Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.) Chapter 8: Growing Older (introduction...) The End of Monthly Bleeding (Menopause) Taking Care of Your Health Sexual Relations Common Health Problems with Aging (introduction...) Weak blood (anemia) Heavy monthly bleeding or bleeding in the middle of the month Breast lumps High blood pressure Problems passing urine and stool Fallen womb (prolapsed uterus) Swollen veins in the legs (varicose veins) Back pain Joint pain (arthritis) Weak bones (osteoporosis) Problems with seeing and hearing Anxiety and depression Mental confusion (dementia) Working for Change

Where Women Have No Doctor - A Health Guide for Women (Hesperian Foundation, 1997, 600 p.)

Chapter 8: Growing Older

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Today more and more people are living longer. Cleaner living conditions, vaccinations and better nutrition help prevent many diseases and modern medicines cure others.

¨ Everyone is the age of their heart.

- Guatemalan proverb

But longer life has also brought difficulties. First, older people tend to have more health problems than younger people. Although most of these problems are not caused by age itself, the changes age makes in a person’s body can make the problems more serious or difficult to treat.

Second, as the world changes and younger family members move away from their communities to earn a living, many older people are left to care for themselves. Or, if they do live with their children, older people may feel like a burden in a family or community that no longer values and respects age.

Older women are more likely to face these problems than older men, because women usually live longer and often reach old age without a partner. So in this chapter we describe how older women can take care of their health, treat common health problems of aging, and work to improve the difficult conditions under which many older women live.

The End of Monthly Bleeding (Menopause)

One of the main signs of growing older is that a woman’s monthly bleeding ends. It may end suddenly, or it may stop gradually over 1 to 2 years. For most women this change happens between the age of 45 and 55.

Signs:

· Your monthly bleeding changes. It may just stop, or you may bleed more often for a while. Or you may stop bleeding for a few months and then bleed again.

· At times you may suddenly feel very hot or sweaty (this is also called having ‘hot flashes’). This can wake you up at night.

· Your vagina becomes less wet and smaller

· Your feelings change easily.

These signs happen because a woman’s ovaries stop making eggs, and her body makes less of the hormones estrogen and progesterone. The signs will start to go away as her body gets used to less estrogen.

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How a woman feels about the end of her monthly bleeding sometimes depends on how she is affected by the changes in her body. It also depends on how her community thinks about and treats older women. She may be relieved not to have her monthly bleeding every month. But she may also feel sad that she cannot have any more children.

What to do during menopause: If you are having signs that make you uncomfortable, try the following: · Dress in clothes that you can take off easily when you begin to sweat. Figure · Get regular exercise. Figure · Avoid hot or spicy foods or drinks. They can cause hot flashes. Figure · Do not drink much coffee or tea. They contain caffeine, which can make you feel nervous and prevent you from sleeping. Figure · If you drink alcohol, drink only small amounts. Alcohol can increase bleeding and hot flashes. Figure · Stop smoking or chewing tobacco. It can cause unusual bleeding and make problems with weak bones much worse. Figure · Explain to your family that your feelings may change easily. It may also help to discuss how you feel with other women who are going through menopause. · Ask about the use of traditional remedies in your community. Often women who have already been through menopause will know ways to help you feel better.

Medicines for problems during menopause

If a woman’s signs of menopause are so severe that they stop her from doing her daily work or keep her from sleeping at night, she can try taking medicine for a few months to see if she feels better. This is called ‘hormone replacement therapy’, or HRT. The most common medicine is made from estrogen and progesterone. If a woman decides to take HRT, she should always take both hormones, unless she has had her womb removed by surgery. Estrogen taken by itself can cause cancer of the womb.

¨ Although women sometimes feel uncomfortable during menopause, only a few need medical treatment.

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HRT can stop hot flashes and make the vagina more wet. If taken for a long time, HRT may also help reduce other health risks, such as weak bones and heart disease, which come from having less estrogen in the body. But HRT can be costly, and may cause an increased risk of gallbladder disease. The medicine may also cause side effects, such as bleeding from the vagina, cramping pains, nausea, tender breasts, weight gain, and depression.

¨ Taking hormones does not cause breast cancer. But if a woman already has cancer, hormones can make it worse.

Before taking HRT, a woman needs to think about its risks and benefits. HRT is usually not recommended for women who have had trouble with blood dots, breast cancer, or liver or gallbladder disease. Be sure to talk to a health worker about the right dose.

¨ Always take the lowest possible dose of the medicines.

