The Changes: Menopause and 'Machopause'

The sixth decade of life is a time of transformation. For women the changes are usually summed up with the word “menopause.” Men also seem to have a “pause” of their own during their fifties, even if it’s not quite as obvious as it is for women.

The changes in the body and mind caused by aging are now more obvious than in the previous decade, with graying hair, more wrinkles, and some memory lapses, perhaps, but the physical or intellectual activity of healthy fifty-year-olds is nothing to sneer at. It’s worth noting that most of the men who became president of the United States have done so while in their fifties. And presidential aspiration is no better example of the wanting-to-do-it-all desires of this age group, whether those doing the desiring are men or women.

If there is a watchword for this decade, it’s “hormones.” Hormones exert a profound influence over our lives, though it’s not until the fifties—when women begin to lose estrogen and men begin to lose testosterone—that we realize how important hormones really are to our health and well-being. The hormones produced by our body are responsible not only for reproduction, development, and normal behavior, but for the maintenance of our normal body processes as well.

The Changes

When people think about menopause, they often think about that old cliché—“the change.” Menopause is not a single event, however, but a transition that begins in your forties, and continues into your fifties and sixties.

By definition, a menopausal woman is one who hasn’t had a period in 12 consecutive months, but menopause is actually a normal, biological process involving hormonal changes that results in both physical and psychological changes.

It’s not an illness, and it’s not the end of your sexuality or your youth. In fact, many women feel that their lives actually begin at menopause.

The first indication that menopause is approaching is having irregular periods. They might stop for a couple of months, then get lighter, and eventually cease entirely. Along with that, of course, comes a decrease in fertility; ovulation begins to fluctuate and ultimately stops, though up until the moment you haven’t had a period for one year you can still become pregnant. Vaginal changes occur as your ovary-produced estrogen levels decline; the tissues lining the vagina and the urethra become thinner and drier, which may lead to burning, itching, and an increased risk of bladder and vaginal infections.

Three out of four women report having troublesome symptoms during menopause, though their severity and frequency vary from one woman to another. Many women experience hot flashes as their estrogen level begins to drop; this drop causes the blood vessels to expand rapidly and the skin temperature to rise. Humid weather, confining spaces, spicy foods, and caffeine or alcoholic drinks can all trigger hot flashes.

Some women entering menopause begin to have sleep disturbances, at least partially because of these hot flashes, or night sweats. The lack of sleep may eventually affect their mood and overall health.

Menopause may also produce a change in appearance. Some women gain weight when they become menopausal, usually an average of five pounds or so. There may also be a thinning of the hair, more wrinkles, and a loss of fullness in the breasts. With the drop in estrogen levels, the small amount of testosterone still produced by the body may lead to the development of some facial hair as well as hair on the chest and abdomen.

It’s a good idea to pay a visit to your doctor as you begin to enter menopause so that you can start keeping a close watch on your hormone levels. You want to do this for several reasons.

One, menopause and the decrease of estrogen that comes with it puts you at greater risk for cardiovascular disease. That means you need to monitor your blood pressure more carefully, not smoke, and eat low-cholesterol foods to make sure that the natural aging process doesn’t further increase your risk of heart disease.

Another reason is that you will lose some bone mass, especially in the first couple of years of menopause. This makes menopausal women more susceptible to hip and other fractures, so it is important to make sure that you are taking adequate amounts of calcium. You’ll need about 1,500 milligrams of calcium and about 400 to 800 international units of vitamin D per day from now on. You should also be exercising to improve the strength of your ligaments and your muscles around your bones in order to compensate for that loss of bone density.

And because the vaginal mucosa gets thinned out due to the loss of estrogen, the bladder tends to protrude into the vaginal wall; as a result, many women will begin reporting symptoms of bladder dysfunction.

There are many things you can do to better adapt to menopause. For vaginal discomfort and dryness, use lubricants like KY Jelly and moisturizers. To optimize sleep, avoid drinking too much coffee or ingesting other sources of caffeine, especially during the first few years of menopause, because your body is changing so much.

It’s very important to develop relaxation techniques to deal with the stress. Exercise regularly, and do your Kegel exercises to improve the muscles in the vagina. Watch what you eat, watch your caloric intake, and take vitamin D and calcium supplements as needed. And don’t smoke.

Serious symptoms of menopause may require medication, but what used to be standard hormone replacement therapy is no longer recommended. Antidepressants, like Zoloft or Prozac, can be quite effective in dealing with mood changes. Women with very serious hot flashes may need a drug like Clonidine, a blood pressure medicine available in pill or patch form, to control the problem.

Nonhormonal medications such as Fosamax and Actonel are quite commonly prescribed today to treat osteoporosis or bone loss. These medications, whose primary side effect is gastrointestinal pain, have basically replaced estrogen as the primary mechanism to help women deal with osteoporosis in menopause. There are also specific vaginal estrogens—administered locally in ring, tablet, or cream form—that can significantly reduce vaginal dryness.

