As a woman approaches her golden jubilee birthday her body starts showing drastic changes both physically and physiologically. This phase also marks the beginning of the big M or what is commonly called menopause. All women go through this phase but even today not many are aware of it, especially women themselves.
The hormonal changes during this time create havoc in the body while ignorance regarding menopause can create havoc in the daily life of a woman and those associated with her.
Hence, here is a must-read article for all women to prepare themselves for menopause and handle this period of life like a pro as always!
What Is Menopause?
To understand the nuances of menopause let us first understand what menopause means in layman’s terms as well as medically. The World Health Organization has defined menopause as the permanent cessation of menstruation resulting from loss of ovarian follicular activity (1). It means that the woman’s ovary will stop releasing eggs during this period and the woman can no longer become pregnant. Her monthly menstrual cycle stops too. Clinically, menopause is diagnosed after 12 months of her final menses.
The average age around which menopause occurs is about 51 years generally between 45 to 55 years. For a small number of women, it may occur earlier too. If it happens before 40 years of age it is called premature menopause while between the ages of 40-45 years it is called early menopause. The age of menopause tends to run in families too.
It is not possible to predict when a woman will experience menopause, although there are associations between the age at menopause and certain demographic, health, and genetic factors. It can also be induced as a consequence of certain surgical procedures that involve removal of both ovaries, hysterectomy (removal of the uterus), surgical removal of their uterine lining, or medical interventions that cause cessation of ovarian function (for example radiation therapy or chemotherapy). Many women who have already stopped menstruating before menopause, may still experience other symptoms.
Perimenopause- it is the period leading up to ‘menopause’. It is also called the menopausal transition. It is the whole duration of time from when a woman first starts having menopausal symptoms. It might just be in months but for most women but perimenopause lasts for many years usually 8 years before the onset of menopause (2).
Changes Associated With Menopause (2)
Just imagine someone telling you that from the next month you will not suffer from period pain anymore! You will no longer have to endure the mood swings, the irritability, or the bleeding due to your cycle. Doesn’t this sound tempting enough? And although you may wish for it now, menopause is far from being a piece of cake.
On second thoughts it may even sound scary but let us face this bitter truth that menopause will be accompanied by uncomfortable changes in women’s life. It has to be treated as a continuum of life and recognizing and appreciating these changes will only help you accept them and yourself better.
Hot Flashes
Hot flashes are a sensation of warmth, frequently accompanied by skin flushing and perspiration. They commonly start during perimenopause. A chill may follow as core body temperature drops.
Hot flashes vary from occasional or frequent, or last from seconds to an hour, and are characterized by mild warmth to profuse sweating. Some women perceive hot flashes as a minor nuisance, whereas this symptom disrupts work, sleep, or daily activities in other women.
Urinary Incontinence
Some studies report an association between menopause and increased urinary incontinence n women, whereas others do not. Postmenopausal changes in the urinary tract may lead to irritative symptoms like an increase in the frequency and urgency of urination thus leading to incontinence.
Urinary Tract Infection
Although it has not been proven that menopause causes urinary tract infection certain physiological changes that occur after menopause may lead to increased susceptibility to such infection. These changes include increased vaginal pH and an alteration in the vaginal flora to predominantly gram-negative organisms.
Vaginal Atrophy
It is also called atrophic vaginitis. Women in their menopausal phase suffer from thinning, drying, and swelling of the vaginal walls due to less production of the hormone estrogen by the body.
It may lead to itching, irritation, and pain during intercourse. Signs consistent with atrophy may be present on examination in the absence of symptoms; conversely, women may have symptoms but no atrophy.
Reduced Sexual Function
Due to reduced estrogen and testosterone during menopause women may experience lower sexual drive and function. One of the main reasons for this may also be the vaginal changes mentioned above that make intercourse a painful experience for women leading to their aversion towards it.
Depression
Mood changes and depression are common during menopause. Women who have previously had affective disorders may be at increased risk of mood disturbances. Insomnia and other stressful life events like aging parents, career pressure, kids problems, etc also contribute to the same.
Other Symptoms
Body composition and cardiovascular risk can also be affected during menopause. Women’s advantage over men in terms of cardiovascular disease gradually disappears during this time due to the significant decline in estrogen. Loss of bone density at menopause is also a significant contributor to higher rates of osteoporosis and fractures.
