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Menopause

Introduction/ Menopause meaning: Menopause is the name given to the biological stage of a woman’s life when her menstrual cycles come to an end. Technically, it refers to the absence of a menstrual cycle for 12 consecutive months. It also describes the changes that women go through right before and after menopause. This usually is witnessed by women between the ages of 40-50. As the menstrual cycles have come to an end, the menopausal woman cannot get pregnant. For the majority of the women, even though menopause symptoms can really make them uncomfortable, yet menopause does not need any medical treatment.

Causes of Menopause:

Menopause is just a natural process of human biological life. It is just the result of the ovaries aging and less production of reproductive hormones. All women are born with limited number of eggs and no more eggs are added in the future life. These eggs start maturing as the girl grows after she has reached the puberty stage. The hormones progesterone and estrogen are responsible for controlling the menstruation process and releasing an egg each month. Every woman must go through menopause at some point in their life. It can, however, be due to the following reasons:

  1. Due to natural decline in the hormones: Your ovaries start producing less reproductive hormones (estrogen and progesterone- which are responsible for the regulation of menstruation) as you move towards your late 30s. These hormones keep on declining along with fertility as age advances. For example, in the 40s, the menstrual cycles may change in the duration (the duration may get shorter or longer), intensity (they can be heavier or lighter), frequency (they can be more or less frequent) until around the age of 50s when there are no more periods due to the menopause.
  2. Surgery: Menopause can also be seen in women who get their ovaries removed surgically (oophorectomy).  The menstrual periods stop, and you may experience hot flashes and may experience other symptoms related to menopause.
  3. Chemotherapy/ Radiation Therapy: Menopause can also be induced by the therapies taken for cancer. These cancer therapies can cause symptoms like hot flashes. However, immediate menopause cannot be caused by hysterectomy (surgery that includes the removal of the uterus). Even though you can no longer have periods, your ovaries will still release eggs and produce reproductive hormones.
  4. Insufficiency of the Primary Ovaries: 1 out of every 100 women witness menopause before the age of 40 years, which is less than the usual age and that is why this condition is also called premature menopause.  This can be caused due to failure/inability of the ovaries to produce significant/usual levels of the reproductive hormones. This can be caused due to some genetic factors or due to any autoimmune disorders. However, we can’t get to the exact cause of premature menopause often. Hormone therapy is usually prescribed to these women till the age of menopause so as to protect the brain, heart, and bones.

Complications:

There are increased risks of development of several medical conditions which are enlisted below:

  1. Cardiovascular disease: When there is a decline of estrogen levels, there are increased risks of cardiovascular (heart and blood vessels) diseases. Heart diseases are among the leading causes of death in both men and women. This is why you should eat a balanced diet, get regular exercise and maintain a healthy weight. You should ask your doctor how to protect your heart, reduce cholesterol or bp levels.
  2. Osteoporosis: Osteoporosis makes the bones brittle and weak which makes the bones prone to fractures. During the initial years after menopause, there can be an increased risk of osteoporosis. Hence, postmenopausal women with osteoporosis are very prone to fractures in the spine, hips, and in wrist.
  3. Urinary incontinence: Due to loss of elasticity in the tissues of your vagina and urethra, you may feel strong and frequent urges to urinate which is followed by involuntary urinary loss (loss of urine) which can happen when you are coughing, lifting, or even laughing. This makes you susceptible to urinary infections more often. Exercises that strengthen the pelvic floor muscles like Kegel exercise and using a topical vaginal estrogen can reduce the symptoms of such incontinence.
  4. Sexual function: Due to loss of moisture production and loss of elasticity, vaginal dryness may occur which can cause a lot of discomforts and even slight bleeding during the time of sexual intercourse. A decrease in sensation can reduce the desire for sex/ sexual activity (libido). In such conditions, vaginal moisturizers and lubricants which are water-based may help. If such lubricating agents do not work, you can get the help of treatment with local estrogen which is available in the form of vaginal cream, tablet, ring, etc.
  5. Weight gain: A lot of women gain weight during this menopausal shift and the metabolism gets slowed down after menopause. You should hence, eat less and exercise more so that you can maintain a normal weight.
  6. Cataract: Cataract is seen to be more prevalent in post-menopausal women than in men of the same age.

