Some companies pay people to post spammy comments on blogs. They will pay desperate fools a penny or two to post comments that are supposed to look like legitimate advice, but that are really just intended to link back to a product website. These products are usually just scams. I’ve seen people trying it here. Currently, the most common one has to do with phony hair-restoration treatments. But it is a waste of time, since comments here are moderated. No one (except the moderator, who doesn’t care) will see the spam. And the stupid person posting the spam won’t get paid, because they get paid only for comments that are visible. The good news is, that the more time they spend trying to post spam on moderated blogs (and the more time their spam masters spend checking their work), the less time they have to post their garbage elsewhere.

Une femme d’un certain age is the kind of lifestyle blog I would love to write if I actually had a lifestyle. It’s all about “living a stylish, adventurous, balanced, delicious life after 50″. It works for those under 50, too.

I did a little research and found this great article that explains why your feet hurt:

http://www.canadafreepress.com/medical/orthopedics060991.htm

It’s written by a doctor who explains how inappropriate shoes conspire with gravity to cause a lot of trouble for women’s feet.

Dear Hotflashes,

I’ve noticed that a lot of older women lost their hair. Not with a bald spot the way men do, but it just gets thinner and thinner. There is more scalp showing than hair. This has happened to a lot of older women in my family. My grandmother wore a wig to cover it up. I can see that my mother is losing her hair too and I’m afraid I’m next. It’s depressing. Does anyone know if there is any way to prevent this?

Katie

Hello, im 26 of age and im too having these hotflashes.

I eaither get them all day or they will be hit and miss during the week. I just had a baby 6mo ago and thought that it was my hormones still going crazy. I will awake in the middle of the night with night sweat so much that it feels as if i wet my bed.

I have been in and out of the doctors for more test then anything, and they can not put there finger on it.

It is scary, at time when i have these so called attacks i get shaky and very light headed then i start to sweat from my back of my neck, under and between my breast, back of my legs and so much under my arms that it get so embarresing, (im not over weight, current weight is 136, 5′6 ft tall)

Then i get hyper, I just wish i knew what is going on, many people are telling me that these sytomps are menapause, but im way to young. Arent I?

What could be the answer?

Perhaps you have reached “a certain age”. Maybe you’ve already noticed some changes, and are wondering what to expect next. The “change of life” can be exciting, scary, sad, exhilerating, mysterious, peaceful, or all of and none of the above.

What is menopause?

Menopause is the permanent end of menstruation and fertility. It happens when the ovaries greatly reduce production of the sex hormones estrogen and progesterone. Menopause is confirmed when twelve months have passed since your last normal period (assuming there is no other reason for the lack of periods). If you had a hysterectomy prior to menopause, but kept your ovaries, you may need blood tests to determine whether you have reached menopause. After menopause, it is no longer possible to become pregnant. Other changes also occur at this time.

Most women experience menopause between the ages of 45 and 55. The average is around 51. Cigarette smokers tend to reach menopause earlier than nonsmokers. If menopause occurs before age 40, it is considered “premature”. Premature menopause may happen naturally, or it may be caused by another medical condition, injury to the ovaries, or surgery.

Most people also use the word “menopause” to refer to the transitional period of a few years leading up to actual menopause. The medical term for this time is “perimenopause”.

What causes menopause?

Natural menopause occurs when the body’s production of sex hormones declines dramatically. Ovulation and menstruation no longer occur. After menopause, the adrenal glands continue to produce androstenedione, which is converted in fat cells to a form of estrogen called estrone. Because obese women have more fat, they may produce more estrone, resulting in fewer menopausal symptoms. The levels of two other hormones, progesterone and testosterone, also drop at this time.

Menopause can also occur as the result of disease, injury, or surgery. Radiation therapy and autoimmune diseases can cause the ovaries to stop functioning. If the ovaries are removed by surgery, menopause will occur immediately.

What is perimenopause?

Perimenopause is the period when hormone levels start to change prior to actual menopause. It may begin anywhere from three to seven years prior to menopause. Hormone production may drop off gradually, or it may become erratic. During this time, your periods may become irregular, and you may start to experience some other menopausal symptoms.

