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Perimenopause: The change of life
Follicle stimulation hormone test
Signs of approaching menopause
Information from Planned Parenthood
Menopause: A guide for women and those who love them
The terrible three: Mid-life, perimenopause, and divorce
Childbearing and the change of life
Other conditions associated with the change of life
Any woman who suspects she may be undergoing the change of life, which can occur any time between the age of 35 and 50, and averages around 43, should seek competent medical help. Any man who recognizes the symptoms tabulated below in his mate, or another woman he is close to, should ask her to visit a doctor with expertise in this phase of a woman's life. A note of caution, however. Most doctors we have talked to are quite uninformed about this period of a woman's life, even physicians who claim to practice in this area. Any woman entering this time of her life is well advised to inform herself about what she is going through.
A great deal of information on the subject of perimenopause and menopause can be found in Menopause: A Guide for Women & Those Who Love Them. Suzanne Somers has also published a popular book on these problems titled The Sexy Years, although most women certainly don't feel that way about this phase of their lives.
Most medical authorities agree that hysterectomies are usually unnecessary. We urge anyone considering such surgery to read Hysterectomy: Before and After and get a second opinion on the necessity for surgery over treatment before proceeding.
Time after time when we talk to couples who are in their forties, or who remember their parents during this time, there are difficulties in the relationship between a man and a woman. One of the contributing factors to those difficulties is a biological change referred to most commonly as the change of life, or perimenopause, that all human females undergo as they approach menopause, or the cessation of menses.
One of the most common threads in the responses we have received through this Web site about abusive women is that they are either in their early 40's or they have had a hysterectomy. If drugs or alcohol are also a problem in the relationship, the mix seems to be explosive. However, our sample is not large enough to be statistically valid and the results are biased toward men and women who are computer literate and usually middle class.
Perimenopause begins at an average age of 43 when a woman's estrogen hormone levels begin to drop. But according to
Planned Parenthood,
perimenopause may begin as early as age 35. It may also occur at a much younger age due to a hysterectomy or naturally. Usually, age 35 is the lower limit for natural onset.
Most women are taken by surprise when it starts.
Perimenopause starts about two years earlier for women who smoke than for women who don't. The timing is not related to race, class, pregnancy, breast feeding, fertility patterns, birth control pills, height, age of menarche (first period), or age at last pregnancy.
Perimenopause, or the period a woman goes through known as the “change of life,” typically lasts at least five years before the cessation of menses that marks actual menopause. Women reach actual menopause at different times. While for most women perimenopause will last about five years, for some it lasts as long as 10 to 12 years.
As noted in Table 10 of the section on frequency of domestic violence, there are dramatic shifts in the perpetrator of family violence during these years. Since modern medicine has made vast strides in relieving the problems associated with perimenopause, or the hormonal imbalance introduced by a hysterectomy, it is our contention that this is an area where family violence can be reduced, and domestic harmony increased, by education and proper medical care. We would like you to note that our approach is in stark contrast to the feminist approach of always blaming the male, invoking police intervention, and forcibly separating the couple.
The danger to both partners during this period is not trivial. In the data available to me, extreme violence by women peaks around age 40 (Table 11). It is unknown how many of these women had had a hysterectomy. Langran and Dawson (1995) found that in the spouse murders they investigated the average age of husbands who had killed their wife was 41; and 37 years for wives who had killed their husbands.
We suggest that you consult the Planned Parenthood Web site for additional information on the change of life. We also recommend you read Menopause: A Guide for Women & Those Who Love Them by Winnifred B. Cutler, Ph.D. and Celso Ramon Garcia, M.D.
It could save your relationship and possibly your life!
If your wife, companion, or other female friends are 35 or over and suddenly begin acting or feeling strange, then the onset of perimenopause should be considered as likely. If a woman is between 40 and 45, and experiencing any of the symptoms listed below, it is a virtual certainty that perimenopause has begun.
A woman's gynecologist or family doctor can run a simple and fast Follicle Stimulation Hormone (FSH) test to determine if a woman is perimenopausal, or it can now be done at home. But if she is experiencing perimenopausal symptoms, an FSH test is basically a waste of time and money except possibly to convince her. Many women deny the change of life is happening to them so the FSH test may help overcome their denial of mortality.
