Menopause simply means “Menstrual pause” or “Cessation of menses” but it’s not that simple. Females all through their lifetime, experience many issues related to periods like menarche, PMS or menses itself. End of this journey is also associated with many hormonal changes in the female body. These changes are both physiological and psychological. Like all menstrual issues, menopause is also not widely discussed and females don’t find support from family and friends in this time of crisis. Nowadays females spend almost one third of their lifetime post menopause. By knowing what is menopause and how to deal with menopausal changes, females can improve their quality of life in postmenopausal life.
Lets learn all the important things you need to know about menopause, whether it’s for you, your mother, your sister, your wife, your daughter or your friend, your partner.
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What is menopause?
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Why do menses stop forever?
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At what age females attain menopause?
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What is the effect of menopause on a female’s body?
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How to overcome these changes?
What is menopause?
Menopause is complete cessation of menstruation. Absence of periods for more than 12 months in case of natural menopause or induced by surgery, radiation or chemotherapy is menopause.
Mostly it is associated with other symptoms like hot flushes, night sweat, increased abdominal girth etc.
Why do menses stop forever?
Menstruation stops when there is reduced secretion of ovarian hormones and it coincides with exhaustion of ovarian follicular reserve.
Every woman is born with a prefixed number of primordial follicles. Some of them reach the stage of primary oocyte during puberty but most of them degenerate. So, out of 2 million primordial follicles at birth only 400 are likely to ovulate in lifetime. No more follicles are left at menopausal age and menstruation stops.
Absence of follicles causes a decrease in estrogen and progesterone hormones. As a result of which, there is no endometrial growth in the uterus leading to no monthly shedding of endometrium meaning NO PERIODS.
What’s the normal age of menopause?
Normal age for menopause ranges from 45- 55 years, average age being 51 years.
Age of menopause is more genetically predetermined than any other factor. Menopausal age is not much affected by the number of children, lactation, use of pills, race, height, weight etc.
Cigarette smoking or malnutrition may cause early menopause. In females who smoke, menopause hits around 1.5 to 2 years earlier than non-smokers.
Period between normal ovulatory cycles to cessation of menstruation is called the perimenopausal period. Most females experience perimenopausal phase, as sudden cessation of menses is rare.
What’s the effect of menopause on the female body?
Females may experience gradual decrease in amount and duration of menstrual bleeding during perimenopausal stage as sudden cessation is rare. Some females experience irregular or heavy bleeding. Gynaecologists should be consulted in case of abnormally heavy or irregular bleeding to rule out any genital malignancy or any other pathological cause.
Most symptoms in the menopausal stage are due to deficiency of oestrogen. Oestrogen is not only a reproductive hormone but also a pleiotropic hormone means that it plays an important role in non reproductive functions as well like bone formation, memory functions, cardiovascular functions as well as immune system functioning.
So menopause comes with many more symptoms along with cessation of menstruation. These symptoms are widespread all through the body involving hair to leg bones.
Hot flushes-
Hot flush/ flash is the commonest symptom associated with menopause. There is a sudden feeling of heat followed by profuse sweating and perspiration. These can be associated with palpitations, weakness or fatigue. Single episode can last from 1-10 minutes. Hot flushes during menopause can extend from 6 months to 2 years, sometimes even upto 8 years in few females.
Vaginal changes-
Vagina losses its elasticity and its ph changes from acidic to alkaline making it vulnerable to infections, painful sex or dyspareunia and prone to trauma.
Other vaginal symptoms include vaginal dryness, itching or vaginal discharge.
Decreased libido-
Decreased libido can result from psychological as well as atrophic changes. Atrophy is the shrinkage of the vaginal wall causing narrowing of introitus.
Urinary changes-
Oestrogen deficiency produces shrinkage of bladder and urethra along with vagina. This leads to stress incontinence, urgency, recurrent infections, painful urination or dysuria.
Hair and skin changes-
Thinning and wrinkling of skin starts after menopause as skin starts losing its elasticity in absence of estrogen. Skin collagen content and thickness decreases by 1-2% every year.
“Purse string wrinkles” around the mouth and “Crow feet” appear around the eyes.
There is loss of pubic and axillary hair due to decreased supportive hormones and there can be slight balding as well.
Breast changes-
Breast tissue gets reabsorbed in absence of estrogen. Like other hormone dependent tissues, it also starts shrinking in absence of estrogen. Breast becomes flat and pendular.