A woman can stop taking the medicine at any time, but she should do so slowly - or her signs may come back.

Taking Care of Your Health

Just as a girl’s body changes when she becomes a woman, so a woman’s body changes when her childbearing years end. Menopause and aging cause changes in bone strength, muscle and joint strength and flexibility, and overall well-being.

A woman can make a big difference in living her later years with energy and good health by:

Eating well. As a woman grows older she still needs nutritious food to keep her body strong and to fight disease. Her need for certain kinds of food also increases. Because her body makes less estrogen, it helps to eat foods high in plant estrogens, such as soy beans, tofu (bean curd), lentils, and other beans. Since her bones become less dense as she ages, it helps to eat foods high in calcium, a mineral that makes strong bones.

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Sometimes older people feel less like eating than they used to. This may be caused by changes in taste and smell, which make eating less pleasurable. Or changes in the body that come from aging can make a person quickly feel full after starting to eat. But this does not mean that older people need less nutritious food. They need encouragement to continue to eat well, and to eat a variety of foods.

Drinking a lot of liquids. As a person ages, the amount of water in the body decreases. Also, some older people drink less to avoid having to pass urine during the night or because they are afraid of leaking urine. All these things can cause dehydration. To prevent this, drink 8 glasses or cups of liquid every day. To avoid getting up at night to pass urine, try not to drink anything for 2 to 3 hours before going to sleep.

Getting regular exercise. Everyday activities, such as walking, playing with grandchildren, going to the market, cooking, and farming can all help keep a woman’s muscles and bones strong, and prevent stiff joints. Regular exercise will help maintain weight and prevent heart disease.

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Treating illness early. Some people think that getting older means being sick much of the time. But this is not true. If a woman does not feel well, she may have an illness that can be treated, and that has nothing to do with age. She needs treatment as soon as possible.

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Staying active. A woman will stay healthier and happier if she is active and productive. Try to take up an activity, join a group, or work on a community project. This may be a good time for a woman to work for better conditions in the community. Here is an example:

¨ Try to see a health worker if you feel ill and have been unable to treat the problem yourself.

Figure Louise Waithira Nganga is a coffee farmer in Kandara town, in Kenya. In 1991, as a member of an organization planting trees in Kenya, she met a group of women farmers who complained about a coffee factory upstream. The fertilizers and chemicals the factory used to make coffee were getting into the river, and the women’s cows were getting sick and dying from drinking the dirty water. Soon many of the women began meeting to talk with Louise. They became aware of how the river also affected their health and their children’s health. They decided to put pressure on the district officers to force the factory to keep waste out of the river Louise, however, always insisted that rights and responsibilities go together So she also helped the women realize how their own habits affected other people down the river. For example, when they cleaned their fertilizing machines or washed their clothes in the river, it was harmful for the health of the people downstream. As Louise said, “We must first be responsible ourselves so that we may, in clear conscience, demand our rights.” In 1993, Louise and her women farmers created an organization called Rural Women’s Sanitation. Whenever the river is in danger from polluting factories, Louise is able to organize as many as 100 women, who ‘pay a visit’ to the local authorities, and inform them of the problem. Besides taking care of the river, the group is building latrines and demanding that local governments reclaim public wells that have been taken over by private owners. Louise has stopped planting trees, but has no regrets. “There were more pressing problems that were part of Kandara soil itself.” She tells her fellow women, “God will not come to earth to solve your problems. The government cannot know what your problems are. Only you can make sure they get solved.”

Sexual Relations

¨ There is no reason based on age alone that a woman cannot enjoy sex for as long as she lives.

For some women, menopause means freedom from the sexual demands of marriage. Other women become more interested in sex because they no longer fear an unwanted pregnancy. All women, though, continue to need love and affection.

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As a woman grows older, some of the changes in her body may affect her sexual relations:

· She may take longer to become excited during sex (this also happens to men).

· Her vagina may be more dry, which can make sex uncomfortable, or make her get an infection of the vagina or the urine system more easily.

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¨ Do not use petroleum gel or oils that contain perfumes to increase wetness in the vagina. These can cause irritation.

What to do:

· Try to take more time before having sex, so your vagina can make its natural wetness. You can also use spit (saliva), oils made from vegetables (peanut oil, corn oil, olive oil), or other lubricants like spermicides during sex.

IMPORTANT
DO not use oils for wetness if you are using condoms. Oil will weaken the condom and it may break.

· If it is difficult for your partner to get or keep his penis hard (erection), try to learn what he likes. Touching him may help make him excited.