What are the symptoms?

Some women do not experience any obvious symptoms during perimenopause, but most probably will experience at least a few symptoms. Most of these are related to changes in estrogen levels.

Hot flashes: This is probably the most well-known symptom of menopause. A hot flash is a feeling of intense heat, usually starting in the face or chest and focusing on the upper body. It may be accompanied by reddening of the skin and heavy sweating. You may feel tingling in the hands and a faster heartbeat. Sometimes a sudden chill follows the hot flash. Hot flashes rarely last longer than five minutes. They are often more common and more intense at night, and are sometimes referred to as night sweats. Hot flashes generally happen for a year or two, but some women experience them for five years or more. Although most menopausal women experience some hot flashes, only about 15% have real trouble with them.

Irregular menstruation: Periods may become farther apart, closer together, or completely unpredictable. They may be heavier, lighter, more painful, less painful. Women who have never experienced PMS may start having it; those who have it may find it gets worse before it gets better. Eventually, menstruation stops altogether.

Vaginal/Urinary tract: Thinning of the skin in the genital area is often accompanied by vaginal dryness, sensitivity, and irritation. Menopausal women often become more susceptible to urinary tract infections. Many women experience increased frequency of urination and urinary incontinence.

Skin and Hair: The skin may become thinner and drier. Some women may experience itching and increased skin sensitivity and irritability. Some begin to bruise more easily. Some women experience hair loss or hair thinning. Hair may become drier. Some women have an increase in facial hair growth.

Memory: Short-term memory problems are common, as is difficulty with concentration.

Insomnia: Difficulty sleeping, restlessness, fatigue. Often it’s the hot flashes that make it hard to get a good night’s sleep.

Emotions: Mood swings and increased irritability are common at this time. Some women experience anxiety and apprehension. Some may become depressed.

Others: Headaches (sometimes migraines), constipation, leg cramps, joint pains, bloating, breast tenderness, upset stomach, dizziness, faintness, decreased libido.

Few women will experience all of these symptoms, and most women get through menopause without too much difficulty. There are a number of treatments for the various symptoms.

How does menopause affect my health?

If you are healthy now, chances are you will remain healthy throughout menopause. There are two significant health issues that you need to be aware of:

Osteoporosis is a condition in which the bones become thin and fragile. The skeleton becomes weak and may be unable to support normal activity. There is a greatly increased chance of bone fractures. Loss of estrogen is the biggest cause of osteoporosis. Some researchers now believe that estrogen is even more significant than calcium in saving bone mass. The National Osteoporosis Foundation has information on the causes, prevention, detection and treatment of osteoporosis.

Cardiovascular diseases include atherosclerosis, high blood pressure, angina and stroke. During the childbearing years, estrogen provides a great deal of protection against cardiovascular disease. After menopause, the risk increases. For women over 50, cardiovascular disease is a much greater threat than cancer. The American Heart Association has some information about heart disease and stroke.

What can I do to stay healthy?

Exercise can be very beneficial to menopausal women. It helps reduce the risk of both osteoporosis and heart disease. Regular exercise helps to maintain strength and stamina, build muscle tone, and reduce anxiety.

Make sure you are eating a balanced diet. Your doctor may recommend vitamin supplements. Many researchers now urge women to add soy and flax to their diet, as these foods may help reduce menopausal symptoms. Many women experience weight gain at menopause, but this is not a good time for crash diets. A combination of healthy eating and reasonable exercise is the best approach.

Make sure you get regular medical checkups. If you are using herbal products for nutrition or to treat your menopausal symptoms, tell your doctor. Some herbal remedies may have interactions with each other or with other medications you are taking, so it is important that your doctor has all the right information.

If you smoke, this is an excellent time to quit. Smoking is unhealthy at any age, and it is even more dangerous for women after menopause, when the risk of heart disease increases.

What about hormone replacement therapy?

Hormone replacement therapy (HRT) is a complex and often controversial subject. There are different types and combinations of hormones, and different factors that must be taken into consideration when deciding what to do.

