Early and intermediate symptoms of menopause are not likely to be life-threatening. Moreover, most of these symptoms settle within a few years of the periods stopping. However, there are two major long-term consequences that can lead to death. They are osteoporosis, or bone loss, and atherosclerotic cardiovascular disease, which is a form of heart disease. They account for many deaths and are a drain on the victims' financial resources. Research has shown that oestrogen keeps the bones strong and healthy, and protects against heart attacks and strokes.

This is a disease in which the bones become more porous and fragile. As a result, they tend to break more easily. Unfortunately, the victim does not feel any pain as the disease progresses and more bone is lost. Pain is usually felt only when a bone breaks. Hence, the disease is termed "the silent thief".

Bones are living matter, made up of healthy tissues which break down and form bone tissues. If more is broken down than formed, bone tissue is lost and bones become thin and brittle. Slowly and without your feeling any discomfort, your skeleton is weakened. Bone loss is a normal part of aging but the process is accelerated at the time of menopause, when the level of oestrogen - the hormone which protects against bone loss - falls. This is why women are 4 times more likely to develop osteoporosis than men.

Typically, the bones break or fracture in the hip, spine or wrist. Hip fractures are the most serious as they can cause permanent disability. Often, surgery is needed to correct the fractures and this can sometimes lead to deaths because of the complications which may arise.

Fractures in the spine cause it to collapse, leading to loss of height and stooped posture. The wrist often fractures as, in a fall, the victim will instinctively stretch out a hand to break the fall.

Fragile bones may break even from a simple task such as bending over to pick up a copy of newspaper or lifting a light object. Routine activities such as household chores or shopping may become difficult.

Answer the following questions to find out whether you risk developing osteoporosis:

The more times you answered 'Yes', the greater your risk of developing osteoporosis.

What to do:

These are diseases of the heart and circulatory system affecting both men and women. They include high blood pressure, angina, stroke and thickening of the arteries (known as atherosclerosis) that supply blood to the heart disease and limbs. After menopause, the risk of these heart diseases is greater, increasing with each passing year. Cardiovascular disease is a major cause of death in post-menopausal women. Other risk factors include smoking, family history, obesity, hypertension, diabetes and high cholesterol levels.

Menopause changes the level of fats in your blood. These fats, called lipids, are used as a source of fuel for all cells. The amount of lipids per unit of blood determines your cholesterol amount.

There are two components of cholesterol:

As menopause approaches, the level of LDL cholesterol tends to increase while HDL tends to decrease due to the lower level of oestrogen. A high level of LDL and total cholesterol can lead to stroke, heart attack and death.

Oestrogen protects women probably by two mechanisms:

What to do:
The good news is that these heart diseases can be prevented or at least reduced by early diagnosis and changes in lifestyle. For instance, a healthy diet with more fibre and less animal fat as well as regular exercise will help keep heart diseases at bay.

Sometimes a woman who has yet to reach menopause may have had her
ovaries removed surgically. When that happens, she experiences an abrupt menopause and may be affected by the symptoms more severely than women who go through menopause naturally.

For instance, her hot flushes may be more severe, more frequent and may last longer. She may have a greater risk of heart disease and osteoporosis, and may be more likely to feel depressed. Unfortunately, the reasons for these are unknown.

When only one ovary is removed, the woman remains fertile and will experience menopause naturally.

When the uterus is removed in a hysterectomy, but the ovaries remain intact, the woman stops menstruating. She will experience the symptoms of menopause at about the same age as other women would.

Sometimes, however, symptoms may occur at a younger age, possibly because the blood supply to the ovaries has been affected by the surgery, causing them to produce less hormones.