or worthlessness,
  • Thoughts of suicide,
  • Extreme restlessness and irritability
Many women will find diagnosing depression during menopause to be difficult on their own because many symptoms of menopause overlap with symptoms of depression including problems with sleep, physical symptoms such as hot flashes, fatigue, irritability, anxiety and difficulty concentrating.
Depression should not be dismissed as a normal consequence of later life for women!

Treatment13

There are several treatment options for women who have depression during menopause.

They are:

  • Menopausal Hormone Therapy (MHT) -MHT treatment helps control the symptoms of menopause. Some women can take hormones called menopausal hormone therapy to control these symptoms. It is important to note that research has found long-term use of MHT poses some serious health risks. Because of these risks this treatment is usually directed to be used in small amounts during short periods of time.

  • Antidepressants - Antidepressants may be an option for women who are unable or unwilling to take MHT.

  • Talk Therapy - Talk therapy may take place with one-on-one mental health professionals or in a group therapy setting.

Do you think you may be experiencing symptoms of Menopause?
The below links provide access to 'Menopause Quizzes' to assess your symptoms.

http://psychologytoday.psychtests.com/cgi-bin/health/transfer_health.cgi?partner=pt&test=menopause

http://www.riversideonline.com/health_reference/Womens-Health/QZ00041.cfm

Aging Issues

mental_health_and_aging_new.jpg
For more information on aging and the brain click on the imagine.

Mental Health and Aging

The following clip is a brief overview on aging and mental health.

Cardiovascular Changes17

The heart becomes weaker over time and does not work as efficiently. Even though the same amount of blood is being pumped through the body, the heart must work harder. As women age blood vessels may lose elasticity and harden due to fatty deposits building up. The loss of elasticity and the deposits make the arteries stiffer and can lead to high blood pressure amongst other issues.18


  • High blood pressure
    • The heart muscle weakens and has to work harder to pump blood through the body. Deposits may build up inside the arteries and cause the heart to work even harder.
  • Angina
    • Caused by temporary reduction in blood flow to the heart
  • Congestive Heart Failure
    • Caused by the heart either hardening and not being able to absorb blood or the heart muscle weakening and not being able to pump blood out to the body.

Bone, Joint and Muscle Changes

As women age, their bones start to lose density especially after menopause. Joints in the body lose cartilage and intervertebral disks lose fluid and causes the trunk of the body to become shorter. Bones become thinner and brittle due to loss of minerals. Some potential bone, joint and muscle problems due to aging are:
354023_Osteoarthritis_.jpg
  • Osteoporosis
    • As women age, calcium and phosphate minerals may be reabsorbed back into the body from the bones. The loss of calcium and phosphate in the bones makes them brittle and susceptible to fracture even when an injury has not occurred.16
  • Osteoarthritis
    • Joint pain and stiffness are associated with osteoarthritis. Joints become stiff and harder to move over time and feels worse after exercise and putting weight on the joint.15

Bladder and Urinary Changes

  • Urinary Incontinence
    • Urinary incontinence is loss of bladder control. Chronic cough, obesity, menopause and frequent constipation can make urinary incontinence even worse.18



Key Terms

Menopause- Menopause is defined as the final menstruation period. When a women has lived twelve consecutive months without experiencing a menstrual cycle, she has undergone Menopause. Most women experience menopause between ages 40 and 60.
Perimenopause- The transitional phase prior to Menopause. During this time, women begin to experience bodily changes associated with the onset of Menopause. This stage may last several years.
All the time after Menopause- the time after a woman's last period, when her ovaries are no longer active.
Desire- A woman's interest in sex and being sexual.
Arousal- Physical signs of sexual readiness. Blood flow to the genitals increases, the vaginal walls expand and moisten.
Gamete- Is a sex cell carried by both males and females. Gametes in males are called spermatozoon and in females ovum.
Zygote- Is when an ovum becomes fertilized also known as the first stage of development of an embryo.
Follicle-Stimulating Hormone- Responsible for regulating the development of egg follicles within the ovaries as well as the production of sperm within the testes.
Embryo- Occurs once an organism develops from a fertilized egg.





Credible Sources of Information

Evaluation of health information on the Web
Healthy Women
Kentucky Commission for Children with Special Health Care Needs (PDF)
Mayo Clinic
National Institute of Health - Women's Health
The National Women's Health Information Center
US National Library of Medicine
WebMD Women's Health Center
For more information on aging and fun facts please visit http://www.realage.com/the-you-docs/my-realage

Strategies for Evaluating Websites for Credibility14, 16

Anyone can publish information on the internet so it's important to be able to determine whether or not a website found on the internet is a credible source of information. Some key things to look for in a credible website are:
  • Web addresses that end in .edu, .gov and .org.
    • .edu addresses are maintained by educational institutions
    • .gov addresses are maintained by the government
    • .org addresses are usually maintained by non-profit organizations. Make sure it is clear who the organization is and do some research on the organization to find out if it is reputable.
  • Look for when the site was created or last updated
    • New information about health is always being published. Make sure the site you are looking at has been updated recently.
    • Check that links are working and the linked information is current.
  • Is the website selling a product?
    • If the website is selling a product the information presented may be biased and inaccurate in order to convince site visitors to buy the product.
  • Can the facts on the site be verified on another site?
  • Look for contact information for the the person or group that runs the site and also those who contribute information to the site.
  • Does the author have a background or experience with the health topic that he or she has written about?
    • Research the author and learn about his or her professional background
The following video discusses searching for credible information on the web and the importance of visiting a doctor.




