Menopause means cessation of menstruation. This occurs due of the decreasing levels of female sex hormones in the body. It is a retrospective diagnosis for a woman is said to have attained menopause only when she does not have periods for a year or more. It usually occurs between 44 -52 years of age, though, at times, it is brought about abruptly by the surgical removal of ovaries and the uterus. Dr. Amrinder explains the various issues and complications related with menopause exclusively in Different Truths.
Those of you in your mid-forties are standing on the threshold of an interesting new phase of life – life after menopause. Menopause brings with it some of the most significant changes in a woman’s life. It is an exciting time, free from the responsibilities of child rearing, contraception, and financial insecurities. You can take up interests and hobbies that you did not have the time for before. Sexually too it can be a liberating period.
What is menopause?
Meno – month, pausis – halt; hence menopause means cessation of menstruation. This occurs due of the decreasing levels of female sex hormones in the body. It is a retrospective diagnosis for a woman is said to have attained menopause only when she does not have periods for a year or more. It usually occurs between 44 -52 years of age, though, at times, it is brought about abruptly by the surgical removal of ovaries and the uterus.
Menopause is preceded by peri-menopause which occurs for a varying period of time before the periods stop altogether. During this time, periods become irregular, heavier or lighter than usual, infrequent with erratic gaps or stop altogether without warning. Keep a menstrual calendar and report to the gynecologist if you periods are unusually heavy/prolonged/frequent or if bleeding occurs after intercourse. These problems could be serious and need further evaluation.
Menopause can be a trying period for women as certain menopausal symptoms are problematic. These could occur in the immediate post- menopausal period or years after menopause. The latter, are especially relevant in today’s scenario on account of the increased life expectancy.
What Should a Woman Expect During Menopause?
There are so many myths and mystery surrounding menopause. In fact a majority of women experience no symptoms whatsoever and the transition from the reproductive phase of life to the postmenopausal period is smooth. Others have hot flushes and cold sweats, mood swings and weight gain. The skin becomes dry and hair thins out on the head but may begin to grow on the chin or upper lip! Some have vaginal dryness that can affect sex life and urinary complaints like frequency, burning or leakage on coughing and sneezing.
Hot Flushes and Cold Sweats
These are usually precipitated by stress, worry or excitement and can occur once or several times 
during the day or night. Heat rises to the face and lasts for a few seconds to a few minutes. This may be followed by a short spell of palpitations and a cold shivery feeling. There could be nausea, fatigue. Take a cold drink at the first sign of a flush. A cool shower at bedtime decreases night sweats. Use cotton sheets and lingerie which absorb perspiration. Avoid situations that precipitate an attack such as stress, vigorous exercises, spicy foods, going out in the heat. Deep breathing exercises and meditation also help.
Dryness of Vagina
After menopause, the vaginal lining becomes thin and the lubrication decreases leading to vaginal dryness and soreness. There is itching and pain especially after intercourse, increased frequency of urination, burning and repeated urinary tract infections. The vagina also becomes less resistant to invasive organisms.
This can be managed by using water-based lubricating creams while having intercourse. The gynecologist may suggest local application of female sex hormones in the form of creams that keep the vagina moist and elastic thereby decreasing the symptoms.
The embarrassing leakage of urine can be prevented by performing Kegels exercises or taking drugs under medical supervision. At times surgical intervention may be required. Kegels exercises involve the voluntary rhythmic squeezing and relaxing of the vaginal muscles to strengthen them.
Psychological Symptoms
These could take the form of mood swings, fatigue, nervousness, headache, depression, crying spells and inability to sleep well. There is feeling of redundancy and neglect with your husband’s decreasing interest in you or sex and an increasing interest in his business/job. The children too are more involved with college and friends. No one seem to have time for the poor wife and mother who devoted her entire adult life in looking after their needs. Instead of wallowing in self pity, now is the time to develop new hobbies, take up new interests and do some social work. This will considerably reduce stress levels and make you feel useful and needed. Incorporation of yoga and meditation in your daily routine will be vastly beneficial.
