Menopause and becoming empty nesters are transitional stages for women of middle aged approximately beginning in their fifties. Scientific data and treatments for these transitions are given to inform and enhance their lifestyle.
Menopause is the time when menstrual periods cease completely and the production of estrogen, progesterone, and testosterone drops considerably. For women natural menopause is usually between the ages of 42 and 58 (the average age is 51). The sexual desire decreases quite suddenly when the sex hormone in the bloodstream is reduced. Eventually, ovulation stops and conception cannot naturally occur.(Berger, K., 2008).
Technically the onset of menopause is one year after your final period, but signs and symptoms of menopause, appear long before the one-year date of the last period. The signs include irregular periods, decreased fertility, vaginal dryness during sexual arousal, body temperature disturbances including hot flashes (feeling hot), hot flushes (looking hot), cold sweats, sleep disturbances, mood swings or irritability, cardiac discomfort (palpations), bladder problems, increased abdominal fat, thinning hair and loss of breast fullness. (Mayo Clinic 2009). Stress can make the menopause symptoms worse and hormone surges and dips throughout menopause affect your brain as well as the rest of your body (WebMD, 2005). Hot flashes and night sweats happen to more then two out of three North American women. (WebMD, 2005) They affect about 75-80% of women and are accompanied b palpations, disturbed sleep, difficulty in concentration and loss of confidence (Holloway, D., 2011). Also, entering the menopause period is related to worse health conditions, increased incidence of vascular diseases, osteoporosis and body mass increment (Stachon, A. etal, 2010).
Hormone replacement therapy (HRT) is one way to manage menopausal women largely because they are living longer and are searching for improvement in lifestyle and the quality of life during this transition of life, so the need of dealing with the symptoms that are listed is more necessary today than ever. HRT is widely considered to be the remedy for public health problems associated with menopause, namely heart disease osteoporosis and more recently Alzheimer’s disease. Advocates of long-term HRT recommend commencement of women from the age of 45-55 years and they should continue therapy for at least 10-15 years (Guillermin M., 1999). The uses for HRT are hot flashes, night sweats and vaginal dryness. There is a 75% reduction in hot flashes using HRT. Vaginal dryness is often followed by loss of libido and disruption of interpersonal relations. Women receiving HRT fared better in all aspects of their sex life, including libido, sexual activity, sexual satisfaction, sexual pleasure and frequency of orgasms than the the non-HRT group (Taavoni, S. etal, 2005). HRT will increase diseases such as breast cancer and cardiovascular disease. Breast cancer is increased with all types of HRT within 1-2 years of beginning the treatment and the longer the duration of treatment the risk increases, but the individual risk returns to that of the population after 5 years of discontinuing treatment. The increased risk of endometrial cancer depends on the dose and duration of estrogen only HRT so most of the literature stated that one should use the lowest dose of hormone for the shortest duration to give symptom relief. The risk is even less for healthy perimenopausal women. Patches (delivers transdermally), have a lower thromboembolic risk. Topical HRT can take months to develop and often these treatments are needed long term but the systemic absorption has minimal risk than the oral HRT and patients do not need to use progesterone alongside of it. HRT comes in tablets, topical preparations for local use, transdermal patches, gels, nasal sprays and implants; there is no scientific support that any type of use is better than another. (Peet D., 2009).
Although HRT has been proven affective for menopausal symptoms the serious side effects have caused women to use remedies that are natural. The only licensed non-hormonal medication is the antihypertensive clonidine, given at a dose of 50-75 mcg twice daily to reduce hot flashes. Tibolone is a synthetic steroid with weak estrogenic, progesteroneic and androgenic properties that can help with alleviating severity and reducing frequency of hot flashes as well as vaginal dryness (Holloway D., 2011). Serotonin reuptake inhibitors can reduce hot flashes up to 60% and gabapentin reduces hot flashes frequency by 45% and symptom severity by 54%. (Peet D., 2009)
Herbal medicines are used for those who do not want to take the route of HRT. Black cohosh (cimicifuga /actaea racemosa) was recommended for menopausal complaints. From 1982 and onward there have been reports from clinical trials of its effectiveness in specifically relieving hot flashes (van Die, D. 2010 ). Black cohosh extract has been found to have a greater effect on women who had just begun menopause. The effect size was similar to that of conventional hormone replacement therapy in a clinical trial (Milot,B. & Blumenthal, M. 2005). Studies have demonstrated the efficacy and tolerability of black cohosh (in particularly Remifemin) in alleviating menopause symptoms (Milot, B. & Blumenthal, M. 2005)
St. John’s wort (Hypericum perforatum) is recommended for climacteric depression and is reported to be of comparable efficacy to diazepam (van Die D. 2010) St. John’s wort is used to treat mild to moderate depression (Oliff, H. 2008). It is the most thoroughly researched natural antidepressant. A study conducted in women with menopause symptoms found that 900 mg/d of St, John’s wort for 12 weeks significantly improved psychological and psychosomatic symptoms as well as a feeling of sexual well being (Hudson, T. 2010).
