Preparation and Planning - Perimenopause

<div data-rte-type="old"><div data-rte-type="old"><div data-rte-type="old">Good news for grandma! Researchers recently discovered that <a target="_blank" rel="noopener noreferrer" href="http://www.babymed.com/menopause" title="menopause">postmenopausal</a> grandmothers who babysit their grandchildren one day a week score highest on tests of mental acuity. Too much of a good thing, though, can be truly too much. Grandmothers who babysit five or more days a week score lowest in these tests of mental sharpness. Why? It's probably not the rambunctious kiddos. Active social engagement in one's golden years is vitally important for keeping the mind sharp and most grandmothers will agree that their grandchildren provide social engagement at its most active and rewarding best. Regular social interaction with others is an effective way of lowering one's risk of Alzheimer's disease and other age-related cognitive disorders and it just keeps life interesting. A group of researchers in Australia enlisted 186 women who were enrolled in a study called the Women's Healthy Aging Project to test their mental skills and describe their babysitting activities during the previous year. Each woman was postmenopausal and between the ages of 57 and 68. Of the 186, 120 of them were grandmothers. The three tests of mental agility were the:<ul><li>Symbol-Digit Modalities Test (SDMT)</li><li>California Verbal Learning Test</li><li>Tower of London</li></ul>The grandmothers taking care of grandchildren one day a week during the previous year scored highest in two of the three tests — the SDMT and the California Verbal Learning Test, especially the section of the California test involving immediate recall performance. The grandmothers babysitting five or more days a week during the previous year scored the lowest, especially in test areas that covered working memory and mental processing speed. The research team was surprised by this finding. Dr. Margery Gass, the executive director of the North American Menopause Society (NAMS), was not a part of the study, but in response to it, she says, "We know that older women who are socially engaged have better cognitive function and a lower risk of developing dementia later, but too much of a good thing just might be bad." The Australian study did not delve into why the women kept busiest with grandchildren scored lowest but the researchers are already actively engaged in continued study of the matter. The lower scores could result from the mood of an exhausted grandmother but there are hints in the study that point to the grandchildren's parents. One part of the study included the question of how demanding their children had been of the grandmothers in the previous year. The grandmothers who did the most babysitting reported strong feelings that their children were putting too much demand on them. Source: Burn, Katherine F, et al. "Role of grandparenting in postmenopausal women's cognitive health: results from the Women's Healthy Aging Project." Menopause. The North American Menopause Society / Lippincott Williams &amp; Wilkins. Apr 7, 2014. Web. Apr 21, 2014.</div></div></div>

Good news for grandma! Researchers recently discovered that
postmenopausal grandmothers who babysit their grandchildren one day a
week score highest on tests of mental acuity.

