What is menopause?

It is the absence of menstrual period for 12 consecutive months.It is the time in a woman’s life when the function of the ovaries ceases, and there is no production of eggs. Normally, it occurs between 45-55 years (mean 50 years) (but can occur earlier or later than this age).Perimenopause means the time around menopause, and this is the time when the woman starts to experience menopausal symptoms.

Certain medical & surgical conditions can influence the timing of menopause.

  • Surgical menopause – where the ovaries are removed during surgery due to ovarian pathology or at hysterectomy (uterus removal)
  • Cancer chemotherapy & radiation therapy
  • Premature ovarian failure-the occurrence of menopause before the age of 40.

Physical

  • Tiredness
  • Night sweats
  • Hot flushes- a feeling of warmth that spreads over the body & is most pronounced on the head & chest & is sometimes followed by flushing and sweating.
  • Difficulty in sleeping
  • Vaginal symptoms-this occurs as a result of the lining tissues of the vagina becoming thinner & drier due to the fall in oestrogen (female sex hormones) levels.Symptoms may include vaginal dryness, itching or irritation and pain with sexual intercourse(dyspareunia)
  • Urinary symptoms –The lining of the urethra also undergoes similar changes as above & become drier and thinner and this can lead to increased risk of urinary infections,feeling the need to urinate more frequently, or leakage of urine(urinary incontinence)which may occur during straining as in coughing.
  • Skeletal system – loss of bone density (osteoporosis), increased risk of bone fractures
  • Cardiovascular system – Increase risk in atherosclerosis  &heart disease

Changes in the cholesterol levels

Total cholesterol Increased
HDL cholesterol Decreased
LDL cholesterol Increased
Triglycerides No change

Other physical changes 

  • Weight gain with more body fat deposited in the waist and abdomen
  • skin changes such as wrinkles & hair growth on chin , upper lip, abdomen etc.

Psychological

  • Mood swings
  • Anxiety
  • Loss of short term memory
  • Lack of concentration
  • Loss of self confidence
  • Depression
  • Irritability

Menopause is not a disease. However, treatment of associated symptoms is possible if these become substantial or severe.

Hormone replacement therapy(HRT)

Synthetic forms of oestrogen or combination of both oestrogen and progesterone.It has been used to control the symptoms of menopause, related todeclining oestrogen levels.The decision about HRT is an individual decision in which the patient and doctor must take into account the risks and benefits of it considering each woman’s medical history.

What should you do before starting HRT?

Consult a doctor!

A thorough history including past medical/surgical history and family history will be reviewed.
A full physical examination including a breast and pelvic examination will be done.
Investigations

Trans Vaginal Scan to asses the thickness of endometrium, ovaries, uterus
CA 125
FBS/PPBS or OGTT
Lipid profile
Breast scan + mammogram

  •   Other Vitamins and minerals

    Calcium, Magnesium, Zinc & Vitamin E are important

  •  Physical exercise (regular) – eg; Jogging
  •  Have a healthy diet & maintain the BMI between 19-23kg/m2

What are the things I should consider after menopause?
1) Routine medical screening should be done.

  • Pap smear
  • Breast examination
  • Lipid profile
  • FBS
  • Blood pressure monitoring
  • Pelvic and physical examination

2) Self breast examination

ATTENTION!!!

Make sure you see a doctor as soon as possible if you encounter  vaginal bleeding, after menopause however scanty it may be, because it may be a warning of a developing cancer.