She is a specialist in gynaecology and birthing assistance. The idea to start changeoflife.com has emerged along with the great need for information which she has experienced with her patients at Femina Specialist Center in Oslo, Norway.
- Many of my patients are women between 40 and 60 years of age. They often have questions concerning women’s health and I have experienced an enormous need for information about what we call menopause medicine. When I tell my patients that menopause is ovarian failure, many are surprised and astonished.
They really don’t know so much about the physical causes of menopause. Compared to other patient groups, such as those who are pregnant or confronted with cancer who are well informed via internet and other sources, it seems that women fumble with understanding their own menopause, says Åsle-Marit Ullern.
Began Norwegian pregnancy website barnimagen.no.
Nine years ago, together with midwife Siri von Krogh, Åsle-Marit began a website for expecting mothers (barnimage.no). It developed throughout the years to become a great success and is today owned by the publishers HjemmetMortensen AS. Åsle-Marit Ullern is herself a few years older since then and with her 50 years of age cheerfully finds herself right in the middle of her new website’s own target group.
- I hope to give of myself as both a fellow woman and as a doctor. The fact that I myself am in the middle of the target group I hope will give users the necessary familiarity and understanding through my engagement, she says. She also adds that she envisions a website in which not only menopause discomforts and symptoms are discussed but also the positive sides of being in the middle of life.
- The years around menopause are a unique opportunity to invest in your own health. We certainly have more money, more time and statistically many more years left to live. Menopause can be a struggle for many but it is no long-term condition. It passes and then it’s important to appreciate the positive it brings.
Premenstrual discomforts and menstruation problems will disappear as well as, for example, the hormonally-driven migraines. Many will also most likely be relieved to be able to quite using contraceptives and perhaps have a more liberated and relaxed sex life, she says.
Åsle-Marit Ullern is concerned with changeoflife.com providing good, balanced information and hopes that its users will be as eager to participate in the interactive portions of the website as are the users of the pregnancy website (barnimagen.no). She hopes that many who have used the pregnancy website all these years will also join her further.
Many of them are now in their forties and even though this doesn’t necessarily mean menopause, it is the beginning of a new phase of life. And also, most have left child-birthing years behind them.
In our hormonal commotion
- We have chosen a phase of life, from 40 to 60 years old. Menopause is no illness and no long-term condition. It is in fact ovarian failure which brings about a great decrease in your body’s hormonal levels. For some, these hormonal changes cause great discomfort, so great that they can handicap one’s daily life. Hot flashes especially can be a large problem in every day life.
Others hardly notice menopause; but the majority of us experience small to perhaps great discomforts which we live with. The most common is a disturbance in our menstrual bleeding. Menstruation changes before it finally disappears. We usually say that when you can look back and see that a whole year has gone by since your last menstruation, then you are in menopause.
On average, this happens when a woman is around 51 ½ years old, explains the gynaecologist who during her schooling years teetered between becoming a surgeon or a gynaecologist. But after one Christmas eve in the 1980s with pinning four hip fractures she thought, “no, there must be something more exciting than this…” And with that her choice was made and she’s never regretted it.
It is interesting and exciting to work with women’s health. In many ways, we women are in the throes of hormonal commotion. First is puberty, with all the changes it causes in a young girl’s life. Then follows the intense years with pregnancy and birthing where the body’s oestrogen levels increase a thousand times! And then we enter a new hormonal phase, menopause, where oestrogen more or less disappears. But one thing for sure is that these hormonal changes are experienced very differently from woman to woman.
Shocking report on breast cancer
In 2002, an American research report (WHI) came out that scared the wits out of many women, while simultaneously provided many bold headlines in otherwise lean newsworthy summer weeks.
The report basically stated that there were no healthy benefits of giving oestrogen to otherwise healthy women in menopause. The disadvantages and health risks compared to the advantages of taking hormonal supplements were too great. Especially the focus on the risk of breast cancer quickly reduced the use of oestrogen by Norwegian women by half. Today the numbers are on their way up, but Åsle-Marit still notices the consequences of this shocking report in her patients.
- Many are a bit anxious, and I well understand that. Breast cancer is the most common form of cancer with women between the ages of 50 to 59, but there is still so much that we don’t know of why this type of cancer effects so many women and why it has increased. We don’t know, for example, long-term effects of the use of birth control pills. I try to provide balanced information; I include both benefits and disadvantages.
