Menopause

Menopause is the stage in a woman’s life when her monthly menstruation stops. Medically speaking, menopause is defined as at least 12 months of amenorrhea (or absence of menstruation). Menstruation in the months leading to menopause can occur less frequently. The intervals can be 3 months, 6 months, 8 months, or longer; but these prolonged intervals are not enough to say that a woman is menopausal. It has to be 12 months of amenorrhea. This period of irregular menses in the months leading to menopause is called the peri-menopausal period. This peri-menopausal period is important because some of the symptoms of menopause can start at this period. It provides a window or a signal to a woman that her menopausal years are about to come.

There are several causes of menopause:

• Natural aging - Physiologic menopause is a natural process that happens with aging. As a woman gets older, her ovaries produce less and less female hormones until it stop ovulating completely. Menopause usually occurs between the ages of 45 and 55. The average age is 51.
• Surgery - In some cases, surgical removal of the uterus and ovaries might be needed to treat a woman’s condition. Without a uterus and ovaries, a woman will not be able to menstruate. This is called surgical menopause. This type of menopause is, abrupt and is not preceded by a period of perimenopause.
• Medical conditions - Some medical conditions can lead to menopause. Autoimmune disorders (wherein the body’s immune system destroys itself) can damage the ovaries and lead to menopause.
• Medications and Radiation - Some treatment modalities are toxic to the ovaries. Many chemotherapeutic agents are harmful to the ovaries. Radiation therapy that is directed in areas close to the ovaries can destroy the ovaries.

Symptoms

As estrogen decreases in the months leading to menopause, the symptoms of menopause begin to be felt. These symptoms include:

• Hot flashes
• Dryness of the skin
• Vaginal dryness
• Night sweats
• Sleeping disorders
• Mood swings
• Hair loss
• Decrease in breast size
• Slowed metabolism
• Constipation
• Weight gain

Complications

Estrogen is an important hormone in the body. With its decline, the woman becomes susceptible to many other health problems. These include:

• Heart disease and stroke - Estrogen is proven to be protective of cardiovascular diseases. With menopause, a woman is placed a higher risk to develop cardiovascular diseases like hypertension, heart disease and stroke.
• Osteoporosis - Bone density decreases rapidly with menopause. This makes a woman’s bones brittle and at risk for fractures.
• Infertility - A woman can still be pregnant in the peri-menopausal years as long as she is still menstruating. However, once ovulation or menstruation stops completely, a woman can no longer be pregnant. Some women might find this a relief because they will have nothing to worry about anymore. However, some women who are unable to conceive and are desirous of having children might find this dreadful. It is like a deadline that puts an end to their hopes.
• Urinary incontinence - With the decrease in estrogen, the muscles of the pelvic floor loose its elasticity and become lax. This leads to problems in continence and sometimes even prolapse of the vaginal wall.
• Decreased sexual drive - Changing body hormones can make a woman less desirous of sex. On top of this, vaginal dryness makes sexual intercourse a less pleasant activity for a woman.
• Obesity - With the slowed metabolism in the menopausal period, women find it too easy to gain weight. This can lead to obesity and other serious complications.

Diagnosis

A simple history is enough to diagnose menopause. Additional tests are rarely necessary except when the doctor is ruling out other non-physiologic causes of menopause. These tests might include blood examinations like:

• Hormonal levels of estrogen and follicle stimulating hormone (FSH)
• Thyroid function test

Treatment

Treatment for menopause is directed at managing its signs and symptoms. These symptomatic treatments include:

• Hormonal replacement medications to supplement the decreasing levels of estrogen in the body. This is the most effective treatment in terms of managing most of the symptoms of menopause including hot flashes, vaginal dryness, and mood swings.
• Vaginal estrogen. This can help address the vaginal dryness.
• Anti-depressant and anti-convulsants. Although it is off label, these medications can alleviate the symptoms of hot flashes.
• Calcium and medications that prevent bone loss. These medications are prescribed for the treatment of osteoporosis.
• Some home remedies can also be helpful in managing the symptoms of menopause.
• Dress in layers so that when you experience hot flashes, you can easily remove a layer at a time.
• Control the thermostat at your home. Turn down the heater or turn up the aircon.
• Use lubricants during intercourse.
• Exercise regularly.
• Monitor your weight.
• Eat fiber-rich foods to prevent constipation.
• Drink plenty of water.
• Avoid caffeinated drinks like coffee, tea, or soda.
• Do Kegel’s exercise to strengthen your pelvic muscles.