Okay, ladies (and guys who live with a woman-of-a-certain-age).
Time to think about menopause, the long term health problems associated with frequent hot flashes, and how this relates to money.
For years, many years, I suffered from nightly hot flashes. I’d get into bed, read a few pages of my book, feel my eyelids become heavy, and doze off into blissful sleep – until about a half hour later when I woke up in the tropics, dripping with sweat, a blast of adrenaline coursing through my body.
Then it took time, often hours, before I could fall back to sleep. Nothing helped – not listening to guided meditations on youtube, or acupuncture, or reducing the amount of spicy food I ate.
Every. Single. Night. For years and years.
Why did I let this go on so long?
Well, first of all, I don’t like taking medicine. I’d rather change my diet or exercise more or do anything else rather than take a pill. My doc prescribed an anti-depressant that’s supposed to help control hot flashes. I resisted and resisted, and finally gave it a try.
It didn’t work.
Like a lot of other things in my life, I just toughed it out.
You can get used to almost anything. For example, I lived for years with kitchen drawers that came off their glides and couldn’t be repaired. Not wanting to spend money for new ones, I just got used to drawers that stuck out (until I did a low-budget reno. More on that in a later post).
Broken drawers became normal.
Living in a tired haze all day also became normal. I lost a lot of productivity, took afternoon naps whenever I could, and just pushed through, day after day.
Risks Associated with Hormone Replacement Therapy, and with Hot Flashes
Hormone Replacement Therapy (HRT) scared me.
I had read the results of the Women’s Health Initiative study, including increased risk of breast cancer, heart disease, stroke, and even dementia for women who take medication that includes both estrogen and progestin.
Estrogen-only treatments didn’t produce the same scary outcomes, but doctors only prescribe those treatments to women who have had a hysterectomy. Estrogen-only therapy can increase the risk of uterine cancer in those with an intact uterus.
But sleep deprivation can also predict terrible outcomes. The long-term consequences of sleep disruption can include, among other things, hypertension, cardiovascular disease, type-2 diabetes, and colorectal cancer.
Perhaps the scariest of all? Lack of sleep increases the protein in the brain associated with impaired brain function and Alzheimer’s.
Lovely.
So finally, after suffering for years, I decided that I needed to sleep. I really, really needed to sleep. According to follow-up studies, low-dose HRT started before age 60 should – hopefully – mitigate some of the risk, especially if I don’t take it long term.
I held my nose and swallowed the little pink pill. And I’ll tell you, it’s like magic.
No more waking up with my heart pounding, so sweaty I have to change the T-shirt I sleep in. I feel SO much more productive. Getting through the day without walking through the haze of exhaustion is life-changing.
I hope to be able to stop the treatment in a year or two, at which point my hot flashes will hopefully be in the rear-view mirror.
But if they’re not?
Then I have to weigh the risks. Possible breast cancer from taking HRT for too long, or the chance of Alzheimers from sleep deprivation.
Which would you choose?
There’s also danger, though, from the hot flashes themselves.
New research links frequent and persistent hot flashes with cardiovascular disease and cognitive decline.
Great.
No matter what I do, I’m at increased risk for trouble. Tough it out and live with night sweats and sleep deprivation, or take HRT long term – either way, I’m looking at the possibility of cancer, heart disease, dementia, or other scary health problems.
Not just scary. Expensive.
The Cost of Menopause
We all know about the “pink tax:” women pay more for personal care products and other necessities than men do.
We also know about inequalities in pay. In the female-oriented Facebook groups I belong to that focus on finances, I can’t tell you how many times I’ve seen posts that say something like this: “I just found out that a male colleague with less seniority and experience makes $10,000 more a year than I do.”
But what about the costs associated with being an older woman?
The Invisibility of Older Women
First, men and women of a certain age face discrimination in the job market. That women have it worse, though, seems obvious, and research confirms this. Men become “distinguished” as they age; women become invisible.
