The Fifth Decade: Is It Just My Life or Is It Perimenopause - Softcover

Wagner, Deborah R

Softcover

ISBN 10: 1614481520 ISBN 13: 9781614481522

Verlag: Morgan James Publishing, 2012

Inhaltsangabe

The "Fifth Decade" enlightens women and their families about the shifts to women’s emotional states, their bodies and their sense of wellbeing during their midlife years. With balanced, accessible and humorous discussions of female physiology and psychology as well as current treatment options, author and psychologist Deborah R. Wagner Ph.D., provides a forum to help her readers get comfortable with the volatile, powerful and colorful decades of life in the 40s and 50s.
With added advice for families---including a segment for partners and children---as well as candid discussions on the impact of unanticipated (but interconnected) conditions such as anxiety, depression, changing body image, loss of feelings of empathy and nurturing and empty nesting, Dr. Wagner delivers a potent blend of science and comfort in a voice that women identify with easily.
A compelling insight for women and their loved ones, "The Fifth Decade" provides a roadmap to the chaos. . .hormonal and otherwise. . .of midlife.

Über diesen Titel

Über die Autorin bzw. den Autor

Deborah Wagner, Ph.D. is a developmental psychologist with an active practice in individual and family therapy. She has focused her career on lifespan development and has published on parenting and child development. She currently writes a popular blog, http://yourmentalhealth.info, addressing the psychology of perimenopause, anxiety, depression and insomnia. She practices in Ridgewood, New Jersey.

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The Fifth Decade

Is It Just My Life or Is It Perimenopause?

By Deborah R. Wagner

Morgan James Publishing

Copyright © 2012 Deborah R. Wagner, Ph.D.
All rights reserved.

ISBN: 978-1-61448-152-2

Contents

Foreword, 
Acknowledgements, 
Prologue, 
PART I: THE PHYSIOLOGICAL UNDERPINNINGS OF THE PSYCHOLOGY OF PERIMENOPAUSE, 
Chapter 1 Changing Hormones Equals Changing Emotions, 
Chapter 2 Almighty Estrogen, 
Chapter 3 Puberty and PMS: Emotional Hostage Takers, 
Chapter 4 Navigating the Storm, 
Chapter 5 Am I Becoming a Man?, 
Chapter 6 When Our "Feel Good" Hormone Fades, 
Chapter 7 Losing our Estrogen, Losing Ourselves?, 
Chapter 8 First Alert: When Estrogen Takes Over, 
Chapter 9 Sleep Is Not Just Sleeping: Sleep Challenges and Dreaming, 
PART II: THE VOLATILE PSYCHOLOGY OF PERIMENOPAUSE AND LIFE IN THE FORTIES, 
Chapter 10 Psychological Stages of Perimenopause, 
Chapter 11 The Birth of Anxiety, 
Chapter 12 Stress Becomes Anxiety, 
Chapter 13 Differentiating Between Anxiety Disorders, 
Chapter 14 The Face of Anxiety: How the Anxious Woman Appears to Others, 
Chapter 15 Treatment Options for Anxiety, 
Chapter 16 What is Depression?, 
Chapter 17 Who Is at Risk for Depression?, 
Chapter 18 The Bottom Line, 
Chapter 19 The Face of Depression, 
Chapter 20 Treatment for Depression, 
Chapter 21 Perimenopausal Women with Prior Emotional Issues, 
Chapter 22 Sexual Functioning-Who Has Run Off with My Libido?, 
Chapter 23 The Emotional Blender, 
Chapter 24 Finding a Way Out, 
Chapter 25 After the Storm, 
PART III: PERIMENOPAUSE AND INCREASED RISK OF THYROID DISEASE: DISCOVERING THE HIDDEN TROUBLE MAKER, 
Chapter 26 Hypothyroidism-Understanding the Metabolic, Physical, Cognitive and Emotional Changes, 
Chapter 27 Hyperthyroidism-Metabolic, Physical, Cognitive and Emotional Symptoms of an Overactive Thyroid, 
Chapter 28 Partners in Crime: Estrogen and Thyroid Hormone, 
PART IV: FOR THE MEN, 
Chapter 29 Who Are You and What Have You Done with My Wife?, 
Chapter 30 OK, I Will Take Directions, Just Tell Me What To Do!, 
Chapter 31 Who is going to Take Care of Me?, 
Appendix I Hormone Testing, 
Appendix II Effects of Stress on the Adrenal Glands, 
About the Author, 
References, 
Index, 

CHAPTER 1

Changing Hormones Equals Changing Emotions

It was Monday morning and Sari awoke to the sound of her alarm clock. Her husband, Sam, walked over to the bed, gave her a hug and asked her to join him for breakfast, which was almost ready in the kitchen. He was happy and smiling and ready to start the week. Sari shook her head, fighting the tears that were about to spill over. She did not have the heart to bring Sam down again. When Sam left to have his breakfast, Sari dragged herself into the shower. As the hot water poured over her, she allowed the tears to flow, as she had done so many times before. For the hundredth, if not the thousandth time, Sari searched her heart and her mind for what could possibly be so wrong to make her feel this way. With a loving husband, happy healthy children, financial security and a job she loved, why now, was she so miserable?

