9.4: The Climacteric (Ob4,Ob5,Ob6)

One biologically based change that occurs during midlife is the climacteric. During midlife, men may experience a reduction in their ability to reproduce. Women, however, lose their ability to reproduce once they reach menopause.

Menopause for women

Menopause refers to a period of transition in which a woman's ovaries stop releasing eggs and the level of estrogen and progesterone production decreases. After menopause, a woman's menstruation ceases (U. S. National Library of Medicine and National Institute of Health [NLM/NIH], 2007).

Changes typically occur between the mid 40s and mid 50s. The median age range for a women to have her last menstrual period is 50‐52, but ages vary. A woman may first begin to notice that her periods are more or less frequent than before. These changes in menstruation may last from 1 to 3 years. After a year without menstruation, a woman is considered menopausal and no longer capable of reproduction. (Keep in mind that some women, however, may experience another period even after going for a year without one.) The loss of estrogen also affects vaginal lubrication which diminishes and becomes more watery. The vaginal wall also becomes thinner, and less elastic.

Menopause is not seen as universally distressing (Lachman, 2004). Changes in hormone levels are associated with hot flashes and sweats in some women, but women vary in the extent to which these are experienced. Depression, irritability, and weight gain are not menopausal (Avis, 1999; Rossi, 2004). Depression and mood swings are more common during menopause in women who have prior histories of these conditions rather than those who have not. And the incidence of depression and mood swings is not greater among menopausal women than non‐menopausal women.

Cultural influences seem to also play a role in the way menopause is experienced. Numerous international students enrolled in my class have expressed their disbelief when we discuss menopause. For example, after listing the symptoms of menopause, a woman from Kenya or Nigeria might respond, "We do not have this in my country or if we do, it is not a big deal" to which some U. S. students reply, "I want to go there!" Indeed, there are cultural variations in the experience of menopausal symptoms. Hot flashes are experienced by 75 percent of women in Western cultures, but by less than 20 percent of women in Japan (Obermeyer in Berk, 2007).

Women in the United States respond differently to menopause depending upon the expectations they have for themselves and their lives. White, career‐oriented women, African‐American, and Mexican‐American women overall tend to think of menopause as a liberating experience. Nevertheless, there has been a popular tendency to erroneously attribute frustrations and irritations expressed by women of menopausal age to menopause and thereby not take her concerns seriously. Fortunately, many practitioners in the United States today are normalizing rather than pathologizing menopause.

Concerns about the effects of hormone replacement has changed the frequency with which estrogen replacement and hormone replacement therapies have been prescribed for menopausal women. Estrogen replacement therapy was once commonly used to treat menopausal symptoms. But more recently, hormone replacement therapy has been associated with breast cancer, stroke, and the development of blood clots (NLM/NIH, 2007). Most women do not have symptoms severe enough to warrant estrogen or hormone replacement therapy. But if so, they can be treated with lower doses of estrogen and monitored with more frequent breast and pelvic exams. There are also some other ways to reduce symptoms. These include avoiding caffeine and alcohol, eating soy, remaining sexually active, practicing relaxation techniques, and using water‐based lubricants during intercourse.

Andropause for men

Do males experience a climacteric? They do not lose their ability to reproduce as they age, although they do tend to produce lower levels of testosterone and fewer sperm. However, men are capable of reproduction throughout life. It is natural for sex drive to diminish slightly as men age, but a lack of sex drive may be a result of extremely low levels of testosterone. About 5 million men experience low levels of testosterone that results in symptoms such as: a loss of interest in sex, loss of body hair, difficulty achieving or maintaining erection, loss of muscle mass, and breast enlargement. Low testosterone levels may be due to glandular disease such as testicular cancer. Testosterone levels can be tested and if they are low, men can be treated with testosterone replacement therapy. This can increase sex drive, muscle mass, and beard growth. However, long term HRT for men can increase the risk of prostate cancer (The Patient Education Institute, 2005).