What is Menopause?
The end of a woman’s menstrual cycle is called menopause. When a woman has gone 12 months without a menstrual period, menopause is diagnosed. Usually, menopause starts between the ages of 47 to 55 years, 51 being the average. In some women, it may start earlier due to underlying medical conditions or previous surgeries.
There are three stages of menopause –
- Perimenopause – The transitional time before menopause is called perimenopause. This includes the 12 months after a woman’s last period.
- Menopause – When it has been 12 months since a woman’s last period or when menstruation stops due to a clinical reason such as removal of the ovaries, it is called menopause.
- Postmenopause – The years after menopause is referred to as postmenopause.
Causes
Menopause can occur due to various reasons, such as –
- The natural decline in reproductive hormones – The ovaries start to produce less progesterone and estrogen, the hormones are responsible for regulating menstruation, as you approach your late 30s. Due to this, fertility declines. Eventually, the ovaries stop releasing eggs and periods stop.
- Oophorectomy – Oophorectomy is the surgery to remove the ovaries. This leads to immediate menopause as your periods would stop once the ovaries are removed.
- Primary ovarian insufficiency – Around 1% of all women experience premature menopause, which is menopause before the age of 40. Generally, there is no exact cause of premature menopause but it can be attributed to the ovaries not producing normal levels of reproductive hormones known as primary ovarian insufficiency. This might be due to autoimmune disease or genetic factors.
- Chemotherapy and radiation – Radiation and chemotherapy are cancer treatments that can induce menopause.
Symptoms
Early menopause symptoms include –
- Vaginal dryness
- Urinary urgency
- Trouble sleeping
- Hot flashes
- Breast tenderness
- Fatigue
- Irregular periods
Menopause symptoms include –
- Lower fertility – As a woman approaches menopause, the level of estrogen starts to fall which reduces the chances of pregnancy.
- Irregular periods – One of the first signs of menopause is irregular periods. As a woman approaches menopause, periods start occurring less regularly and may be lighter or heavier.
- Hot flashes – Around the time of menopause, hot flashes are common. A sudden sensation of heat in the upper body occurs. It may begin in the chest, neck or face and progress downwards or upward. Due to hot flashes, sweating and red patches on the skin occur. Some women might experience cold flashes, chills or night sweats along with or instead of hot flashes. Generally, hot flashes occur in the first year after menstruation ends and can continue for up to 14 years after menopause.
- Emotional changes – During menopause, it is common to experience anxiety, low mood and depression. Women also experience crying spells and irritability. This is due to hormonal changes as well as sleep disturbances. Sometimes, a woman’s feelings regarding menopause can also contribute to depression and anxiety.
- Physical changes – During menopause, there may be various physical changes including weight gain, breast tenderness and reduction, a buildup of fat around the abdomen, urinary incontinence, and changes in hair texture, volume, or colour.
- Vaginal discomfort and dryness – Women might experience vaginal discomfort, itching, and dryness during perimenopause as well as menopause. They might also experience discomfort and chafing during intercourse. In some cases, atrophic vaginitis occurs wherein the vaginal wall becomes thin, dry, and inflamed.
- Disturbed sleep – Sleep problems arise during menopause, stemming from night sweats, anxiety, and an increased urge to urinate.
- Trouble learning and focusing – During the years approaching menopause and perimenopause, many women have trouble concentrating and learning.
- Increased risk of health conditions – It has been observed that after menopause, the risk of certain health issues increases. This isn’t due to menopause itself, but it might be due to the hormonal changes occurring. Conditions such as breast cancer, cardiovascular disease, and osteoporosis might occur after menopause.
Diagnosis
Generally, signs and symptoms of menopause are indicators that menopausal transition has begun, so tests aren’t required to diagnose it. However, in some cases, your doctor might recommend blood tests to check the level of follicle-stimulating hormone (FSH), estrogen, and thyroid-stimulating hormone (TSH).
Treatment
No medical treatment is required for menopause. Menopause treatment includes options for relieving symptoms of menopause as well as for preventing or managing complications that occur due to menopause.
These include –
- Hormone therapy – One of the most effective treatment options to find relief from hot flashes is estrogen therapy. Your doctor will recommend the dosage and time frame for the therapy, depending on your personal as well as family medical history.
- Low-dose antidepressants – Menopausal hot flashes can also be relieved with low-dose antidepressants. This is useful for women who cannot go for estrogen therapy due to health reasons. It is also useful for women who need antidepressants for mood disorders.
- Vaginal estrogen – Estrogen can be administered directly to the vagina using a vaginal ring, tablet, or cream. This helps to relieve vaginal dryness, discomfort, and other urinary symptoms.
- Osteoporosis prevention or treatment medication – Various medications can be prescribed to you by your doctor, to strengthen bones as well as reduce bone loss and risk of fractures.
Lifestyle changes and home remedies
Since most symptoms of menopause are temporary, some lifestyle changes and home remedies can help reduce the effects of menopause, including –
- Relief from hot flashes – To cool hot flashes, try to wear comfortable clothes that aren’t tight. You can also have a glass of cold water or go to a cooler place. There can be various triggers of hot flashes such as spicy foods, hot weather, alcohol, hot beverages, stress and caffeine. Identify your triggers and try to prevent them.
- Proper sleep – To manage your menopause symptoms, sleep is essential. Try to avoid consuming too much caffeine or alcohol as this can interrupt sleep. Exercising during the day can also help regulate sleep.
- Pelvic floor strengthening – To find relief from urinary continence, do pelvic floor exercises also known as Kegel exercises.
- Avoid smoking – Smoking should be avoided as it can bring on early menopause as well as increase hot flashes. The risk of stroke, cancer, heart disease, and osteoporosis also increases due to smoking.
- Decrease vaginal discomfort – Vaginal discomfort can be decreased by using water-based or silicone-based lubricants and moisturizers.
- Regular exercise and balanced diet – A balanced diet, as well as regular exercise, are essential in relieving symptoms of menopause.
Sometimes, women may experience heavy bleeding during menopause. This might be due to the uterine lining building up. Uterine lining might build-up due to high levels of estrogen or a skipped period. Some women experience bleeding after menopause. This is not normal and you should consult your doctor immediately as it could indicate endometrial cancer or some other complication.
