Menopause is a normal condition that all women experience as they age. The term "menopause" can describe any of the changes a woman goes through either just before or after she stops menstruating, marking the end of her reproductive period.
• A woman is born with a finite number of eggs, which are stored in the ovaries. The ovaries also make the hormones estrogen and progesterone, which control menstruation and ovulation. Menopause happens when the ovaries no longer release an egg every month and menstruation stops.
• Menopause is considered a normal part of aging when it happens after the age of 40. But some women can go through menopause early, either as a result of surgery, such as hysterectomy, or damage to the ovaries, such as from chemotherapy. Menopause that happens before 40, regardless of the cause, is called premature menopause.
Natural menopause is not brought on by any type of medical or surgical treatment. The process is gradual and has three stages:
• Perimenopause . This typically begins several years before menopause, when the ovaries gradually make less estrogen. Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last 1 to 2 years of perimenopause, the drop in estrogen quickens. At this stage, many women have menopause symptoms.
• Menopause. This is the point when it's been a year since a woman last had her last menstrual period. At this stage, the ovaries have stopped releasing eggs and making most of their estrogen.
• Postmenopause. These are the years after menopause. During this stage, menopausal symptoms such as hot flashes ease for most women. But health risks related to the loss of estrogen rise as the woman ages.
Most women approaching menopause will have hot flashes, a sudden feeling of warmth that spreads over the upper body, often with blushing and some sweating. The severity of hot flashes varies from mild in most women to severe in others.
Other common symptoms around the time of menopause include:
• Irregular or skipped periods
• Insomnia
• Mood swings
• Fatigue
• Depression
• Irritability
• Racing heart
• Headaches
• Joint and muscle aches and pains
• Changes in libido (sex drive)
• Vaginal dryness
• Bladder control problems
• Not all women get all of these symptoms.
Either you'll suspect the approach of menopause on your own, or doctor will, based on symptoms you've told her about. To help figure it out, doctor can do a certain blood test.
The loss of estrogen linked with menopause has been tied to a number of health problems that become more common as women age.
After menopause, women are more likely to have:
• Osteoporosis
• Heart disease
• A poorly working bladder and bowel
• Greater risk of Alzheimer's disease
• Poor skin elasticity (increased wrinkling)
• Poor muscle power and tone
• Some weakening in vision, such as from cataracts (clouding of the lens of the eye) and macular degeneration (breakdown of the tiny spot in the center of the retina that is the center of vision)
• A number of treatments can help lower risks that are linked with these conditions.
Menopause can lead to the development of complications, including:
• Cardiovascular disease: A drop in estrogen levels has been associated with an increased risk of cardiovascular disease.
• Osteoporosis: A woman may lose bone density rapidly during the first few years after menopause. Low bone density leads to a higher risk of developing osteoporosis.
• Urinary incontinence: Menopause causes the tissues of the vagina and urethra to lose their elasticity. This can result in frequent, sudden, and overwhelming urges to urinate. These urges can be followed by involuntary loss of urine. Women may involuntarily urinate after coughing, sneezing, laughing, or lifting during menopause.
• Breast cancer: Women face a higher risk of breast cancer following menopause. Regular exercise can significantly reduce the risk.
• Treatment for menopausal symptoms can range from hormone replacement therapy to self-management.
• During menopause, women can pursue a number of treatments to maintain comfort.
• Most women do not seek medical advice during this time, and many women require no treatment. However, a woman should visit a doctor if symptoms are affecting her quality of life.
• Women should choose the type of therapy dependent on their menopausal symptoms, medical history, and personal preferences.
• Women can keep the symptoms of menopause at bay by supplementing their estrogen and progestin levels.
• Hormone replacement therapy can be received through a simple patch on the skin. This patch releases estrogen and progestin. HRT is highly effective for many of the symptoms that occur during menopause.
• There are benefits to HRT, but be conscious of the risks:
• HRT effectively treats many troublesome menopausal symptoms.
• It can help prevent osteoporosis.
• HRT can lower the risk of colorectal cancer
• HRT raises the risk of breast cancer, ovarian cancer, and uterine cancer.
• It increases the risk of coronary heart disease risk and stroke.
• Hormonal therapy slightly accelerates loss of tissue in the areas of the brain important for thinking and memory among women aged 65 years and over.
There are other medicines available to help reduce the effects of menopause.
Selective serotonin reuptake inhibitors (SSRIs) have been shown to decrease menopausal hot flashes
Treatments for osteoporosis include dietary supplements and drug therapy.
• Vaginal estrogen may be applied to the area as a tablet, ring, or cream. This medication effectively treats vaginal dryness, dyspareunia, and some urinary problems.
• Moisturizers are available over-the-counter.
• It is often possible to manage the symptoms of menopause without medical intervention.
• Exercise during menopause can have a range of benefits, including preventing weight gain, reducing cancer risk, protecting the bones, and boosting general mood.
• Women should exercise earlier in the day during menopause to avoid causing any interruptions to their sleep cycle.