Information on HRT is constantly being revised. It’s been very difficult to maintain links to current articles, as they become obsolete very quickly. It seems that “experts” are becoming less and less enthusiastic about benefits vs. risks. If you are considering hormone replacement therapy, it is very important to discuss with your doctor all the latest information, and how it applies to you.

What else should I know?

See our page of helpful links.

© 2008 Rosemary K. West

Hot Flashes

Hormone replacement therapy can help relieve hot flashes, but many women prefer to try a more natural approach first. Some researchers believe that a diet high in soy products can help prevent hot flashes. Alcohol, spicy foods, hot beverages, tobacco, marijuana, hot baths, and stress are identified as triggers for hot flashes. A well-balanced diet with adequate amounts of B and C vitamins, calcium and magnesium is recommended. As usual, we are advised to avoid caffeine, alcohol and spicy foods. Many women find that regular aerobic exercise can reduce or eliminate hot flashes. Breathing exercises can also be helpful. It may help to wear layered clothing that can be easily adjusted, drink plenty of cold water, take a tepid shower before bedtime, and sleeping a cool room.

Menstrual irregularities

Heavy bleeding is common during perimenopause. It can lead to other problems, such as anemia, and it may be a symptom of other ailments, such as fibroids. If you are experiencing heavy, prolonged periods, you should see your doctor to find out the cause. Sometimes a D & C (dilation and curettage) is used as a treatment for heavy bleeding. In the past, hysterectomy was often used to put an end to the bleeding, and it is still recommended by some doctors. A newer procedure, called endometrial ablation, may be helpful. (Be aware that both hysterectomy and endometrial ablation eliminate the ability to get pregnant.) Non-surgical approaches involve the use of birth control pills or hormone therapy to regulate the menstrual cycle. Women with excessive bleeding are advised to avoid medications that can promote bleeding, such as aspirin, vitamin E (in high doses), and garlic pills. Heat can also increase bleeding, so it’s a good idea to avoid hot baths and heating pads at this time.

Vaginal/Urinary tract

If you are having problems with frequent urination or incontinence, it is important to have a medical examination to determine the cause. Bladder control problems can be caused by a number of different medical conditions, such as bladder or kidney infections, nerve damage, weak muscles, and the side effects of medications. Limiting or eliminating caffeine and alcohol can help with the problem. However, do not reduce your intake of water unless your doctor advises you to do so. Reducing your water consumption can actually make bladder and kidney problems worse. Dehydration can lead to health problems that have serious consequences. Often, learning some simple exercises can strengthen the muscles and retrain the bladder. In some cases, surgery may be recommended. There are also medications that can help with some kinds of bladder control problems.

Vaginal dryness can often be treated fairly simply with lubricants and non-irritating creams or oils. Vaginal creams containing estrogen are also available, and there is now an estrogen ring that can be inserted like a diaphragm. Other forms of hormone therapy may also alleviate this condition.

Each year in the United States, over 500,000 women have hysterectomies. One-third of all women in the U.S. will have hysterectomies before age sixty, most while they are still in their forties.

Hysterectomy is a controversial subject, because many hysterectomies are probably unnecessary. Some health experts suggest that a third or more of all hysterectomies should not have been performed. Necessary or not, most women have strong feelings about this surgery. If your doctor has recommended a hysterectomy for you, it is important to understand exactly what this means.

What is a hysterectomy?

Hysterectomy is surgery that removes the uterus (womb). With the uterus removed, you will not have any more periods, and you cannot become pregnant.

Here are the four basic kinds of hysterectomy:

Total hysterectomy: The phrase “total hysterectomy” can be confusing, as many people think it includes removal of the ovaries, leading to “instant menopause”. This is not the the case. In a total hysterctomy, the uterus and cervix are removed. The fallopian tubes and ovaries are left intact. The ovaries will continue to produce hormones, possibly for as long as they would have without the hysterectomy.

