Dr Tejal informs about menopause and the ways to deal with it. She tells us that to be forewarned is to be forearmed. The medical fraternity is debating on the issue of andropause or male menopause. Here’s an in-depth report.
Just as women’s bodies change during puberty and they begin to menstruate, so again—usually at midlife—they transition from their reproductive years to the natural end of monthly menstrual cycles. The transition usually begins in the forties and ends by the early fifties.
Menopause is marked by the final menstrual period, known to be final after twelve months with no periods. After no flow for one year, the ovaries settle down and the reproductive hormones—estrogen and progesterone, which the body no longer needs for possible reproduction—have declined to low, steady levels. Most of us will live a third of our lives in what many call post menopause.
The timeframe from when symptoms first appear to when menopause occurs may be several years. This timeframe is medically referred to as the climacteric or the perimenopause. Perimenopause is the one-to-ten-year stretch during which the ovaries function erratically and hormonal fluctuations may bring a range of changes, such as hot flashes, night sweats, sleep disturbances, and heavy menstrual bleeding. Perimenopause is a natural transition that affects each woman differently; for some women, the discomforts are so disruptive that they need major support and/or medical interventions.
Menopause is a normal part of ageing for a woman and literally means ‘last period’. The term, however, is commonly used to describe the years when the ovaries gradually begin to produce fewer eggs and less of the female hormones oestrogen and progesterone. This reduction in hormone production causes the periods to become progressively more irregular until they stop altogether, and produces physical and psychological symptoms in many women. Consideration of treatment and lifestyle change options may depend on the severity of a woman’s symptoms.
Menopause is generally considered complete when a woman has not had a period for one year. Menopause, often referred to as ‘the change of life’, usually occurs between the ages of 45 and 55 years with the average age being 52 years.
As a woman ages the number of follicles in her ovaries decreases and the ovaries produce fewer hormones. Menopause occurs when the ovaries fail to produce enough hormones to stimulate the monthly growth of the endometrium, and periods stop permanently.
After menopause a woman’s risk of coronary heart disease (including high blood pressure, heart attack and stroke) increases and becomes as high as it is for men. The risk of developing osteoporosis (bone thinning) is also increased.
There are three types of menopause: natural, premature, and artificial.
Natural menopause occurs when levels of oestrogen and progesterone decline naturally.
Premature (early) menopause is when periods stop before the age of 40 years. This can be due to many reasons including medical conditions such as diabetes or thyroid disease, and surgery or medications that have affected the blood supply to the ovaries. Genetic factors may also play a part as premature menopause can run in families. Women who smoke are also more likely to go through premature menopause. Sometimes, however, there is no identifiable cause.
Artificial (surgical) menopause is a consequence of surgical removal of both ovaries or destruction of the ovaries by some cancer treatments. With artificial menopause there is a sudden drop in hormone levels and menopausal symptoms begin abruptly. Often the symptoms experienced are more severe than those experienced with natural or premature menopause.
Signs and Symptoms
Often the first symptom of impending menopause is a change in bleeding patterns. Periods may become lighter or heavier, longer or shorter, the time between periods may increase and there may be occasional missed periods. These changes may occur gradually in some women, yet are more abrupt in others.
There are also a wide range of physical and psychological signs and symptoms associated with menopause. In some women they are very mild while in others they are more severe. They may last for only a few months, or may continue for several years. The average length of time for menopausal symptoms to be experienced is three to five years.
- Hot flashes (occurring in approximately 60% of women)
- Cold sweats (often at night)
- Joint and bone pain
- Unusual skin sensations
- Vaginal dryness, incontinence and infections of the urinary tract and vagina may occur due to the thinning of the vagina and bladder walls.
Psychological signs and symptoms may include:
- Reduced interest in sex
- Irritability and mood swings
- Difficulty concentrating
- Loss of confidence
- Difficulty sleeping
There is no one test to diagnose menopause. Symptoms experienced may indicate that menopause is imminent, however menopause can only be confirmed retrospectively after periods have been absent for one year. Blood tests may be taken at this time as the levels of hormones produced by the pituitary gland – follicle stimulating hormone (FSH) and luteinizing hormone (LH) – may be higher if menopause has occurred.
A change in bleeding patterns, particularly where periods become heavier, and an absence of periods (amenorrhoea) can indicate various medical conditions. It is therefore advisable to consult a doctor before assuming that the changes are menopausal symptoms. Also, if bleeding occurs after periods have been absent for a year, a doctor should be consulted, as this is not considered normal.
The intensity and frequency of menopausal symptoms vary from woman to woman. If symptoms are problematic, or a woman is at high risk of developing osteoporosis or heart disease, medical treatment may be recommended. Ultimately, the decision to have treatment is a very personal one and should be made by the woman only after receiving a full explanation from her doctor of the benefits and counter benefits of the various treatment options.