Follicle-stimulating hormone encourages the ovaries to produce estrogen. During her fertile years a woman normally has very low levels of FSH, generally less than 20 or so nanograms per milliliter of blood. As women age, however, the ovaries respond less and less to escalating levels of FSH. In turn, the pituitary gland produces more FSH, seeking to prod the ovaries into producing more estrogen. Thus, elevated levels of FSH are normally associated with decreased estrogen levels and the onset of perimenopause.
Increased levels of testosterone relative to decreasing estrogen during this period in a woman's life has the same effect on women as it does on men when the balance is destroyed.
One study found that the female hormone estrogen “...was a source of aggressive tendencies.” (Cook, 1997, p. 33) What new scientific research may be finding is that any imbalance of testosterone or estrogen may lead to higher levels of aggression in both males and females who are predisposed to violence.
The net result is that your once sweet wife may now be a raging monster that you don't even recognize at times. You may even need to physically restrain her until the problem is recognized and she begins the Hormone Replacement Therapy (HRT) regime, assuming she will. Even after she begins HRT it will usually take 2 to 3 months, or longer, before she returns to 'normal.'
In the interim it does no one any good, and a substantial number of people harm, to treat the physical restraint that is occasionally necessary as 'domestic violence.' Nor should the quarrels that almost inevitably occur in such unfortunate situations be regarded as domestic abuse by the male.
Perimenopause is a natural biological condition with emotional side effects that can be medically treated.
Involving the police and the courts does immeasurable harm.
The conditions women experience before and after menopause are very real and sometimes very serious. While the change of life is something that all human females go through, about 10%-15% of American women experience no signs of menopause. Conversely, about 10%-15% become physically or emotionally disabled for various periods of time by these conditions. Put another way, there is roughly a 90% chance that a woman will experience varying levels of physical and emotional distress as she passes through the change of life.
For the unfortunate 10% to 15% of women who become physically and emotionally disabled during these years, life can be a nightmare for the woman, her mate, and any children they have at home. While going through the change of life, an RN, who is now an elderly matron, said she would be quietly washing dishes at the sink and turn around ready to kill someone. Another RN, age 50, who had started taking hormone replacement therapy (HRT), told of how she would come home from work looking for a dog to kick before she began HRT. Conversely, women who do start HRT after the onset of perimenopause, or a hysterectomy, often refer to the treatment as “happy pills.”
Repeatedly, women who have been through the emotional distress of perimenopause say that they are not aware it is happening. Therefore, the person to whom it is happening is the worst possible judge of her condition.
Any man who has been with a woman who has had a hysterectomy, or while she is going through the change of life, recognizes the grim humor in “I'm out of estrogen and I have a gun.” The good news for everyone is that she will almost certainly return to normal within a few months of beginning HRT. Hormone therapy has also been shown to be effective in maintaining lean body mass and keeping cholesterol levels low.
In her popular book
The Sexy Years,
Suzanne Somers describes her experience with the onset of perimenopause as the Seven Dwarfs (p. 2) that she names:
in the order she experienced them.
She notes that she first “...developed this itch on my right calf that was so irritating, I wanted to scratch the skin right off my body.” As scratch marks are often used to suggest domestic violence has occurred, any woman 35 or over with scratch marks or similar skin blemishes should get an FSH test to see if the problem is with the onset of perimenopause.
Ms. Somers also promotes the use of bioidentical hormones over synthetic hormones and Marcelle Pick OB/GYN NP with Women to Women concurs. A great deal of medical information about natural hormone-replacement therapy with bio-identical hormones can be found on the web site of Kenton Bruice, M.D., Board-certified gynecologist.
As described below, perimenopause may express itself with many other symptoms, and the problems will probably not occur in the order experienced by Ms. Somers. As noted above, some women experience virtually no symptoms and others, more unfortunate, will experience physical and emotional breakdowns during this phase of their lives if left untreated. Obviously, more severe problems with perimenopause will lead to difficulties, and even violence, in the woman's relationships. Medical treatment is the answer, not blaming the man and calling 911.
According to Planned Parenthood the average age for cessation of menses, or actual menopause, is 51. They list the following as common signs of approaching menopause, or perimenopause. Such symptoms begin at an average age of 43 as estrogen levels begin to drop:
• Most women's menstrual periods become irregular.
