Category Archives: Reproduction Well-Being

KEBIJAKAN & STRATEGI NASIONAL KESEHATAN REPRODUKSI DI INDONESIA

Pada saat ini Kesehatan Reproduksi telah mendapat perhatian khusus secara Global sejak diangkatnya isu tersebut dalam Konferensi Internasional tentang Kependudukan dan Pembangunan (International Conference on Population and Development, ICPD), di Kairo, Mesir, pada tahun 1994. Dalam Konferensi tersebut dihasilkan kesepakatan tentang Perubahan Paradigma dalam mengatasi masalah yang berkaitan dengan kependudukan, yang semula lebih menekankan pada pendekatan Pengendalian Populasi dan Penurunan Fertilitas menjadi pendekatan yang difokuskan pada Kesehatan Reproduksi serta upaya pemenuhan hak-hak reproduksi. Continue reading

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“LARANGAN KAUM PRIA saat nge-SEX……”

PECINTA membosankan bukanlah sesuatu yang Anda inginkan dalam cerita seks. Agar tak jadi pecinta membosankan, temukan dan lancarkan berbagai greget dalam variasi bercinta. Dengan tujuan membantu Anda keluar dari masalah seks yang menakutkan, berikut tujuh hal yang dianggap membosankan bagi wanita saat di ranjang. Baca dan pelajari apa yang sebaiknya tidak Anda lakukan untuk membuatnya minta lagi dan lagi, seperti dikutip Askmen.

TIDAK PERNAH BEREKSPERIMEN

Jika Anda berdua ingin saling menjaga gairah, cobalah posisi dan gaya baru, luapkan fantasi seks Anda, praktikkan role playing selama bercinta, dan berbagai hal yang akan memanaskan segalanya untuk mengusir kebosanan pasangan saat di ranjang.Tuangkan wine untuk Anda dan pasangan, dan ungkapkan tentang apa yang membuat Anda turn on. Mungkin saja dia akan segera memenuhi fantasi seks yang Anda ungkapkan, bahkan lebih cepat dari yang Anda pikirkan.

MINTA IJIN

Tak ada sisi seksi dari seorang pria saat Anda merasa harus meminta ijin tiap kali ingin bersetubuh dengan pasangan. Pecinta sempurna tahu bagaimana membiarkan pasangan tahu bahwa Anda sedang punya mood baik untuk bercinta. Selanjutnya, Anda mampu membuat pasangan turn on, tentu tanpa meminta ijin terlebih dulu. Cukup sederhana, dengan pandangan yang intens atau sentuhan penuh arti bisa jadi jalan terbaik untuk membawanya menuju ronde-ronde bercinta yang ingin Anda lewati bersamanya.

TERLALU BERISIK ATAU TERLALU SUNYI

Suara erangan atau desahan yang terlalu berisik atau mengulang kata-kata romantis tertentu bisa jadi hal membosankan, sama halnya kesunyian atau tanpa suara sama sekali. Pilihan kata yang tepat dapat membuatnya turn on. Katakan padanya bahwa apa yang dia lakukan sangat memukau, bahwa dia sangat hot, atau aksi yang ingin Anda lancarkan berdua. Hal tersebut akan mencegahnya dari rasa bosan saat di ranjang.

BISA DITEBAK

Alasan mengapa Anda terlihat hot saat bercinta adalah karena dia tidak tahu aksi yang akan Anda lancarkan. Jika Anda ingin menjaga rasa penasarannya, jagalah “kesegaran” tiap aksi yang Anda punya. Jangan takut mencoba hal-hal baru. Jangan biarkan dia mengantisipasi setiap aksi Anda. Sebagai contoh, jika Anda selalu menghabiskan lima menit untuk foreplay, kini cobalah tambah menjadi 15 menit dan rangsang birahinya dengan penuh kesungguhan. Dan segera setelahnya, Anda pun akan dikejutkan dengan aksi spontan dan tak bisa ditebak darinya.

SEKS MEKANIK

Kebanyakan wanita akan setuju bahwa seks tanpa gairah adalah kebodohan penuh bisu. Tak ada wanita yang ingin diperlakukan bagai sebuah boneka. Anda sebaiknya jangan pernah mengabaikan kenyataan bahwa, tak peduli seberapa “dingin” dia, dia tetaplah wanita yang sangat senang diperlakukan lembut. Jadilah pencinta impiannya dengan bercinta penuh kelembutan.