When a woman's body enters perimenopause the regular cycling of hormones that she has been accustomed to since puberty begins to undergo a change. An irregular pattern of hormonal fluctuations is activated, beginning with a significant rise in levels of estrogen and ending with a gradual decrease in estrogen and progesterone. Although all of the hormones, estrogen, progesterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH) are still cycling, the patterns of the cycle begin to become unbalanced. This is often when the emotional struggles begin.

Before a woman enters perimenopause, approximately a week after menstruation has begun, low estrogen levels signal FSH to stimulate the ovarian follicles to maturity. One prevailing follicle matures and begins secreting large quantities of estrogen. This in turn, shuts down further production of FSH and stimulates the release of LH, a signal of imminent ovulation. Ovulation is the process by which the follicle ruptures and the egg is released. The ruptured follicle, the corpus luteum, now begins to secrete large quantities of progesterone in preparation for a potential pregnancy. When no pregnancy occurs, the corpus luteum depletes its store of hormones, which results in a lowering of estrogen and progesterone. The lining of the uterus prepares for shedding and menstruation begins along with a new cycle.

When women are in their late thirties, their ovaries begin to accelerate the ripening and loss of follicles every month. Eventually, the number of follicles available for ovulation diminishes until there are none left. This is the body's way of discarding old, potentially defective eggs. FSH increases as it did before, but in the forty-something perimenopausal woman the follicles are no longer as sensitive to the effects of FSH. FSH is knocking on the follicle door, but no one is answering. With the lowered sensitivity to FSH and the highly variable amount of estrogen that is secreted, FSH production is not suppressed. In early perimenopause when estrogen levels may be even higher than in the premenopausal woman, FSH levels are still on the rise (when, in fact, they should be falling). The problem this creates is that with elevated FSH levels, LH is not signaled for secretion. Without LH no follicle matures, no follicle is ruptured, no egg is released, there is no corpus luteum and progesterone production is not signaled. This is the process by which women begin having anovulatory cycles in perimenopause and the start of the emotional ups and downs that we saw in Sari.

These changes in the menstrual cycle do not follow a linear pattern, and that makes this period a very trying one. A woman may have months of normal cycles followed by a stretch of irregular cycles. Some women have a pattern of one month normal, and the next irregular but any type of pattern is possible. In one study on perimenopausal women, 100 different patterns of menstrual flow and cycles were documented in 300 women! This irregular releasing of the hormones creates the variability in the menstrual cycles causing the physiological and psychological effects of perimenopause. As we will learn in the coming chapters, estrogen and progesterone have powerful effects on mood. When estrogen levels plummet, women will experience anxiety, especially if progesterone levels are low or declining with the estrogen. With estrogen levels bouncing around, as they do in perimenopause, a woman's mood, or ability to tolerate stressful events changes in accordance with those estrogen level changes.

When no progesterone is produced in the anovulatory cycles, there is an insufficient amount of progesterone in comparison to the amount of estrogen. This creates a situation called "estrogen dominance." As we will learn, balance among hormones is key to feelings of wellbeing. Estrogen dominance in combination with excess FSH and the elevation of estrogen in the follicular phase of the menstrual cycle are all major culprits in the emotional distress of perimenopause.

Progesterone is the "feel good" hormone. In pregnancy, it is the abundance of progesterone that leaves women with a peaceful, calm and radiant emotional experience. In perimenopause when progesterone is in short supply and estrogen levels are erratic, women are inclined to feel that the protective barriers between their emotional stability and the outside world are dangerously fragile.

The changing hormone levels are all very clinical and scientific but what is important to understand is how estrogen and progesterone affect how we feel and how we behave. We will begin to understand Sari's changes in mood as we learn more about the physiological and social psychological challenges that Sari will experience as she passes through perimenopause on her way to menopause.