Menopause Symptoms:

The majority of the women experience various symptoms due to menopause. Although, the severity/ intensity and the duration for these symptoms may be different in different women. Menopausal symptoms may begin to occur a few months or even years before the menopause. These symptoms of menopause can be around for several years even after the periods have stopped/ menopause. In very rare cases, these symptoms can last even up to 12 years after the menopause. The symptoms can be worse if the menopause has appeared suddenly like in women who have undergone cancer treatment. The symptoms associated with menopause are:

  1. Changes in the menstrual periods: Changes in the patterns of menstrual periods are usually among the first noticeable signs of the menopause (one of the menopause early symptoms). One can experience/ notice the periods getting either lighter or heavier than usual. The frequency of the periods can also change. For example, one can have periods more often like once every 2-3 weeks, or not have them for months. This ultimately leads to no menstrual periods at all i.e., menopause.
  2. Hot flushes: Experiencing sudden feelings of warmth which is generally more intense in the face, neck, and the chest region. These flushes can make your skin sweaty and appear red in color.
  3. Sleeping difficulty: The decrease of estrogen hormone due to menopause can lead to disrupted sleep primarily caused because of the hot flushes and sweats which can lead to feelings of anxiety and even depression in an individual which then leads to non-restorative sleep and wakening in the early morning.
  4. Vaginal dryness: Experiencing pain, itching, or any discomfort during the time of sexual intercourse.
  5. Reduced libido (sex drive): Women may experience a loss of sexual desire around the time of menopause due to the decreased levels of estrogen hormone (female reproductive hormone).
  6. Having pain and stiffness in the joints.
  7. Reduction in muscle mass.
  8. Problems with memory and concentration.
  9. Thinning of hair and hair fall.
  10. Palpitations or increased heart rate.

Menopause Diagnosis:

Usually, the signs and symptoms associated with menopause are enough to tell that you have stepped into your menopausal transition. Hence, this is also the reason why you should get a proper diagnosis from your doctor if you have been experiencing menopausal symptoms or even if you have crossed the menopause age (45).  Tests are usually recommended under certain cases only. If one is among such certain conditions, then the doctor might suggest the following blood tests:

  1. FSH and estrogen testing: These include testing for the levels of Follicle Stimulating hormone and the estrogen (estradiol) hormone as usually, the FSH levels get increased and the estradiol levels get reduced as one shift into menopause.
  2. TSH (Thyroid Stimulating Hormone): This test is usually done to check the TSH levels as if the thyroid levels are reduced then that can also produce symptoms similar to the ones seen in menopause.

One can check the FSH levels themselves as one there are also over-the-counter home tests available nowadays. These tests can tell you if your FSH levels are elevated or not and hence, one can know if they are in perimenopause (the stage at which the body transits into menopause) or the menopause stage. But because these FSH levels also change during the time of menstrual cycles hence, one cannot be sure if they are in any menopausal stage and therefore, you will need an experienced doctor who can tell you for sure.

Menopause Treatment:

The most effective treatment for menopausal symptoms is the Hormonal Replacement Therapy (HRT) even though there are other treatment options available. A list of all the mainstream treatment options available is given below:

  • Hormone Replacement Therapy:

This refers to the replacement of missing hormones. As most of the menopausal symptoms are caused due to abnormally low levels of the estrogen hormone hence, it is really an important hormone that needs replacement. HRT is very effective in relieving the symptoms caused due to menopause. It is available in the form of tablets, patches, and rubbing gels.

  1. The major benefit of HRT is its ability to relieve most of the menopausal symptoms like hot flushes, joint pains, vaginal dryness, brain fog, and mood swings. Hence, we can say HRT manages all or most of the symptoms associated with menopause.
  2. HRT can also help in preventing the thinning of the bones which can ultimately lead to frequent and easy fractures (due to osteoporosis which is very common after menopause).
  3. HRT has very few and small risks associated with it like an increased risk of breast cancer and clotting of blood in very few women and the risks are significantly outweighed by the benefits.

You should, however, talk to your doctor regarding the benefits and risks associated with your condition before getting started with the treatment, as these both can vary in some cases. There are also other symptom-specific treatments that are used to reduce the symptoms produced due to the menopause.