LOKASI YANG SAMA

Jika pasangan bosan bercinta di ranjang, Anda harus segera mencari alternatif tempat menyenangkan lainnya. Tapi jangan bayangkan Anda harus mengeluarkan banyak biaya untuk mendapatkan tempat yang memuaskan.Cukup sederhana, bisa di bawah pancuran air (shower) kamar mandi, meja dapur, mobil, atau kalau ada sedikit biaya bisa di pulau wisata privat, dan berbagai tempat yang tak ada batasnya untuk dicoba. Gunakan imajinasi Anda dan jangan terjebak dalam kondisi tak menggenakkan.

KURANG ROMANTIS

Kebanyakan wanita, seperti juga pria, merasa bahwa mereka harus penuh arti dengan apapun aksi seksualnya saat bersama pasangan. Namun, nyatanya mereka akan lelah dengan rutinitas itu. Jadi, jika Anda ingin mencegah pasangan dari perasaan lelah dengan aksi bercinta Anda, sesekali lancarkan sedikit usaha ekstra keras saat bercinta.

Kata kuncinya cukup simpel, yakni romantisme. Bukan romantisme hanya dalam aksi bercinta, tapi dalam berbagai kesempatan bersamanya. Sebagai contoh, tinggalkan untuknya sebuah pesan yang mengungkapkan aksi bercinta apa yang Anda inginkan darinya atau apa yang ingin Anda lakukan padanya di dekat bantal, di sofa, ataupun di atas kulkas. Bisa pula dengan menyiapkan makan malam romantis untuk berdua dan menyalakan alunan lagu romantis. Buat ia merasa nyaman. Setelahnya, dia pasti akan melakukan apapun untuk menyenangkan Anda.

Available from : http://lifestyle.okezone.com/read/2010/01/09

WOMEN’S PERSPECTIVES ON THE MENOPAUSE

WOMEN’S PERSPECTIVES ON THE MENOPAUSE

 

 organ-menop                            The only consistent factor in every woman’s experience of the menopause is that eventually menstruation stops. Other than this, you can help to prepare a woman for the onset of menopause, explaining what might happen and how she may feel, but you can­not say for certain how she will feel. Every woman’s experience of the climacteric period is unique – her life will be influenced by many factors other than just hormonal ones. Her expectations of the menopause and related symptoms, her life experiences, her cul­ture and her circumstances will all influence her perception and experience of the climacteric.

 

CHANGING TIMES

Attitudes to the menopause have changed over the years, particu­larly as society itself has changed. In the Victorian era the word menopause would hardly have been mentioned as being of medical concern, except perhaps to recognize that it sometimes resulted in women having a ‘nervous disposition’. Women themselves would have welcomed it as a release from childbearing. In the early to midtwentieth century, the menopause was viewed as a time of loss or decay. Women were often prescribed tranquillizers or antidepresants, showing that the climacteric was viewed as a time of distress. ­Now, in the twenty-first century, the menopause is sometimes viewed as a deficiency disease that needs to be treated, particularly by the medical profession who tend to have ‘medicalize’ the menopause in some respects. Women may feel that they are less feminine after the menopause, or less healthy, if they decline the offered hormone replacement therapy (HRT). Yet women are anxious about the use of HRT and want to be sure that it is really safe and appropriate before they consider its use.

In recent years stereotypes have started to be recast: women are no longer considered `over the hill’ at 50, but rather may experience what has been termed a ‘post-menopausal zest’ (Sheehy, 1993).

 

If 45 is the old age of youth, 50 is the youth of a woman’s second adulthood’ (Gail Sheehy, 1993)

 

The menopause is no longer seen as a sickness but as a ‘transi­tion phase’ into a new life. Women are seeking information on the subject of menopause and want to decide for themselves whether or not to take HRT. The media play an important role in informing women about the menopause and HRT. This has both positive and negative implications for women’s knowledge about the subject. One thing is certain, however: women no longer consider the menopause as a taboo subject – they actively seek the information they need to be informed. Armed with the facts, gleaned from women’s magazines, radio chat shows and television documen­taries, they resent medics trying to make the decision for them about HRT. Women want to be accurately informed and actively involved in the decision as to whether to take HRT. They are also turning to alternative means of alleviating menopausal symp­toms using complementary or non-hormonal therapies. The modern challenge to women is to `know your own menopause’ or, as Gail Sheehy puts it in her book, The Silent Passage, ‘claim the pause’.