It should be made clear that oestrogen can improve one’s quality of life or provide healthy benefits. Oestrogen works especially well for hot flashes, night sweats and sleeping problems. It is also most likely that it can help against bone loss and cardiovascular illness if one starts early, that is around the time of menopause.
But it also must be pointed out that that American research report should be interpreted more moderately than the Norwegian newspapers did at that time. In addition, the survey included a type of oestrogen supplement which wasn’t usual in Norway and the women surveyed were older than those who are generally treated with oestrogen in this country.
A lot has also happened during the last five years: old formulas are on their way out and being replaced by newer and better, she says, and can also confirm the myth that there is no other professional group who take more hormonal supplements than female doctors.
I believe that is because, naturally, we have a different background from which to evaluate the risk. New knowledge must be judged from a more balanced perspective rather than just from newspaper headlines. It is this balance which I try to further provide for my patients. But it is important that the decision is their own.
Menopausal discomforts should not be more afflicting than necessary, and many choose to live with their discomforts without doing anything about them. That is perhaps easy but important measures can be taken. Exercise is good for reducing hot flashes. The body then has several opportunities to get the sweat out. Proper diet with reduced intake of alcohol and coffee are more important than ever.
Enough rest and sleep and less stress also are beneficial. We know that smoking advances aging so quitting smoking isn’t such a bad idea, she says.
Feelings of vulnerability in menopause
Åsle-Marit isn’t negative towards alternative medicines. In the wake of frightening propaganda during the last few years, there has also been more research into natural medicines that has come forth.
But many alternative medicines are not tested well enough to know whether they work or not. Neither is the amount of effective substances and additives always as well documented. But the fact that many women do try natural medicines is of little doubt.
- Women have what I call a hidden information exchange about menopausal discomforts. They talk with each other but often confidentially.
I hope that this interactive part of our website will bring forth much of this important information exchange. In our culture, there is a certain type of perceived shame in growing older. And at the same time, there is a sensitive vulnerability in this that some part of us is now gone for ever. We lay our fertility years behind us to start on the latter third part of our lives, something our bodies clearly confirm for many of us.
It is unique that the modern human being lives so long in a non-fertile state. If we look at animals, they die not long after they are no longer fertile, she says.
It is exactly because we live long after menopause that Åsle-Marit Ullern is so concerned that we take our health seriously, both physically and mentally.
With further studies of depression, there has also been research in to any connections between menopause and depression. Nothing has been found that supports that menopause leads to depression, but the discomforts during these years can bring about a vulnerability which can make one easier depressed than in other life phases. A divorce, for example, can be experienced as extra heavy when it happens during a woman’s menopause.
But we emerge from these years more stabile. And it is then that we can reap the health benefits which are both dependent on our genes and on how we have lived our life so far. It is a time to look back in order to plan ahead.
Western women often say they feel younger than they are, and many do keep themselves very well. It appears that there are some cultural differences in how we experience and handle menopause which I hope we can learn more about on changeoflife.com. What we do know is that despite cultural differences there are great individual differences due to a combination of genetics and lifestyle.
Every woman will experience her menopause as unique and individual, but that doesn’t mean that we can’t enjoy exchanging information and experiences, emphasizes the gynaecologist who again reiterates that she herself in the middle of her own target group.
Åsle-Marit looks forward to putting together a specialist panel. In the pregnancy website it was this that was an important element in the expansion and trustworthiness of the site. She herself will participate in the weekly specialist panel which she hopes covers a broad spectrum. This means, among other things, that there will also be space for alternative information.
It is our wish to cover as many perspectives of menopause as possible. It is no secret that marriage can be put to the test during these years. But let us invalidate at once; sexuality doesn’t disappear. It is important to be aware of and open to these changes which occur. Many can experience lack of desire and somewhat weaker orgasms, but sex is of course a blend of head, heart and hormones.
The most important thing is that couples talk with each other about these changes and that they are open and understanding towards each other. It is often actually positive to be a little prepared. A person’s sex life most likely will be different, but just as important and good to take care of, she emphasizes.
Åsle-Marit herself lives with her physician husband and three teenage sons. Much of her free time is spent on the football fields with the boys and at other sports activities. According to her, she has created a balanced life: only females at work and only males at home.