Osteoporosis-
Decrease in estrogen levels causes decreased collagenous bone matrix and causes bone mass loss. Bone loss increases to 5% per year, postmenopause. This makes females vulnerable to fractures especially in vertebrae, hip joint and wrist joint. Osteoporosis also causes back pain, joint pain especially knee joints, loss of height and kyphosis or curving of back.
Psychological changes-
Oestrogen protects our brain functions so its deficiency may cause multiple psychological problems like increased frequency of anxiety, headache, irritability, depression, memory loss or dementia, mood swings, loss of concentration. Also the physical changes may also increase anxiety in females.
Females have to realize their mental and physical state and should react positively towards it to prevent further deterioration.
Increase in abdominal girth-
Increase in the body mass causes increased amount of fat deposition especially around waist, causing increased ratio of waist-to-hip circumference.
Females tend to gain weight in spite of their physical activities.
Cardiovascular/ Heart effects-
Estrogen increases HDL or good cholesterol and decreases LDL or bad cholesterol and total cholesterol. It also dilates our blood vessels and prevents atherosclerosis. Post menopause females’ chances for cardiovascular diseases increases gradually. In 10 years, risk of cardiac diseases in females equalises that in males. Their protective shield from estrogen vanishes and it exposes them to heart attacks and atherosclerosis.
What can be done to overcome these changes?
Spontaneous menopause is unavoidable. Every woman faces some or the other effects of menopause along with cessation of menses. Proper explanation about these bodily and psychological changes remove their fears, lowers anxiety, depression and many other psychological symptoms. Reassurance can go a long way. Most postmenopausal symptoms like hot flushes, insomnia, anxiety, bloating are short lived and eases out with time.
Things that can be helpful:
1. Acceptance-
Acceptance about the changes your body is experiencing and living gracefully through these changes by showing a positive mindset is important. Most symptoms are transient and eases out with time.
2. Support-
Support from family and friends is equally important. Let your family know what you are going through. Take your partner along to see the doctor. Ask help of the family members, whenever required.
3. Nutritious diet-
Diet should be balanced especially rich in calcium and proteins, with adequate amount of fluids.
4. Supplements-
Calcium and Vitamin D supplements help in reducing chances of osteoporosis and fractures. Daily intake of 1.5 grams of calcium is helpful. Fluoride given for a short period may help prevent osteoporosis, and increase bone matrix.
5. Exercise-
Women should start building their muscle mass in their early 40s. This will be helpful when they hit menopause. Weight bearing exercises, walking and jogging can be helpful.
6.Alcohol minimization and smoking cessation.
7.Cooling pads-
Cooling pads, ice packs, bedside fans, sipping cold drinks, moving out in fresh air can help keeping cool during HOT FLUSH episodes. Partner may help in keeping the room temperature appropriate. Few things like hot spices, caffeine, alcohol can trigger the hot flush episodes. Avoiding these things help prevent the flushes.
8.SERMs-
Serms are selective estrogen receptor modulators. Natural sources contain phytoestrogens, isoflavones. These work on estrogen receptors the same way as estrogen does and helps in improving symptoms.
Food rich in phytoestrogens are
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Nuts and seeds- Flax seeds, sunflower seeds, sesame seeds, almonds and walnuts.
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Fruits- Apples, Carrots, pomegranate, strawberries and grapes.
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Vegetables, lentils and grains- Sprouts, lentils, wheat, oats, barley, dried beans, rice bran, broccoli.
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Soy products- Soybeans, tofu, miso soup.
9. Pelvic Floor exercises-
Pelvic floor strengthening exercises help in relieving urinary incontinence symptoms. If started during reproductive years, pelvic floor exercises can go a long way in relieving many urogenital problems.
10. Lubricants-
Sexual activity can be uncomfortable due to change in hormones, decreased libido and vaginal atrophy. It’s helpful if the partner understands this condition and helps in achieving sexual pleasure. Foreplay and generous use of lubricants helps reduce dyspareunia or painful sexual act. Avoiding sex may not solve the issue as sex improves discharge and blood supply in the urogeintal area which may be helpful in relieving symptoms caused by decreased estrogen.
11. Regular Health checkups-
Regular health checkups are important after your 30s. But if you have not started that till your menopause, its better to go for routine health checkups once you reach menopause. Few of the recommended health checkups as per your age are
https://docdaisyclinic.com/agewise-recommended-health-checkups-for-females/
12. Medications-
Certain medications like bisphosphonates, calcitonin, and raloxifene helps in improving symptoms. A medical practitioner can be consulted for medications in case symptoms are affecting your daily routine and performance.