 CHANGING CULTURES

The menopause is inevitable for women who live long enough, but how it is experienced is unique to individuals. Even purely physio­logical symptoms such as hot flushes, sweats and vaginal dryness are not universally experienced, or at least acknowledged, by all cultures. Lock (1991), studying Japanese women, and Wright (1983) studying Navaho Indians, found that in each of these cultures there are no words for ‘hot flush’. Symptom reporting in Japan is signifi­cantly lower than in women from North America (Lock 1994). Lock reminds us, though, that, when considered alongside Japan‘s low incidence of heart disease, breast cancer and its high life expectan­cy it is possible that biological factors as well as psychological ones will influence their experience of menopausal symptoms.

For some African women the time of menopause indicates a higher social status, and life becomes easier after it. This means that the menopause is seen as a positive life event, whereas in countries such as the USA, Germany and Italy, it is viewed in a negative way – as a demarcation of ageing (Flint 1994). This may influence how a woman feels at the time of the menopause.

In China, few women seek advice about the menopause, although it is possible that they do experience symptoms, but suf­fer in silence. Chinese women generally perceive the menopause as a natural process and so perhaps have a positive attitude towards any symptoms they may experience (Tang 1994).

In the UK, cultural differences are less profound but still impor­tant, particularly with regard to the use of HRT. The following fac­tors are worth considering:

Catholic women may associate HRT with the contraceptive pill and refuse it because of religious objections. Careful coun­selling on the differences between HRT and the contraceptive pill is required.

Orthodox Jews or Muslim women may not wish to resume bleeding again after the menopause because of religious restric­tions during menstruation. HRT regimens that achieve amenor­rhoea may be acceptable.

Vegetarians or vegans may be keen to know whether their HRT is derived directly from animals. Alternatives, derived from plants, may be preferred.

 CHANGING PRESSURES

The climacteric is a time in a woman’s life of great physical change, which may last for months or even years. For the average woman, these hormonal changes will occur at around the age of 50 years, when she may also be experiencing pressures in other areas of her life. All of these other factors may influence how a woman feels and also how she copes with any menopausal symptoms that may occur. Long-standing problems may become harder to live with or to deal with when a woman is also experiencing physical or psychological upset as a result of hormonal changes. Every woman approaching the menopause has a variety of needs, not just hor­monal ones, so it is important to take a holistic approach and con­sider all aspects of a woman’s life, not simply her hormones.

 

“It’s your age”

There is a tendency to blame the menopause for every upset or complaint that arises around this time of a woman’s life. Anxiety, depression and panic attacks may all be labelled as being menopausal symptoms and for some women it can be hard to sim­ply find a listening ear. Certainly the menopause cannot be blamed for every emotional upset, although some problems may be exacer­bated by hormonal influences, causing long-standing problems to be highlighted or new ones to be recognized.

 Factors that may affect a woman’s attitudes to the menopause include:

·        changing body image

·        ageing

·        attitudes towards sexuality

·        dreams and expectations

·        relationships

·        ’empty nest’ syndrome

·        roles and responsibilities.

 

1)      Changing Body Image

The media would have us believe that all women must be slim to be beautiful. Society strives towards maintaining a youthful figure into middle age and beyond. Large sums of money are spent by women trying to lose weight and keep young-looking. Yet it is a fact of life that, as we get older, our bodies do change and unless we can afford plastic surgery it is inevitable that we will begin to `show our age’. Wrinkles may appear, hair often greys, waistlines thicken and muscles sag, particularly if underused. Both men and women have to learn to accept their changing bodies and yet still look after them. HRT is not a youth drug and will not prevent many of the effects of ageing on the body. Exercise, diet and lifestyle are proba­bly more important factors (see Ch. 8). Women who turn to HRT hoping to ‘turn back the clock’ will be sadly disappointed.

