What is menopause?
Menopause is sometimes called ‘the change of life’ as it marks the end of a woman’s reproductive life. At menopause, the production of the female hormones estrogen and progesterone drastically reduces. The word “menopause” refers to the last or final menstrual period a woman experiences.
When a woman has had no periods for 12 consecutive months she is considered to be “postmenopausal”. Most women become menopausal naturally between the ages of 45 and 55 years, with the average age of onset at around 50 years. “Premature menopause” may occur before the age of 40 due to either natural ovarian function ceasing, following surgery to remove the ovaries, or as a result of cancer treatments. Menopause is considered “early” when it occurs between 40 and 45 years.
What is perimenopause (menopausal transition)?
Perimenopause refers to the time leading to menopause when a woman may start experiencing changes in her menstrual periods; such as, irregular periods, heavy or lighter bleeding, shorter or longer duration.
Symptoms that may also be experienced include hot flushes and night sweats, aches and pains, fatigue, or irritability as well as premenstrual symptoms such as sore breasts and bloating. These changes are usually caused by fluctuations in the production of hormones from the ovary. Some women can experience menopausal symptoms for five or six years before their final menstrual period. At present, there is no way to predict the age at which a woman’s menopausal symptoms will start or how long they will last.
What to do about contraception in perimenopause?
A woman’s fertility declines naturally in the 40s and the risk of pregnancy after the age of 50 years is estimated at less than one per cent but women may ovulate twice in a cycle and up to three months before the final period. Women are advised to keep using contraception until two years after their last period if they experience the menopause under the age of 50, and for one year after the last period if aged 50 years or more.
Physical symptoms of menopause
Symptoms commonly reported by peri-and post-menopausal women include hot flushes and night sweats, bodily aches and pains, dry skin, vaginal dryness, loss of libido, urinary frequency, and sleeping difficulties. Some women may have unwanted hair growth, thinning of scalp and pubic hair, skin changes and increased bleeding gums.
These symptoms are due to the fluctuating and declining levels of the ovarian hormones, primarily estrogen. This can have a significant impact on many women, with more than 75% experiencing menopausal symptoms and 25% describing their symptoms as severe. About one out of three women experience long-term symptoms, which may last for seven years or longer.
Now that women are living longer, problems arising contributed to by estrogen deficiency, including incontinence and osteoporosis are more common.
Psychological symptoms of menopause
Hormonal changes can contribute to mood changes, anxiety, irritability, forgetfulness, and trouble concentrating or making decisions. Low levels of estrogen are associated with lower levels of serotonin, a chemical that regulates mood, emotions and sleep.
Depression is not more common at menopause than at other stages of life, but a past history of depression and stress during perimenopause may make a woman more likely to succumb to moodiness.
How is menopause diagnosed?
Doctors diagnose the menopause based on a woman’s symptoms and changes in menstruation. The diagnosis is obvious where a woman has had her ovaries removed surgically.
It is not necessary to have hormonal tests to “prove” a woman is menopausal. However, a doctor may order tests if there is concern that physical changes are a sign of illness, such as thyroid disorder, rather than natural ageing or if spontaneous menopause occurs at an early age.
How can symptoms be handled?
Being informed about what may happen during the menopause transition is a very good starting point.
Women are encouraged to pay attention to their health, including quitting smoking, eating well, exercising regularly and incorporating some relaxation techniques.
Self-management strategies for management of hot flushes such as carrying a fan, dressing in layers, always having a cool drink and a facial water spray can be helpful. Avoiding spicy foods, red meats, caffeine and alcohol will also reduce flushing.
Some women may find relief from menopausal symptoms with herbal or alternative remedies, however most have not been studied or shown to be of benefit scientifically and some, like black cohosh, have been occasionally linked to liver damage. It is not recommended that these treatments are taken for longer than 6 months.
Menopause Hormone Therapy (MHT), in patches or tablets, has been demonstrated scientifically to reduce menopausal symptoms. However, for each individual woman, its benefits must be weighed against the increased risk of serious side effects such as thromboembolism (blood clots) and breast cancer. Any woman taking MHT should be reviewed regularly by her doctor.
Doctors may prescribe other drugs to relieve symptoms, such as anti-depressants (which have been shown to reduce hot flushes), gabapentin, and clonidine.
Feeling positive about menopause
Women may experience physical and emotional changes during menopause but that doesn’t mean life has taken a turn for the worse! Many women are prompted at this time to ‘take stock’ of their lives and set new goals. The menopause occurs at a time when many women may be juggling roles as mothers of teenagers, as carers of elderly parents, and as members of the workforce.
Experts suggest that creating some ‘me time’ is important to maintain a balance in your life. Menopause can be seen as a new beginning: it’s a good time to assess your lifestyle and your health and to make a commitment to strive for continuing ‘wellness’ in the mature years.
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The Later Years (≥50 years old) Menopause can be seen as a new beginning: it’s a good time to assess your lifestyle and your health and to make a commitment to strive for continuing ‘wellness’ in the mature years. Do consult with your Doctor if you feel overwhelmed or require some advice on managing this change |