CHAPTER 2

Almighty Estrogen

Puberty is a young woman's first experience with a huge rise in estrogen levels. Valerie, at 11 years old was on the cusp of puberty. Her ovaries began secreting large amounts of estrogen. This initiated the maturation and development of her female sex organs and secondary sexual characteristics. Valerie began to experience breast development and growth of hair in the pubic area and in her armpits. Her figure began changing with the widening of her hips and slimming of her waist. What Valerie was unaware of, was that the estrogen was also preparing her uterus to begin menstruation and eventually to be ready for pregnancy. Valerie had yet to learn that this new influx of estrogen was at least partially responsible for the cycling symptoms of breast tenderness, bloating and moodiness that were soon to become a powerful disruption to the simple easy emotions of childhood.

Estrogen's influence in the body is enormously powerful. It affects cell growth in the body and in the brain. It is the hormone implicated in women's ability to tolerate more physical pain than men and the development of the notorious and very real "women's intuition." Researchers believe this is due to the greater number of cells in specific areas of the brain that track bodily sensations.

During the stage of infantile puberty, a period that lasts from birth until two years of age, the female infant's ovaries produce a large quantity of estrogen, comparable to the levels found in adults. This estrogen not only prepares the ovaries for later reproductive capabilities but also has a major impact on the development of the brain. Neurons grow and develop, creating brain circuits with a specifically female bias. The female brain, bathing in estrogen, becomes more developed in the areas of observation and communication, giving women unique capabilities in these areas.

As Valerie progresses through puberty and estrogen begins to change the structure of her brain, she will become more intuitive, nurturing and caring. Research shows that these areas of the brain are more highly developed in females as a result of the high estrogen levels. Practically speaking, this leaves a female more capable of reading facial expressions, of hearing emotional nuance in vocalizations, of interpreting and responding to "body language" or unspoken cues in others. When Valerie is mingling with her other adolescent girlfriends, they will all automatically utilize these new skills to communicate and understand each other. These attributes allow for greater socialization between girls along with an inclination to create a community with others.

Estrogen is a bit more complex than it seems. "Estrogen" is actually a term that is used to represent the three different types of estrogen that exist in the human body. The first estrogen, estrone, makes up about 10 to 20 percent of circulating estrogens before menopause. After menopause, estrone becomes the principal estrogen in the body since the levels of estrone drop off less than the levels of the other estrogens. There is a notable dearth of information on estrone and emotion but some obscure data suggests that estrone levels are extremely reactive to stress. Stressful situations will depress estrone levels for several days before there is a rebounding to normal levels.

The second estrogen, estradiol, makes up another 10 to 20 percent of the circulating estrogens before menopause. Estradiol is the estrogen we most often associate with the feminine characteristics of estrogen. This is the type of estrogen that gave Valerie mature egg-bearing follicles, her developed breasts and fertile ovaries and uterus. Until recently it was believed that perimenopause was the opposite of puberty-that in puberty estradiol steadily increased, with the onset of perimenopause it steadily decreased.

Current research has shown the opposite of what was believed for generations. Early in perimenopause estradiol levels actually increase significantly. Estradiol levels in the follicular phase of the menstrual cycle in perimenopausal women exceed the estradiol levels in the same phase of the menstrual cycle in premenopausal woman. These shifting levels of estradiol are believed to be responsible for many of the emotional difficulties in early perimenopause. When estradiol levels begin to fall, it is the reduction of estradiol that accounts for the increase in anxiety and depression during perimenopause. Supporting research has shown an improvement in depressive symptoms when perimenopausal women were supplemented with estradiol.

One other significant function of estradiol is that it is the estrogen most influential in evoking maternal behaviors. This is the estrogen that compels women to nurture. When women are of childbearing age it is critical to have an ample amount of estradiol in order to facilitate mothering. Do we need as much of this hormone once we are past childbearing? We will explore later the implications of the dramatic decrease in this estrogen at the end of perimenopause and how it affects nurturing behaviors.

The third estrogen is estriol. Estriol, the weakest estrogen, accounts for 60 to 80 percent of the circulating estrogens. Estriol is the only estrogen that has anticancer properties. The other main function of estriol is that when abundant, it has positive effects on the urogenital tissues. As it declines with perimenopause, it contributes to the thinning of these tissues which not only causes physical discomfort, but also indirectly negatively influences mood.

Often women are not able to enjoy sex because it has become painful due to inadequate vaginal lubrication from decreasing estriol. This may introduce or augment emotional challenges already present from shifting hormones. Relief of these symptoms has been accomplished by using a topical estriol cream. Estriol, similar to estrone, has been found to decrease in response to stressful stimuli. We can begin to see the interactive effects of our female hormones and our moods. When stress suppresses the very hormones women need to manage stress, they are truly challenged!