References and Resources

  1. A.D.A.M., Inc.(2010). Retrieved March 2011 from PubMedHealth website. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001896/
  2. Alexander, L.L., LaRosa, J.H., Bader, H., & Garfield, S. (2007). New demensions in womens health (4th ed). Sudbury, Mass: Jones and Barlett Publishers.
  3. Campbell,N., Reece, J.B., Urry, L., Cain, M.L., Wasserman, S. A., Minorsky, P.V., & Jackson, R.B.(2009). Biology (8th ed). San Francisco, CA: Pearson Benjamin Publishers.
  4. Freudenrich, C. (2011). How sex works. Retrieved on March 25, 2011 from http://health.howstuffworks.com/sexual-health/sexuality/human-reproduction4.htm
  5. Hughey, L. (2011). How menopause works. Retrieved on March 22, 2011 from http://health.howstuffworks.com/wellness/women/menopause/how-menpause-works.htm
  6. MayoClinic.(2011). Menopause. Retrieved March 2011 from MayoClinic website. http://www.mayoclinic.com/health/menopause/DS00119
  7. "Menopause: Time for a Change." National Institute on Aging. 18 Aug. 2010. Web. 25 Mar. 2011. <http://www.nia.nih.gov/HealthInformation/Publications/Menopause/>
  8. North American Menopause Society.(2011). Retrieved March 2011 from North American Menopause Society website. http://www.menopause.org/
  9. National Institute on Aging. (2011). Age Page. Retrieved from National Institute on Aging website. http://www.nia.nih.gov/healthinformation/publications/menopause.htm
  10. Office on Women’s Health. (2011). Menopause and Menopause Treatments. Retrieved from The National Women’s Health Information Center website. http://www.womenshealth.gov/faq/menopause-treatment.cfm
  11. "Understanding Menopause - Menopause and Mental Health." Women's Health Information Center | WomensHealth.gov. 28 Sept. 2010. Web. 25 Mar. 2011. <http://www.womenshealth.gov/menopause/mental/>.
  12. "Menstruation, Menopause, and Mental Health." Women's Health Information Center | WomensHealth.gov. 29 Mar. 2010. Web. 25 Mar. 2011. <http://www.womenshealth.gov/mental-health/menstruation/>.
  13. "Menopause and Depression - U-M Depression Center." University of Michigan Depression Center. Web. 04 Apr. 2011. <http://www.depressioncenter.org/women/menopause.asp>.
  14. Kentucky Cabinet for Health and Family Services. Tips for Evaluating Internet Sites for Credibility. Retrieved March 2011 from Kentucky Cabinet for Health and Family Services website. http://chfs.ky.gov/NR/rdonlyres/CEC5CEE4-63CB-4150-A8F3-A3852B0E66F0/0/EvaluateWebSites.pdf
  15. Cedars-Sinai.(2011). Osteoarthritis. Retrieved March 2011 from Cedars-Sinai website. http://www.cedars-sinai.edu/Patients/Health-Conditions/Osteoarthritis.aspx
  16. Dalhouse University. (2011). Evaluation of health information on the Web. Retrieved March 2011 from Dalhouse University Inspiring Minds Libraries website. http://dal.ca.libguides.com/content.php?pid=88898
  17. U.S. National Library of Medicine. (2010). Aging changes in heart and blood vessels. Retrieved March 2011 from U.S. National Library of Medicine website. http://www.nlm.nih.gov/medlineplus/ency/article/004006.htm
  18. MayoClinic. (2010). Aging: What to expect as you get older. Retrieved March 2011 from MayoClinic website. http://www.mayoclinic.com/health/aging/HA00040




Team Member Bios


Doucette M. Alvarez obtained her BA in International Studies with an emphasis in global health in 2008 from The University of Iowa. She is currently working on her MS in Health Education with in emphasis in public health at Western Illinois University.

Rebecca M. Fauvie graduated from Kent State University in 2005 with a BS in Technology. Rebecca currently works as a web developer for the Center for the Application of Information Technologies developing online learning modules. She is currently pursuing a MS in Health Education at Western Illinois University.

Jo Ann Howd obtained a Bachelors of Science degree with emphasis in Health Services Management from Western Illinois University in 2009. She is currently persuing a Masters of Science Degree in Health Education at Western Illinois Univeristy.

Joe Heckman received a Bachelors of Science in Emergency Management from Western Illinois University in 2009. He is currently a candidate for graduation with a Masters of Science degree in Health Science at Western Illinois University.