Total hysterectomy with oophorectomy: (bilateral oophorectomy, bilateral salpingo-oophorectomy) Total hysterectomy plus removal of the ovaries (and usually the fallopian tubes). There are some variations on this which may include leaving one ovary or part of an ovary. For women over age 45, many doctors recommend removal of the ovaries as part of any hysterectomy, even when the ovaries are still healthy. The doctor may feel that since the woman is near menopause anyway, this is not a great loss, and it will protect her against ovarian cancer. (Note, however, that ovarian cancer is not common in women who do not have a family history of ovarian cancer.) Removal of the ovaries results in instant menopause. Hormone replacement therapy (HRT) may be recommended, and the doctor will usually start your HRT while you are still in the hospital, possibly even placing a hormone patch while you are still unconscious.

Supracervical (subtotal, partial) hysterectomy: The body of the uterus is removed, but the cervix is left in place. In the past, the cervix was always left in place, because surgeons did not have safe techniques for removing it. In the 1950s, new techniques (and the desire to prevent cervical cancer) led to removal of the cervix being the typical method. However, supracervical hysterectomies are still performed in some cases. Because you still have a cervix, you will need to continue regular getting Pap tests.

Radical hysterectomy: The uterus, ovaries, fallopian tubes, upper portion of the vagina, and the pelvic lymph nodes are all removed. This kind of hysterectomy normally is done only if there is a serious disease, such as cancer, that warrants it. If your doctor is recommending a radical hysterectomy, find out why! And get a second opinion.

Do I really need this?

Hysterectomy is usually “optional”, but may be the only effective treatment for a condition that is causing pain or other complications. Unfortunately, some doctors may not be aware of the effectiveness of alternative treatments, or they may simply prefer hysterectomy because it is simpler. On the other hand, sometimes hysterectomy is the only (or the best) way to solve the problem.

Most authorities now agree:

Hysterectomies are necessary for: Uterine, ovarian or invasive cervical cancers, or for the management of other cancers

Hysterectomy can be an appropriate treatment for: Large or rapidly-growing fibroids, severe endometriosis, serious damage to the uterus from infection or childbirth, severe bleeding that cannot be controlled through other methods, chronic pain from pelvic adhesions, prolapse

It is usually not appropriate for: Precancerous conditions of the cervix, benign ovarian cysts, small or painless fibroids

It is unnecessary for: Sterilization, abortion, menstrual irregularities

If your doctor has recommended hysterectomy, make sure you understand exactly why. Find out exactly what type of hysterectomy is being proposed. Find out whether or not there are alternative treatments, and how they may apply to your case.

It is always wise to get a second opinion before undergoing major surgery. Some insurance companies may require that you do so. Your doctor or your insurer can provide you with an appropriate referral. Don’t be afraid to ask questions!

What are the alternatives?

Available alternatives depend on the condition that is being treated and your overall health. Some possible alternatives:

Do nothing. If your condition is not life-threatening and does not pose a significant threat to your health, you may choose to take a “wait and see” approach. You will need to decide whether you can tolerate the current symptoms, and discuss with your doctor the best way to continue monitoring your condition. Some conditions are likely to get worse if untreated, but others will stay the same. Some conditions, such as fibroid tumors, may improve after menopause.

Treat the problem with hormones or other medications. Hormones or drugs may be helpful in controlling some conditions. However, not everyone can safely take hormones. Hormones and other medications can have unpleasant side effects, and some are not appropriate for long-term use.

Use some other kind of surgery. It may be possible to remove certain kinds of tumors, such as fibroids, and repair the uterus. Sometimes other organs or tissue can be removed without removing the uterus.

Other treatments. Treatments such as D&C, endometrial ablation, insertion of mechanical devices, laser treatments, radiation therapy, and others may be helpful for some conditions.

What will it be like?

How is the surgery done?
What are the risks?
How should I prepare for surgery?
What is the recovery like?
How will this change my life?

For information about before, during and after a hysterectomy, see the following post about “Having a Hysterectomy”.

What else should I know?

Hystersisters is a nonprofit organization providing positive support for women before, during and after hysterectomy.
See our page of helpful links.