 

2)      Ageing

The menopause is an event that most women cannot ignore. Some women see the menopause as marking the beginning of new free­dom, new choices and new challenges. For others it represents a turning point, a stage in life one step nearer to old age and, ulti­mately, death. Attitudes to ageing vary, but for some women, the menopause may be an uncomfortable reminder of one’s lost youth and vigour. For women who struggle with acute menopausal symp­toms, the perimenopausal phase may be a difficult one to come to terms with, as they wonder how long these symptoms really will continue. An understanding of a woman’s perspective will help when trying to counsel or advise a woman at this time.

 

3)      Sexuality

The menopause marks the end of the fertile years. Contraception can (eventually) be stopped and sexual intercourse continued with­out concern about pregnancy. For some, this is a release, for others a sadness, perhaps highlighting the ageing process. A woman may feel less desirable or less attractive to her partner. This, along with physical effects such as vaginal dryness or reduced libido, may lead to sexual difficulties at this time. Sensitive counselling, practical advice, HRT if appropriate and sometimes psychosexual therapy will be of benefit.

 

4)      Dreams and expectations

Some women look upon the menopause as a life event, a stage in life to be recognized and coped with, either in a positive way or negatively. It may be a time of evaluation of past life or of planning for a future one. Women may look back with regret because of failed dreams or sad memories. For childless women, the menopause, marking the end of the reproductive era, may be par­ticularly poignant.

For working women, success may not be as great as one had hoped, promotion may be out of reach and retirement becomes the next major step. Marriages and relationships may come under scrutiny, particularly as children leave home and women are given more time to evaluate their own lives. Expectations of life may not be fulfilled, the partner may be going through similar ‘mid-life’ thoughts and decisions. Some women may feel as though the menopause is simply highlighting negative aspects of life, rather than signifying a time of new beginnings and expectations. Helping a woman to understand both the negatives and the positives of middle age may help her to deal more easily with the hormonal effects of the menopause.

 

5)      Relationships

Mid life can be a time when relationships are tested or re-eva~luated. Marriages may be faltering and need a concerted effort to revive them. Physical and psychological effects of the menopause can test a stable, loving relationship, yet alone one that is faltering. Men, too, may be experiencing difficulties, as they come to terms with approaching middle age. Men do not experience a true hormonal change in the same way as women do, but they undoubtedly have to face similar issues regarding health, work and sexuality. Couples may seek help in making adjustments to changing roles and changing lives. For some couples, relationship counselling may be of benefit.

 

6)      `Empty nest’ syndrome

The so-called ’empty nest’ syndrome is used to describe the feelings of sadness and emptiness that a woman may experience when her last child leaves home. A woman who has dedicated her whole life to the upbringing of her children may struggle with the new role she finds herself in – as an independent woman and/or partner. In these days, when many women work outside the home and are encouraged to pursue personal interests as well as those of their family, these feelings may be less intense.

 

7)      Roles and responsibilities

Mid life may be viewed as a time of increased freedom: children leave home, finances may be more secure, work life may be settled. It can come as a shock to some to realize that, just as they are los­ing the dependence of their children, their own parents may be becoming more dependent on them. Women may find themselves torn between caring for their parents and remaining loyal to their partner. For some, this may cause feelings of resentment and frus­tration, leading to guilt when the elderly parent does die. Counselling may be of help in these circumstances.

Some women also struggle with the changing roles from mother to grandmother, as their own children have families of their own. However, the role of grandparent can be immensely satisfying and rewarding.

Work relationships may change. For most women, menopausal symptoms are not usually severe enough to require more than simple adaptations to the working life, such as opening more win­dows, wearing layers of clothes and keeping a notebook for those forgotten messages! However, women who lose their job during mid life, for whatever reason, may find it very difficult to get back into the workplace. A woman may find that her husband is reach­ing the peak of his career, with all its satisfaction and achievements, just at the point that she feels unsettled in work or poorly motivat­ed, because of climacteric symptoms.

When advising a woman about the menopause and HRT, try to find out what other factors – social, emotional or physical – may be affecting how she feels. Helping her to cope with some of these other difficulties may make it easier for her to cope with the menopause. Alternatively, helping her through the hormonal upset of the menopause may make her more able to cope with other problems by herself.

 

Next : Contraception at The Perimenopause

WHAT HAPPENS AT THE TIME OF THE MENOPAUSE . . . ?

what-happen-mnpsWHAT HAPPENS AT THE TIME OF THE MENOPAUSE ?