Sex and the Menopausal Woman
Your sexual life does not end with menopause. In fact some women have an increased desire for sex as they are free from the worries of childbearing and contraception. There is an unopposed action of testosterone – a male hormone that is present is small quantities in females too and is responsible for a woman’s sex drive. As female sex hormones are no longer in circulation, it gets an upper hand leading to increased libido and/or growth of facial hair in some women.
Others may lose their desire for sex due to social/cultural/religious reasons, vaginal dryness which causes pain during intercourse or repeated urinary tract infections. There is a remedy for the medical conditions so there is no reason why you should not enjoy an active sex life after menopause.
However, not all postmenopausal symptoms are innocuous. There are some real concerns that must be addressed. These are:
Postmenopausal Bleeding
Bleeding after menopause is not to be ignored even if slight for it could be due cancer or precancerous conditions of the genital tract. These can be confirmed or ruled out by a pap smear, cervical biopsy, D&C, hysteroscopy as advised by your doctor. Bleeding after intercourse could be due to cancer of the cervix and must be addressed. It may also be due to something as harmless and treatable as vaginal atrophy/ polyps/infections so instead of worrying visit your doctor as soon as possible.
Osteoporosis
After menopause bones lose calcium rapidly and become fragile. It is a silent process that becomes apparent when the brittle calcium depleted bones break after the slightest mishap. Therefore it is good idea to take milk, calcium and vitamin D3 supplements from the age of 35 onwards. Regular exercise is also a must. Once osteoporosis develops more vigorous treatment is required.
Menopause and the Heart
After menopause the protective effect of estrogen is lost and women become as vulnerable to heart attacks and stroke as men. Physical inactivity and weight gain are contributory factors as are high blood pressure, diabetes, cholesterol. Therefore postmenopausal women should go for regular checkups, blood tests and take preventive measures. Heart attacks may not present typically with classical symptoms like chest pain but may present as vague as fatigue, nausea, shortness of breath, jaw pain and general discomfort in the chest and abdominal area.
One can decrease the risk of heart attack by adopting a healthy lifestyle. Quit smoking, avoid passive smoking and eat a diet rich in fruits and vegetables. Exercise at least thrice a week, maintain a healthy body weight and go for yearly preventive health checkups.
Hormonal Replacement Therapy
No discourse on menopause can be complete without a few words on HRT (Hormone Replacement Therapy). A few years ago it was considered a panacea for all ills, an elixir of youth but not anymore. Though it does alleviate debilitating menopausal symptoms like hot flashes, it is to be used with caution under strict medical guidance for, in a small percentage of cases HRT could cause cancer of the breast and uterus. However it still has an important role to play in certain situations like surgical menopause when there is sudden stoppage of hormone supply. For vaginal dryness local application of hormonal creams is recommended as they serve the purpose with the side effects of oral administration of hormones.
While the life expectancy of women was 62, 50 years ago, these days women live for 80 years or more. This means that approximately 30 years are spent in the post-menopausal phase which makes it that makes it imperative that a good quality of life is maintained. Menopause is best managed by lifestyle changes such as avoiding caffeine, smoking, alcohol, and spicy foods. Menopausal women should eat soy foods as they contain natural estrogens, ingest adequate amounts of calcium and vitamin D in food or as supplements. They should get plenty of exercise and try relaxation techniques such as yoga or meditation. Kegel exercises strengthen vaginal muscles and prevent that embarrassing leakage of urine. They should remain sexually active and if necessary, use water-based lubricants during sexual intercourse. Blood pressure, cholesterol, diabetes and weight should be kept in check.
Menopause is the end of menstruation and not the end of the world. It is the beginning of a new life where you can live your life on your terms as an individual with personal needs and desires instead of the selfless wife and mother your were, so relax and enjoy the years ahead. You deserve it.
©Dr. Amrinder Bajaj
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