Menopause

CONDITION

What is menopause?

Menopause is the the time in a woman’s life when menstruation ceases. It is a natural biological process, not a medical problem. Although it’s associated with hormonal, physical and psychosocial changes in your life, menopause isn’t the end of your youth or your sexuality.

At what age does menopause occur?

Menopause does not occur overnight; it is gradual, and most people reach menopause between the ages of 45 and 55, the average being around 50. This depends on the individual’s body and hormone levels.

What is perimenopause?

Signs and symptoms may begin much before the actual onset of menopause. This period is called perimenopause. It is characterised by gradual changes in hormones and cessation of your menstrual periods.

What is early or premature menopause?

Premature menopause is a condition when your ovaries stop producing hormones, your periods stop and you experience menopausal symptoms before 40 years of age. The condition can be acquired or induced due to an autoimmune disease, genetics, or certain treatments such as chemotherapy or radiotherapy.

What are the bodily changes that occur at the onset of menopause?

As you approach menopause the production of hormones (for example oestrogen) by the ovaries starts to slow down. As this process accelerates, hormone levels fluctuate more and a woman often notices changes in her menstrual cycle. The ovaries also stop releasing eggs every month.

Changes to your reproductive tract may include:

  • Walls of your vagina become thinner, less elastic, dryer and irritated
  • Tissue of your external genital thins out and becomes irritated

Which part of the body is affected?

The ovaries are paired organs that are a part of the female reproductive system. Situated on either side of the uterus, their main function is to produce ova and release sex hormones. Each month, one ovum matures, is released and picked up by the fallopian tubes for reproduction.

Born with a repository of about 6 to 7 million eggs, a woman’s ovarian reserve begins to decrease gradually each year, and much more rapidly after the age of 35 years until menopause, when she is left with less than 1000 eggs in her ovaries.

How does menopause affect you?

For some, menopause may not cause any unpleasant symptoms or complications, but for others, the symptoms may be uncomfortable and sometimes unbearable, lasting for many years.

Menopause also affects your fertility as you will not be able to get pregnant.

What are the causes of menopause?

Menopause is a natural condition that occurs with the decline of hormones secreted by the ovaries with age. It can also be caused by the following cases:

  • Following hysterectomy and oophorectomy: Hysterectomy is a surgical procedure where the uterus, and sometimes, the ovaries are removed (oophorectomy). Removal of the uterus only can stop your period completely, but does not cause menopause and its other symptoms. However, the removal of the ovaries along with the uterus leads to immediate menopause.
  • Cancer treatment: Chemotherapy and radiotherapy can temporarily cause menopause symptoms during or immediately after treatment. This is not permanent.
  • Primary ovarian insufficiency: Autoimmune diseases and genetics can affect the ovary’s production of hormones before the age of 40.

What are the signs and symptoms of menopause?

The common symptoms of menopause include:

  • Changes in your menstrual cycle:
    • Cycles may become longer, shorter or totally irregular.
    • Bleeding may become lighter.
    • Bleeding may become unpredictable and heavy.
    • Eventually, the hormone levels will fall to a level where menstruation (periods) will cease altogether, and menopause is reached.
  • Hot flushes: As your oestrogen levels drop, your blood vessels may expand rapidly, causing your skin temperature to rise.
  • Decreased fertility: When ovulation begins to fluctuate, you’re less likely to become pregnant, even if you haven’t had a period for a year. However, pregnancy is still possible.
  • Vaginal changes: As your oestrogen levels decline, the tissues lining your vagina and urethra (the opening to your bladder) become drier, thinner and less elastic. With decreased lubrication, you may experience burning or itching, along with increased infections of the urinary tract or vagina.
  • Sexual health: Vaginal changes may make sexual intercourse uncomfortable, painful and sometimes associated with slight bleeding.
  • Sleep disturbances and night sweats: Night sweats are often a consequence of hot flushes. You may awaken from a sound sleep with soaking night sweats followed by chills. You may have difficulty falling back to sleep or achieving a deep, restful sleep.
  • Changes in appearance: After menopause, the fat that once was concentrated in your hips and thighs may settle above your waist and in your abdomen. You may notice a loss of fullness in your breasts, thinning hair and wrinkles in your skin.
  • Emotional changes: As you go through menopause, you may experience mood swings, be more irritable or be more prone to emotional upset.

Women sometimes experience several of these symptoms:

  • Aches and pains
  • Crawling or itching sensations under the skin
  • Forgetfulness
  • Headaches
  • Irritability
  • Lack of self-esteem
  • Reduced sex drive (libido)
  • Tiredness

What are the complications of menopause?

Menopause can increase your risk of developing:

  • Cardiovascular diseases as a result of the decline in oestrogen levels
  • Loss of bone density, osteoporosis, and fractures of the spine, hips and wrists
  • Urinary incontinence because of the loss in elasticity of the vaginal and urethral tissues
  • Increased risk of vaginal yeast infections because of the changes in your vaginal tissues

How is menopause diagnosed?

Menopause is usually diagnosed by your signs and symptoms. If you experience menopause symptoms at an early age, your doctor may order blood tests to determine your levels of follicle stimulating hormone (FSH), oestrogen and thyroid stimulating hormone (TSH), and confirm on the diagnosis.

TREATMENT

What are the treatment options for menopause?

Menopause is a normal consequence of aging and not a disease; therefore, it does not require any treatment. However, if your symptoms are severe and cause a lot of discomfort, your doctor may suggest:

  • Hormone replacement therapy: administration of oestrogen to relieve hot flashes, and prevent bone loss and heart problems
  • Vaginal oestrogen: administration of oestrogen in the form of a vaginal cream to relieve vaginal dryness and discomfort during intercourse
  • Antidepressants and anti-seizure medication: prescribed in low doses, to reduce hot flashes when oestrogen is contraindicated
  • Medication to prevent bone loss and treat osteoporosis

What are the lifestyle recommendations to manage menopause?

You can manage the symptoms of menopause with the following lifestyle changes:

  • Avoid hot flash triggers such as hot beverages, alcohol, caffeinated drinks, stress, hot weather and spicy foods.
  • Practice relaxation techniques, such as yoga and tai chi
  • Perform pelvic floor exercises to strengthen your pelvic floor.
  • Quit smoking.
  • Engage in regular exercises.
  • Eat a balanced diet.
  • Get ample amount of sun exposure.

What are the side effects of menopause treatment?

Hormone replacement therapy may be associated with side effects such as:

  • Headache
  • Vaginal bleeding
  • Breast tenderness
  • Risk of blood clots and breast cancer

What is the current research regarding menopause?

Extensive research is being done to find better management options for menopause symptoms. Some of the recent studies are listed below:

  • Semeghini MS, de Azevedo FG, Fernandes RR, et al. Menopause transition promotes distinct modulation of mRNAs and miRNAs expression in calvaria and bone marrow osteoblastic cells. Cell Biol Int. 2017 Jun 2. doi: 10.1002/cbin.10802. [Epub ahead of print]
  • Ferreira Poloni P, Vespoli HL, Almeida-Filho BS, Bueloni-Dias F, Nahas-Neto J, Nahas EAP. Low bone mineral density is associated with breast cancer in postmenopausal women: a case-control study. Climacteric. 2017 Jun 1:1-7. doi: 10.1080/13697137.2017.1329290. [Epub ahead of print]
  • Saccomani S, Lui-Filho JF, Juliato CR, Gabiatti JR, Pedro AO, Costa-Paiva L. Does obesity increase the risk of hot flashes among midlife women? A population-based study. Menopause. 2017 May 29. doi: 10.1097/GME.0000000000000884. [Epub ahead of print]