 

Hormonal influences

In order to understand how menopause occurs it is important to have a basic understanding of the normal female physiology during reproductive years.

During menstruation, low levels of oestrogen and progesterone are released into the bloodstream. The hypothalamus controls the secre­tions of these hormones through the release of luteinizing hormone releasing hormone (LHRH), which then stimulates the pituitary gland to produce follicle stimulating hormone (FSH). FSH, in turn, stimu­lates the ovaries  to produce oestradiol, which causes the endometrium to proliferate. As circulating levels of oestradiol increase, FSH and luteinizing hormone (LH) levels fall until around day 14 of the cycle. LH concentration then peaks and ovulation gen­erally occurs. If fertilization does not take place, oestrogen and progesterone levels fall and the endometrium is shed – menstru­ation takes place. The falling levels of oestrogen and progesterone are detected by the hypothalamus and the cycle starts again.

From around the age of 35 years, the natural cycle becomes less predictable and ovulation may not occur in every cycle. Oestrogen levels fall and, as a result of the negative feedback system of the pituitary and hypothalamus glands, more and more FSH is released in an attempt to stimulate ovarian function. When oestrogen levels fall too low to stimulate endometrial growth, bleeding stops alto­gether and the menopause occurs.

 

Follicle stimulating hormone

Hormonal changes begin well before a woman sees an alteration in her menstrual pattern. Fluctuations in the levels of FSH and LH occur throughout the perimenopause, eventually peaking 2-3 years after periods stop and remaining high for the next 20 years or so, unless hormone replacement therapy (HRT) is taken (Teede & Burger 1998). FSH levels fluctuate widely during the menopausal transition.

 Oestradiol and oestrone

In the premenopausal woman, both oestradiol and oestrone are present, with oestradiol being the dominant hormone. Both are secreted by the ovaries but oestrone is also available through conversion in fatty tissue of the hormone androstenedione, which is secreted by the adrenal glands. Oestrone is biologically less active than oestradiol. After the menopause, the ratio of oestradiol to oestrone changes, with oestrone becom­ing the dominant hormone. There may be transient periods of excess oestrogen, even with raised FSH levels (Teede & Burger 1998).

 

Measuring hormones

Many women believe that they need a blood test to confirm whether or not they are menopausal. In practice such tests are often unnecessary. Symptoms of the menopause do not correlate with actual levels of circulating oestrogen. Some women experience symptoms whilst maintaining relatively high oestrogen levels, whereas others, even with lower levels, may not have such bad symptoms.

Measurement of FSH levels will help diagnose the menopause, but as levels fluctuate widely in the perimenopause repeated deter­mination of the level would be required to be certain of an accurate result. Measuring FSH or oestradiol concentration will not help in predicting whether or not a woman needs HRT. However, FSH lev­els may be useful in the following circumstances:

  • Hysterectomized women
  • Diagnosis of premature menopause, which may have medical or psychological implications
  • To confirm lack of ovarian function for women seeking advice about contraception

 Effect of hysterectomy on menopause

It is possible that, even if the ovaries are conserved at the time of hysterectomy, vascular supply to the ovaries may be compromised, resulting in the menopause occurring earlier than it otherwise would. If a woman experiences an hysterectomy, but is asymptomatic, of osteoporosis and cardiovascular is not detected.

  

LIFE EXPECTANCY

Women approaching the menopause can now expect to live for many more years; many women are living into their eighties and beyond. It is therefore becoming increasingly important to women that the postmenopausal years are as healthy as those before the menopause. Women often ask, ‘Why must I think about the menopause, when my grandmother just got on with it ? The truth is that far fewer women of her grandmother’s genera­tion lived for many years after the menopause. It is not the menopause that has changed in character (although we do have a greater understanding of the physical changes now), but rather that women’s expectation of life beyond the menopause has changed.

 

CONCLUSION

The menopause is a natural event which marks the end of fertility and the end of periods. The menopause itself is merely the outward manifestation of all the hormonal changes that will occur in a woman at this time. Helping women to understand the physiologi­cal causes of menopause and reminding them how their bodies normally function is the first step in helping them to come to terms with their changing body and then with all the other changes that may be occurring at the same time.

