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'18 and hot' to '50 and not'
Perimenopause is the term used to describe the transitional period around menopause when the hormone level (estrogens, progesterone) is falling and fluctuating leading to some physical and psychological symptoms.

This transitional period can vary from person to person. It can be very gradual, spanning over a period of 10 years or can be very abrupt like in cases of surgical removal of ovaries.

Typically a perimenopausal woman experiences irregularities in menstrual cycle accompanied by other menopausal symptoms. Common menopausal symptoms include - hot flashes, insomnia, night sweats, mood swings, pains and aches (due to loss of bone tissue), loss of libido, hair loss etc.

These symptoms are the outcome of a declining female hormone level in the body. Menopause is, however, a normal phase of life; every thing that starts (menarche) has to end (menopause) at a certain stage, this is how life works.

After long years of staying busy taking care of others, a typical middle-aged woman looks at the mirror and notices her grey strands, wrinkles in the forehead, lustreless skin - she laughs nervously only to discover “crow's-feet” at the corner of the eyes!

To make it worse, there is ugly fat deposition in the least desired parts of the body. It is not unlikely to feel vulnerable momentarily, as if a cry rising up from deep within the soul and feeling overwhelmed with despair.

Women who have body image issues may resist this normal physiological process by going to the extent of plastic surgery (e.g. face lifting, liposuction etc.). Women who feel the pressure of looking young (e.g. working in the entertainment industry) may start feeling a huge sense of loss.

If you are a fighter, you fight back with whatever you can (anti wrinkle creams, facials etc.) to maintain the youthful look. No matter how hard you try (wearing the latest fashion shalwar kameez, costly makeup, dyed hair etc.), when the beggar or peddler in the street calls you “khalamma” instead of “apa” (and not “nani”, if you are lucky!), it upsets you enormously.

Women's experience with menopause also varies widely. Unfortunately the majority of women report it to be an unpleasant experience for them. However, a significant portion of women do sail through it quite well and find it very liberating not to have periods anymore.

Sexually active women find it a big relief that pregnancy is one less thing to worry about the morning after. However, the erroneous belief that sexual activity is the prerogative of youth can be enough to inhibit her normal physiological sexual responses. After all, a stereotyped middle-aged woman's image is that she is above all basic human needs and an all-giving mother who puts everyone else before her!

Middle adulthood (40-65 years) is the time when people start reflecting on what they want to achieve in terms of work, family and leisure, where they had started and where they would like to go and so on and so forth. Besides, they have already received this MA (middle adulthood) degree from the school of life!

A menopausal woman is thus forced to review her purpose of life, which is pretty scary for someone who doesn't know where to start again at this time of internal chaos. If the man beside her is not compassionate enough or is not willing to grow old together, that would make her even more vulnerable.

A society, which worships youth, tends to put down older women. Youth is seen as the symbol of energy, growth and possibility. It would be nice to remember that experience, leadership, wisdom and understanding can make this middle age the prime time of life.

There has got to be more to life than just hot flashes, headaches and wrinkled skin. This journey from “18 and hot” to “50 and not” ought to be full of life events, more so if one has had taken a less travelled path without falling off the edges. A willingness to accept this aging process, loving the individual and collective humanness and seeking personal growth and fulfillment is a choice one can make over perfectionism in outer self.

Some women report a wide range of psychological symptoms like anxiety, panic attacks, and depression as a part of menopause. Past history of mental illness, personality traits, feeling trapped in an intolerable life situation (e.g. bad marriage, financial problems) or last child leaving home (empty nest syndrome) also tend to play an important role in such cases.

Too many obligations and duties of life (taking care of children as well as ailing parents) can easily overwhelm people and make them vulnerable to stresses. This has a snowball effect on the emotional well being of a menopausal woman.

Lifestyle changes, which includes regular exercise, healthy moderate eating habits and building stress management capacity has been reported to be helpful. Maintaining a supportive social network (acquaintance, friends and relatives), voluntary work or hobbies for personal fulfilment or for commercial purpose can bring new excitement to life.

Prayers, meditation and learning about your own and other people's religion for spiritual development can be the key to a peaceful life. Happiness and peace can restore youthfulness and increase longevity. Massage and breathing exercises can help release the muscular tension and promote relaxation.

Maintaining the standard body weight helps to avoid many chronic health conditions. Fruits and fresh vegetables are important sources of vitamins and minerals. Enough fluid intakes to keep the body hydrated and taking supplements like Calcium,Vitamins (B-complex, Multi-vitamins) is recommended. Low dose of aspirin on a regular basis also helps prevent some cardio-vascular problem.

In case of severe menopausal symptoms, hormone replacement therapy can be considered after weighing the benefits against the costs (e.g. higher risk of getting cancer, blood clots, cardiac problem etc.).

Anti-depressant use might be indicated if there is clinical depression that can't be corrected by lifestyle changes. Annual complete physical check-ups help to detect illnesses at an early stage, menopausal women should do regular breast self-examination (any lump in the breast) and mammogram as advised by her doctor, Pap test (for cervical cancer) and colonoscopy (to exclude colon cancer or any growth) and visit her doctor as soon as possible if there is any health concern. Menopause is only what you make out it: it is for you to decide whether it is a merely physical turning point or a life altering phenomena.



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