· To prevent urine problems, do not try to make the vagina dry before having sex. Pass urine as soon as possible after sex to flush out germs.

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Protecting yourself against pregnancy and sexually transmitted diseases (STDs) You can still become pregnant until your monthly bleeding has stopped for one full year. To prevent unwanted pregnancy, you should continue to use a family planning method during that time. If you are using a hormonal method of family planning (the pill, injections, or implants), stop using it around the age of 50 to see if you are still having monthly bleeding. Use another method of family planning until you have no monthly bleeding for one whole year (12 months). Unless you are certain neither you nor your partner has an STD, including HIV/AIDS, be sure to use a condom each time you have sex - even if you can no longer become pregnant. Figure

Common Health Problems with Aging

The following pages describe some of the most common health problems of older women. For other problems, like gallbladder problems, heart trouble, stroke, thyroid gland problems, sores on the legs from poor blood flow, and difficulty sleeping, see Where There Is No Doctor or another general medical book.

Weak blood (anemia)

Although many people think that anemia is a problem only of young women, it also affects many older women - most often because of poor nutrition or heavy monthly bleeding.

Heavy monthly bleeding or bleeding in the middle of the month

Between the ages of 40 and 50, many women have changes in their monthly bleeding. Some have heavier bleeding, or bleeding that lasts longer. Heavy bleeding that goes on for months or years can cause anemia.

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The most common causes of heavy monthly bleeding and bleeding that lasts longer are:

· hormone changes
· growths in the womb (fibroids or polyps)

Treatment:

· Eat foods every day that are rich in iron, or take iron pills.

· Take 10 mg medoxyprogesterone acetate once a day for 10 days. If bleeding has not stopped at the end of 10 days, take the medicine for another 10 days. If you are still bleeding, see a health worker.

· Try to see a health worker for heavy bleeding that has lasted for more than 3 months, for bleeding in the middle of the month, or for bleeding that starts 12 months or more after menopause. A trained health worker will need to scrape out the inside of the womb (D and C) or do a biopsy and send the tissue to a laboratory to be checked for cancer.

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If you have had pain and heavy monthly bleeding for years, see the chapter on “Cancer and Growths.”

Breast lumps

Older women often find lumps in their breasts. Most breast lumps are not dangerous, but some may be a sign of cancer. The best way to find lumps in your breasts is to examine your breasts yourself.

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High blood pressure

High blood pressure can cause many problems, like heart disease, kidney disease, and strokes.

Signs of dangerously high blood pressure:

· frequent headaches
· dizziness
· ringing sound in the ears

¨ All these signs can also be caused by other diseases. For more information, see Where There Is No Doctor or another general medical book.

If you are visiting a health worker for any reason, try to have your blood pressure checked at the same time.

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IMPORTANT
High blood pressure at first causes no signs. It should be lowered before danger signs develop. People who are overweight or who think they might have high blood pressure should have their blood pressure checked regularly.

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Treatment and prevention:

· Get some exercise every day.
· If you are overweight, try to lose weight.
· Avoid foods with a lot of fat, sugar, or salt.
· If you smoke or chew tobacco, try to stop.

If your blood pressure is very high, you may also need to take medicine.

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Problems passing urine and stool

Many older women have problems with leaking urine or have difficulty passing stool. They may be too embarrassed to speak about these problems, especially to a male doctor. So they suffer alone.

Urine problems are often caused by a weakness in the muscle inside the vagina. The ‘squeezing exercise’ helps strengthen this muscle. Also, to help push the stool out during a bowel movement, a woman can put 2 fingers into her vagina and push toward her back.

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An older woman may also have trouble passing stool because her intestines work more slowly as she ages. It helps to drink a lot of liquids, to eat foods with a lot of fiber (like whole grain breads or vegetables), and to get regular exercise.

Fallen womb (prolapsed uterus)

Sometimes, as a woman gets olden the muscles that hold up her womb become weak. The womb can fall down into her vagina and part of it may even stick out between the folds of the vulva. In very bad cases, the whole womb can fall outside the vulva when a woman passes stool, coughs, sneezes, or lifts heavy things.

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A fallen womb is usually caused by damage during childbirth - especially if the woman has had many babies or babies born close together. It can also happen if the woman pushed too early during her labor, or if the birth attendant pushed on the mother’s belly from the outside. But both aging and lifting heavy things can make it worse. The signs often appear after menopause, when the muscles become weaker.