• Kegel exercises can be useful for preventing urinary incontinence. These are exercises to strengthen the pelvic floor. Practicing 3 or 4 times a day can lead to a noticeable improvement in symptoms within months.
• It is important to maintain a healthful and varied diet when managing the bodily effects of menopause.
• Researchers found that omega-3 may ease psychological distress and depressive symptoms.
• Omega-3 is available in foods such as oily fish. Supplements are also available.
• Women experiencing menopause should eat a well-balanced diet that includes:
• vegetables
• fruits
• whole grains
• unsaturated fats
• fiber
• unrefined carbohydrates
• Try to consume between 1,200 and 1,500 milligrams (mg) of calcium and plenty of vitamin D each day.
• Deep breathing techniques, guided meditation, and progressive relaxation can also help limit sleep disturbance.
• Stress can aggravate hot flashes and night sweats, so avoiding known stressors and practicing relaxation techniques can help these symptoms.
• There are a few ways for a woman to comfortably accommodate the effects of menopause:
• Avoid tight clothing.
• Limit the consumption of spicy food, caffeine, and alcohol.
• Stay sexually active to reduce vaginal dryness.
• Keep stress levels to a minimum, and get plenty of rest.
• Maintain a cool and comfortable temperature in the bedroom at night to minimize night sweats.
• Wake up and go to sleep at the same times every day to regulate the sleep cycle.
• Smoking can exacerbate symptoms, so avoiding it is important. Staying active and healthy and responding to symptoms rapidly can help a woman maintain a good quality of life during menopause.
• Early or Premature menopause, when menstrual periods stop permanently before age 40, affects 8-10 per cent of women but receives little attention.
• When medical reasons cause premature menopause, it is known as premature ovarian failure. Other causes of premature menopause include damage to the ovaries by chemotherapy and/or radiation treatments, or surgical removal of the ovaries.
• The symptoms of premature menopause are those of typical menopause. They can include mood swings, vaginal dryness, cognitive changes, hot flashes, decrease in sex drive, and sleep disturbances. Diagnostic tests can show an elevated level of follicle-stimulating hormone (FSH) and low level of estradiol.
• Complications of premature menopause include infertility and an increased risk for osteoporosis.
• Hormone replacement therapy (HRT) is recommended for women diagnosed with early menopause in order to replace the hormones the body is missing.
• Ease menopausal symptoms
• Maintain bone density and reduce the risk of osteoporosis
• Reduce risk of early onset of cardiovascular and heart disease
• In one in 10 women, pregnancy can potentially occur spontaneously after the diagnosis of POF, and where a woman wants to have this chance of spontaneous pregnancy, the hormone therapy consists of continuous oestrogen with cyclic progestin therapy. Otherwise, a woman can be prescribed the oral contraceptive pill. Both of these therapies will normally give a monthly period. If your period doesn’t occur then a pregnancy test should be performed.
• Higher doses of hormones are often prescribed because younger women require more hormones to maintain quality of life and wellbeing..
• Long-term risks of hormone therapy
Although there are no long-term studies of HRT in women experiencing an early menopause, it is recommended that HRT should be taken to the expected age of menopause (45-50 years of age). All the studies of long-term use of HRT published in recent years have been in women some years after the expected age of menopause, who have much greater risks of heart disease, stroke and cancer because of their age
• Long-term follow up is recommended
• Monitor your symptoms and therapy
• Maintain regular monitoring of heart disease risks and bone density along withe surveillance to exclude the development of other gland failure mainly , thyroid, adrenals, and diabetes.
• What causes primary ovarian insufficiency?
• Although the exact cause of primary ovarian insufficiency may be unknown, a genetic factor or a problem with the body's immune system may play a role in some women. In an immune system disorder, the body may attack its own tissues-in this case, the ovaries.
• Primary ovarian insufficiency may develop after a hysterectomy or other pelvic surgery or from radiation or chemotherapy treatment for cancer. In some of these cases, the condition may be temporary, with the ovaries starting to work again some years later.
• How is primary ovarian insufficiency diagnosed?
• If your periods become irregular or stop, your doctor will do a physical exam and ask you questions about your general health and whether you have other symptoms of primary ovarian insufficiency. You will also have a pregnancy test. And your blood will be tested for other possible causes of irregular periods.
• To check for possible ovarian failure, your blood level of follicle-stimulating hormone (FSH) will be checked. FSH signals your body to release an egg every month. If the amount of FSH in your blood is higher than normal on more than one day, you may have primary ovarian insufficiency. Another blood test also may be done to measure the amount of estradiol (or estrogen) in your blood. Very low estrogen with a high FSH is a sign of primary ovarian insufficiency.
• Some women find out they have primary ovarian insufficiency when they see a doctor because they are having trouble getting pregnant.
• How is it treated?
Treatment for primary ovarian insufficiency will help you manage your symptoms. But there is currently no treatment that will make the ovaries start to work properly again. We may prescribe hormone therapy or other medicines to help with hot flashes. Hormone therapy can also help prevent early bone loss in women who have this condition.
MD (AIIMS), DNB, FRCS
(UK)
MBBS, MS, DNB
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