Photo: Stephen Mease

Two very different-aged women talk about body image and the physical changes that every woman experiences.

Body Image? Ha! My Real Body Rocks — and Rolls
by Cindy Hill

How come no one walks into our factories, corporate offices, college campuses and malls, and pulls the 45-year-old men and women into separate cubbies, and tells us what will happen to us, the way they did in 5th grade when they talked about puberty? If only they did. If only we were warned.

Eventually a woman stops menstruating. Average menopause age in the U.S. is 51, but it varies around the globe. The average in India is the mid-40s, while many women of the world cease menstruation in their 30s because of low body mass from poverty and malnutrition.

Low body mass is a less common phenomenon in the U.S., so we are at the higher end of the average age spectrum. In at least 12 of the world’s 198 countries, women’s life expectancy is shorter than the average age of menopause. Women there don’t experience the symptoms of menopause; they die before they reach it. Sobering. So for those of us who anticipate a looming and gray horizon the most important thing to have is:

Perspective

“The only symptom of challenge that women have to go through is the cessation of their periods they are not obligated to have any of these other challenges or discomforts,” says naturopathic physician Lorilee Schoenbeck of Mountain View Natural Medicine in South Burlington, and author of the book, Menopause: Bridging the Gap Between Natural and Conventional Medicine (Kensington Publishing 2002). Naturopaths receive four years of graduate training and are NDs, not MDs.

Before women in Japan were told what symptoms to expect, they didn’t have them, Schoenbeck claims. She says only after popular American women’s press began spreading in Japan, did Japanese women start reporting the hot flashes, weight gain and moodiness that American women associate with menopause.

Maybe.

While knowing potential effects can help to reassure you that you’re not crazy, keep in mind that those laundry-lists of possible symptoms don’t mean you’ll get all or even any of them. “I don’t want people to go into menopause with dread,” Schoenbeck says. But for those of us who live long enough, here is just a smattering of the things you may or may not be aware of that are likely to actually happen to your body, never mind your body image:

— No period .eventually.
You stop getting your period and how great is that, right? Only problem is, it doesn’t go quietly. You don’t get to officially wear the silver letter M emblazoned on your chest until you have gone one full year period-free. Your period is so used to seeing your face every month that it really doesn’t want to leave. It’ll vanish for three months, four months at a time and then you’ll get all three or four months of it at once. “Some days I can’t even leave the bathroom,” Tammy, a late-40s Vermont woman says with an audible shudder.

— Hot flashes.
Don’t let the word “flash” give you a false sense of security. It can only be interpreted here in its geological sense, as in: human beings have been in existence on earth for only a short flash of time. A straw poll of a half-dozen menopausal women in Vermont saw every single one refer to hot “flashes” by putting finger-quotes around the word “flashes.”

The cause is the impact of decreased estrogen on estrogen receptors in the blood vessels, according to Schoenbeck. Estrogen buffers the ability of blood vessels to maintain their tone; without it, blood vessels on the surface of the body may dilate, sometimes causing chills as the blood flow rushes from internal organs to the skin.

— Night sweats.
In days of old we might have soaked our sheets with the sweat of passionate episodes. But now we can produce the same uncomfortably damp, tangled sleeping environment without the bother of all that grunting and rolling. “Yikes!” says Mary, a mid-50s Bristol office professional, “I could go on and on about these. Sometimes I get out of bed and go sleep on the couch.”

— Staring at the ceiling all night.
Count yourself lucky if you sleep on the couch. “NOT sleeping well” is a common refrain of 50-ish women. Increased anxiety and a racing mind at this time may or may not be a direct by-product of menopause; the financial and emotional pressures of raising teens or college students, tending to ailing parents, coping with changing relationships, and all else that hits you at this time of life might just be anxiety-provoking. Regardless, sleeplessness often happens.

