By J. Ron Eaker, M.D.


Applicants classified “4F” by the U.S. Selected Service System 
are considered not physically or emotionally fit to serve in
the U.S. military. Unbeknownst to many women in the menopause, 
they may achieve a different “4F” status because of a combination of factors.

Frazzled, Fatigued, Frigid and Fat


We live in Frazzled times. A recent study by a University health group estimates that 70 percent of visits to a primary care physician are at least partially stress related. Stress can act as a volume control on your symptoms stereo, turning up or down the intensity of a problem. 

Chronic stress can actually change the physiological functioning of the brain initiating changes that can lead to clinical depression and other anxiety disorders. In menopause there is a drop in a woman’s estrogen level, which, for some, may alter how some brain hormones are produced or metabolized, potentially magnifying any stress related alterations. 

No longer is it acceptable to patronize a woman and tell her it’s just hormones because we know midlife can be a stress tsunami waiting to happen. Often there are career changes, relationship issues, kids leaving home, kids returning home and, if you couple this stress with hormonal fluctuations, you have a recipe for Frazzled fricassee. 

There is hope, however, as there are a number of lifestyle changes, supplements, medications, counseling and support groups that can effectively help you navigate these potentially turbulent waters. The first and most important step is recognizing the problem as real and seeking information and assistance.


“I’m sick and tired of being sick and tired.” Fatigue, that overwhelming sense of exhaustion, is epidemic in midlife. There are as many reasons for fatigue as there are Republican presidential candidates (actually many more), so it is important to investigate potential causes. Reasons for fatigue range from anemia to problems sleeping to a variety of medical issues that have unusual tiredness as a part of their symptom spectrum.  

Once again, menopause may be a factor, and this is why women in this age group exhibit fatigue to a greater degree than their male counterparts. It also may be the fact that women are expected to work 40 hours a week, run a household, take care of the kids, manage the 401K, harvest the crops and do 54 loads of laundry a day.   

A common but often overlooked cause of fatigue is poor quality or quantity of sleep. There are receptors in the sleep-associated part of the brain that respond to estrogen. In turn, a lack of estrogen, which is characteristic of menopause, may affect sleep. This can greatly diminish daytime energy level. Not all menopausal women are bothered by this, and sleep disruption, or lack thereof, illustrates the individual nature of menopausal symptoms. Once again there are a variety of approaches to resolve this problem, but it all stems from properly identifying the source.


Frigid, in this context, doesn’t mean you are cold to the touch but refers to a lack of libido. It ranks number two in frequency of complaints of menopausal women (stay tuned for number one), and is a classic example of a multi-factorial problem. That is to say sex drive is influenced by many factors, both mental and physical, and rarely is one item responsible for a decline in friskiness.  

Many women get solace in knowing they are not the only ones suffering from low libido. Reliable medical journals like Cosmopolitan Magazine often promote a false narrative that something is wrong with you if you don’t want to hop in the sack four or five times a day. The top two causes of one’s sex drive driving off are stress and fatigue. (Gee, where have we seen those before?) Are you beginning to get a sense of how all this ties together? Certainly libido can vary throughout a woman’s life; however, there are just a number of factors that seem to coalesce during this timeframe that can lead to changes.  As before, treatments are available that can rebalance many of the underlying problems and restore what is normal for you.


The final “F” refers to an almost inevitable accumulation of weight that becomes more advanced as age increases. I say almost because it doesn’t have to be so. Basic metabolic rates decline as you age, but that can be countered by exercise and proper nutrition. Fat and 50 don’t have to be synonymous, but you have to be intentional to prevent this from being a time when your knees buckle but your belt won’t. Exercise is truly the fountain of youth and will stave off many of the ravages of aging better than Botox or liposuction.

If you find yourself classified as “4F” in midlife, know that each “F” can be combated and overcome with the twin guns of knowledge and action.   

This article appears in the February 2016 issue of Augusta Family Magazine.
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