Menopause

Menopause signifies that time in a woman’s life when she stops menstruating. With the cessation of periods, a woman may go into depression because due to unpredictable fluctuations in hormone levels she may undergo stress, ageing, infertility and other health problems, which may cause emotional discomfort resulting in mood swings or depression. Hence, it is imperative to know the signs and symptoms of menopause so that a woman can sail through it smoothly.

Menopause

What is menopause?

The definition of Menopause can be summarised as a normal part of ageing in women when menstruation completely stops, as the ovaries stop functioning due to the natural decline in reproductive hormones and she can no longer have her children. The diagnosis can only be made when there is an absence of menstrual periods for consecutive 12 months.

It is not a sudden phenomenon but is a gradual process. The period just before menopause is called perimenopause. In the perimenopausal period, menstruation usually starts to become less frequent before it stops altogether. By Indian standards, the average age for menopause is 47-51 years. However, 1% of women may experience early menopause that is before the age of 40. This condition is known as Premature Ovarian Failure.

What are the signs and symptoms of menopause?

The hormonal levels do not usually decline overnight. Instead, a woman enters a phase just before her menopause, called perimenopause, where her hormone levels (oestrogen & progesterone) start to decrease. This stage signals the onset of menopause. Also, the signs and symptoms of menopause start showing from this perimenopause period. Symptoms usually vary widely because of the many effects that these hormones have on the female body. There are three stages of Menopause, and the transition to each step takes time. The stages are Perimenopause. Menopause and Post-menopause.

Symptoms of Menopause

The signs and symptoms that a woman commonly experiences during her transition to menopause are:

  • Irregular Periods :
    This is one of the early signs of menopause where a woman may have her periods frequently, i.e. every 2-3 weeks, or in some cases a woman may not have her periods for months. She may also have heavier or lighter periods and occasionally spot.
  • Hot Flushes :
    Often women complain of hot flushes during menopause, which is a sudden feeling of heat in the upper part of the body or all over. The face and neck may turn red, and you may be all sweaty. Most women encounter hot flushes after menopause also but compared to the perimenopausal and menopausal period; they reduce in intensity.
  • Night Sweats :
    If hot flushes occur during the sleep cycle, then it is termed as night sweats. Night sweats may disturb the sleep cycle in the woman.
  • Vaginal Dryness :
    Due to less oestrogen and progesterone level, the vaginal wall may get thin, become dry and swell. It makes sexual intercourse painful and can lead to incontinence (lack of voluntary control over urination or defecation).
  • Decreased Libido :
    During the menopausal period, women become less interested in sex, and this is due to a reduced level of oestrogen, which can bring physical changes in the body.
  • Decreased Fertility :
    Due to the decline in reproductive hormones, the chances of getting pregnant becomes difficult.
  • Insomnia :
    During menopause, it becomes hard to sleep due to anxiety, night sweats that occur due to fluctuations in hormone levels.
  • Urinary Incontinence :
    During the menopausal years, a woman may find it difficult to hold her urine and may have a frequent urge to urinate. This is because the vaginal tissues and the urethral tissues lose their elasticity and the pelvic muscles also weaken.
  • Urinary Tract Infections :
    Low levels of oestrogen and changes in the urinary tract may make a woman more prone to urinary tract infections. While passing urine, a woman may have a burning sensation.
  • Depression :
    Fluctuations in hormones levels at this time may cause mood swings, irritability and in extreme cases depressions.

Complications that arises after menopause

The post-menopausal period is that time after a woman has been through her menopause and it can bring in many difficulties along with it.

  • Osteoporosis - A woman loses bone density during her first few years after menopause. Also, a drop in the oestrogen hormone can lead to osteoporosis.
  • Heart Diseases - A decline in the reproductive hormone oestrogen may be a reason that postmenopausal woman may develop heart diseases. Oestrogen is thought to play a significant role in maintaining the inner layer of the artery wall, thus helping to maintain the blood flow inside the arteries.
  • Urinary Tract Infections - Postmenopausal women have a risk of contracting urinary tract infections. And, Oestrogen deficiency has a vital role to play in the development of bacteriuria (presence of bacteria in the urine).
  • Breast Cancer - Women also face a high risk of developing breast cancer during her post-menopausal period. It doesn’t mean that Menopause cause cancer. However, the risk of developing cancer increases as a woman ages. If menopause occurs after 55 years, then it increases the risk of developing breast cancer, as she has been exposed to more oestrogen.
  • Endometrial & Ovarian Cancer - During a woman’s menstrual cycle, oestrogen stimulates the uterus and breast tissue. So, the number of menstrual periods a woman has, the longer these tissues are exposed to oestrogen, thus increasing the risk of endometrial cancer. It is also seen that a woman who starts her menopause later may have the risk of developing ovarian cancer too because the number of ovulations she had been more.