Keep Grandma Mentally Sharp; Let Her Babysit One Day a Week

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Many of today’s families enjoy the babysitting duties most grandmothers contribute willingly and lovingly. An anthropologist from Utah suggests grandmothers have contributed much more to human evolution than feeding babies and changing diapers. Her “grandmother hypothesis” suggests monogamy and longevity exist today because grandmothers of long, long ago stopped being fertile decades before they reached the end of their natural lifespans. That by losing their own fertility to <a title="menopause" href="https://babymed.com/menopause">menopause</a>, grandmothers actually generated greater numbers of offspring in their bloodlines and made it possible for humans to fall in love and live 80+ years today.
<h2>Grandmother Hypothesis</h2>
Anthropologist Kristen Hawkes of the University of Utah says her grandmother hypothesis contradicts the traditional theory that mate-bonding behaviors (monogamy) evolved from a trade-off between providing food and claiming descendants. The common theory is that males paired with one female by feeding her and her children so he could father her children and advance his genetic contribution to future generations. Hawkes theorizes it was grandmotherly child-rearing assistance, not the food itself, that allowed females to have more babies sooner than without grandma’s help. When grandma took over feeding duties for weaned grandchildren, her daughter was free to have more babies with shorter intervals in between.
<h2>Chimpanzees and Modern-Day Hunter-Gatherers</h2>
Hawkes tested her theory using computer-simulated models based on how two specific populations would evolve over 30,000 years:
<ul>
<li>Chimpanzees, humans closest genetic relatives. Chimps are promiscuous and do not form male-female bonds. Grandmother chimps don’t babysit their children’s offspring.</li>
<li>Modern-day hunter-gatherer societies, which do form male-female monogamous bonds and include grandmothers that do tend to their children’s children.</li>
</ul>
<h2>The Effect of Menopause</h2>
<ul>
<li>When Hawkes ran her computer models with grandmothers who retained fertility all their lives (no menopause), both societies evolved into female-dominant societies like today’s chimp societies. Females eventually outnumbered males, as is typical of a chimpanzee colony. </li>
<li>When Hawkes’ computer-simulated grandmothers did experience menopause, the ratio of fertile males to fertile females skyrocketed, to an eventual stable ratio of 156 fertile males to 100 fertile females. </li>
<li>When the fertile male population is so much larger than the fertile female population, males become much more guarded of their female mate. As the natural human lifespan lengthened over time, the number of older fertile males in a population grew even larger and competition for fertile females became more fierce.</li>
</ul>
<h2>Romance Blossomed</h2>
Promiscuous males fathered fewer children than males who bonded within a closed relationship with a female or a family containing several fertile females. Over time, the male’s mate-guarding behaviors became more complex than survival and procreation; affection and romance blossomed and fertile couples fell in love.
<h2>Longevity and Grandmother’s Genes</h2>
As the role of grandmothers became more valuable to the survival of small children, grandmothers started living longer after menopause. They became as valuable to the society infertile as when they were fertile. Since they lived longer, they could take care of more grandchildren, freeing up their children to have more children in quicker succession. Human longevity increased with each generation as grandmother’s genes for long lifespan were passed forward. Hawkes’ computer-simulated society with infertile grandmothers eventually reached lifespans of 70 or 80 years, as happens in real life today. Sources:
<ol>
<li>Coxworth, James E., Peter S. Kim, John S. McQueen, and Kristen Hawkes. "Grandmothering life histories and human pair bonding." <a title="PNAS " href="http://www.pnas.org/content/early/2015/09/02/1599993112" target="_blank">PNAS / Proceedings of the National Academy of Sciences of the United States of America</a> (2015). Web. 10 Sep. 2015.</li>
<li>Kelly, Diane. "Menopause May Be the Evolutionary Origin of Romantic Relationships — And Cheating." <a title="Gizmodo" href="http://throb.gizmodo.com/menopause-may-be-why-you-want-a-romantic-relationship-1729384829" target="_blank">Gizmodo</a> / Throb. Gizmodo, 8 Sep. 2015. Web. 10 Sep. 2015.</li>
</ol></div></body></html>

The “grandmother hypothesis” suggests monogamy and longevity exist today because grandmothers of long, long ago stopped being fertile decades before they reached the end of their natural lifespans.

Grandmother Hypothesis: How Menopause Shaped Human Evolution

<div data-rte-type="old">One of the scariest meetings in my life was my first appointment with a new gynecologist when I moved to Las Vegas. The gynecologist sat and listened to my medical history with true interest. He jotted down a few notes when I told him how many children I had and the fact that my tubes were tied after my last pregnancy. Then, when I started talking about my first abdominal surgery to remove a large endometrial cyst and my current pain and burning, he stopped writing. Just 25 minutes into the meeting he suggested a total abdominal hysterectomy with bilateral ovary removal. Being a young woman, the thought of being thrust into menopause this early was scary, but I was willing to do anything to stop the pain. Despite the CAT scan showing there was nothing causing the pain, the doctor completed the surgery anywhere. While inside he was nice enough to remove some scar tissue from my previous surgery. We later found out that scar tissue with a large endometrial cyst that was hemorrhaging. The doctor had not only stopped the pain, he'd saved my life.&nbsp;&nbsp;Five Years Later Five years have passed since that fateful surgery and I am happier and healthier than ever before. No more pain; no more menstrual cycles; no more menopause symptoms. I stopped taking hormone replacement therapy two years into menopause to protect my heart and reduce the risk of known side effects of long-term <a target="_blank" rel="noopener noreferrer" href="https://babymed.com/menopause/hormone-replacement-therapy">HRT </a>use.&nbsp;Menopause symptoms do stick around for years after hitting menopause. For women who naturally enter menopause the symptoms may not be as strong because reproductive hormones gradually fade away. Surgery stops hormone production immediately - like RIGHT NOW. Most doctors suggest using a hormone replacement patch, placed on the skin immediately after surgery, for at least a few months post surgery to help the body heal before adding pressure. You can leave the hormone replacement patch behind when you're ready as long as you are willing to deal with menopause symptoms for a while.&nbsp;What Can I Tell Other Young Women? The symptoms DO stop. Don't worry about living the rest of your life sweating all over the place, acting like Cybil and fighting that constant headache. HRT is great for the first couple of years, get used to life in menopause. Work with your doctor to gradually reduce dosage and then fade off medication all together.&nbsp;</div>

One of the scariest meetings in my life was my first appointment with a
new gynecologist when I moved to Las Vegas. The gynecologist sat and
listened to my medical history with true interest.