Mood Swings:

One can also experience mood swings, low mood, and feelings of anxiety around the menopausal time. One should take self-help measures like getting proper rest and doing regular exercises along with relaxing activities like yoga, meditation, etc. in order to get help with the mood swings Although HRT is the most effective treatment yet, one can also take the help of therapies like Cognitive Behavioural Therapy (CBT) for these mood swings. If one has been diagnosed with depression, then she can take the help of antidepressants.

Hot Flushes:

Menopause can cause various symptoms in women like hot flushes and night sweats. If you are also among the ones who are experiencing hot flushes and night sweats, then you can take the following preventive measures:

  • Wearing clothing that is not heavy.
  • Keep your bedroom cold during nighttime.
  • Take a cold shower
  • Try to avoid taking a lot of stress
  • Have a balanced diet and do regular exercises.

Reduced Sexual Desires:

It is very commonly seen in women to lose their sexual desires around the menopausal time. If HRT doesn’t prove to be that effective (which it mostly is) then your doctor may recommend using a testosterone gel that can be applied on the skin (usually applied on the abdomen or on the top of the leg). Testosterone has proven to be effective in restoring the sex drive in some women. Testosterone can however cause side effects like acne and unwanted growth of hair.

Vaginal Dryness:

If you experience dryness, itching, and pain in your vagina due to the menopause then your Gynaecologist may prescribe treatment which includes using estrogen hormone in the form of cream or vaginal ring that can be put in the vagina. However, one can use this estrogen treatment along with HRT treatment also. But, if one is using estrogen treatment then she will have to use it indefinitely as the symptoms may reappear when this treatment is stopped. Side effects are very rare to this treatment. One can also use moisturizers or lubricants either with this treatment or instead of it.  

Weak Bones:

There is an increased risk of the bones getting weak due to osteoporosis (caused due to the lower levels of the estrogen hormone) after the menopause.

You can reduce/ manage your chances of getting osteoporosis by taking the following steps:

  • Going for the HRT: HRT can prevent your bones from getting weaker due to osteoporosis. Yet, one should always keep in mind that the effect lasts only till the treatment is continued.
  • Eating a healthy diet: Your diet should consist of fruits, veggies, and different sources of Calcium like milk and yogurt, which can stop the decalcification process of your bones.
  • Regular exercise: You should do exercises that include weight-bearing and resistive exercises.
  • Stop harmful habits like drinking, smoking, etc.
  • Get some sunlight: Sunlight triggers the production of Vitamin-D (Calcitonin) which keeps your bones strong.
  •  You should take Calcium and Vitamin-D supplements to fulfil the bodily requirements for healthy bones.

You should have regular follow-up appointments with your doctor. You should make a follow-up appointment after every 3-3.5 months and then, as the symptoms get reduced, then you can extend this follow-up appointment up to once every year.

Your doctor might do the following things during this follow-up:

  1. She will make sure that your symptoms are under control.
  2. She may ask you if there are any side effects of the earlier prescribed treatments.
  3. She will examine your bp levels and weight to make sure that they are in the normal range.
  4. She will review the ongoing HRT treatment and see if any changes are required in it.

Most women need menopausal treatment only for a few years (these years are uncertain as the menopause duration can be different for different people) until the majority of the symptoms have disappeared. Although, a lot of times, many women may wish to continue with HRT for some additional years just to be safe and be sure that the symptoms would not return.

Conclusion:

Menopause is a phase of life that comes in every woman’s life. One should always remember that it is just the natural stopping of a woman’s menstrual cycle, not the woman’s life. Many women think that menopause indicates that they are getting old and moving towards death. However, no one sees the fact that it indicates the beginning of the time where a woman should start living to the full extent. Because of this pessimistic mentality, many women think that it is okay to suffer from post-menopausal symptoms as they are starting to get old and hence, are going to have a few things which might make them suffer. One needs logical thinking along with a competent gynecologist / doctor / healthcare provider who is having a good amount of expertise to guide you properly. There are high chances of one getting benefited from treatments like HRT so one should not think that she will have to suffer from the symptoms associated with menopause.

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