• Fatigue and decreased energy.
• Weight gain and increased cholesterol levels.
• Difficulty in concentrating.
• Hot flashes or night sweats (including extreme sweating and difficulty breathing).
• Mood changes (these may be sudden and radical).
• Conditions commonly associated with PMS.
• Changes in sexual desire (either an increase or a decrease).
• Many women also report asthma attacks associated with perimenopause.
• Itching, or a feeling that ants or other insects are crawling on your skin, a condition known as formication.
Planned Parenthood also points out that a woman's experiences during menopause may be influenced by other life changes:
• Changes in domestic, social, and personal relationships.
• Changes in identity and body image.
• Increased anxiety about aging and death.
• Loss of friends, loved ones, and financial security.
• Increased responsibility for aging parents.
• Anxiety about loss of independence, disability, or loneliness.
• Increasing numbers of perimenopausal women also have young children to care for as they bear later in life.
Many women also report “feeling invisible” to men due to a loss of sexual attraction as menopause approaches.
In Menopause: A Guide for Women & Those Who Love Them , Winnifred B. Cutler, Ph.D. and Celso Ramon Garcia, M.D. also list the following possible symptoms but there is no way to predict which ones a woman will suffer from as she goes through perimenopause and menopause:
• Backaches (a very common complaint).
• Memory loss or difficulty remembering things.
• Offensive menstrual odor or increased discharge.
• Breasts become very tender and sore at odd times (occurs in about one-third of women).
• Emotional distress that may include, but is not limited to, irrational anger or fear, violent acts, unjustified jealousy, and erratic behavior.
• Evidence of skin aging (increased dryness, 'liver spots', sagging skin, wrinkles, etc.)
• Changes in visual acuity requiring changes in eyeglass prescriptions or other vision problems.
• Genital and urinary-tract infections.
A woman may have one, some, or none of these signs. But the ones she does have can be so unpredictable and disturbing that she can feel like she's “going crazy.” Her mate may think she is.
Often her mate will feel she is taking her frustration out on him and most males have a very hard time recognizing or dealing with perimenopause, particularly if the woman is unaware it is happening due to early onset or other factors. She may also refuse to seek treatment.
Formication, the feeling that ants or other insects are crawling on their skin, affects about 20% of women during perimenopause and menopause. Formication can cause a woman to scratch herself raw. Formication is also associated with alcoholism and may be accentuated in women who drink heavily. Legal and illegal drug use, particularly methamphetamine, or disease of the spinal cord and peripheral nerves, may also be associated with formication. Some schizophrenics also experience formication.
Note that many women experience severe itching during perimenopause that is unrelated to formication. Consultation with a gynecologist who has experience with such symptoms and hormone replacement therapy will usually provide relief. Note, however, that a number of women have told us that their gynecologist was not aware that itching and formication were associated with perimenopause. So you may well need to visit a dermatologist or endocrinologist to find a doctor with experience in this area.
Divorce is a common companion of this period of a woman's life as the husband is unable to cope with the erratic, irrational, destructive, and violent monster he now finds himself living with. Or she finds she can no longer tolerate behavior she once found so adorable. Allegations and actual incidences of domestic violence surface three times as frequently for separating wives than for divorced women, and twenty-five times more often than for married women.
This period of a woman's life is commonly described as The Terrible Three: mid-life, perimenopause, divorce. To obtain an estimate of the effect of perimenopause on many women's lives one need only look in the personals column of any newspaper to see the preponderance of women in their 40's.
In a study of domestic violence as it relates to age among cohabiting and married partners, Stets and Straus found that the ratio of female-only violence actually increases with age. For cohabiting couples 45+, female-only violence rises to an astonishing two-thirds of the violent couples studied (Table 10).
Langran and Dawson (1995) found that in the spouse murders they investigated the average age of husbands who had killed their wife was 41; and 37 years for wives who had killed their husbands. We have also been looking at the age relationship for extreme violence by women. Table 11 shows that extreme violence by women peaks between age 35 and 44, the age range in which most women's estrogen levels begin to decline.
The previous two paragraphs suggest that easing the problems of the change of life that all females undergo could be a significant factor in reducing domestic violence. The current practice of arresting middle-aged males because the wife has gone berserk is counter-productive for society.