The combination of black cohosh and St. John’s wort has been suggested also. The herbal combination was more effective in menopausal patients with pronounced mood complaints, such as, depressive moods, nervousness, and irritability (Oliff, H. 2008).
The empty nest transition, or the period when children permanently leave the parental home, a phase faced in midlife whereby parents expect their children to leave, become independent, and to successfully negotiate the demands associated with this life stage. Many parents view it as a highly positive event, for others it is a conflicted time: a period of loving and letting go and a time when the day-to-day parental role is surrendered. (Mitchell, B. & Lovegreen, L., 2009). Some parents suffer the depression known as Empty Nest Syndrome (ENS), which is a major transition that tends to be uncomfortable, even if in the long run it leads to changes that people believe they want. Early research on transitions to the empty nest has focused primarily on midlife role loss, especially among the mother and even more among the stay-at home mothers. Data from a study 31.6% of mothers are more likely than fathers to state that they and experienced Empty Nest Syndrome.
Parents who worked part-time or were homemakers were slightly more likely to report ENS than those employed in full-time work, with a difference of 5% to 8% difference (Mitchell, B. & Lovegreen, L., 2009). It was suggested, that the empty-nest syndrome will be most likely to occur among women who are housewives who are experience in the maternal role loss, who have been overprotective and over involved in the lives of their children and they also believe that their children’s needs was put over their own needs (Borland, D. 1982). Many parents reported that the primary reason it was extremely emotionally difficult for their children to leave home was that their previous relationship was now seen as severed. Health professionals and community programmers could benefit from the knowledge that a significant number of parents do experience some degree of sadness or depression when children leave home and that this reaction is relatively normal.
Unfortunately, middle age women may self-medicate with alcohol or prescription drugs to deal with loss and feelings of loneliness creating additional health risks (Mitchell, B. & Lovegreen, L., 2009). “ Professor Lee Handy says there is nothing wrong with parents letting their offspring know they are having difficulty with the separation, but he recommends parents draw upon their own coping skills rather than intrude on their children’s new found freedom.”(McLean C., 1998, p.3). The role identity theory argues that role loss will have a negative impact on psychological functioning because it provides existential meaning and guidance in behaviors and actions; according to the role identity theory the more roles individuals have, the better of they will be psychologically (Hogg, M. 2004) Supporting research suggests that a crucial mediating variable appears to be a mother’s degree of involvement with the maternal role, as well as the perception that she indeed has a career and mothers that adopt alternative roles to coincide with the declining mothering role may experience less distress.
The lack of multiple roles was often detrimental for women in mid-life and parents who enjoy their children suffer a moderate increase in psychological distress when a child moves out of the home. These findings might suggest that women who are securely attached as adults might be more able to reinvest their energy into alternative roles, and possibly will cope more adequately with the empty nest. (Hobdy et al, 2007) There is strong evidence that in recent years dramatic changes have occurred in the transition to the empty nest and mothers are more likely to be continuously employed outside the home, engage in multiple roles and have alternative sources of self-definition (Mitchell, B. & Lovegreen, L., 2009).
Many studies find that the role stress theory (argues that the effect of a role change depends on the stress associated with that role and if the stress associated with a role, then the individual who is able to shed that role will benefit from the role loss) that there is evidence that the parental role is a stressful one, thus, causing the role status change to an empty nest stage of the family life cycle will result in a positive effect on the parent well-being (Hogg, M. 2004). Data from a large community mental health survey found that parents both mothers and fathers whose children were not living within were significantly less depressed than other respondents of comparable age, income, occupational role, and marital status; suggesting that depression is not a typical reaction to an “empty nest” situation (Radloff, L., 1980). Within the western culture typically the attitude is of parents find success in raising well-adjusted children because adult children who remain at home are often unable to live independently and with contrast non-Western cultures may be reflective of a breakup of family ties and parents failure in instilling family oriented values in their children. (Mitchell, B. & Lovegreen, L., 2009).
Another factor is what will arise between the parents who no longer have children at home. Roles that have been placed for up to at least 18 years for the typical household are now changed and the parents focus is no longer just on the children they on each other now. Empty nesters fond themselves not knowing what to do or talk about and characterizes this phase of marriage as a grieving process for some. They have prepared a made plans for their children but have not prepared to reconnect with each other provided by the time they now have without the child being home. Community centers and churches around the country are tuning in to the problem and hosting seminars in which parents try to reunite their relationship and prepare themselves to move forward (Rochman, B. 2009) Parents that have a personality that have a more dimensions of control, commitment, and challenge are increasingly coughing up money to attend an empty-nest workshop. To the wise parents should not get too use to the echoing hallways, since todays recession often means an empty nest won’t stay empty for long.(Rochman B., 2009).
The average age of life transitions is around fifty years of age. It produces collective problems in both the menopause and empty nesting transitions in life. Menopause alone causes biological and psychological symptoms. Hormone Replacement therapy and alternatives can be used to regulate symptoms. The empty nest syndrome is a psychological impact or grieving process that some women develop. Scientific reports have suggested facts and clues in how a woman can adjust better to this era in life.