Signs:

· You need to pass urine often, or it is difficult to pass urine, or urine leaks out of your body.
· You have pain in your lower back.
· You feel as though something is coming out of your vagina.
· All of the above signs disappear when you lie down.

Treatment:

The ‘squeezing exercise’ can make the muscles around the womb and vagina stronger. If you have been doing this exercise every day for 3 or 4 months and it does not help, talk to a health worker. You may need a vaginal pessary (a piece of rubber shaped like a ring) that you put in the vagina to keep the womb in place. If this does not work, you may need an operation.

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Kinds of Vaginal Pessaries Put the pessary high up in your vagina to hold your womb in place.

If pessaries are not available where you live, ask older women in your community what they use for this problem.

Swollen veins in the legs (varicose veins)

Varicose veins are veins that are swollen and often painful. Older women who have had many children are most likely to suffer from this problem.

Treatment:

There is no medicine for varicose veins, but the following can help:

· Try to walk or move your legs at least 20 minutes every day.

· Try not to spend much time standing or sitting with your feet down, or with your legs crossed.

· If you have to sit or stand for a long time, try to take breaks to lie down with your feet above the level of your heart. Do this as often as possible during the day.

· When you have to stand for a long time, try to walk in place.

· Sleep with your feet up on pillows or on a bundle of cloth.

· To help hold in the veins, use elastic stockings, elastic bandages, or cloth that is not wrapped too tightly. But be sure to take them off at night.

This woman is keeping her leg up as she sews.

Back pain

Back pain in older women is often caused by a lifetime of heavy lifting and carrying.

It can often be helped by:

· exercising every day to strengthen and stretch the muscles in the back. It may be more enjoyable if you organize a group of women to exercise together.

· asking younger members of your family to help you, if you must continue to do hard work.

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Joint pain (arthritis)

Many older women suffer from joint pain caused by arthritis. Usually it cannot be cured completely, but the following treatment may help.

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Treatment:

· Rest the place that hurts.

· Soak cloths in hot water and place them on the painful areas. Be careful not to burn your skin. (Some people with joint pain lose their sense of feeling from the skin on the painful areas.)

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· Keep your joints moving by gently rubbing and stretching them every day.

· Take a mild pain medicine. Aspirin works best for arthritis. For very bad pain, take 600 to 1000 mg of aspirin up to 6 times a day, with food, milk, or a large glass of water. Ibuprofen also works well. Take 400 mg 4 to 6 times a day.

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IMPORTANT
If your ears start to ring or you start to bruise easily, take less aspirin. Also, if you are having a lot of bleeding from your vagina, you should not take aspirin.

Weak bones (osteoporosis)

After menopause, a woman’s body starts to make less estrogen, and her bones become weaker. Weak bones break easily and heal slowly.

¨ Weak bones are a major cause of disability for older women.

A woman is more likely to get weak bones if she:

· is over 70 years old.
· is thin.
· does not exercise.
· does not eat enough foods rich in calcium.
· has been pregnant many times.
· drinks a lot of alcohol.
· smokes or chews tobacco.

¨ Both exercise and calcium make the bones stronger.

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Treatment:

· Walk for 20 to 30 minutes every day.
· Eat foods rich in calcium.

It may also help to take hormone medicines.

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Problems with seeing and hearing

As they get older, many women are not able to see and hear as well as they used to. Women with seeing or hearing problems are more likely to have accidents, and less likely to work outside the home or to take part in community life.

Problems with seeing

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After the age of 40, it is common to have problems seeing close objects clearly. This is called being farsighted. Often eye glasses will help.

A woman should also watch for signs of too much pressure from fluid in the eye (glaucoma), which can damage the inside of her eye and lead to blindness. Acute glaucoma starts suddenly, with severe headache or pain in the eye. The eye will also feel hard to the touch. Chronic glaucoma usually is not painful, but a woman slowly starts to lose vision to the side. If possible, older women should get their eyes checked at a health center for these problems. For more information, see Where There Is No Doctor or another general medical book.

Problems with hearing

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Many women over the age of 50 have hearing loss. Other people may overlook the problem since they cannot see it. Or they may start to leave the person out of conversations and social activites.

If you notice that you are losing your hearing, here are some things you can do:

· Sit facing the person you are talking to.

· Ask family members and friends to speak slowly and clearly. But tell them not to shout. Shouting can make words even more difficult to understand.

· Turn off radios or televisions when participating in conversations.

· Ask a health worker if your hearing loss can be treated with medicines, surgery, or by using a hearing aid.

