Menopause

What is menopause?

Menstruation is a process during which women normally shed the lining of the uterus at regular intervals under the influence of the female sex hormone, oestrogen. At about the age of 45 to 50 the ovaries stop making oestrogen and the withdrawal of the hormone results in stoppage of the monthly menstrual periods. This is called menopause and it happens naturally to all women sooner or later but may also be induced if the ovaries are removed or stop functioning for any other reason.

What does oestrogen do?

Oestrogen along with another female sex hormone, progesterone plays an important role in developing the female body and its functions, most notably pregnancy. Development of breasts, broadening of hips and functions of the vagina, uterus and other female organs depend on oestrogen. With progesterone, it maintains the cyclical periods and prepares the uterus for pregnancy.

Other beneficial effects include maintaining bone growth and protecting the heart by increasing the good cholesterol (HDL) and lowering the bad cholesterol (LDL). This is why women are less prone to heart attacks before menopause. This protective effect is lost after menopause.

What are the symptoms of menopause?

The majority of women will observe some symptoms during menopause, but the intensity of these varies in different women.

• Irregular bleeding - Menstrual periods have three normal patterns of stopping: they may suddenly stop, they may come on time, but keep reducing in the quantity of flow till they finally stop or they may keep getting delayed till they finally stop. Heavy or frequent periods are NOT normal.
• Hot flushes - This is the most prominent symptom. There is a sudden sensation of heat that spreads to various parts of the body, particularly the face. Flushing and sweating may occur. These flashes of warmth last a few seconds or minutes. These are more common in the first few years after menopause but may continue for many more years. If they occur very frequently, they can be the cause of social embarrassment. These flashes may be brought on in hot and humid weather, by drinking caffeine or alcohol or eating spicy foods.
• Vaginal thinning and dryness - Due to oestrogen withdrawal, the vagina becomes thinner and dry. This makes sexual intercourse painful. There may be associated itching and irritation. Regular sexual intercourse may help keep the vagina moist and toned.
• Mood changes - Women become irritable and anxious around menopause. There may be loss of memory and concentration and lack of energy. Depression may also be present. These symptoms may not be a direct effect of oestrogen withdrawal, but may be compounded by career pressures, sexual inadequacies and loss of fertility and body image.
• Sexuality - Several factors adversely effect the libido or sex drive. Besides the mechanical factor of vaginal dryness that makes intercourse painful, mood fluctuations and lack of energy all contribute to a poor sex drive.
• Osteoporosis - Bones become thin, weak and are more likely to break. This happens because the oestrogen that helps reduce bone absorption is no longer available. Osteoporosis is more likely in Asian women, and those that are slim built. Cigarette smoking increases the risk of developing osteoporosis.
• Heart disease - Women lose the protective effect of oestrogen in preventing heart disease after menopause. They then become susceptible to heart attack as much as men. This risk is increased if the woman is obese, has high blood pressure or diabetes, smokes cigarettes and does not do any physical activity regularly.

What can be done?

Menopause happens to all women and cannot be prevented. The bad effects can be minimized by hormone replacement therapy (HRT). In this, oestrogen along with progesterone is given around the time of menopause. These reduce the symptoms of menopause, prevent bone loss and reduce the risk of heart attack. However, HRT is not without its risks, which may include cancer of the breast or the uterus. The risks and benefits of HRT must be fully discussed with the doctor before starting treatment.