Hold the Hormones

Not long ago it was standard medical practice to give menopausal women hormonal replacement therapy (HRT). The therapy followed the standard medical practice of restoring what the body fails to produce on its own. Just as we replace insulin when the body doesn’t produce enough of it, it seemed logical that we should be replacing estrogen when a woman’s body was no longer producing enough of it.

Then the Women’s Health Initiative (WHI) came along and published a study showing that estrogen therapy causes an increased risk of breast cancer and other diseases. So while estrogen therapy had helped prevent bone loss, it was also increasing the number of breast cancers and strokes in women.

The estrogen in HRT came from horse urine, and when it was synthesized in the human liver, it would break down into two kinds of estrogen, the good estrogen a woman needs, and a bad estrogen that poses a health risk. For good reason, once these findings were released, millions of women stopped taking HRT.

Since 2002 many American women and their doctors have found an alternative treatment in what is called the bio-identical hormone approach. In contrast to traditional hormone treatment, bio-identical hormones are an exact match to the hormones produced naturally by a woman’s body. Not only can they can be created by modifying soy or yam hormones (no more horse urine), but any molecule that does not exist on the human hormone counterpart is removed. While more studies on bio-identical hormone therapies are needed, a large body of evidence points to the potential advantages of this approach in the future.

Some complimentary medicines are said to be quite effective in relieving menopausal symptoms. Natural estrogens called isoflavones can be found in certain foods like soybeans, chickpeas, and other legumes, while those known as lignans occur in whole grains, nuts, seeds, and beans. The Chinese, who have a diet rich in these types of foods, report fewer menopausal signs and symptoms, though there are no clinical studies to back up these claims.

Vitamin E is also said to provide some mild relief for hot flashes. A very popular herb called black cohosh, which is used extensively in Europe for treating hot flashes, is becoming popular in the States, though again there are no major scientific studies to back up these reports.

Other products like licorice, evening primrose oil, and wild yam are all said to be beneficial for menopausal symptoms. But before using any herbal treatments or dietary supplements, make sure you first get an okay from your primary care doctor, because many of these products can trigger allergic reactions or can cross-react with a prescribed medication you happen to be taking.


Women are not the only ones who suffer from the effects of changing hormones. It can happen to men, too. Andropause, as it is known, is the male version of menopause. Just as estrogen is vital to females, testosterone is vital to the development and normal functioning of males.

If a man is healthy, his hormone production may remain normal into old age, and he may be able to produce sperm well into his eighties or even later. On the other hand, as men get older, starting usually between the ages of 45 and 50, subtle changes in the functioning of their testicles may take place that dramatically reduce their testosterone, with levels of the hormone dropping off more quickly in some men than in others.

Typically, this decrease in male testosterone leads to symptoms of depression, fatigue, and lack of energy. In some men it may decrease their appetite for sex. A decline in testosterone can also put men at risk for heart disease and osteoporosis.

Andropause is more gradual in men than menopause is in women. It may also be accompanied by a variety of psychological effects known as a “mid life crisis,” which is expressed through the purchase of a sports car, for instance, or through leaving their family and finding a younger woman.

However, such behavior cannot be entirely explained by a drop in testosterone—usually there are other factors involved as well.

Though andropause has not been as well described in men as menopause has been in women, it’s real, and it’s clear that men do experience it. However, since the symptoms of depression and fatigue have traditionally been attributed to the aging process, andropause has not been recognized as a clinical problem and is still being debated. Consequently, you won’t find many men going to see their primary care doctor saying, “I think I’m going through male menopause.”

There are now diagnostic tests that can measure the amount of free or bioavailable testosterone in the body. You might think that hormonal replacement therapy for males would be an easy solution to the problem, but it isn’t. Testosterone is a very strong hormone, and high levels of testosterone have been linked to heart disease and prostate cancer; so in the management of andropause, it’s a good idea to look at factors that might influence the natural testosterone level of the individual without having to take in extra testosterone.

One such factor is obesity. If you are excessively overweight, the fat is going to interfere with your testosterone production, especially if that weight gain is the result of what I call the White Diet, which consists of white bread, flour, refined carbohydrates, and sugars. But by losing weight and decreasing your body fat, you can not only reduce your natural estrogen (yes, men have the female hormone in their bodies, just as females have the male hormone testosterone), but increase your natural level of testosterone as well. Many times this is all that is needed to overcome obesity.

Male hormonal therapy is an option for increasing testosterone levels, but it has to be very carefully monitored by an endocrinologist who knows how to prescribe testosterone: it’s not only a question of which testosterone to give but how much to give.

Other medications have been tried with some success, including Clomiphene, a medication that typically has been given to women to improve ovulation. In men, Clomiphene improves the natural levels of male testosterone by reducing their natural level of estrogen.

The best way to cope with andropause is to relieve your stress, eat a nutritious, low-fat, high-fiber diet, get plenty of sleep, exercise regularly, and limit your consumption of alcohol.

Click here to check out Dr. Manny's book The Check List (Harper Collins, 2007), from which this article was excerpted.

Dr. Manny Alvarez is the managing editor of health news at, and is a regular medical contributor on the FOX News Channel. He is chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey. Additionally, Alvarez is Adjunct Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City.