CHAPTER 3

Puberty and PMS: Emotional Hostage Takers

Puberty

Perimenopause has been equated with two, perhaps more familiar, difficult hormonal events in women's lives: puberty and premenstrual syndrome (PMS). Puberty is the first time in a female's life that her brain is flooded with estrogen and progesterone, produced by the ovaries. These hormones begin to cycle monthly with fluctuations on a daily and or weekly basis. As Louann Brizendine, a neuropsychiatrist who specializes in the workings of the female brain explains, "The rising tide of estrogen and progesterone starts to fuel many circuits in the teen girl's brain that were laid down in fetal life. These new hormonal surges assure that all of her female-specific brain circuits will become even more sensitive to emotional nuance." This is when we see adolescents, like Valerie, becoming highly reactive to the slightest intimation of emotion. Valerie will be brought to tears over a sad story of a homeless kitten or have fits of rage because a parent reminds her of her curfew in front of her friends. Every day she will have new issues with her friends. Parents will find it next to impossible to keep up with all of the "drama."

Progesterone and estrogen directly affect many parts of the brain, in particular the areas for memory and learning, the area responsible for emotions, and the brain's ability to negotiate stress, which varies with the changing hormonal levels.

As females reach puberty, their overall responsivity to stress intensifies from what it was prior to puberty and shows an increase in comparison to male responsivity to stress. The type of events that stress an adolescent female becomes more specific, for instance, relationship conflicts are the more threatening issues to an adolescent female compared to a male who is more stressed by authority challenges than social conflict. Anyone who knows an adolescent female is familiar with how sensitive girls at this age are to social stresses. The positive side is that the female brain that is exposed to estrogen is compelled to respond with nurturing behaviors to stressful stimuli. This will be a more reliable response once the volatility of rapidly shifting pubescent hormones has quieted down.

Puberty brings with it another hormonal surge, that of the androgens. Testosterone, DHEA and androstenedione are the three main androgens that begin to increase in puberty, peaking at nineteen years of age. While testosterone and DHEA are associated with sexual interest, androstenedione is associated with aggressiveness. The second and third weeks of the menstrual cycle see the androgen levels peak. Females with low androgen levels generally have a weaker sex drive and are less aggressive. Here again, we see how influential hormones are on human behavior. Now we can begin to understand why our pubescent girls are such whirling forces of emotional confusion. One moment they are loving and nurturing, while the next they are aggressive, sarcastic or socially "phobic" and the next are sexy little vamps!

To complicate matters further, another significant development at puberty is the activation of oxytocin and dopamine by ovarian estrogen. Oxytocin is a neurohormone in females that is involved with human intimacy. It evokes and is evoked by intimate behaviors. When estrogen is at its highest in the middle of the menstrual cycle so are oxytocin and dopamine (a neurochemical that stimulates the pleasure centers in the brain and creates a sense of wellbeing). Intimate behaviors, including verbal intimacy, physical intimacy, sexual intimacy and other bonding behaviors are being chemically encouraged by this increase in oxytocin and dopamine. With the influx of oxytocin, our little Valerie becomes the wonderful girl we love to hug.

Understanding the evolution of the female hormones and their effects on the brain and neurohormones in puberty is helpful in understanding the challenges of perimenopause. As we see certain behaviors evolve with the influx of estrogen and progesterone into the body in large amounts at puberty, we can appreciate how some of these same behaviors and emotions are affected in the opposite direction as the hormones begin to ebb later in life in perimenopause. We can also begin to understand what actions we can take to stimulate or replace some of the hormones that are being reduced in perimenopause and why so many of our emotions and preferences feel so alien to us in this transition.

PMS

PMS is a result of a number of physiological and psychological changes in the two weeks prior to menstruation and occasionally lasting a couple of days into menstruation. Severe PMS affects up to five percent of all premenopausal women while mild PMS affects a third of all premenopausal women. Unfortunately, it is not commonly understood that PMS severity increases as women enter perimenopause. The unpleasant physical sensations of PMS that women experience include bloating, food cravings, headaches, loss of energy, breast tenderness, backache and abdominal cramps. The psychological symptoms of PMS typically include depression, anxiety, moodiness, feelings of fatigue, inability to concentrate, panic attacks and irritability.

(Continues...)

Excerpted from The Fifth Decade by Deborah R. Wagner. Copyright © 2012 Deborah R. Wagner, Ph.D.. Excerpted by permission of Morgan James Publishing.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Details zur Ausgabe

• Verlag: Morgan James Publishing
• Erscheinungsdatum: 2012
• Sprache: Englisch
• ISBN 10: 1614481520
• ISBN 13: 9781614481522
• Einband: Tapa blanda
• Anzahl der Seiten: 276
• Kontakt zum Hersteller: Nicht verfügbar
• Verantwortliche Person: Nicht verfügbar