Hysterectomy: Where Am I Five Years Later?

<div data-rte-type="old">Women are hitting the ground running with hopes, dreams and personal expectations both in life and work, that keep the idea of starting a family a bay. Sometimes women choose to freeze eggs when they are healthy and abundant in hopes of starting a family later in life, but as the years of menopause approach, does the uterus age to the point that conception and healthy pregnancy is impossible? The uterus, unlike the ovaries, does not age and successful pregnancy can be achieved, in some cases, well into the 60s.&nbsp;&nbsp;Reproduction and Age Women are born with a set number of eggs, unlike men who produce sperm by the millions throughout life. When the number of available eggs starts to diminish, perimenopause starts. For some women, perimenopause starts in the late 30s, but other women don’t notice the subtle changes until they are already in their 40s or early 50s. The most common symptom of perimenopause is irregular menstrual cycles. Some women experience shorter periods and others experience longer times between periods, but in the end all women stop having periods all together and that is when perimenopause changes to <a target="_blank" rel="noopener noreferrer" href="http://www.babymed.com/menopause" title="menopause">menopause</a>.&nbsp;During the late perimenopause period, only the older eggs are left, which may increase the risk of birth defects or make it more difficult to conceive. But, this change has nothing to do with the uterus. The uterus does not physically change during menopause, though changes do occur inside the uterus as a result of lower levels of reproductive hormones like estrogen. Essentially, the uterus can hold and sustain life indefinitely no matter how old mom is at conception.&nbsp;How to Achieve Pregnancy After Menopause Even though the uterus does not age, it is impossible to conceive naturally after menopause. In-vitro fertilization clinics can help women conceive even after menopause is complete. Each clinic will have different in-house rules – often set by personal comfortability – about later in life conception, but many clinics are willing to help women up to 60 years of age.&nbsp;</div>

Sometimes women choose to freeze eggs when they are healthy and abundant
 in hopes of starting a family later in life, but as the years of
menopause approach, does the uterus age to the point that conception and
 healthy pregnancy is impossible?

Does My Uterus Age?