© 2005 Rosemary K. West

In 1961 Jenny Joseph wrote a poem entitled “Warning” which begins,

“When I am an old woman…
I shall wear purple
With a red hat which doesn’t go, and doesn’t suit me…
But maybe I ought to practice a little now?…”

In 1996, a BBC poll found that “Warning” had become Britain’s favorite poem.

Inspired by the poem, and by her own enjoyment of a red hat, Sue Ellen Cooper of California, along with a few friends, started the Red Hat Society. Members meet for tea parties and other events, wearing bright purple outfits and red hats. (Junior members, who are under age 50, wear lavender outfits and pink hats.) As the society grew, the idea spread, and there are now over 55,000 members with over 2,000 chapters around the world.

Information about the original Red Hat Society can be found at www.redhatsociety.com. The rights to reproduce and sell copies of the poem “Warning” belong to Elizabeth Lucas, who has a website at www.elizabethlucasdesigns.com.

Wait and Watch

If your fibroids are not causing any symptoms, or if the symptoms are minor, your doctor may recommend that you simply leave them alone, with periodic examinations to see whether or not they are growing.

Medication

If your symptoms involve menstrual irregularities, the doctor may suggest that you try taking birth control pills to regulate your periods. Although estrogen can cause fibroids to grow, low-estrogen birth control pills are available. If the pills can regulate your cycle, this may provide the relief you need. Of course, if you want to become pregnant, taking birth control pills is not an appropriate long-term solution for you.

For severe bleeding symptoms, some doctors may prescribe a drug treatment known as a GnRH (gonadotropin-releasing hormone) agonist. Lupron is one brand name for this kind of drug. Lupron works by decreasing your body’s estrogen production. This treatment leads to shrinkage of the uterus and fibroids. Unforuntately, the side effects can be unpleasant, including hot flashes, reduced libido, and vaginal dryness. This treatment also prevents pregnancy. Because long-term use of GnRH agonists can lead to bone loss, they are usually prescribed for only a few months. After the drug is discontinued, the fibroids will probably start growing again. For that reason, GnRH agonists are used mainly as a pre-surgical treatment. Because the drug is expensive and has side effects, it may be considered unnecessary or undesirable prior to surgery, especially if the fibroids are not very big. There is some concern that if small fibroids shrink too much, the surgeon will not be able to find and remove them. However, if the woman has severe anemia, this drug in combination with iron supplements can be very helpful in reducing or eliminating the anemia prior to surgery. The use of these drugs is controversial, so if they are recommended for you, make sure you understand exactly why and what your doctor expects.

Myomectomy

Myomectomy is a “conservative” surgery that removes the fibroids, leaving the uterus intact. This procedure is preferred by women who wish to become pregnant or who simply prefer to keep the uterus. There is a chance that after a myomectomy, the fibroids will grow back, although it may take a long time for this to happen. It is difficult to know how likely regrowth is, as various sources estimate that anywhere from 10% to 80% of women will experience a recurrence of fibroids after myomectomy.

In some cases, myomectomy may be performed by entering the uterus through the vagina. However, if the fibroids are too large and numerous to use this option, an incision will be made in the abdomen. This is usually a horizontal cut above the pelvic bone, below the “bikini line”.

After administering general anesthetic, the doctor will insert a catheter to keep the bladder drained during the surgery. A second catheter is used to stain the interior of the uterus with blue dye. Once the abdomen has been opened, the surgeon will locate the uterus and the fibroids. Each fibroid is injected with a drug called Pitressin. This cuts off the fibroid’s blood supply for about twenty minutes, giving the surgeon enough time to cut the fibroid out of the uterine wall. After removing the fibroids, the surgeon repairs the incisions in the uterus.

Hysterectomy

Hysterectomy is a “nonconservative” surgery that removes the uterus. With the uterus removed, you will not have any more periods, and you cannot become pregnant. Your fibroids will not grow back.

In the past, hysterectomy was often the only choice available to women whose fibroids caused serious symptoms. Hysterectomies are one of the most commonly-performed surgeries in the United States, the country which leads the world in hysterectomies. Many women’s health experts believe that a large number — perhaps even most — of hysterectomies are unnecessary. Only about 10% of hysterectomies are performed for life-threatening conditions such as cancer.

