This chapter discusses midlife and menopause in women. It defines midlife as ages 45-65, a time of emotional, social, and physical changes for women, including menopause. Menopause is defined as the end of monthly menstrual periods, and is usually around age 51 but can vary. During this transition, women experience hormonal changes, social role changes as children leave home, and increased health risks. The chapter outlines common symptoms, health concerns, and lifestyle strategies including exercise that can help manage this period.

1. Chapter 26
Boston Women’s Health Collective
Our Bodies, Ourselves

2. “With the advent of menopause, children leaving home,
or the decline of a parent, we come to the end of
familiar roles and ways of being and begin a different
way of life”
-page 528

3. Midlife is defined as ages 45 – 65
Midlife is a time of emotional, social & physical
changes which for women includes menopause
Menopause defined as end of monthly bleeding
1 – 10 years prior to menopause a woman may
experience symptoms of “peri” (around) menopause
which include hot flashes, irregular periods, more
pronounced PMS
Menopause occurs at different times for women, the
average age is 51
Menopause can be brought on earlier by smoking, or
be surgically or chemically induced

4. Midlife is often a time of social changes including
children leaving home, health decline of parents, and
assumption of new roles including mother-in-law or
grandmother
It can be a time of redefining oneself as nurturing roles
shift providing more time and energy for achieving
goals put on hold years earlier
Often comes with increased perspective on life and/or
accomplishment, along with a new sense of self-pride
and awareness

5. Many women in midlife enter the “sandwich
generation” where they are caring for children and
ailing parents
Divorce/separation after children leave home may
occur creating further stress (or relief )
Transition can trigger emotional problems – or
feelings restlessness associated with changes
occurring emotionally, physically and socially

6. Physical changes including weight gain, loss of
reproductive capabilities, wrinkles, thinning hair can
create emotional stress in a society focused on youth
and beauty
May be associated with “ageism” & discrimination due
to age
Health changes related to decreased estrogen
production increase a woman’s risk for osteoporosis,
cardiac disease, urinary incontinence, weight gain

7. With decreased production of estrogen/progestin
women experience symptoms of “the change of life”
while their body adjusts to hormonal changes
During perimenopause & menopause a woman may
experience:
More severe PMS symptoms
Irregular periods varying in occurrence, flow, duration
Hot flashes and night sweats
Insomnia and sleep disturbances
Vaginal dryness and/or pain with intercourse
Urinary changes such as stress or urge incontinence
and increased urinary tract infections
Increase or decrease in sexual libido
Mood changes

8. Health related risks associated with decreased
estrogen production include:
Increased risk of heart disease
Increased risk of fracture secondary to decreased
bone density and/or osteoporosis (only 15% of women
are diagnosed w/osteo)
Decrease in lean muscle mass and increase in adipose
tissue
What to do….
Aerobic exercise and weight bearing exercise help to
greatly diminish these risks and symptoms related to
menopause

9. Sexuality (unlike fertility) continues throughout our
lives
Post menopause women no longer need to worry about
pregnancy or birth control providing more spontaneity
Vaginal changes in women post menopause put them
at higher risk for contracting STI’s and HIV, (if not in a
mutually monogamous relationship) hence “safe sex”
practice is encouraged
Vaginal dryness and/or discomfort can often be
remedied with OTC moisturizers or lubricants
For sexual dysfunction and or pain with intercourse
medical intervention may assist

10. Hormone Replacement Therapy (HRT) available since
1960’s, generally uses estrogen in pill, patch, ring or
cream form. Many also include progestin additive.
Widely prescribed when first available, but often
associated with negative side effects – including
increased risk of breast cancer and blood clots
Women's Health Initiative (WHI) 2002 published
study confirming risks of HRT for breast cancer and
blood clots. They also concluded women were more at
risk for cardiovascular disease & stroke with HRT
 Study tested only one regimen of HRT – leaving some
questions remaining regarding efficacy and safety of
HRT

11. HRT concerns have generated new drugs for providing
benefits of hormone replacement without negative side
effects
Selective Estrogen Receptor Modulators – SERM’s
(Raloxifene/Evista®), Tamoxifen, help prevent bone
loss and reduce risk of fx without stimulating breast or
uterine tissue to become cancerous
Biphosphonates (Fosamax®, Boniva®) are another class
of drug which help to prevent bone density loss
Herbal treatments such as black cohosh, red clover and
soy are felt safe for short term (<6 mos) use

12. Exercise, well-balanced nutrition, and cessation of
smoking, drinking or substance abuse can have
dramatic results on the effects of aging and menopause
Aerobic exercise – walking, running, jogging, dancing,
greatly improves stamina, cardiovascular status, and
releases “feel good” endorphins
Weight resistance exercise – push ups, pull ups, squats,
lunges, weight lifting, or water exercise help to increase
load bearing on muscles & tendons thereby increasing
muscle mass, and decreasing bone density loss

13. Many women in midlife are without health insurance
and/or do not receive this through a spouse or
employer
Midlife women without health insurance (if not
disabled) must pay privately for coverage or seek
employment that provides it
For older women needing insurance (<65), full-time
work may not be an option and they may not meet
poverty level for state Medicaid assistance
Affordable Care Act designed to provide more
affordable insurance options for under privileged
Americans through state wide insurance exchanges

14. Many support groups exist for women over 50, and
provide an important source of information, sharing
and networking.
In addition, several over 50 advocacy groups are
campaigning to improve the status an image of older
people in the U.S.
National Women’s Health Network provides women
with updates on current research and findings

15. So when did I get here? As a woman who is officially in
“midlife” I can tell you it has to be one of the best times
of my life. I am more confident, self-aware, and love
my new titles including “Mom-in-Law” and “Grandma”.
I feel I’m at the top of my game mentally, and
professionally, and no longer feel the need to put my
needs on the back burner.
I found this chapter to be very informative and helpful
in realizing some of the “restlessness” that comes with
this age is normal.

16. A thought for discussion:
What are you experiencing if you are indeed in
“midlife”. If you are not even close, where do you
think you will be when you get there?
I wince at saying this for fear of sounding “old”, but
time does go so fast. You really need to enjoy every
minute of your life, and make the most of what God
has given you.