— Scratching.
“Itchy skin!” One mid-Vermont, mid-50s woman reports as her worst menopausal symptom. Dry skin can occur all over the body, creating impossible-to-reach back itches in the middle of the night, and unbearable vaginal itching any time of night or day. “Our skin gets a lot drier as we go through menopause,” says Susan Pendrok, aesthetic teacher at O’Briens Aveda Institute in South Burlington. “One of the most important things you can do is eat properly, more veggies and fruit. And drink more water to hydrate from within. Moisturize, and definitely wear sunscreen every day."

Facial treatments can help protect the delicate skin on your face, as well as provide a relaxing respite from stresses.

— Vaginal Dryness.
That itching is just the tip of the iceberg of genital effects. The Mayo Clinic horrifically refers to this potential change, caused by drying and thinning of the vaginal walls as estrogen decreases, as “vaginal atrophy.” Thanks, Mayo Clinic, I hope your genitals atrophy, too.

— Breasts.
Say goodbye to them. They’re out of sight. Rejoice that the extra roll around your belly is keeping your boobs from hitting your waist. See, it all works out.

— Mood.
Not like, I’m in the mood for love. More like, I’m in the mood to murder anyone who breathes near me. “There are times when I am ready to explode,” one Middlebury woman explains. Our moods can resemble all the drama of puberty but now we have the wisdom and maturity to REALLY make the people around us suffer. “Don’t forget the men, we suffer too!” says her husband. He’s jesting of course. Sort of. Well, actually not.

— Hair.
It turns gray, loses its luster, thins and falls out. And that’s just the pubic hair. The hair on your head may start breaking off and coming out in clumps. “If you look at the top of the head of older women, you can see where you are going,” Schoenbeck says, though she warns that hair loss can also be exacerbated by stress or thyroid issues.

— More Hair.
But don’t worry about your head of hair; you’ll sprout lots everywhere else. “Facial HAIR,” pronounces June, a Ripton woman in her 60s, in a very real horror. “Weird eyebrows,” mentions another, noting that despite her trim figure, neat haircut and gorgeous manicures, her adult daughter constantly nags her about her weird old-lady eyebrows.

An increase in male hormones can prompt male-pattern hair growth including unibrows and odd long, hard eyebrow hairs, shadow moustaches, and other sprouts. “You can get hair growing in parts of your body where you never had hair before, and I mean all over,” says Susan Pendrok. Tweezing, waxing, over-the-counter or salon hair removal treatments can do away with the unwanted growths or not. Don’t feel embarrassed about it. It happens to lots of us.

— What else? Depends.
No, not on circumstances, Depends as in adult undergarments. Estrogen also helps keep your bladder and urethra healthy and supple. That is, it did when you used to have estrogen. A more frequent need to urinate, and even incontinence, can occur during and after menopause. Do not jump on trampolines anymore. In fact, don’t sneeze.

— Nails.
Keratin production can be disrupted by the estrogen drop. Result? Your fingernails split, tear off, or become brittle. Your toenails curl, develop ridges and you can get painful hangnails or ingrown corners. Good nutrition, ample hand cream, and frequent manicures and pedicures can help keep nails strong and protected, not to mention helping you feel better about all this.

— Skin.
That estrogen drop helps decrease water and collagen in the skin. Dry, crepey, sagging skin results. Lots of sunscreen and lots of water help except, of course, for that perpetually over-active bladder issue. “There is no tissue type in the body that is void of estrogen receptors,” says Schoenbeck, “so it affects every tissue type from breasts to pubic hair to skin and bone and blood vessels. So all are to some degree affected by estrogen levels."

— Deadly diseases.
Estrogen offers us some protection from the full frontal assault of heart disease and all its brethren high blood pressure, hardened arteries, stroke. Once our estrogen knight errant is gone, the marauding dragons of deadly disease descend on us in legions similar to those lobbed against men. All that exercise you aren’t getting, and weight you’re putting on, and extra anxiety you are lying awake with, doesn’t help, so try to counteract those. Estrogen won’t help now, so you’ll have to fight your own battles with diet, exercise, yoga classes and regular massages. War can really be hell.

