MENOPAUSE

When a woman reaches close to her 50s, she goes through another major phase shift of life. This new phase is known as Menopause. It marks the end of a woman’s reproductive years.

  • Menopause means that a woman can no longer conceive (become pregnant) naturally

  • Her monthly menstruation cycle will come to a stop eventually, after decreasing gradually for some years

  • It's diagnosed after a woman has experienced at-least 12 months without menstrual bleeding

  • Menopause usually begins between the ages of 45 and 55, but can develop before or after this age range

  • Menopause is divided into 3 phases:

    • Perimenopause 

    • Menopause 

    • Postmenopause

This phase is very critical in the life of a woman as her hormones change drastically, production of estrogen stops completely. It can be taxing for a woman emotionally, mentally and physically. Lot of patience, care and love is required to sail through this challenging time.

Menopause and associated symptoms

SYMPTOMS OF MENOPAUSE

 

In the months or years leading up to menopause, most women go through a few primary symptoms, and some or all of the secondary symptoms listed below. Symptoms are different for every woman, varying in severity and duration. Lets look at these symptoms:

 

Primary Symptoms

  • Irregular menstrual cycle

    • Periods may skip a month and return, or skip several months and then start monthly cycles again for a few months

    • Menstrual bleeding can occur for shorter or longer duration than regular

  • Vasomotor symptoms

    • Hot flashes (sudden feeling of extreme warmth in chest, neck and face)

    • Night sweats

    • Flushing

  • Insomnia

  • Vaginal dryness

  • Weight gain

  • Extreme mood swings

 

Secondary Symptoms

  • Depression and anxiety

  • Difficulty in concentrating

  • Memory loss issues

  • Reduced sex drive

  • Dry skin, mouth and eyes

  • Increased urination

  • Sore or tender breasts

  • Less fullness in breasts

  • Headaches

  • Heart palpitations

  • Urinary tract infections (UTIs)

  • Reduced muscle mass

  • Joint pain and stiffness

  • Reduced bone concentration

  • Hair loss from scalp

  • Increased hair growth on body parts except head

STAGES OF MENOPAUSE

The three stages of menopause are as follow:

Perimenopause

  • Perimenopause starts a few years before menopause

  • This phase prepares the body for menopause, the point at which the ovaries stop releasing eggs

  • This phase is diagnosed by the falling levels of estrogen hormone in a female's body

  • The menstrual cycle becomes irregular, but the women can still get pregnant during this stage

  • In the last 1 to 2 years of this stage, estrogen levels fall rapidly and the symptoms of menopause are more severe

 

Menopause

  • Menopause is achieved once the woman has had a period free phase for at-least 12 months

  • The ovaries have stopped releasing eggs and estrogen production levels are very low

  • The symptoms of menopause still continue

  • Night sweats, hot flashes, depression, insomnia and mood swings become very prominent during this phase, interrupting the normal life style of a woman

  • The cholesterol levels also rise increasing the chances of heart diseases

 

Postmenopause

  • Most of the menopausal symptoms have either reduced in severity or stopped completely

  • Women face greater health risks due to reduced secretion of estrogen

  • Osteoporosis and heart disease become very common in women

CAUSES OF MENOPAUSE

  • Natural Decline of Reproductive Hormones

    • In the late 30s, the ovaries start making less estrogen and progesterone

    • In the 40s, the frequency, length and severity of your periods may vary, until the ovaries stop producing eggs, and you do not have periods anymore

  • Hysterectomy (medical surgery) 

    • A hysterectomy that removes only uterus and not ovaries, usually doesn't cause immediate menopause

    • Surgery that removes both uterus and ovaries causes immediate menopause

    • Your periods stop immediately, and you're likely to have hot flashes and other menopausal signs and symptomsThe symptoms can be severe, as these hormonal changes occur abruptly rather than over several years

  • Chemotherapy and Radiation Therapy

    • These cancer therapies can induce menopause, causing symptoms such as hot flashes during or shortly after the course of treatment