At a wedding recently, I was having a conversation with two men, one a titan of Wall Street, the other a young engineer at the beginning of his career. I had a few interesting things (I think …) to add to the conversation, but the titan didn’t look at me. He glanced my way occasionally when the young man included me in the discussion, then returned to bestowing all of his attention on my young friend – another male with more important things to say, obviously.
Not an uncommon experience for me in the last 10 or so years.
How about you?
Older women lose credibility and influence, and the consequences of this show up on the job and in the job market.
Planning for Menopause-Related (or Other) Health Care Costs
So women in general pay more for many products, and older women suffer from the lower-wage consequences of invisibility. But what about the costs of menopause itself, especially the constant hot flash variety?
Poor health costs money.
My retirement plan counts on my continued good health. This is a BIG mistake!
If I develop cancer or heart disease or dementia – all possibilities that increase in likelihood due to my history of disruptive menopausal symptoms, the sleep deprivation they cause, and even the medication that treats them – I need to plan for the costs associated with my care.
Really hard stuff to think about. Even harder to plan for.
My Plan – Assuming Good Health
Here’s my current plan:
- Aggressively pay down debt. Other than my mortgage, the only debt I have is money I borrowed from my HELOC. It will take me four years to retire that debt, or less time if I can generate some significant income from side hustles. I’m working on it!
- Work until I pay off my mortgage in six years. I’ll be 66.
- Once I kill the mortgage, I’ll be able to close my preschool and retire, living off of the following five income sources:
1) Rental Income: I own a two-family home. The rent my tenants pay covers my mortgage, taxes and insurance. Once the mortgage is gone, I will use the rent for living expenses (minus taxes and insurance).
2) More Rental Income: My finished basement houses my preschool. It’s bright, sunny, includes a full kitchen, has a separate entrance, and doesn’t feel basement-y. With some modifications – taking out the child-sized sinks, installing a shower in the half bath – I can create a really nice rental. I could either Airbnb it, or, more likely given my city’s new short-term rental restrictions, I could lease it out long-term.
3) Side Hustle Income: I don’t know how much or exactly what this will look like, but my goal is at least $500/month. If this blog finds the right audience, it could generate some affiliate income (only from products I use myself). I’m working on building my editing business, and have some ideas for other income-generating projects.
4) Eventual Income from Savings/Investments. I don’t have much, but once my debt is gone, I plan to aggressively save and invest for the next ten or more years. By the time I’m 70, or even older, I’ll hopefully have a nice little nest egg. Given my late start, it likely won’t support me on its own, but in combination with my rentals, side hustle income, and Social Security, it will help.
5) Social Security: The system may be in trouble, but at my age, I’m not worried about it going away before I reap the benefits. I just received my SS statement in the mail. If I start taking benefits at my full retirement age of 66 and 10 months, I’ll get $2,408/month. If I can manage to wait until I’m 70, my payment would be about $3,022.
With those sources of income, I’ll be able to live comfortably, travel using credit card rewards, and generally enjoy life.
If I’m sick and need long-term care, though? That’s another story.
What Happens if I’m Sick and Incapacitated?
If the worst happens – physical impairment, or even scarier, cognitive decline (an increased possibility given my menopause-related risks) – I need a different plan.
I absolutely will not burden my kids with my care. They need to live their own lives without being tied to an elderly, infirm parent. Hopefully they’ll visit me in my decline! But I would – seriously – rather die than have them responsible for my day-to-day personal care.
I’m also clear that if at all possible, I want to live (and die) at home.
So a financial plan for the possibility of illness or mental incapacity has to include funds for personal caregivers and the costs of keeping and maintaining my home (and possibly renovating to allow for in-home care).
Long-term Care Insurance
I recently contacted the American Association for Long-term Care Insurance, a member organization for insurance providers offering long-term care products.
I submitted their online quote request form, and soon received an email and phone call from the office of Mary Ann DeKing, whose website says she’s “regarded as the nation’s leading expert in long-term care insurance.”