— Was there something else? I forget.
Oh yeah, forgetfulness. Remember that wonderful haze of pregnancy and then the “milk brain” that followed. It’s like that, times ten, so it’s fortunate that you are not a new mom who has to remember that she sat the baby in the car seat on top of the car. However, you may be a grandma who does have to remember that she sat the grandbaby in the car seat on top of the car, so slow down and pay attention. And don’t forget, you know, that thing you have to remember. Whatever it was.

— Why This Weight?
Weight gain may not be inevitable during menopause. It could be more a product of inertia than it is an unavoidable side effect of estrogen loss. But with sleepless nights and increased responsibilities, better eating and more exercise can be a challenge. Pounds pack on, which adds to the anxiety, insomnia, and desire to reach for the M&Ms. Tragic but true.

Weight re-distribution, however, cannot be avoided. “There will definitely be a weight distribution difference,” Shoenbeck says, “with more around the belly. That’s a normal change when the estrogen levels shift. It’s normal for women to look less like an hourglass. It’s impossible to not have that shift in body fat.”

Gym ads and diet pill salespeople will try to convince you that their products and services can create an unrealistic ideal, and get that shape back to what it was when you were 20. Word to the wise: They can’t.

The most notable change in menopausal women that Shoenbeck has noticed since the publication of her book 12 years ago is that women’s health has declined because of weight gain. “My main concern is people’s health problems due to weight,” she says. There is going to be more arthritis, immobility, heart disease, diabetes. American women have an unrealistic expectation about how much exercise is real exercise and how they need to cut portion sizes and carbohydrates. We need to start re-assessing we need to get up and move.”

Time and stress conspire to limit our activity, but exercise simply has to be a priority for women, especially through menopause.

Is There a Cure?
No. But there is a spectrum of approaches that can help ease troubling symptoms. Naturopathic doctors tailor a holistic approach to each individual woman, and start with the least-invasive natural therapies. Dietary and lifestyle changes are the natural starting point for peri-menopause and menopause management.

Unfortunately the first step is painful for those women who find caffeine a trigger eliminating caffeine consumption. Although evidence is mixed, and the experiences of women differ, Schoenbeck believes that caffeine is often a strong hot flash trigger. “When the caffeine wears off, the vessels dilate,” Schoenbeck explains, noting that women are more sensitive to caffeine after they stop menstruating. Some women report that alcohol, spicy foods, and sugar can also trigger those hot flashes and night sweats.

Next level of intervention would be plant-based treatments that have been used extensively in Europe. Anecdotally, some women get relief from black cohosh for night sweats and mood swings, and vitex, or chaste tree berry, for peri-menopausal PMS and bleeding irregularities. A growing array of hormonal replacement therapy solutions, ranging from natural to conventional, has developed in recent years. Some conventional doctors are also increasing their prescriptions of anti-depressants and anti-convulsants to treat hot flashes treatments at the very high end of the intervention scale.

Work with your doctor. Trust your body. Don’t panic.

— Over the Estrogen Rainbow
After the menopausal storm, there really are blue skies and rainbows. “No more PMS. No worries about getting pregnant,” Schoenbeck says. “Stable moods. A calmness that settles in, not caring so much what other people think, a more strong sense of self-assuredness. I see this in my patients all the time.”

Many menopausal and post-menopausal women see more clearly and deeply, developing their interests in spiritual pursuits. Facing the reality of life’s limitations, they assess their personal life goal and mission, exploring paths long deferred while attending to the needs and interests of others. Schoenbeck suggests doing some “life housekeeping” before menopause hits with full force, to avoid having to go through major life changes AND the change of life.

Her advice for the menopausal fits women of any age: “Assess relationships, self-care, and come to the realization that you might have to prioritize,” she suggests. “It’s an opportunity, an invitation to assess, and re-balance. No longer can you get away with putting yourself last.

Cindy Hill is a writer and contributor to Vermont Woman.