We like to think that a little humor might help to relieve and lighten a situation that can be very troubling for many women and their husbands. Thus, we hope you enjoy:
1. Everyone around you has an attitude problem.
2. You' re adding chocolate chips to your cheese omelet.
3. The dryer has shrunk every last pair of your jeans.
4. Your husband is suddenly agreeing to everything you say.
5. You' re using your cellular phone to dial up every bumper sticker that says: “How's my driving-call 1- 800-....”
6. Everyone's head looks like an invitation to batting practice.
7. Everyone seems to have just landed here from “outer space.”
8. You can't believe they don't make a tampon bigger than Super Plus.
9. You' re sure that everyone is scheming to drive you crazy.
10. The ibuprofen bottle is empty and you bought it yesterday.
1. You sell your home heating system at a yard sale.
2. Your husband jokes that instead of buying a wood stove, he is using you to heat the family room this winter. Rather than just saying you are not amused, you shoot him.
3. You have to write post-it notes with your kids' names on them.
4. The phenobarbital dose that wiped out the Heaven's Gate Cult gives you four hours of decent rest.
5. You change your underwear after every sneeze.
6. You' re on so much estrogen that you take your Brownie troop on a field trip to Chippendales.
7. Don't think of it as getting hot flashes. Think of it as your inner child playing with matches.
Unfortunately, we have replaced the relatively delicate means by which society previously handled menopausal women with laws that blame the male for an act of nature.
It seems to go unremarked in the literature that the trend in modern life is for women to bear children in their late 20's and 30's. Sometimes women today are even in their early forties before having their first child. The biological consequences for women of delaying child bearing can be profound.
Before the development of modern medicine, women typically began bearing children sometime between about age 15 and 20, and children were typically grown by the time their mother reached age 40. That was a biological necessity because humans only lived to an average age of about 45 until about a hundred years ago. But modern hygiene and medicine have modified the biological cycle and women now often bear their children much later.
Unless she has a hysterectomy (surgical menopause), virtually every human female will go through perimenopause sometime between the age of 35 and 50, with the average age around 43 as noted above. As noted humorously in estrogen issues, this can be a very difficult period in many women's lives without the added stress of children.
For most children, puberty and their teenage years are among the most difficult years of their childhood. They are difficult years for their parents as well.
Now if we do some simple addition, for a woman who has her children between, say, age 28 and 32, when she reaches perimenopause around age 43 the children will be in the middle of puberty and their teenage years. These are not likely to pleasant years for her, the children, and, particularly, her husband. Permanent damage may easily result for all parties, but most especially the children, if perimenopause is combined with teenage children.
Nor is life much easier for women going through perimenopause with even younger children. Or for the young children.
Divorce at this time can only make the change of life worse and will almost certainly destroy her children's futures. Divorce certainly solves very few problems for women during this period of their life and commonly creates many more. Typically, the problems are not her husband's fault, however convenient it may be to blame everything on him.
The lesson for women is, if you have a choice, bear your children early in life so you can enjoy them later, and they can enjoy you. Or at least tolerate you through the transition.
During their fertile years up to 75% of women suffer from what has been termed Pre-Menstrual Syndrome (PMS) each month in the days leading up to menstruation.
While we are not aware of any research connecting domestic violence and PMS, any man living with a woman who suffers from PMS is well aware of the tensions and depression associated with this time of her monthly cycle.
Warren Farrell does list PMS as one of the twelve female only defenses he tabulates. So there is almost certainly a link between domestic violence (and abuse) and PMS that hasn't yet been researched.
Women suffering from PMS suffer from one or more of the following symptoms:
• Mood swings, depression, anxiety, anger, and crying spells.
• Bloating or swelling, often in their belly or legs.
• Craving for sweets, particularly chocolate, or salts.
• Breasts become tender in the days before menstruation.
• Lower backache or overall aches and pains.
Note that many, if not all these problems are also associated with perimenopause. It is suspected that one reason many women don't recognize the onset of perimenopause is that they have been suffering for years from PMS. Perimenopause then just seems like the same old problem. It isn't!
