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Understanding Menopause

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What is Menopause?

Menopause is a natural biological process, which is also referred to as ‘the change of life’ as it marks the end of a woman’s reproductive life. A women’s body undergoes many changes during this phase that no longer allow her to get pregnant as her periods (menstruation) eventually stop. It is an unavoidable change that normally occurs in women during the ages of 45 – 55 years.

Menopause doesn’t happen suddenly; mostly it starts with the menstrual cycle getting irregular. Menopause symptoms can begin gradually over two to six years before the last menstrual period. Every woman experiences menopause differently, with different impressions and feelings. Menopause is not confirmed until a woman has not had a period continuously for 12 months.

Amenorrhea

It’s the absence of any menstruation for one complete year

Age and Menopause

The average natural menopause age is in late 40s or early 50s.

  • In the United States, the average age of menopause is 51 years.
  • In Australia, the average age of menopause is 51.7 years.
  • In India and the Philippines, the age of natural menopause is considerably earlier, at 44 years because of prevalence of low socioeconomic status and chronic diseases, such as tuberculosis.

 

 

 

 

 

 

 

 

 

There are many factors that influence the age when menopause starts. These include:

  • Autoimmune diseases
  • Eating disorders
  • Excessive exercise
  • Family history
  • Medical conditions
  • Race
  • Smoking
  • Stress
  • Socioeconomic status
  • Treatment of breast cancer

 

Why Does Menopause Happen?

Menopause happens because the ovaries stop releasing eggs. Since, ovaries also produce hormones; any change in the ovaries affects the balance of hormones in the body. This can cause a variety of symptoms, and it can take the body a while to adjust to the changing hormones, i.e. estrogen and progesterone. This process can take up to four to six years on average in women. Eventually, hormone levels fall to a level where menstruation stops altogether and menopause is reached.

During the few years prior to menopause, hormone levels increasingly swing up and down and often, you may notice changes in your menstrual cycle. For example:

  • Cycles may become longer, shorter, or totally irregular;
  • Bleeding may become lighter; or
  • Bleeding may become unpredictable and heavy. (Women with unpredictable or heavy bleeding should seek advice from their health care practitioner as soon as possible).
Additional Fact

Although fertility after the age of 45 years is low, you still need to use contraception to prevent pregnancy. A woman needs to continue using contraception for the next 12 consecutive months after her last natural period.

Signs & Symptoms

Menopause, also known as ‘the change of life’, marks the end of the monthly cycle of menstruation in a woman’s life. It’s a roller coaster ride for women, where their body undergoes many changes due to the fluctuating hormone patterns that begin during the menopausal transition. Symptoms vary from woman to woman and these may last for many years. Some women may have worse symptoms than others. The signs and symptoms of this natural mid-life process are discussed in detail below.

 

Not all women experience menopause symptoms, in fact:

  • 20 per cent experience no symptoms
  • Some 60 per cent experience mild symptoms
  • Only 20 per cent suffer severe symptoms

Diagnosis & Complications of Menopause

Although, the diagnosis of menopause can be made by a patient’s medical history and symptoms of menopause, laboratory testing is performed to confirm the same. A good diagnosis always considers many factors. Therefore diagnosis of menopause should be a combination of all the three factors, i.e. medical history, symptoms, and lab tests.

Medical History + Symptoms + Lab Tests = Diagnosis

Diagnosis in menopausal women should start with an assessment of the following steps:

  • Record of all medical history, maternal menopausal history including risk factors for breast cancer, thromboembolic disease, and osteoporosis.
  • A detailed record of woman’s menstrual cycle history (ideally with a menstrual calendar) is taken.
  • A detailed history of menopausal symptoms such as (hot flashes, sleep disturbances, depression, and vaginal dryness) is taken.
  • Lab tests should be performed.
  • All women with symptoms of vaginal dryness, dyspareunia, or sexual dysfunction should have a pelvic exam to evaluate vaginal atrophy.

Management of Menopause

Menopause is a natural stage of life, not something that you must take medicine for. If your doctor says that you are in the menopausal transition and the symptoms are not bothering you, you don’t have to do anything about them.

If the symptoms are making you very uncomfortable, there are things you can do to relieve your discomfort. Your treatment should be chosen based on your own symptoms and health risks. What your sister or friend does may not be the right choice for you. Talk to your doctor about the best approach for you.