<html><head></head><body><meta charset="utf-8">If you’re experiencing symptoms or have concerns about perimenopause, asking your doctor specific questions can help you understand what’s happening in your body and how to manage it effectively. Here are some valuable questions to consider:&nbsp;1. What symptoms are normal during perimenopause, and which should I be concerned about?This can help you differentiate between typical perimenopausal symptoms and signs that may need further investigation, like heavy bleeding or unusual pain.2. How can I confirm that I’m in perimenopause?Ask if hormone level testing or other assessments might clarify whether you’re in perimenopause or if another condition might be contributing to your symptoms.3. How can I manage my symptoms naturally?Many doctors recommend lifestyle changes like diet and exercise modifications, stress management techniques, and supplements. Ask which ones might be helpful for your specific symptoms.4. What treatment options are available for severe symptoms?If symptoms like hot flashes, night sweats, or mood swings are significantly impacting your life, ask about treatment options, including medication, Hormone Replacement Therapy (HRT), or non-hormonal options.5. What are the risks and benefits of Hormone Replacement Therapy (HRT)?If you’re considering HRT, understanding the pros and cons, especially based on your personal health history, is essential. Ask about short- and long-term effects and alternative treatments.6. Are there lifestyle changes I should consider to manage weight gain and other metabolic changes?Since weight gain, muscle loss, and metabolic shifts are common, your doctor can advise on diet, exercise, and specific approaches for maintaining a healthy weight and metabolism.7. How can I protect my bone and heart health during this time?Declining estrogen affects bone density and cardiovascular health. Ask about ways to prevent osteoporosis and maintain heart health through diet, exercise, and possibly supplements or medications.8. What can I do to manage mood swings, anxiety, or “brain fog”?Perimenopausal hormonal changes can affect mental clarity and emotional health. Ask about lifestyle tips, counseling, or medications that may help improve mood and cognition.9. Is there anything I can do to improve sleep quality?Many women experience sleep disturbances during perimenopause. Ask about techniques, supplements, or medications that can help, and whether a sleep study might be beneficial.10. How will I know when I’ve transitioned from perimenopause to menopause?Clarify what to expect when perimenopause ends and how to monitor the transition. Understanding what marks the official start of menopause (12 consecutive months without a period) can provide clarity.11. Are there tests or screenings I should prioritize during perimenopause?Certain screenings, like mammograms, bone density scans, or heart health tests, may be more relevant as you transition into menopause. Ask about routine tests to monitor your health.12. What resources are available if I need more support?Your doctor may have recommendations for support groups, counselors, or specialists who focus on menopause, as well as reputable online or local resources.Having a list of questions can make it easier to address your concerns, get reassurance, and receive guidance on next steps. Perimenopause can feel challenging, but working with a healthcare provider ensures you’re supported and informed as you navigate it.&nbsp;Sources:American College of Obstetricians and Gynecologists. (2021). Management of menopausal symptoms (Practice Bulletin No. 141). Obstetrics &amp; Gynecology, 137(1), e30-e46.Anderson, D. J., Chung, H. F., &amp; Seib, C. A. (2021). Lifestyle factors and vasomotor symptoms: A systematic review and meta-analysis. Climacteric, 24(2), 108-119.Eastell, R., Rosen, C. J., Black, D. M., Cheung, A. M., &amp; Murad, M. H. (2019). Pharmacological management of osteoporosis in postmenopausal women: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology &amp; Metabolism, 104(5), 1595-1622.El Khoudary, S. R., Aggarwal, B., Beckie, T. M., Hodis, H. N., Johnson, A. E., Langer, R. D., Limacher, M. C., Manson, J. E., Stefanick, M. L., &amp; Allison, M. A. (2020). Menopause transition and cardiovascular disease risk: Implications for timing of early prevention. Circulation, 142(25), e506-e532.Gold, E. B., Crawford, S. L., Avis, N. E., Crandall, C. J., Matthews, K. A., Waetjen, L. E., Lee, J. S., Thurston, R., Vuga, M., &amp; Harlow, S. D. (2020). Factors related to age at natural menopause: Longitudinal analyses from SWAN. American Journal of Epidemiology, 189(1), 34-45.Maki, P. M., Kornstein, S. G., Joffe, H., Bromberger, J. T., Freeman, E. W., Athappilly, G., Bobo, W. V., Rubin, L. H., Koleva, H. K., Cohen, L. S., &amp; Soares, C. N. (2019). Guidelines for the evaluation and treatment of perimenopausal depression. Journal of Women's Health, 28(2), 117-134.North American Menopause Society. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767-794.Pinkerton, J. V. (2020). Hormone therapy for postmenopausal women. New England Journal of Medicine, 382(5), 446-455.Santoro, N., Roeca, C., Peters, B. A., &amp; Neal-Perry, G. (2021). The menopause transition: Signs, symptoms, and management options. The Journal of Clinical Endocrinology &amp; Metabolism, 106(1), 1-15.Shifren, J. L., &amp; Gass, M. L. S. (2019). The North American Menopause Society recommendations for clinical care of midlife women. Menopause, 26(10), 1238-1257.The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. (2018). The 2017 hormone therapy position statement of The North American Menopause Society. Menopause, 25(11), 1362-1387.</body></html>

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Concerned about Perimenopause? Questions to ask your doctor

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Perimenopause: Questions Everyone Has

