Module 7

Women who experience early menopause, particularly those who had their ovaries removed and don't take estrogen therapy until at least age 45, have a higher risk of:

*Osteoporosis *Heart disease *Earlier death *Parkinson's-like symptoms (parkinsonism) *Anxiety or depression For women who reach menopause prematurely, the protective benefits of hormone therapy usually outweigh the risks. Your age, type of menopause and time since menopause play significant roles in the risks associated with hormone therapy. Talk with your doctor about your personal risks.

Who should avoid hormone therapy?

*Women who have or previously had breast cancer, ovarian cancer, endometrial cancer, blood clots in the legs or lungs, stroke, liver disease, or unexplained vaginal bleeding should usually not take hormone therapy. *If you aren't bothered by menopausal symptoms and started menopause after age 45, you do not need hormone therapy to stay healthy. Instead, talk to your doctor about strategies to reduce the risk of conditions such as osteoporosis and heart disease. These strategies might include lifestyle changes and medications other than hormone therapy for long-term protection.

As adults enter late adulthood (age 60+), it is true that there are some age-related cognitive changes that can occur. Normal age declines include:

*slower processing—taking longer to think through and react to things *increased trouble with free recall of information *increased trouble with the tip-of-the-tongue phenomenon. This is when one knows an answer, and it feels like one can almost recall it, but the specific idea or term can't be retrieved. *Many of these declines can be compensated for with strategies such as writing things down and working harder to focus one's attention.*

This study indicated that middle-aged adults outperformed their younger selves in a variety of areas:

*verbal abilities (such as increased vocabulary) *spatial reasoning *simple math (such as real-world problem solving) *abstract reasoning **While middle-aged adults may feel that they are starting to lose cognitive functioning (and, based on the "use it or lose it principle," it is true that they may be losing abilities that they don't use very often), this study shows that with lifelong experience and maintenance behaviors such as reading, cognitive improvements can occur. *Middle-age may be considered a cognitive peak* *It is important to keep in mind that the Seattle Longitudinal Study examines reasonably healthy adults who generally have high levels of education.

Risks of hormone therapy

-heart disease -stroke -blood cots -breast cancer Subsequent studies have suggested that these risks vary, depending on age. For example, women who begin hormone therapy more than 10 or 20 years from the onset of menopause or at age 60 or older are at greater risk of the above conditions. But if hormone therapy is started before the age of 60 or within 10 years of menopause, the benefits appear to outweigh the risks. The risks of hormone therapy may also vary depending on whether estrogen is given alone or with progestin, the dose and type of estrogen, and other health factors such as your risks of heart and blood vessel (cardiovascular) disease, cancer risks, and family medical history.

consequences of dropped estrogen levels:

-mood fluctuations -hot flashes -shrinking of reproductive organs -difficulty becoming sexually aroused -decreased skin elasticity -loss of bone mass -raised blood pressure *one size does NOT fit all when it comes to menopause and its symptoms, culture and genetics appear to play key roles

If you take hormone therapy, how can you reduce risk?

1. Find the best product and delivery method for you 2. Minimize the amount of medication you take 3. Seek regular follow-up care 4. Make healthy-lifestyle choices *If you haven't had a hysterectomy and are using systemic estrogen therapy, you'll also need progestin. Your doctor can help you find the delivery method that offers the most benefits and convenience with the least risks and cost.

cultural differences with menopausal symptoms

A clear example of the difference in Eastern and Western perspectives on the emotional and physical changes women typically experience as they get older are the very terms used to describe these changes. The Japanese word for this phase of life, konenki, when broken down, stands for "renewal years" and "energy," whereas the Greek roots of the English word "menopause" simply mean "monthly stop." caucasian women: more muscle aches, difficulty sleeping and more irritability than women of other backgrounds African-American: more hot flashes and night sweats, they also had a more positive attitude about menopause Japanese and Nigerian women: more commonly experience frozen shoulders=limited and painful shoulder mobility Mayan/indian: reported no hot flashes or significant symptoms. look forward to menopause because become "wise women" Findings from the SWAN study also showed that ethnic background influences the age at which menopause starts. Latina and African-American women often entered menopause earlier than white women, while Asian women reached menopause several months later. (Interestingly, women who smoke tend to begin menopause one to two years earlier than non-smokers.) What accounts for these diverse experiences? Differences in diet, environment, cultural beliefs, and genetics may all play a role. Greater awareness and understanding of the diversity in how women experience menopause across ethnic groups gives all women permission, in a way, to celebrate and embrace their new status in any way they like.

