Managing Menopause

Menopause is the time in a woman’s life when her reproductive capacity has ended and she no longer passes eggs out of her ovaries or creates a lining in her uterus for one of those eggs to grow in, should it be fertilized. There is a great deal of attention paid to this transition for women, which leads us to think of it as a medical event rather than what it really is: a normal passage into the next phase of a woman’s life.

This midlife transition for women has gone from being an uncomfortable subject enshrouded in secrecy to being the very public basis for jokes and off-handed references. Every woman who lives through her 50’s will go through menopause, though, interestingly, women’s experience of it varies. Some women barely notice anything beyond the absence of their menstrual period, while others are plagued by uncomfortable and distressing symptoms. Some of this may be genetic. Asian women, for example, tend not to have hot flashes as much as Caucasian women do. Over the past several years, we have begun to look anew at what menopause is like for different women around the world and we have discovered that there are aspects of it that women can impact if they are well-informed.

The average age of menopause in the United States is 51 years, though the normal span is from early 40’s to late 50’s. Women who smoke or are very thin may have menopause earlier than other women. Along with the cessation of menstrual periods, other changes occur in women’s bodies. In fact, these changes begin to appear in the years or months before menstruation stops, and many continue for a while afterwards. Understanding the processes in the body, and learning how to adapt to these shifts can make this stage of life easier to move through and can set the stage for better health in the postmenopausal years.

Although we mark menopause from the time a woman has not had a period for 12 months, the years before that, referred to as “perimenopause,” are often marked by the beginning of hot flashes, sleep disturbances, sexual dysfunction, and mood changes. Research shows that regular exercise during menopause can reduce symptoms.

Studies show that the best exercise plan during and after menopause is relatively high-intensity physical activity performed several days per week. That said, what matters most is participation in an exercise program that you can be consistent with. Exercise has been shown, among other benefits, to be correlated with decreased levels of stress and improved quality of life.

Once a woman is fully in menopause, her body is producing markedly less estrogen and progesterone. At this time, several health issues become much more of a concern. Among these are bone density, heart disease, weight maintenance, and mental health. Fortunately, women can impact their likelihood of encountering these health challenges. Below are some suggestions for addressing these major issues.

Bone up! Our bones are constantly being remodeled. On a cellular level, they are broken down and rebuilt constantly. At menopause, bones begin to break down faster than they are rebuilding. This is the basis of osteoporosis which puts women at risk for fractures. Weight bearing exercise is essential to keep bones strong. Taking Calcium supplements and Vitamin D can help, too, as does eliminating soft drinks.

Keep the beat! At menopause women’s rate of heart disease catches up with men’s risk. Aerobic exercise and low fat diets have a big impact on heart health.

Choose the right “weight”. As metabolism slows with the hormone changes, it becomes very easy for women to gain weight. The deposition of fat, especially in the abdomen, is linked with many serious diseases. Keeping strong helps keep your metabolism up, and burning calories with moderate levels of exercise will keep those extra pounds off.

Let the good times roll! Studies show that depression and difficulty concentrating are common in perimenopausal women. Both of these can arise from many factors. While exercise is not a cure, it has been shown to help reduce the severity of both depression and cognitive impairments. Getting involved in meaningful projects, learning new skills, and developing healthy approaches to handling stress are all ways to enhance mental health.

Written by Peg Maas, PT
Physical Therapist, Seattle Athletic Club Northgate

Understanding the Essentials of the Lymphatic System

Lymphedema is a type of swelling that can occur anywhere in the body, but most commonly occurs in the limbs. It is often discussed in the course of care for women who have been treated for breast cancer, but it is not unique to this population. In fact, the condition is an issue for individuals with many types of cancer and also for people who have never had cancer at all. Anyone with insufficient lymph transport abilities, either because we were born that way or because we have been through medical procedures that compromised them, may develop lymphedema. The reason people who have had cancer are at increased risk is that surgeries and radiation are likely to damage nodes and lymphatic pathways.

The vessels of the lymphatic system run parallel to the blood vessels. Their job is to transport the body’s cellular waste. Lymph nodes along the way screen out the large particles. This is an important part of our body’s ability to heal localized injuries and clear infections. Lymphedema is the result of impaired transportation within this system.

Looking at traffic flow provides an excellent analogy to the problem of lymphedema. When our local highways get overloaded with cars, traffic slows, gets backed up, and then cars on the highway may exit and spill over into adjacent streets. In the case of lymphedema, the fluid traveling up through lymphatic vessels gets trapped because of insufficient pathways. Just like the traffic jam scenario, the fluid transit gets stopped and then seeps out into the nearby tissues, causing swelling.

Many people do not have full-blown cases of lymphedema, but have a tendency to have some sluggishness in their lymphatic system that is manifest as ankle swelling or other mild impaired fluid transport. There are some simple strategies we all can use to help support and enhance our lymphatic flow. Gentle exercise helps, as does one of life’s great joys: laughter!

When lymphedema occurs it is usually recognizable by chronic swelling. Sometimes people feel heaviness or a dull aching in their limb. This is not an emergency unless it is also accompanied by redness, fever, or any other signs of being ill. Even though it is not an emergency, promptly informing your healthcare provider will make it easier to address and begin to manage the situation. Untreated lymphedema worsens and has the potential to be a serious condition.

Treatment of lymphedema must be performed by professionals who have special training in evaluation and treatment of the condition. Currently, there is no nationally recognized certification process, though many institutes that train therapists issue a certificate. The people who might market themselves as lymphedema therapists are physical therapists, occupational therapists, and, occasionally, massage therapists. Massage therapists are generally not covered by insurance for treating this diagnosis, and they are not licensed to assess for range of motion deficits or give any exercise prescriptions.

A visit to a lymphedema therapist includes a thorough discussion of your history, including exercise habits, past orthopedic injuries, recent surgeries and treatments, and what your lifestyle is like in terms of hobbies, job activities, and other elements. Assessment includes range of motion, measurement and palpation of swelling, and inspection of surgical incisions. Depending on findings, patients may need treatment in the clinic or taught how to care for themselves independently. The three major elements of lymphedema treatment are lymphatic drainage massage, compression, exercise and education about self-care. Each of these elements needs to be specifically tailored to the individual.

If you are experiencing lymphatic swelling, or are at risk for the condition, make a point of learning about it from reliable sources. There are many simple strategies for managing it, and the research in the field is progressing at an exciting pace! The more you know, the better you can care for yourself.

Written by Peg Maas, PT
Seattle Athletic Club Northgate