Menopause - A continuing doubt

Menopause means permanent stoppage of your menses at the end of your reproductive life. It is a natural process which every woman has to undergo in her life with advancing age.

It indicates that your ovarian function us coming to a stand still, however life moves on with a few changes in your mind and body.

You can rightly say that you have attained menopause, when you have had no cycles for the past 12 months consecutively with no other underlying medical reason for it.You belong to the “perimenopausal age group”, if you are around 40-55 years and that is when you await menopause and experience menopausal symptoms the most. The age at which you can expect menopause would be roughly the age at which your mother, sister or your maternal aunt attained their menopause, as it is genetically predetermined.

Remember that the number of pregnancies, OCP pills, race, height, weight and lactation has no influence on the timing of attaining menopause. Smoking, stress, thin built, and severe malnutrition can lead to an early menopause.The average age is said to be 50 years to attain a natural menopause.

There is a change that undergoes in your body. A change that is slow but irreversible. The hypothalamus, pituitary axis decreases its negative feedback effect, causing a hormone called FSH to rise, leading to shrinking of ovaries, reduced follicles in them and an increase in the hormone FSH. Estrogen decreases and androgen or the male hormone tends to rise.

The size of the ovaries, Fallopian tubes, uterus reduces. Vagina gets narrower losing its elasticity and dryness prevails. The breast fat regresses, urinary changes like increased frequency and painful urination set in, incontinence is also experienced. Bones get softer and you can be prone to fractures with a slight fall. Heart ailments can occur due to the loss of estrogen related protective function.

You can be alerted in expecting a menopause to occur soon if

  • The cycles suddenly stop for 12 months and never return at all
  • Gradual decrease in flow of bleeding and the duration as well. Spotting and delayed cycles.
  • Heavy and irregular cycles.

Symptoms of menopause include hot flushes, a sudden feeling of heat all over the face and body followed by profuse sweating, palpitations and weakness lasting for 10 minutes with each episode.

Even a minimal friction or trauma or intercourse can cause bleeding from the vagina. Frequent vaginal infections, increased white discharge, dryness, itching, painful intercourse are common. You may feel a lack of sexual desire and psychological emptiness as well.

Wrinkling of the facial skin and puffiness of the eyes is noticed due to estrogen deficiency. Loss of pubic hair, axillary hair and frontal balding can happen.

Dementia, mood swings, depression, headache, anxiety, irritability and lack of concentration are common.

Consult a gynecologist well in advance or when you experience any of the symptoms, so that you are counseled in prior and can plan your menopause.

The doctor would want to examine your general condition and do a local examination too. Routine blood and urine tests along with a pap smear may be necessary. Estradiol levels, FSH and LH levels, lipid profile and additional tests for the general well being like ECG, blood sugars ,etc.

If you have got your uterus and ovaries also removed, undergone multiple radiotherapy, shrinking your ovaries prior to menopause, you have said to have attained “surgical menopause”.

The treatment includes home remedies and medications with hormonal supplements.

Lifestyle modifications include increased physical activity, brisk walking, increased consumption of milk and daily products to increase calcium, stop smoking and alcohol.

Have a balanced, nutritious diet that is rich in antioxidants, green vegetables and fresh fruits. Vitamin D 3 supplementation upto 2000IU/day prevents fractures. Exposure to natural sunlight to increase Vitamin D absorption is recommended daily. Increase intake of soy proteins to reduce hot flushes and palpitations.

Consult your doctor to know about hormone replacement therapy, which includes estrogen and progestin supplement. Micronised progesterone relieves all the symptoms and is cardioprotective. Many oral regimens like estrogen and progestin cyclic regimen for 25 days and continuous regimens are available. Subdermal implants inserted over the abdomen subcutaneously can serve for 6 months and suitable in surgical menopause. Estrogen gels, transdermal patches that can be changed twice a week, vaginal creams and intrauterine hormonal devices like Levonorgestrel intrauterine devices help which release 10 mg of the LNG / day.

Low dose HRT is also an option. Other drugs like antidepressants, SSRI, fluorides, calcitonin, Tibolone, SERM, bisphosphonates are also an option to deal with specific symptoms.

HRT does come with side effects and has a risk of developing uterine and breast cancer, Deep vein thrombosis, Coronary heart disease, Gall bladder stones, dementia, etc. However, it is not seen in all patients and HRT can be tailor made.

Dealing with menopause is no longer a tiring and stressful task, with advancement in medical science, menopause is indeed a pleasure of aging.