relationships

According to Sternberg, couples can have loving relationships that are based on just one of these components. However, more complete forms of love include two or, ideally, all three components. Therefore, combining the different components can help us understand different types of love. The triangle below shows the various types of love—see the description underneath the triangle to learn what component each type of love contains. Hint: #2 is Intimacy, #4 is Commitment, and #6 is Passion, and the various types of love are constructed by including one or more of these elements. Sternberg said that at the beginning of a relationship, passion is strong. Thus, infatuation, fatuous, and romantic love might be more likely early in a relationship. Based on what we learned about sexual behavior, it is likely for passion to decline somewhat over time. In the most lasting relationships, therefore, it is beneficial for another component of love to be present in the relationship.

C. Socioemotional Development in Middle Adulthood 1. The Midlife Crisis

Current research indicates that "crisis" is perhaps too strong a word for what happens to most people at this age. Typically, middle adulthood is a transition for many adults, as they become accustomed to the changes that aging brings about and become ready for the next phase of life. *Only a small portion of adults (typically, men) experience a full-blown crisis *Cross-culturally, it is not at all typical to have a midlife crisis. Some cultures don't even recognize "middle age" as a distinctive age group. *In summary, it is common for middle aged individuals to take stock of life, evaluating where they've been and we're they would like to be. It is common to make some important life decisions and changes at this point. However, this typically looks more like a transition than a crisis, particularly for women.

Who should consider hormone therapy?

Despite its health risks, systemic estrogen is still the most effective treatment for menopausal symptoms. The benefits of hormone therapy may outweigh the risks if you're healthy and you: *Experience moderate to severe hot flashes or other menopausal symptoms *Have lost bone mass and either can't tolerate or aren't benefiting from other treatments *Stopped having periods before age 40 (premature menopause) or lost normal function of your ovaries before age 40 (premature ovarian insufficiency)

Physical peak in early adulthood

Early adulthood marks the physical peak of an individual. This peak occurs between the ages of 20 and 35, although certain athletic activities may peak at earlier ages. For example, see the list below of various sports and the ages at which one is considered to have peaked physically for these sports: swimming: early twenties tennis: early/mid-twenties sprinters: early/mid-twenties football (running backs & receivers): 27 basketball: 27 football (quarterbacks): 25-35 baseball: 27-29 golf: 25-35 long distance runners: late 20s, early 30s The general principle seems to be that sports requiring quick movements, speed, and heavy endurance peak at younger ages. However, sports that don't require these elements may peak later. Activities requiring a more cerebral or mental aspect of the game—such as being a football quarterback—tend to peak a little later likely due to the types of brain changes discussed in the previous section.

Hormone therapy for menopause

Hormone replacement therapy — medications containing female hormones to replace the ones the body no longer makes after menopause — is sometimes used to treat common menopausal symptoms, including hot flashes and vaginal discomfort. Pros: -prevent bone loss -reduce fracture in postmenopausal women Cons/risks: risks depend on dose and how long the medication is taken. For best results, it should be tailored to each person and re-evaluated often

Menopause therapy

If you haven't had your uterus removed, your doctor will typically prescribe estrogen along with progesterone or progestin (progesterone-like medication). This is because estrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of uterine cancer. If you have had your uterus removed (hysterectomy), you don't need to take progestin.