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Anxiety and depression

Older women sometimes feel anxious or depressed because their role in the family and community has changed, because they feel alone or worried about the future, or because they have health problems that cause pain and discomfort. For more information on anxiety and depression, see the chapter on “Mental Health.”

Mental confusion (dementia)

Some older people have difficulty remembering things and thinking clearly. When these problems become severe, it is called dementia.

Signs:

· difficulty concentrating, or getting lost in the middle of a conversation.

· repeating the same thing over and over. The person will not remember having said the same thing before.

· difficulty with daily tasks. The person may have trouble knowing how to dress or prepare food.

· behavior changes. The person may become irritable, angry, or do sudden, unexpected things.

These signs are caused by changes in the brain, and usually develop over a long period of time. If the signs begin suddenly, the problem probably has other causes, such as too much medicine in the body (toxicity), a serious infection, malnutrition, or severe depression. The confusion will often go away if these problems are treated.

Treatment:

There is no special treatment or cure for dementia. Caring for someone who is confused can be very hard on family members. It helps to share the responsibility of care and get support from people outside the family when possible.

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To help the person with dementia, try to:

· make her surroundings as safe as possible.

· keep daily routines regular so she knows what to expect.

· keep familiar objects around the house.

· talk to her in a calm, slow voice. Give her plenty of time to answer.

· set clear limits without a lot of choices. Ask questions that can be answered “yes” or “no.”

Working for Change

It is traditional in most places for families to live together and for young people to care for their elders. But now many women and men work away from their communities, often traveling far from their homes to earn money to support their families. Older people are now often left to care for themselves.

Older women are more likely than men to live alone. Women usually live longer than men and often marry older men. In many places women whose partners have died are considered less important than married women. When an older woman lives in a community that no longer values elders, she - as well as her family - may feel that her health problems are not worthy of treatment. Or services to treat her health problems may not exist.

When an older woman is also very poor, the problems she faces are much worse. She may not have the money to pay for health care and medicines, to buy healthy foods, or to pay for a healthy place to live.

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Income earning projects. One way that older women can improve their situation is by finding ways to earn money to support themselves and even help their families, such as:

· raising animals, like chickens, goats, or cows, and then selling the eggs, milk, cheese, or meat.

· making bread or other food to sell.

· making traditional crafts or sewing things to sell.

Six widows living in a small community in, EI Salvador decided they wanted to earn some money by raising chickens to sell for meat. None of them had ever raised chickens before, but they asked a group that supports cooperatives to help show them how. After a local community association loaned them money, the group started to work. At night the women took turns sleeping in the chicken coop to keep animals and people from stealing the chickens. At dawn the women rose to kill and clean chickens. Every day the women walked for miles to other communities to sell the chickens, carrying them in baskets on their heads. Men from their community - and even a specialist who worked with an agency - all told them their project would not be successful. But the women earned enough money to cover their costs, buy new chickens, and pay themselves each about $45 a month. Although it was not much money, it was more than any of them had ever earned before. And they gained respect in their community because they had a successful business. As one of them said, “We never imagined that we could run our own business. Now look at us. We are the bosses!”

Community services for older women. By working together, older women can encourage their communities to:

· create less costly housing for older women, or form groups that live together to cut down on living expenses.

· include older women in nutrition programs.

· train health workers in the special health needs of older women.

Older women can teach others. Older women are the main keepers of traditional healing practices, and only they can pass on this knowledge to the next generation. To preserve these practices and remind others that older women have important skills, women can teach these practices to their children and grandchildren. Older women can also help health workers learn traditional healing practices, so that health workers can use the best methods of both traditional and modern medicine.

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¨ Older women have much wisdom and experience. Working together can make them very powerful.

Changing government policies and laws. Many governments provide monthly income (pensions), housing, and health care for older people. If your government does not, try to work together with other women to change these laws. This kind of change takes time. But even if a woman does not see the changes herself, she will know she has worked toward a better life for her daughters and grand-daughters.

Accepting death Every culture has a system of beliefs about death and ideas about life after death. These ideas, beliefs, and traditions may comfort a person facing death. But she also needs support, kindness, and honesty from her loved ones. You can help a dying person most by listening to her feelings and needs. If she wants to die at home - surrounded by the people she loves - rather than in a hospital, try to respect her wishes. If she wants to talk about death, try to be honest. Anyone who is dying usually knows it, partly by what her body tells hen and partly by the reactions she sees in those she loves. Let her talk openly about her fears, and about the joys and sorrows in her life. This way, when death comes, she may more easily accept it as the natural end of life.