What you need to know about Menopause

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Menopause refers to the end of menstrual cycles in women. It signals the end of reproductive period in women. Its symptoms may begin before the periods finally stop (perimenopause) and extend beyond the end of menstrual cycles (post-menopause).

Menopause can be natural or induced. Natural menopause is diagnosed one year after a woman has her last menstrual period. It may be normal when it occurs after 40 years, though in majority of women, this occurs after 45 years of age.

Menopause may be induced following surgery which involves the removal of the ovaries, radiation or chemotherapy for cancers which affects the ovaries by destroying the eggs stored in them.

Why does menopause occur? – Natural menopause occurs when the eggs in the ovaries of a woman have been depleted to the level where ovulation is no more possible. Women are born with all the eggs they need throughout the reproductive years.

These eggs keep depleting in numbers every month, even before they start menstruating. By the time a girl reaches the age of puberty when ovulation and menstruation begin, close to one-quarter of the eggs have been destroyed. 

Every month, a number of follicles (sacs in which eggs develop) emerge from the ovaries and start growing. About 5-15 follicles may start this journey; from where only one, usually, will emerge as a dominant follicle.

These follicles produce reproductive hormones (oestrogen and progesterone) as they grow. These hormones prepare the lining of the uterus (endometrium), which sheds at menstruation, if fertilization does not take place.

With this process repeated monthly, the eggs in the ovaries get depleted; and at certain stage of life, there are no follicles to recruit for ovulation. 

Many women start to experience the manifestation of this depletion after the age of 40 years. Menopause proper sets in between age 45 and 55 years in women. If it occurs before this but after 40 years, it is referred to as early menopause.

Those who have menopause before reaching age 40 years are said to have premature menopause. In the majority of these women, it is due to premature ovarian failure which may be spontaneous as a result of genetic disease, autoimmune disease or infection of the ovaries with tuberculosis or mumps.

Premature menopause may also be induced by chemotherapy or radiotherapy for primary ovarian malignancy or other pelvic malignancies. Others may be due to surgical removal of the ovaries.

What are the symptoms of menopause? – Few years / months before menopause sets in, women experience reduced fertility as it becomes difficult to stimulate the remaining eggs to ovulation due to ageing and genetic modification. Consequently, menstruation becomes irregular and erratic. It may come more or less frequently than it has always been. It may also be lighter or heavier than it has always been.

When menopause proper sets in, women may experience hot flushes, night sweats, vaginal dryness and discomfort, low sex drive, mood changes, sleep disturbances, anxiety and lack of concentration.

In addition to these, women in this condition may experience physical changes such as reduction in breast size and texture as well as skin changes like wrinkling and less turgidity of the skin due to loss of collagen following oestrogen withdrawal.

During menopause, women are also at increased risk of certain health conditions such as hypertension, easy fracture of long bones due to reduction in density of the bones as a result of demineralisation. Breast and ovarian cancer are also more common in these women.

These changes are not specifically caused by menopause but they are a result of withdrawal of reproductive hormones which serve protective roles during the reproductive years and ageing.

Treatment of menopause – Though menopause is not a disease, it may involve some unwanted physical and psychological changes which may be disturbing to the woman as to affect her daily functioning.

It is therefore important that any woman who is concerned with menopausal symptoms should seek medical advice. Treatments are usually targeted at symptomatic relief. Some of the recommended treatment regimens include:

  1. Lifestyle modification – this involves regular exercise, avoidance of smoking and alcohol intake; having healthy & balanced diet with lots of fruits and vegetables; staying physically active and adequate daily rest.
  2. Vaginal dryness: topical oestrogen-containing cream – this partly restores the vagina to its pre-menopausal state which allows sexual intercourse to occur with less discomfort to the woman. The advantage of topical oestrogen cream is that it acts locally on the vaginal with little effect on other parts of the body. This reduces the potential side effects of replacement oestrogen on the body.
  3. Hot flushes: hormone replacement therapy – this replaces the reproductive hormones (oestrogen and progesterone) which have been depleted in the woman as a result of the menopausal status. It thus helps ameliorate hot flushes and night sweats. This may come in tablet form or skin patches. Hormone replacement therapy is only used when strictly indicated. This is because using it may increase the risk of a woman developing certain diseases. These include: heart disease, liver disease, breast cancer, increased risk of blood to clot in the circulation, high levels of cholesterol, stroke etc. Women at risk of these diseases should avoid hormone replacement treatment.
  4. Keeping active sex life – This helps increase vaginal blood flow which help keep the tissues healthy. The fact that there is no more risk of pregnancy and the need to for contraceptives may make sex more enjoyable for some women. 
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