    Note: Woman who undergoes HRT (Hormonal Replacement Therapy) may develop the risk of having breast cancer, ovarian cancer, and uterine cancer.

  • Physical changes - With the onset of menopause, a woman may gain weight, especially at the abdomen and waist area. A woman may experience changes in her skin and hair too.

Causes of menopause

The causes of menopause can be:

  • Natural - When there is a natural decline of reproductive hormones when the ovaries stop functioning as woman age.
  • Induced - Induced menstruation refers to menstrual periods that have been stopped purposely as a part of the treatment of certain diseases.
    • Hysterectomy – If the ovaries are removed at the time of hysterectomy, then menopausal symptoms will start immediately after the procedure.
    • Chemotherapy & Radiotherapy – Treatment in cancer patients, may induce menopause, and the woman may experience the symptoms of menopause like hot flushes, vaginal dryness, and so on.
  • Premature Ovarian Failure - Premature ovarian failure (POF) can be described as a condition when the ovaries lose their normal function of releasing a mature egg every month. And 1% of women may face early menopause due to either genetic factors or autoimmune diseases.

Diagnosis of menopause

There are no tests that are needed to diagnose menopause. But some doctors may recommend blood tests to check the level of Follicle-stimulating hormone (FSH) and oestrogen because FSH levels increase and oestrogen levels decrease as menopause occurs. A Doctor might also recommend a pregnancy test to confirm whether it is actually the onset of menopause or pregnancy.

Treatment of menopause (symptoms)

Menopause is a normal phenomenon and does not require treatment, but a woman may face many issues during her transition to menopause phase. To soothe these symptoms and improve her quality of life, she may undergo some treatments.

  • Hormone Replacement Therapy - A woman can prevent the symptoms from bothering her by undergoing Hormone replacement therapy that is by supplementing oestrogen and progestin levels. HRT is highly effective for most of the symptoms that occur during menopause. It can prevent osteoporosis and reduce the risk of colorectal cancer. However, the risk of developing breast cancer is there, along with uterine and ovarian cancer.
  • Healthy Lifestyle - A Doctor may advise leading a healthy lifestyle by eating a balanced diet and by regularly exercising because by maintaining a healthy weight, some symptoms of menopause can be improved.
  • Medicines - can help to reduce the after-effects that the symptoms of menopause causes. Low dose antidepressants are prescribed to help deal with depression. Osteoporosis is treated by giving dietary supplements and medicines. lubricants and vaginal oestrogen may be suggested to treat vaginal dryness and dyspareunia (difficult or painful sexual intercourse). Clonidine may be prescribed to relieve hot flushes.

Is pregnancy possible during transition to menopause phase?

When a woman is moving towards menopause, that is the perimenopause phase, and it is possible to become pregnant. Irregular periods at that time doesn’t mean that the woman may not be ovulating. Chances are there that she might be ovulating, and intercourse at that time might result in pregnancy.

Once a woman attains menopause, it is not possible to become pregnant naturally as the ovaries stop their normal function of releasing a mature egg every month. So, if a woman desires to have a baby and she has her uterus intact, then she can consider IVF with donor egg.

Related questions on menopause:

Q1) Is bleeding after menopause normal?

A) Vaginal bleeding after menopause is not normal and may mean uterine cancer, endometrial cancer, cancer of the cervix and vagina. Abnormal bleeding from the rectum and urinary tract, presence of fibroids and polyps can also cause bleeding.

Q2) What are the early signs of menopause?

A) The early sign of menopause that a woman usually experiences is that of irregular periods, along with mood swings, hot flushes, vaginal dryness.

Q3) How long do the symptoms of menopause last?

A) A) The transition phase to menopause (perimenopause) may last four years or more on average. The symptoms will slowly reduce during menopause and post-menopause phase.

Q4) What is the average age when a woman stops menstruating?

A) The average age of menopause in India is 47-51 years. But some women may experience late menopause, and some woman may experience in between 40-45 years.

References

1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890704/
2) https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072495/
3) https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0023140/
4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1847879/