In severe cases of PMS, drugs such as Prozac have been prescribed to provide relief. However, there is increasing evidence that Prozac side effects include increased depression, rather than relieving it. Also, Prozac has been linked with violent behavior, including murder and suicide. However, we know of no studies to date that has linked the use of Prozac with domestic violence but ClinicalTrials.gov is currently (August 2005) recruiting volunteers for such a study.
There is also evidence that calcium supplements may ease the problems of PMS for some women. As is usually the case, a healthy diet and exercise will help as well. Some women report sexual congress during PMS helps relieve the symptoms as well.
Whatever the problem, PMS is not her male partner's fault, though victims of PMS often rant and irrationally complain about and to their mates during this time of the month.
Should domestic violence and abuse prove to be linked to PMS, we most certainly won't solve the problem by blaming the man.
Hysterectomy is the most common nonpregnancy-related surgery performed among American women. About 600,000 women undergo the procedure each year, and by the age of 60 nearly one out of every three women will have undergone a hysterectomy. Often this procedure is done at a relatively young age. Aside from the fact that such operations are frequently unnecessary, the emotional distress introduced by the resultant hormone imbalance must very frequently be a factor in domestic relations. It is, after all, the equivalent of castrating a male.
A hysterectomy is instant menopause and, in general, the medical profession does a very poor job of preparing women for the physical and emotional changes associated with the operation. To do so would no doubt cut into the lucrative, but unnecessary, surgical practices of many doctors.
For example, a study by Dr. Glenn Braunstein, of Cedars-Sinai Medical Center of Los Angeles, found that about 43% of women who had hysterectomies reported sexual dysfunction after their surgery. The problems included a decrease in sex drive and sexual pleasure, inability to achieve orgasm, and sometimes depression.
Despite adequate estrogen-hormone replacement therapy (HRT) to overcome vaginal dryness, women who have had this operation often complain of a loss of physical attractiveness.
A hysterectomy, with or without removal of the ovaries, also accelerates the endocrine changes characteristic of aging. Even when the ovaries are retained, the surgery accelerates ovarian senescence by approximately 5 years.
If someone close to you has undergone a hysterectomy, and their physician or surgeon has not started them on hormone replacement therapy (HRT), we would suggest they seek another opinion regarding the desirability of beginning HRT. An excellent book on the subject is: Hysterectomy: Before and After by Winnifred Cutler, Ph.D. It is best to read this book well in advance of submitting to “surgical menopause.” We would particularly recommend consulting this book, and discussing it with your doctor, if someone dear to you is being advised to have a hysterectomy.
Men are almost always totally unprepared for hormonally-induced mood swings in women. PMS is bad enough, but when, during perimenopause, or after a hysterectomy, the lovely and loving creature he lives with turns into a volcanic virago, the male is baffled. Almost certainly, everything he tries to do to fix the problem will make things worse.
If you talk to the male companions of most women who have undergone a hysterectomy, they often find themselves dealing with a crazy woman they don't recognize. Most men can't deal with women's moods even when they are presumably “normal.” It commonly takes more than a year to stabilize the required HRT regime after surgery. Survival of a relationship during that period is an iffy proposition.
The playful kitten he lives with is suddenly a raging lioness after a hysterectomy, and he is forced to defend himself and the children against her. Arresting the male, forcing him from his home, and taking his children away is not the solution to this problem, but it is the approach taken by current laws.
Very few men can handle arrest and forced eviction gracefully, and the common result is separation and divorce, children in misery, and lowered living standards. That seems such a waste when most hysterectomies are unnecessary, and HRT has been shown to be commonly safe and effective in relieving the emotional distress.
The menopause cycle is natural, hysterectomies are not. Neither is a situation that should be handled in a criminal court under the guise of “domestic violence.” There are also many other factors that lead to emotional disturbances in women, and men, that are commonly associated with violence. Arrest and imprisonment are seldom the solution to such medical problems.
For many people, middle age is a period when other biological problems crop up. If a woman goes to her doctor for menopausal symptoms, a competent physician will also test for thyroid and other endocrinal problems. Late-onset diabetes, asthma, and weight control problems also are common during the middle years. All of these conditions can cause personality and physical changes that bring added strain to what may already be a troubled relationship.
The good news is that with proper medical care and exercise these conditions can often be controlled and even cured.
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