Pregnancy is still possible during perimenopause. Contraception is recommended to avoid unintended pregnancy until after 12 consecutive months without menstruation. Pregnancy after menopause is unlikely.
During perimenopause and following menopause, it is still possible to acquire sexually-transmitted infections (STIs), including HIV, through unprotected sexual contact, including oral, anal, and vaginal sex. The thinning of the vaginal wall after menopause increases the chances of lesions and tears, thereby increasing the risk of HIV transmission during vaginal sex (3).
Management of Menopausal Symptoms
Symptoms that impact your health and well-being should be discussed with your physician or gynecologist. They can help you identify the available management options, with consideration of medical history, values, and preferences. There are a variety of non-hormonal and hormonal interventions that you can choose from. They may help you relieve menopausal symptoms. Let us have a look at some of these interventions briefly.
Hormonal Interventions
These can involve the use of either estrogen alone or with another hormone called progesterone. In common words, it is also called hormone replacement therapy or HRT. Depending on the symptoms these hormones may be taken daily (continuous use) or on only certain days of the month (cyclic use).
They also can be taken in several ways, including as tablets, through a patch on the skin, as a cream or gel, or with an IUD (intrauterine device) or vaginal ring. How the therapy is taken can depend on its purpose. For instance, a vaginal estrogen ring or cream can ease vaginal dryness, urinary leakage, or vaginal or urinary infections, but does not relieve hot flashes.
Although HRT has proved to relieve the majority of menopausal symptoms they come with its disadvantages that need to be weighed before starting the treatment.
Hormone therapy may cause side effects, such as bleeding, bloating, breast tenderness or enlargement, headaches, mood changes, and nausea. Further, side effects may also vary by how the hormone is taken. For instance, a patch may irritate the site where it’s applied (4).
Non-Hormonal Interventions
Positive moves you can make to feel better during the menopausal phase are related to adopting a healthy lifestyle. Following lifestyle changes can help you during menopause
Reduce or Avoid Alcohol- studies have shown that alcohol can exaggerate your hot flushes (5). Try to manage how much you’re drinking.
Stop Caffeine and Smoking- Studies show that caffeine as well as smoking increases hot flushes. Caffeine can also interfere with a good night’s sleep so consider reducing your caffeine intake and stopping smoking.
Kegel Exercises- Kegel or pelvic floor exercises can help reduce bladder control problems and you can do them at any time! They strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine, and rectum.
General Exercise- Exercise can help boost mood, and energy levels and reduce stress. Combined with a healthy diet it can also help maintain a healthy weight.
Diet- Many women find they put on weight during menopause so eat a healthy balanced diet to help manage your weight and give you more energy.
Mindfulness- Coping with symptoms can be hard, so consider things to reduce your stress, such as practicing yoga and mindfulness. You can indulge in your favorite hobbies too.
Try To Sleep- It can be hard to sleep when you’re dealing with menopausal symptoms but not getting enough of it can make things even worse! Try to practice sleep routines that regulate your sleep and aim for at least 7-8 hours of it per night.
Moisturise- Use moisturizers and lubricants to help with vaginal dryness.
Menopause is a challenging phase in the majority of women’s lives. This phase may indeed negatively affect women but it is equally true that it will affect more if you let it. It is in your hands to control the symptoms and not let this phase control you. We hope this article helps you gain some insight and help you prepare for menopause and manage it well. Let us know your views in the comments section below.
Author: Dr Pooja Nilgar (Content writer and editor)
References
- Pincus, G. (1957) Recent Progress in Hormone Research. Vol. XII, AIBS Bulletin. doi: 10.2307/1292058.
- Greendale, G.A., Lee, N.P. and Arriola, E.R., 1999. The menopause. The Lancet, 353(9152), pp.571-580.
- www.who.int. (n.d.). Menopause. [online] Available at: https://www.who.int/news-room/fact-sheets/detail/menopause.
- U.S. Department of Health and Human Services. (2005) ‘Facts About Menopausal Hormone Therapy’, AWHONN Lifelines, 9(6), pp. 491–492. doi: 10.1111/j.1552-6356.2005.tb00915.x.