Treatment Options Include:
Hormone Replacement Therapy (HRT)
Hormone Replacement Therapy (HRT) involves replacing hormones previously produced by the ovaries. It can be effective in relieving the symptoms of hot flushes, night sweats and dryness of the vagina. HRT can also help to reduce the risk of heart disease and osteoporosis following menopause.
HRT may be given as tablets, skin patches and as vaginal preparations such as creams and pessaries. Vaginal preparations can help to reduce symptoms of vaginal dryness, incontinence and bladder and vaginal infections.
Some forms of HRT may increase the risk of endometrial cancer and using some forms of HRT or longer than five years may increase the risk of breast cancer. As there are many different forms of HRT it is important to discuss with a doctor the pros and cons of HRT, and which type and delivery method is most appropriate.
These include natural hormones, herbal preparations, vitamins and minerals and homeopathic remedies.
Ginkgo biloba, evening primrose oil, vitamins B, C and E, ginseng, St. Johns Wort and soy based phyto-oestrogens (natural hormones) are all used as treatment for menopausal problems. Treatments such as acupuncture, massage and reflexology have also proved successful for some women.
Unsupervised use of alternative therapies, particularly herbal preparations, can cause adverse effects and monitoring by a health practitioner trained in their use is strongly advised. It is also advisable to discuss the intended use of these therapies with a doctor, especially if taking prescription medications.
Changes in lifestyle can help to reduce the severity of menopausal symptoms and decrease the risk of osteoporosis and heart disease. Diet and exercise are two very important aspects of these lifestyle changes.
Women need a higher intake of calcium and Vitamin D after menopause to help reduce the risk of osteoporosis. Excellent dietary sources of calcium include low fat dairy products (milk, cheese, yoghurt), nuts, dark green vegetables (eg: broccoli, spinach) and fish with bones in (eg: sardines, salmon). Vitamin D, which helps the body to absorb calcium, is manufactured by the skin after exposure to sunlight. Small quantities are found in foods such as dairy products and eggs.
An intake of at least 1000mg of calcium daily is recommended for women after menopause. If the diet contains insufficient amounts of calcium and Vitamin D, dietary supplements may be required.
Eating a healthy balanced diet that is low in fat and refined sugars and maintaining a healthy body weight is recommended. Limiting alcohol and caffeine and not smoking are also important.
Regular weight-bearing exercise such as walking, dancing, tennis, aerobics or golf helps in maintaining a healthy weight, fitness and general wellbeing. Exercise also helps to decrease the risk of osteoporosis by strengthening the bones and may assist in reducing the severity of menopausal symptoms such as hot flushes. Specific pelvic floor exercises can help to reduce urinary problems such as incontinence and pain on urination.
Medications to Relieve Stress
Some women may need medicines to sleep well, tide over stress, and anxiety relieving medicines, for a while. Under medical supervision, these can help you through a potentially difficult time.
Rest and stress reduction also play an important role in managing menopause symptoms. Fatigue and stress can worsen symptoms, so employing strategies to ensure adequate rest is attained and stress is managed will assist in alleviating symptoms.
Sexual life doesn’t have to change because the period stopped. In fact, freedom from pregnancy can better your sex!
You are not alone. Talk to friends, family, support groups, therapists. Remember, menopause is simply a natural and normal phase all women will go through.
“You yourself, as much as anybody in the entire Universe deserve your love and attention. Be happy and help others be happy” ~ Gautam Buddha
Andropause or Male Menopause
Women may not be the only ones who suffer the effects of changing hormones. Some doctors are noticing that men are reporting some of the same symptoms that women experience in perimenopause and menopause.The medical community is debating whether or not men really do go through a menopause.
Because men do not go through a well-defined period referred to as menopause, some doctors refer to this problem as androgen (testosterone) decline in the aging male — or what some people call low testosterone, male climacteric, andropause, etc.
Unlike menopause in women, when hormone production stops completely, testosterone decline in men is a slower process. The testes, unlike the ovaries, do not run out of the substance it needs to make testosterone. A healthy man may be able to make sperm well into his 80s or later.
Otherwise, factors that can cause testosterone levels to fall include certain forms of medication, poor diet, excessive alcohol consumption, illness, lack of sleep, diabetes, stress, or surgery, and of course, aging. Normal aging wouldn’t generally require any treatment for lowered testosterone levels. An underlying condition, obviously, needs treatment.
With the right lifestyle, menopause is just a natural progression of life, to be enjoyed and savoured, like every new experience.
“The secret of change is to focus all of your energy, not on fighting the old, but on building the new.” ~ Dan Millman
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Dr. Tejal Shah, M.D. (Obstetrics and Gynecology), is a nutrition and fitness consultant. She did her schooling from Bombay and medical education from Karad. She is fond of dogs and other animals. Tejal loves reading, cooking, travelling, listening to music and dancing. She is passionate about books, gadgets and plants. She stays with her doctor husband and school going son at Dhule, Maharashtra, India.