Divorce

Incidentally, it is important to note that the "50 percent of all marriages end in divorce" statistic that is frequently presented in the media is based on a prediction from research in the 1970s. Since this familiar statement, taken at face value, makes it sound like researchers count the total number of married couples now and then see what percentage divorce, it is a little misleading. That is, this "50 percent" figure is not based on the current number of couples who have actually divorced. Instead, it reflects a prediction of the percentage of currently married couples who are likely to divorce. Since the divorce rate has dropped since the 1970s, it is no longer an accurate predictive value. As the article indicates, the likelihood of divorce varies across couples. For example, a 2006 report of the National Marriage study conducted by Rutgers University indicated the following: having an annual income over $50,000 lowers your divorce rate by 30 percent. having a baby at least seven months after marriage versus before marriage lowers your divorce rate by 24 percent. Essentially, waiting to have a child decreases potential strain on the relationship. growing up in an intact home versus a divorced home lowers your likelihood of divorcing by 14 percent. being religious lowers your likelihood of divorcing by 14 percent. attending college at all lowers your likelihood by 13 percent. Interestingly, highly educated women today (compared to the 1970s) have some of the lowest divorce rates, although these divorce rates also vary by race. Basically, the more education a woman has, the less likely she is to get a divorce.

2. Sexuality and Relationships

Less frequent adolescent sexual behavior than some have thought. For example, the survey found that only nine percent of males and 11 percent of females aged 14 to 15 have had vaginal intercourse, with oral sex rates ranging from one to 12 percent for both genders in this age group. Rates increase to 30 percent for 16-to-17-year-old males and females for vaginal intercourse, and 2 to 31 percent (males) and 5 to 24 percent (females) for oral sex. These are still lower rates than have been estimated by some in the past. More recently, Jean Twenge published a book on the iGen generation (or Generation Z), which includes people born in 1995 or later. Based on longitudinal survey data, she found that this generation is less likely to have had sex at all in their teens and early twenties compared to prior generations. For example, the percentage of 20 to 24-year-old males who have had no sexual partners since age 18 increased from around 10 percent in the 1980s and is now at 18 percent (Twenge, 2017). Back to the myth about marriage and decreased sex, the National Survey of Sexual Health and Behavior indicates that married couples engage in sex more frequently than singles

B. Cognitive Development in Middle Adulthood: Seattle Longitudinal Study

Many people mistakenly believe that cognitive decline, rather than improvement, is typical in adulthood. K. Warner Schaie started the Seattle Longitudinal study in 1956. The most recent data collection for this study occurred in 2005-2006 and is one of the most extensive longitudinal studies to date on adult development. This study is a cohort-longitudinal design and tests cohorts of people across many decades. To date, the study is in its third generation, so there are grandparents, parents, and grandchildren who are all part of this study together!

socioemotional development in early adulthood

One of the most famous theories on love in relationships is Sternberg's Triarchic Theory of Love (1988). "Triarchic" refers to Sternberg's contention that love has three components: intimacy, passion, and commitment.

Multidirectional development

These ages are generalizations, but participation in sports can be maintained throughout adulthood if healthy behaviors are maintained and adaptations are made to avoid injury. For example, Olympian Dara Torres was able to maintain an exceptionally high level of performance in swimming throughout her thirties and early forties, including after childbirth. An important feature of development, as you learned in Module 1, is that it is multidirectional; development can involve improvement and decline, and sometimes at the same time! Adulthood is when multidirectional development can be observed. For example, an adult in his late thirties may find that he can no longer beat his twenty-year-old cousin in a race, and when he tries to, his body is sore for days! However, he may be healthier than he was in his twenties because he is eating better and getting more sleep. However, for most people (particularly if physical exercise is not maintained), physical decline begins in certain areas in early adulthood. The list below shows an overview of some of the changes that occur in early adulthood. maximum heart rate may gradually decrease respiratory capacity gradually decreases (becomes noticeable after age 25 under heavy exercise conditions) lens of the eye stiffens, thickens sensitivity to sound at high frequencies decreases fast-twitch muscles decline in size and amount

The bottom line: Hormone therapy isn't all good or all bad

To determine if hormone therapy is a good treatment option for you, talk to your doctor about your individual symptoms and health risks. Be sure to keep the conversation going throughout your menopausal years. As researchers learn more about hormone therapy and other menopausal treatments, recommendations may change. If you continue to have bothersome menopausal symptoms, review treatment options with your doctor on a regular basis.