  • Primary Ovarian Insufficiency

    • Menopause may result when your ovaries fail to produce normal levels of reproductive hormones

    • For these women, hormone therapy is recommended at least until the natural age of menopause in order to protect the brain, heart and bones from side effects

PREMATURE/EARLY MENOPAUSE

  • Premature Menopause refers to the condition where menopause starts before the age of 40 

  • Early Menopause

    • Menopause that starts between the ages of 40 and 45

    • About 5% of women naturally go through early menopause

 

Causes of Premature/Early Menopause

  • Family History

    • Women with a family history of early or premature menopause are more likely to have early or premature menopause

  • Smoking

    • Women who smoke may reach menopause as much as two years before nonsmokers

    • They may also get more severe menopause symptoms

  • Chemotherapy or Pelvic Radiation Treatments

    • These treatments can damage the ovaries and cause your periods to stop for sometime or forever

    • Not all women who have chemotherapy or radiation will go through early menopauseThe younger a woman is at the time of chemotherapy or radiation, the less likely she is to go through menopause

  • Ovary Removal

    • Surgical removal of both ovaries, called a bilateral oophorectomy, may cause menopausal symptoms right away

    • Your periods will stop after this surgery, and your hormone levels will drop quickly

    • You may have strong menopausal symptoms, like hot flashes and less sexual desire

  • Certain health conditions:

    • Autoimmune Diseases

      • Diseases such as thyroid disease and rheumatoid arthritis causes the body’s immune system to mistakenly attack the ovaries and keep them from making hormones

    • HIV and AIDS

      • Women with HIV whose infection is not well controlled with medicine may experience early menopause

      • Women with HIV may also have more severe hot flashes than women without HIV

    • Missing Chromosomes

      • Women born with missing chromosomes or problems with chromosomes can go through menopause early

      • Their ovaries do not form normally at birth and their menstrual cycles, including the time around menopause, may not be normal

    • Chronic Fatigue Syndrome (CFS)

      • Women with CFS have extreme tiredness, weakness, muscle and joint pain, memory loss, headache and non-refreshing sleep

      • Women with CFS are more likely to have early or premature menopause

DIAGNOSIS OF MENOPAUSE

Signs and symptoms of menopause are usually enough to tell most women that they've started the menopausal transition.

Under certain circumstances, your doctor might also test your blood for levels of:

  • Follicle-stimulating hormone (FSH) level goes up as a woman reaches the menopause

  • Estradiol levels indicate the amount of estrogen produced by ovaries.   

  • Thyroid hormones imbalance shows issues with the thyroid gland. This can impact the menstruation cycle and also cause symptoms similar to menopause

  • Anti- Mullerian hormone (AMH) helps the doctor to identify the reserve of eggs in the ovaries

CHANGES IN THE BODY

Hormonal Changes

  • Estrogen

    • During the onset of menopause, estrogen levels fluctuate and become unpredictable

    • Post menopause, production of estrogen falls to a very low level

  • Progesterone

    • Production stops during menstrual cycles when there is no ovulation

    • Production ceases after the final menstrual period

Change in estrogen and progesterone hormone levels over a woman's life

Physical Changes

  • Reproductive System

    • The ovaries stop producing eggs for fertilisation, leading to irregular or missed periods

    • Eventually, the ovaries stop ovulating altogether, and periods stop completely

    • Thickening of cervical mucus, a symptom signifying ovulation, also stops

  • Weight Gain

    • Menopause causes the body to reserve energy more, which means you won’t burn calories and fat as easily

    • This can lead to weight gain. Menopausal women are also more prone to gaining weight around their midline

  • Skeletal System and Musculature

    • Menopause causes the bones to lose their density. This can increase the risk of bone fractures in women

    • A loss of muscle mass during menopause may also occur at a higher rate than before

    • Joints may become stiff and achy, leading to joint pain

 

TREATMENT OF MENOPAUSE

Menopause is a natural process. Many symptoms will go away over time. But if they’re causing problems, the following treatments are commonly used:

  • Hormone Therapy

    • Estrogen therapy is the most effective treatment for relieving hot flashes

    • Estrogen also helps prevent bone loss and some of the secondary symptoms of menopause

    • Estrogen can also be administered directly to the vagina using a cream, tablet or ring to relieve vaginal dryness

  • Non Hormonal Medications

    • Medicines called selective estrogen receptor modulators (SERMs) help your body use its estrogen to treat hot flashes and vaginal dryness

    • Certain medicines, related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs), may decrease menopausal hot flashes

  • Medications for Osteoporosis

    • Based on patient needs, vitamin D and calcium supplements are prescribed to strengthen the bones

 

Treating Emotional and Mental Health

A woman needs more support, love, care and patience during her menopausal phase. The hormonal imbalance severely impact the mental and emotional health. Here are few ways to heal her:

  • Sleep - Mood swings associated with menopause are often improved by getting a good night’s sleep

  • Antidepressants - If mood swings remain, discuss with your doctor to identify the cause, screen for severe depression, and choose the right treatment

  • Practicing relaxation techniques such as deep breathing, paced breathing, guided imagery, massage and progressive muscle relaxation may help with menopausal symptoms

  • Channel Anger into Creative Activities

    • Activities like painting, writing, gardening, and even home decorating can give women the space to process their emotions in a positive way

    • Accepting that they’re moving into a new phase of life and embracing that change as a positive one decreases strong mood swings

  • Journaling - Note down your frustrations and reflect back on your own behavior to identify triggers. This may help in preventing emotional outbursts by avoiding such triggers.

  • Power of the Community

    • Take a stress management class so you can have new ways to stop stressful outbursts

    • Consider an online menopause support group

Lifestyle Changes to Treat Symptoms

  • To deal with hot flashes, drink cold water and sit/sleep in proper ventilated cold areas or use air conditioner. Also sleeping naked or in thin cotton clothes can also help

  • Smoking tobacco can increase the chances of early menopause. Smoking also aggravates the hot flashes

  • Use a lubricant to treat vaginal dryness

  • Stay active. Regular exercising can help with sleep better and also strengthen the bones and musclesThis mitigates the risk of osteoporosis and heart disease

  • Maintain a healthy social life to ease on depression and memory issues

  • Avoid the day time nap to get better sleep at night

  • Limiting alcohol intake can reduce the risk of breast cancer

  • Maintain a balanced diet and keep a healthy weight

  • Increase the intake of multivitamins, calcium and vitamin D

  • Practice yoga, mindfulness or massages to help you relax the mind and body

  • Communicate your feelings with family members or even a therapist, if needed


 

HOW TO SUPPORT SOMEONE GOING THROUGH MENOPAUSE?

 

A common complaint among those supporting menopausal women is that whatever they do seems to be wrong and makes things worse. There are concrete steps you can take to support someone as they go through menopause:

  • Be Patient

    • This time in a woman's life is often full of other transitions—not just physical ones

    • Women may be caring for aging parents or relatives, supporting their children as they move into adulthood, or taking on new responsibilities at work

  • Educate Yourself

    • Learn everything you possibly can about what menopause is like and what changes and experiences are common

    • Once you understand that mood swings and hot flashes are typical, it will reduce the tension regarding the mood ups and downs

  • Communicate

    • Talk, even if communication doesn't come naturally to you

    • Let the menopausal partner/friend/mother know you are on her side

  • Offer to Help

    • Help with chores to ease a hectic schedule and prevent the woman from feeling overwhelmed

  • Praise

    • This is a perfect time to appreciate the person and tell her that you admire her efforts as she is going through menopause

    • Women might need reassurance about their bodies and looks as they feel less confident

  • Don't put pressure on women for sexual activity

 

WHEN TO SEE A DOCTOR?