<html><head></head><body><meta charset="utf-8">As more women remain in the workforce beyond their 40s, understanding how perimenopause affects work ability and health is becoming increasingly important. This Dutch study explored how menopausal symptoms influence work capacity, self-rated health, and emotional exhaustion among 4,010 female employees aged 40–67. The findings underscore the need for supportive workplace measures to address the challenges associated with this natural life transition.<h4 style="line-height:1.38;margin-bottom:2pt;margin-top:12pt;" dir="ltr">Key Findings: Prevalence and Symptoms of Perimenopause</h4>The study revealed that 18.5% of participants were in the perimenopausal stage, defined as experiencing irregular menstrual cycles. Among these women, nearly 80% reported menopausal symptoms, with 27.5% experiencing them frequently. Common symptoms included fatigue, low sex drive, muscle or joint pain, and hot flashes, which align with previous research on menopause.Women frequently experiencing symptoms reported more severe psychological, physical, and vasomotor issues, scoring significantly higher on the Greene Climacteric Scale (GCS), which measures menopausal symptom severity. They also tended to work fewer hours, were more likely to work part-time, and were more prone to being overweight or obese compared to their peers.<h4 style="line-height:1.38;margin-bottom:2pt;margin-top:12pt;" dir="ltr">Impact on Work and Health</h4>Perimenopausal women frequently experiencing symptoms reported:<ul style="margin-bottom:0;margin-top:0;padding-inline-start:48px;"><li style="background-color:transparent;color:#000000;font-family:Arial,sans-serif;font-size:11pt;font-style:normal;font-variant:normal;font-weight:400;list-style-type:disc;text-decoration:none;vertical-align:baseline;white-space:pre;" dir="ltr" aria-level="1">Lower Work Ability: These women rated their ability to work lower than premenopausal or postmenopausal women. The average work ability score dropped significantly as symptom frequency increased.</li><li style="background-color:transparent;color:#000000;font-family:Arial,sans-serif;font-size:11pt;font-style:normal;font-variant:normal;font-weight:400;list-style-type:disc;text-decoration:none;vertical-align:baseline;white-space:pre;" dir="ltr" aria-level="1">Poorer Self-Rated Health: Over 37% of women frequently experiencing symptoms rated their health as poor compared to 14% of symptom-free women.</li><li style="background-color:transparent;color:#000000;font-family:Arial,sans-serif;font-size:11pt;font-style:normal;font-variant:normal;font-weight:400;list-style-type:disc;text-decoration:none;vertical-align:baseline;white-space:pre;" dir="ltr" aria-level="1">Higher Emotional Exhaustion: Emotional exhaustion—a key marker of burnout—was reported by 39% of women with frequent symptoms, compared to only 13% of those without symptoms.</li></ul>These findings suggest that menopausal symptoms significantly affect women’s ability to sustain their work performance and overall well-being.<h4 style="line-height:1.38;margin-bottom:2pt;margin-top:12pt;" dir="ltr">Workplace Challenges and Cultural Barriers</h4>Despite the prevalence of menopausal symptoms and their impact on work, there remains a workplace stigma around discussing menopause. Many women fear being judged or stigmatized, and healthcare professionals often lack training to address these issues in an occupational context. This cultural taboo can prevent women from seeking help or adjustments that might improve their quality of life and work performance.<h4 style="line-height:1.38;margin-bottom:2pt;margin-top:12pt;" dir="ltr">Recommendations for Employers and Healthcare Providers</h4>The study highlights the need for proactive workplace policies to support perimenopausal women. These could include:<ul style="margin-bottom:0;margin-top:0;padding-inline-start:48px;"><li style="background-color:transparent;color:#000000;font-family:Arial,sans-serif;font-size:11pt;font-style:normal;font-variant:normal;font-weight:400;list-style-type:disc;text-decoration:none;vertical-align:baseline;white-space:pre;" dir="ltr" aria-level="1">Educational Programs: Raising awareness about menopause among employees and management.</li><li style="background-color:transparent;color:#000000;font-family:Arial,sans-serif;font-size:11pt;font-style:normal;font-variant:normal;font-weight:400;list-style-type:disc;text-decoration:none;vertical-align:baseline;white-space:pre;" dir="ltr" aria-level="1">Flexible Work Arrangements: Allowing adjustments to work hours or remote work options to accommodate symptom management.</li><li style="background-color:transparent;color:#000000;font-family:Arial,sans-serif;font-size:11pt;font-style:normal;font-variant:normal;font-weight:400;list-style-type:disc;text-decoration:none;vertical-align:baseline;white-space:pre;" dir="ltr" aria-level="1">Health Resources: Providing access to healthcare professionals knowledgeable about menopause and its effects on work and health.</li><li style="background-color:transparent;color:#000000;font-family:Arial,sans-serif;font-size:11pt;font-style:normal;font-variant:normal;font-weight:400;list-style-type:disc;text-decoration:none;vertical-align:baseline;white-space:pre;" dir="ltr" aria-level="1">Open Dialogue: Encouraging conversations about menopause to reduce stigma and create a supportive environment.</li></ul><h4 style="line-height:1.38;margin-bottom:2pt;margin-top:12pt;" dir="ltr">Conclusion</h4>Perimenopause is a critical phase where many women face increased challenges at work due to symptoms like fatigue, emotional exhaustion, and health-related difficulties. Addressing these issues with targeted workplace interventions and healthcare guidelines can help improve the well-being and sustainable employability of women during this stage of life. By fostering an inclusive and supportive work environment, organizations can ensure that women can continue to thrive in their professional lives while managing the natural transitions of midlife.Source:Oude Hengel, K. M., Loef, B., Soeter, M., Hooftman, W. E., in der Maur, M., &amp; van Oostrom, S. H. (2023). Perimenopause: Symptoms, work ability and health among 4010 Dutch workers.&nbsp;Maturitas, 176, Article 107793.</body></html>