Because of this, the use of hysterectomy to treat fibroids is controversial. Many doctors understandably do not want to perform this procedure on women who may want to have children or on any young women. Other doctors still believe hysterectomy is the best choice, especially for women over 40 and those not interested in childbearing. Younger doctors are less likely to recommend hysterectomy than older doctors.

A doctor’s attitude may be that if you cannot or do not intend to become pregnant, your uterus is merely excess baggage. Many women agree. Removing the uterus can have many advantages. It eliminates the inconvenience of menstruation, the need for contraception, and the risk of uterine or cervical cancer. Many women who have had hysterectomies feel liberated sexually, personally and medically.

On the other hand, even if pregnancy is not in your plan, you may wish to keep your uterus. Some women find that the loss of the uterus makes sex less enjoyable, since they no longer experience uterine contractions. The vagina may be shortened, leading to discomfort during intercourse. Some researchers believe that removal of the uterus can lead to earlier menopause, even when the ovaries are left intact. Some women simply object to the removal of any organ unless absolutely necessary.

With a vaginal hysterectomy, the surgeon approaches the uterus through the vagina, and pulls it out. With an abdominal hysterectomy, the surgeon makes an incision (similar to that used for myomectomy) in the abdomen.

There are four basic kinds of hysterectomy:

Total hysterectomy: The uterus and cervix are removed. The fallopian tubes and ovaries are left intact. The ovaries will continue to produce hormones, possibly for as long as they would have without the hysterectomy.

Total hysterectomy with bilateral salpingo-oophorectomy: Total hysterectomy plus removal of the fallopian tubes and uterus. There are some variations on this which may include leaving one ovary or part of an ovary. For women over age 45, many doctors will recommend removal of the ovaries as part of the hysterectomy, even though the ovaries are still healthy. The doctor may feel that since the woman is near menopause anyway, this is not a great loss, and it will protect her against ovarian cancer. (Note, however, that ovarian cancer is not common in women who do not have a family history of ovarian cancer.) Removal of the ovaries results in instant menopause. Hormone replacement therapy (HRT) may be recommended.

Subtotal (partial, supracervical) hysterectomy: The body of the uterus is removed, but the cervix is left in place, and the vagina is not shortened. Because you still have a cervix, you will need to continue regular getting Pap tests. There is a small chance that you could have a recurrence of fibroids in connection with the cervix.

Radical hysterectomy: The uterus, ovaries, fallopian tubes, upper portion of the vagina, and the pelvic lymph nodes are all removed. (In some cases one or both ovaries may be left intact if they are not involved in the disease.) This kind of hysterectomy normally is done only if there is a serious disease, such as cancer, that warrants it. If your doctor is recommending a radical hysterectomy, find out why! And get a second opinion.

Other Treatments

Laparoscopic myomectomy: In laparoscopy, the doctors make a small incision and use a camera mounted on a tube to look around inside the abdomen. Additional small incisions are made in order to perform surgery. Laparoscopic surgery is appealing because it is often done on an “out patient” basis, meaning the patient goes home the same day, and because the scars are usually smaller than with more conventional surgeries. However, laparoscopy does have its own risks and limitations, and may not be suitable for all situations.

Hysteroscopic myomectomy: If the tumors are inside the uterine cavity and not deeply embedded in the wall, it may be possible to remove them using a hysteroscope, a tubular instrument inserted through the cervix. As with laparoscopy, this surgery usually allows the patient to return home the same day.

Embolization: This is promoted as a “non-surgical” technique and is performed by radiologists. However, it is invasive, and small incisions or punctures are necessary. Catheters inserted into the arteries are used to introduce material that will plug the blood vessels leading to the fibroids. The fibroids then die and wither. The patient may experience severe cramping for several days, a week, or more. It may take several months before symptoms improve. Currently, this technique is still considered experimental.

Myolysis: The tumors are destroyed with electrical current or a laser. They then die and shrink. This is still an experimental technique, and there is little information available.

© 2005 Rosemary K. West

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