Our Bodies, Ourselves (117 page)

A limit of KEEPS is that it is studying only disease markers such as lipid levels and calcium in the heart and arteries, not heart attacks and strokes. But as many researchers now believe that transdermal estrogen may not increase the risk of thromboembolic events, a risk with oral estrogen, KEEPS findings could be quite significant. (For more on what's known about the risks and benefits of transdermal estrogen, see “Hormones: Not All the Same” on page 538.) Results should be available in 2011 or 2012.

Are pills that use estrogen synthesized in the lab from plant substances safer than pills synthesized from the urine of pregnant mares? Are nonoral modes of administration safer because they avoid metabolism by the liver? We have too few conclusive answers because no blinded randomized trials have yet directly compared these products head-to-head. Given the high cost and large numbers needed for such trials, none is likely to be performed soon.

Two practicing gynecologists and an endocrinologist who contributed to this chapter wrote the following wish list of further studies they'd like to see. These items for further study give a sense of how much still needs to understood.

• Head-to-head comparison of safety and effectiveness of transdermal versus oral estrogen.

• Birth control pill use during perimenopause: Does it suppress the estrogen produced by the body or not?

• Vaginally applied estrogen: Does it improve or worsen perimenopausal urologic symptoms such as incontinence? How about systemic estrogen? What systemic estrogen levels result from vaginally applied estrogen?

• Head-to-head comparison of the safety and effectiveness of estriol and estradiol when used vaginally.

• The mechanism of hot flashes and nonhormonal treatments for them.

• The role of progesterone in perimenopause, in bone formation and loss, and in treatments for perimenopausal discomforts.

Perimenopause, during which our fertility is ending, ushers in what many call postmenopause, a new stage of life that often spans several decades in which our identity and value go well beyond our biologically based reproductive capacity. In postmenopause, we may rethink our roles and find new kinds of creativity and productivity, a new relationship to our bodies and sexuality, and new configurations of family and friends and of work and meaningful activities.

The menopausal transition, in spite of its physical trials for some, offers us an opportunity to think about what we want in the next phase of our lives. By finding and giving support among friends and women our age at work or in support groups, we can share experiences and information, especially about the more difficult aspects
of perimenopause. Perimenopause and menopause need to be discussed. There is no need to feel isolated as we go through this life episode. A woman who joined a support group says:

There's a lot of mutual help; people really listen to each other and laugh a lot. Now I don't worry about menopause or growing older the way I used to
.

Many women are also turning to websites and blogs for information, advice, and support. Organizations are cropping up that recognize the importance of midlife and the older years as a time of engagement, contribution, and advocacy. (See
Chapter 21
, “Our Later Years,” for more on this movement.)

By being informed and proactive as we go through these transitions and by taking good care of our bodies and our health, we can enter postmenopause without buying into ageist and sexist notions. A fifty-five-year-old woman says:

Intellectually, I know some of my physical and mental capacities will diminish as I age, but I want to deal with this with a sense of self-acceptance [and] not lower expectations. I hope my generation of feminist boomers will not deny the limits of aging and not give in to internalized ageist attitudes towards others and ourselves as we age
.

By actively advocating for policies and programs that improve the health, well-being, and financial and social status of women through the menopause transition and beyond, we can ensure that more and more women will go through these experiences of aging with plenty of community support and the best years ahead.

CHAPTER 21
Our Later Years

A
s we age, we may question whether society fully grasps the complexity and diversity of our lives. We're either trim and tan adventurer-grandmothers, with lives as busy and meaningful as ever and an active sex life to match, or we're cast in the more prevalent role of decline, our later lives a pitiful epilogue that depicts us as inevitably frail, vulnerable, and alone.

We know that this stage—like every stage—is more complicated than either story line and traverses decades with highs and lows. As more of us live longer, we are challenging negative myths about aging and redefining what it means to be old—and doing so on our own terms with our own stories. But we're
up against a youth-oriented mind-set that devalues and marginalizes women after our reproductive years. As Ashton Applewhite writes:
1

We call people out for racist and sexist attitudes, but few blink at the suggestion that older people are befuddled or disabled or dependent or creepy, even repulsive. After all, that's how people over 65 tend to be depicted in entertainment and advertising (if they make an appearance at all)
.

Our culture has so far failed to recognize the massive transition that is under way related to aging and the opportunities it presents for both young and old. A number of recent studies
2
signal a shift from an exclusive focus on the problems and deficits of aging to new models that focus on health, growth, development, and meaningful engagement. It is imperative for us to raise awareness, reframe issues, and present practical, women-centered information that challenges the status quo.

This chapter discusses some aspects of aging that affect our health and social/emotional well-being, with an emphasis on reproductive health and sexuality, the focus of this edition of
Our Bodies, Ourselves
. Questions to be addressed include: How can we make the adaptations needed to maximize good health and maintain independence and quality of life? How much medical intervention are we comfortable with in the later years of our lives? What preventive health care exams, including breast and vaginal exams, do we need when we are in our sixties—or in our eighties? How do sex and sexual pleasure fit in?