What can you do if you can't take hormone therapy?

You may be able to manage menopausal hot flashes with healthy-lifestyle approaches, such as keeping cool, limiting caffeinated beverages and alcohol, and practicing paced relaxed breathing or other relaxation techniques. For vaginal concerns, such as dryness or painful intercourse, a vaginal moisturizer or lubricant may provide relief. You might also ask your doctor about the prescription medication ospemifene (Osphena), which may help with episodes of painful intercourse.

Divorce

Your answer should include the following: a discussion of how the "50%" figure is not a literal number but is rather a projection of the likelihood of couples to divorce at the present time. This rate might be much higher or much lower for any particular couple. If you reverse the trends discussed in this module, you can see that the odds for a particular couple to get a divorce are higher if: money is tight, if the couple have a child before marrying, if at least one partner was a child of a divorce, if neither partner is religious, and if one partner never attended college.

2. Family Relationships in Middle Adulthood

a. Launching -time of "launching" children (coming of age and leaving home) -It is becoming increasingly common, however, for launching to not be a one-time event. Rather, adult children may come and go from the family home throughout the emerging adulthood years as they transition to a full adult role. b. Sandwich generation -While middle-aged adults might be continuing or completing direct parental responsibilities, they may also increasingly find themselves in a caretaker role toward their own parents. The term, "Sandwich Generation" is used to describe how middle-aged adults are literally in the middle (the "fixings" of the sandwich) between the two "breads": children and elderly parents. Middle-aged adults may have quite extensive responsibilities caring for both of the other age groups. Some cultural expectations might make it clear who in the family should be the primary caregiver for an elderly parent (for example, eldest daughter). Caring for an elderly parent can result in caregiver strain (which includes anxiety and depressive symptoms). Support groups, counseling, and respite services (taking a brief reprieve from caregiving with the support of others who step in for a time) are some key ways of coping.

passion

biological closeness, sexual and romantic feelings

commitment

cognitive component, a decision to stay together

Low-dose vaginal products

come in cream, tablet or ring form pros: -can effectively treat vaginal symptoms and some urinary symptoms while minimizing absorption into the body CON: -does NOT help with hot flashes, night sweats or protect against osteoporosis

Systemic hormone therapy

comes in a pill, skin patch, gel, cream or spray form--remains most effective treatment for relief of troublesome hot flashes and night sweats pros: -estrogen can ease vaginal symptoms such as dryness, itching, burning and discomfort with intercourse -combined estrogen and progesterone therapy may reduce risk of colon cancer -some data suggests estrogen can decrease risk of heart disease when taken early postmenopause -helps protect against osteoporosis (bone thinning), bisphosphonates treat osteoporosis

postformal thought

describe adult thinking that is more relativistic, seeing shades of gray rather than simple dichotomies. Others theorists have also described various aspects of postformal thought. For example, William Perry conducted research on college students and stated that young adults move from dualistic thinking (right vs. wrong) to multiple thinking (i.e. there are different viewpoints to consider, but it is hard to reconcile the various perspectives) to commitment within relativism (i.e. there are multiple viewpoints, but I can reflect on and decide what I believe regarding these perspectives).

intimacy

emotional connectedness, involves warm communication

Emerging adulthood

in-between period where individuals leave adolescence but are not fully adults *Early adulthood is the first developmental grouping of the adult years (occurs in one's twenties and thirties)

climacteric

midlife transition during which fertility declines -at this point women become unable to bear children and men become less fertile women: -estrogen levels drop (perimenopause)

companionate love

on the other hand, is likely after the relationship has been going on for some time. The love is warm and trusting, but without much passion. For a variety of reasons, it is common for long-term relationships to lose some of the initial passion. However, couples in successful marriages generally report that they love each other more than they did earlier. The form of this love may look a little different than it did early in the relationship.

menopause

the end of menstruation and reproductive capacity -generally occurs anywhere between a woman's late thirties through late fifties

Middle Adulthood

thought to occur between the ages of 40-60