 

 

REFERENCES

 1)       Cramer DW, Xu H, Harlow BL (1995) Family history as a predictor of early menopause.

2)       McKinlay SM, Bifano NL, McKinlay JB (1985) Smoking and age at menopause in women.

3)       Sharara FI, Beatse SN, Leonard MR et al (1994) Cigarettes smoking accelerates the development of diminished ovarian reserve as evidenced by the clomiphene citrate challenge test.

4)       Siddle N, Sorrel P, Whitehead MI (1987) The effect of hysterectomy on the age of ovarian failure: identification of a subgroup of women with premature loss of ovarian function.

What is the Menopause ?

What is the Menopause ?

 

menopause-2The menopause has come of age! For much of society (although sadly, still not all), the menopause is now discussed freely by women both at places of work and in many social situations. Over the past 5-8 years, there has been a huge interest in the menopause by the media (sometimes distorted or inaccurate) and a rapid increase in the number of therapies available to women. Just look in any health food shop and observe the number of packets of pills aimed at ‘midlife women’ or women ‘at the change’. Look in women’s magazines and tabloid newspapers and see how the menopause is widely discussed and debated. But still we meet the stereotypes: menopause is assumed to happen at the age of 50 years, even though many women experience it much earlier – even in their twenties or thirties. The hot flush is assumed to be the worst symptom, yet for some women it will be the psychological symptoms that concern them most. Women hope that by ‘living a healthy life’ they will not encounter problems, but menopausal symptoms may affect even the healthiest of women, and sometimes factors outside her control will influence the health of a woman at the menopause and afterwards.

Women are beginning to understand that there is more to the so-called ‘change of life’ than simply the cessation of periods. Women want information about what happens to their bodies at the time of the menopause. They want to know what to expect in the way of symptoms and experiences. They want to know what they themselves can do or take to make it easier, and they want to know what measures are required to protect their long-term health. Many women want to take responsibility for their health and make their own decisions about whether or not to use medical interven­tions. They understand that health is more than ‘the absence of dis­ease’ and want to invest time and effort into maintaining their physical, sexual, emotional and spiritual health.

 

DEFINITIONS

          We have all heard and read about ‘the menopause’ but the term often means different things to different people. To some women it is simply an explanation of a physiological change taking place in their bodies. To others, the word itself triggers negative thoughts about middle age and loss of femininity. Most women will recog­nize that the time of the menopause is a time of hormonal distur­bance, but many will not understand precisely what those changes are or what causes them to happen.

           Strictly speaking, the term menopause simply means last menstrual bleed and as such cannot be diagnosed until after the event.

The phase of time either side of this last bleed is described as the climacteric and it is during this time that many women experience physical and psychological symptoms, along with the emotional changes that some women will attribute to ‘the menopause’.

In practice, both health professionals and women themselves use the term ‘menopause’ to include all aspects of this phase of life. Women talk about going ‘through the menopause” referring to the months or even years of physical and emotional turmoil that may occur at this time.

 A World Health Organization (WHO 1981) report on the menopause uses the following definitions:

  • Menopause Permanent cessation of menstruation resulting from the loss of ovarian follicular activity.
  • Perimenopause (or climacteric) The period immediately before the menopause with endocrinological, biological and clinical features of approaching menopause, and at least the first year after the menopause.
  • Postmenopause The era following the date of last menstrual bleed which cannot be determined until 12 months of spontaneous amenorrhoea has been observed.

ONSET

In the UK, the majority of women experience the menopause at around the age of 51 years, although it commonly occurs as early as 45 years or as late as 56 years.

Menopause may occur at a very early age in some women, even in their twenties and thirties. This is described as a Premature Menopause and such women deserve special attention, both in terms of physical care and also with regard to emotional support.

Studies have shown a relationship between mother’s and daugh­ter’s menopausal age, suggesting that variation in menopausal age may be determined genetically (Cramer et al 1995, Torgeson et al 1997).

Age of menopause does not seem to be affected by:

  • race
  • use of oral contraception
  • number of pregnancies
  • age of menarche.

Smoking, however, does appear to bring forward the age of menopause by 1-2 years (McKinlay et al 1985, Sharara et al 1994).

 

Next :

WHAT HAPPENS AT THE TIME OF THE MENOPAUSE ?