Although I suspect that the premiums will be out of reach for me, I’m looking forward to a conversation with Mary Ann to learn about different options, levels of coverage, and cost. I’ll update this post (and/or do a deep dive into LTC Insurance in another post) once I speak with her.
Sell the House
If LTC insurance proves too expensive, as I suspect it will, another option is to sell my house.
Although my house still looks like the “before picture” after 22 years, I love it and I love my community, and want to live here for the rest of my days (unless at some point I get really tired of the winters and want to go someplace warmer and with a lower cost of living).
Luckily, the house is worth a lot of money. Who knew when I bought it that my area would take off and the price of real estate would quadruple and more?
I’m directing my kids, if worse comes to worst, to sell the house and use the proceeds to rent me an inexpensive studio apartment, and to use the rest of the house money, along with my other assets, to pay for in-home care.
If that money runs out? Then I’m in trouble.
In a future post, I’ll research and write about programs available for care of seniors who have no income or assets. But better to not need that kind of help in the first place.
Avoiding the Need for Long Term Care
I’m doing everything I can to avoid needing long-term care, and you can, too.
Exercise
This is about the best thing you can do for your long term health. Go for a walk. Look up free low-impact workouts on youtube. Go dancing. Garden. Just get up out of your chair and get moving. SO MUCH research shows that exercise helps prevent physical disease and cognitive decline.
Eat well
Yeah, yeah, you know the drill. Reduce sugar and carbs. Eat whole wheats and brown rice instead of white. Cut down on red meat. Increase daily servings of fruits and vegetables. Blah, blah, blah.
I mostly eat well, but I don’t deny myself that occasional ice-cream cone or cookie. My plan includes enjoying myself along the way.
Get Enough Sleep
This one is really hard for me, and may end up being my downfall. Meditate (use Headspace or free guided meditations on youtube). Exercise will help. Shut off the damn screen an hour before you go to bed (I’m trying, I’m trying …). If something’s on your mind, write it down instead of letting it swirl around in your head. Keep your bedroom dark and cool.
Maintain Strong Social Connections
Especially if you’re single, make a point of getting together with friends on a regular basis. Go to a Meetup. Take a class. Join your local ChooseFI group, even if the members are mostly half your age. Look for inexpensive ways to have fun. I will write a future post on loneliness – a big problem for some of us over 50.
Keep Your Mind Working
Do a crossword puzzle. Learn a new language. Start a business. Keep those intellectual juices flowing.
Be Lucky
We all know it’s a big crap shoot. No matter how many health precautions I take, I could come down with something life-threatening and/or debilitating tomorrow.
Menopausal symptoms feel like a thumb on the scale, pushing me towards negative outcomes.
Still, when you break down the data and look at absolute numbers instead of percentages, it doesn’t seem so bad. Younger subjects of the Women’s Health Initiative study – those in their 50’s – had 12 adverse events (due to hormone replacement therapy) per 10,000 women. Not such bad odds.
Hopefully, menopause won’t cause my decline. But it might. Or something else might.
In the meantime, I’ll live life fully, plan as well as I can for a healthy and a not-so-healthy future, and hope for the best.
Let me know your plan in the comments.
Another great post Deb! Menopause hasn’t hit me yet but I know it’s not far off. I too was a terrible sleeper though and started taking CBD oil before bed and it does wonders to help me sleep. I look forward to reading what you find out about LTC. Back in my Dave Ramsey days a consultant I met with said we’d be better off saving/investing the money and paying for care needs out of pocket rather than pay those LTC premiums. She said you can’t predict what kind of illness and associated care you’ll need and often times the LTC insurance won’t cover many types of care. Sounds like you have a really solid plan though either way.
Thanks, Amelia! Someone else recommended CBD oil – I’m going to give it a try. I think you’re right about LTC insurance, but looking forward to my upcoming conversation with the LTC consultant. Will update the post …