While the chapters on relationships, sexuality, and sexual identity include stories from women over sixty, this chapter takes a closer look at how aging affects sexual health, relationships, and well-being. It also identifies numerous resources that provide trustworthy information on caregiving, housing, and economic concerns, among other issues.

Historically, most people did not have an extended old age; for many of us, our life spans will extend decades beyond those of previous generations. Consider that between 1900 and 2007, life expectancy at birth
3
increased from forty-eight to eighty years for women (closer to eighty-one for white women and seventy-seven for black women; life expectancy varies by race, but the difference decreases with age). Life expectancy at older ages has also increased: Between 1950 and 2007, life expectancy at age sixty-five rose from fifteen to twenty years for women.

By the year 2030, when all baby boomers (those born between 1946 and 1964) are at least age sixty-five, nearly 20 percent of the U.S. population will be sixty-five or older, up from 13 percent in 2010
4
and just 4 percent in 1900.

It is up to us to change the aging paradigm—to create purposeful roles for ourselves and positive role models of aging and elderhood for younger people—and to question how our communities can best address the complexities that accompany growing older.

Many of us are asking: How can we balance affirming the positive aspects of aging with recognizing the problematic realities without giving in to age bias? How can we tap into the vast knowledge and insights of women about the aging process and end the potentially oppressive effects of imposed cultural constructs? How can we address health care gaps, which include inequities in care and health disparities, and advocate for changes in policies, institutions, and programs so that everyone can experience better health and improved quality of life?

The road map for navigating these issues isn't always clear. What is certain, however, is that we are a growing force, and our influence can't be ignored. Our numbers will give us extra clout as voters and activists in our communities—clout we can use to press for social policies that improve
the lives of all women, so that what some call the bonus years are experienced more universally.

Although we are living longer than ever before, the quality of our lives as we age depends on many factors: our health, the losses we have suffered, our finances and living arrangements, our family situation and networks of support, and how well we adapt to new changes and, perhaps, new limitations.

Statistically speaking, the problems of aging are predominantly women's problems. In 2008, women accounted for 58 percent of the population age sixty-five and older and for 67 percent of the population eighty-five and older.
5
We have the benefits—and the potential disadvantages—of living longer. Though we'd like to think we'll all have longer life/health spans, most of us will experience some loss, illness, and increased dependency on others, perhaps as we're still considered caregivers ourselves. We need to incorporate this reality into our view of aging and find ways to plan for and cope with these challenges.

Financial concerns especially add to the stresses of daily living. Among women age sixty-five and older, 12 percent are living in poverty.
6

For married women, the number is much less, around 4 percent. Unmarried older women have considerably less income and a lower standard of living than do married women. For women living alone, the poverty rate jumps to 20 percent overall and varies greatly by race: 16 percent of white women, compared with 39 percent of black women, 33 percent of Asian women, and almost 40 percent of Hispanic women.

Some cultures value and honor older people. Generally speaking, U.S. society is ageist; that is, it idealizes the young and marginalizes and segregates older adults. Ironically, ageism is a form of bigotry unlike any other; most of us will fall victim to it sooner or later.

Many of us have felt discriminated against on the basis of age, sometimes from midlife on at work, in relationships, in media representations, and even in medical care. Women are still valued mostly for their reproductive and sexual capacity and are often held to impossible standards of youth and physical attractiveness. This makes us vulnerable to age discrimination at an earlier age than men. Ageism is bad for everyone—but especially for women.

A sixty-three-year-old woman describes her frustration with the limitations of the commonly used phrase “postmenopausal women”:

I think the term is far too narrow. It defines us by the lack of blood dripping out of our vaginas every month, by our lack of reproductive ability. My 20-something feminist self in the mid-1960s would be appalled at the label; my 60-something self looks at the term quizzically and becomes equally appalled. The time from our early fifties until death, “the postmenopausal years,” may span thirty to fifty years. For many women, they may be some of our most productive and fulfilled years. For me, my life has not stopped getting better. But this time in my life needs a different label from “postmenopausal” that describes its richness and breadth. Years of maturity, years of more harmony, years of moving beyond? While my body may not able to do all that it once could, my life is a tremendous adventure—not waning
.

Though the term “postmenopausal” may be useful in a biological or life context, some women advocate doing away entirely with biologically based terms to describe older women. After all, “postandropausal” is not a term used for men.

Advertisements play on and exaggerate our
fears and anxieties about the natural changes in our bodies as we age. Businesses—especially the pharmaceutical, plastic surgery, and cosmetic industries—exploit and profit from these attitudes. Meanwhile, we are more likely to be put down for things that are admired or ignored in older men, such as pride in our achievements or having wrinkles on our faces or extra weight on our bones. The bottom line is that all of us are growing older and all our lives are touched by aging, but society in many ways doesn't accommodate or value the needs and perspective of older women.