Although menopause is a natural process, but more often women fall prey to cancer, heart disease and unwanted pregnancies during this phase. Seek medical advise if any of the below mentioned conditions develop:

  • Excessively long or short periods during the perimenopausal phase

  • Bleeding during or after the sex

  • Heavy bleeding including blood clots during the periods

  • If you bleed through your vagina even after menopause

  • If any of the symptoms become severe and interfere with your daily life

  • Visit your doctor regularly for preventive health checkups

  • As you age, conduct recommended health screening tests, such as colonoscopy, mammography and triglyceride screening, at regular intervals

  • Your doctor might recommend other tests and exams, too, including thyroid testing, depending on your history, and breast and pelvic exams, to avoid any chance of cancer development

 

HEALTH COMPLICATIONS DURING MENOPAUSE

  • Heart and blood vessel (cardiovascular) disease

    • When your estrogen levels decline, the risk of cardiovascular disease increases

    • Ensure to maintain a balanced diet, exercise and take steps to reduce your cholesterol or blood pressure within safe levels

  • Osteoporosis

    • This condition causes bones to become weak, leading to an increased risk of fracture

    • During and after menopause, bone density is lost at a rapid rate, increasing the risk of osteoporosis

    • Postmenopausal women with osteoporosis are especially susceptible to fractures of their spine, hips and wrists

  • Cataract

    • A cataract is a dense, cloudy area that forms in the lens of the eye that prevent the lens from sending clear images to the retina

    • Surgery to remove a cataract is generally very safe and has a high success rate

    • Most people can go home the same day as their cataract surgery

  • Periodontal Disease

    • Periodontitis is a serious bacterial infection of the gums and teeth

    • Hormonal changes in women (such as menopause occurs) can make the gums more sensitive, and thus, more at risk of periodontitis

  • Urinary Incontinence

    • Women experience frequent, sudden and strong urges to urinate, as the tissues of your vagina and urethra lose elasticity

    • This may be followed by:

      • Involuntary loss of urine (urge incontinence)

      • Loss of urine with coughing or laughing (stress incontinence)

    • Strengthening pelvic floor muscles with Kegel exercises and using a vaginal estrogen cream/ring may help relieve symptoms of incontinence

  • Weight Gain

    • Many women gain weight during the menopausal transition and after menopause as the body metabolism slows

    • You may need to intake lesser food and work out more just to maintain the current weight 

Changes in women body during menopause like mood swings, insomnia, hair loss, hot flashes, night sweat, weight gain and vaginal dryness

COMMON MENOPAUSE MYTHS

Myth: Menopause heals naturally and doesn't require medical attention

Fact: Menopause is a natural process and yet, there can be a lot of complications since there are so many hormones at play. Sometimes, when the symptoms get worse or when menopause occurs prematurely, medical treatment is required

Myth: A woman cannot get pregnant once her period stops

Fact:  During the perimenopause phase, the menstrual cycle becomes irregular and the woman might get her periods in months. She can still get pregnant during this phase. Hence, it is recommended to use contraception until 12 months have passed without any bleeding. Also, menopause doesn't provide protection against STDs, so a condom must be used

Myth: Women will definitely get osteoporosis

Fact: When estrogen falls in the body, bone loss can follow. This increases the chances of osteoporosis. It is critical for the woman to consume a calcium rich diet to maintain bone density and exercise regularly to reduce the risk of osteoporosis. 

Myth: Your sex life is over after menopause

Fact: Menopause can impact the sex drive in women and also make the vaginal lining very dry. This doesn't mark the end of sex life. You can use more lubrication to avoid dryness and perform kegel exercise to increase blood flow to the pelvic region to maintain your sexual health.

Myth: Hormone therapy is harmful

Fact: Low-risk menopausal women under 60 can safely go on hormone therapy to treat hot flashes, insomnia, and more without fear of an increased risk of breast cancer

Myth: Weight gain is inevitable

Fact: Many women gain weight during menopause due to a slowing metabolism. Eating 200 to 300 fewer calories daily can help maintain your pre-menopausal weight

Myth: Hot flashes don't last for long

Fact: While hot flashes do not last forever, they can occur for 7 to 10 years. The most intense hot flashes often occur in the first two to three years of menopause

Some people believe menopause to be an illness, whereas it's just a natural transition in woman's body.