Goals of Therapy

Menopause is an inevitable natural process every woman goes through and there are many symptoms, which occur with menopause. For women who require relief from these symptoms, there are various treatment options available. The goal of therapy for the treatment menopausal symptoms is to control occurrence or minimize impact of these symptoms, which cause discomfort to a woman undergoing the menopausal transition. The symptoms usually occur due to decline in the hormones, i.e. estrogen and progesterone during menopause.

Although, Hormone Replacement Therapy (HRT) is considered as an effective treatment for menopause, it causes some serious side effects. Therefore, it is prescribed only in cases where the symptoms are severe and the benefits outweigh the risks.

  • For mild symptoms of menopause, lifestyle modifications including dietary changes, exercising and physical activity, quitting smoking and limiting the intake of alcohol, and taking care of emotional health should be used as the first line of therapy.
  • If some symptoms like hot flashes, night sweats, urinary inconsistency and vaginal problems bother you more than you can tolerate, then your HCP may prescribe you HRT. The FDA recommends the use of HRT at the lowest dose for the shortest duration. You need to regularly consult your HCP so that your dose of HRT can be lowered or completely stopped, once the symptoms are under control and have stopped bothering you.
  • A healthy lifestyle should be part of any strategy to relieve menopausal symptoms.
  • Also, every woman should learn about the alternatives to treat the menopausal symptoms. Some CAM therapies, life Yoga, Tai Chi, relaxation techniques, and acupuncture may provide significant relief from some symptoms of menopause.

Post Menopausal Health Issues

Osteoporosis

Bones constantly change, and over a period of time the old ones are removed and newer ones are added. Osteoporosis is a condition in which bones become very weak and can break easily. Often, the first sign of osteoporosis is a bone that cracks, sometimes after just straining or twisting. The hormone estrogen plays a vital in building new bone; therefore the decline in this female hormone during menopause leaves many older women at risk for developing osteoporosis.

Some women are more at risk of developing osteoporosis than others. Risk factors, things that increase your chances of osteoporosis include:

  • A family history of osteoporosis
  • Being thin or having a small body frame
  • Early menopause
  • Extended bed rest
  • A fracture in the middle age
  • Insufficient calcium throughout life
  • Long-term heavy drinking
  • Surgery to remove both ovaries before natural menopause
  • Smoking
  • Using certain medicines, such as glucocorticoids or some anticonvulsants, for long periods of time

If you have any of these risk factors or are concerned about the health of your bones, talk to your doctor about what you can do to protect them.

There are steps you can take to prevent osteoporosis after menopause.

  • The first step in preventing osteoporosis is to build as much bone density as possible by age thirty. After that age, some women may begin to lose bone strength. As estrogen levels decline during menopause, the bone loss mechanism picks up speed during this time and continues in the old age. So, get plenty of calcium and vitamin D while you are young and encourage all women around you; friends, daughters, granddaughters to get their calcium doses.
  • Keeping the bone strength you have at menopause is the next step in preventing osteoporosis. Exercise and a proper diet can help maintain the bone strength or slow its loss. Regular weight bearing exercises (such as walking, running, stair climbing, or using
  • weights to exercise) at least three or four times a week can help keep your bones strong. Strengthening and balance exercises can help you avoid falls, which could cause a broken bone.
  • Lifestyle changes can also help protect your bones. If you smoke, preventing bone loss is yet another reason to stop. Women who smoke also seem to go through menopause about 11/2 to 2 years earlier than those who don’t smoke. And, if you drink alcoholic beverages, be careful how much you drink. Having too much alcohol might cause you to fall and break a bone in addition to other serious health problems.
  • Sometimes exercise, diet, and lifestyle changes are not enough, and medicines are needed. Medications include bisphosphonates, raloxifene, estrogen, calcitonin, and parathyroid hormone. Some of these build up bone density. Others prevent further bone loss. Talk to your doctor to find out which would be best for you.
  • If you are over age 65 or if you are 60 to 64 and have any of the risk factors described earlier, don’t wait for a broken bone to find out if you have osteoporosis. Talk to your HCP about a bone density test, perhaps a DEXA-scan (dual-energy X-ray absorptiometry), to find out how solid your bones are. Two spots at high risk for fracture will probably be checked; hips and spine.

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