Menopause is the permanent cessation of menstruation. It can occur as early as age 40 or as late as nearly age 60s. The average age of menopause is usually about 49 to 51. It is normally diagnosed in females after 1 year of absent menstrual flow. Menopause does not occur suddenly. It is a slow transition and peri-menopause usually begins a few years before the last menstrual period. Menopause is only one event in the transition period involving changes in the female body between the mid or late 40’s, when the production of female hormones (estrogen and progesterone) begins to decline. Most of the signs and symptoms of menopause arise from this decrease in estrogen production even before periods stop altogether. Menopause occurring before age 40 is termed premature and may need medical evaluation for the cause. However, if menopause is delayed beyond the age of 55 (meaning a woman is still experiencing menstrual bleeding), there is an increased risk of breast, ovarian, and uterine cancer. This is due to the increased amount of time a woman’s body has been exposed to the estrogen. Therefore, regular mammograms and gynaecological review by specialist is important for women experiencing late-onset menopause.
Frequent symptoms and signs
- Menstrual irregularity – the menstrual flow can be scanty, heavy and/or prolonged.
- Hot flashes or flushes – sudden sensations of heat spreading from the waist or chest toward the neck, face and upper arms (symptoms are often referred to as vasomotor instability). Often associated with excessive sweating. It may occur frequently and last for few minutes. If they occur at night, they may disrupt your sleep. Hot flashes usually stop within one or two years but may persist for several years.
- Headaches, dizziness, rapid or irregular heartbeat.
- Sexual changes such vaginal itching and dryness, burning or discomfort during intercourse, (usually beginning a few years after menopause), reduced libido, or sex drive.
- Urinary symptoms such as bladder irritability, discomfort, frequent urination and urinary tract infection may be more common.
- Digestive issues such as constipation, diarrhea, bloating, heartburn.
- Physical changes such as weight gain, thinning hair, dry skin, loss of breast fullness, reduced muscle mass, painful or stiff joints, increased hair growth on other areas of the body (such as the face, neck, chest), fatigue.
- Psychological symptoms – such as mood changes, pronounced tension and anxiety, panic attack, sleeping difficulty, depression, difficulty concentrating, memory problems
Causes
- This is a part of the normal aging process, when there is a decline in ovary function, resulting in decreased levels of the female hormones.
- Surgical removal of both ovaries (surgical menopause).
- Loss of ovarian function resulting from certain immunological diseases, infection, effects of radiotherapy or chemotherapy.
- Genetic or chromosomal disorders
Risk factors
- Smoking.
- Hysterectomy.
- Chemotherapy or radiotherapy.
Prevention
Menopause cannot be avoided and currently there is no preventive strategy to avoid or delay it.
Possible complications
- Increased irritability and susceptibility to infection in the urinary tract.
- Decreased skin elasticity and vaginal moisture.
- Increased risk of hardening of the arteries, heart disease, stroke.
- Osteoporosis.
- Changes in feelings of self-worth and mental health issues.
Investigations
- A blood test to confirm menopause is usually not necessary, unless when premature menopause is suspected.
- Bone mineral density testing is recommended in older women or in those with a higher risk of osteoporosis.
Treatment
- Menopause is a normal process, not an illness. Most women can make an easy transition without difficulty.
- Diagnosis is determined by patient’s age and symptoms. Laboratory tests (blood hormonal level assessment) are often not required for diagnosis.
- Lifestyle changes may be necessary with the onset of menopause. Stay as healthy and happy as you can and live life to the fullest.
- Psychotherapy or counseling may be required if emotional changes interfere with personal relationships or at work.
- If you are sexually active, do continue to use birth-control measures until at least 12 months after your last menstrual period.
- Reduce stress in your life as much as possible. Acupuncture, meditation, and relaxation techniques are all harmless ways to reduce the stress of menopause.
- Herbal (or products termed as natural remedies) may be of help to some women, especially those with significant hot flushes. Discuss this with your health care provider.
- Women who smoke may start menopause about two years earlier than nonsmokers. Also, smoking is linked to a decline in estrogen. If you smoke, talk to your health care provider about programs to help you quit.
- See your doctor on a regular basis for health screening (Pap smear, mammogram, ultrasound scan and blood tests). Discuss the screening intervals with your doctor.
- Activity – there is no restrictions. Active exercise is beneficial. Weight-bearing activities (such as walking) are helpful for bone strength. Swimming is also beneficial.
- Diet – eat a well-balanced diet. Increase your calcium intake.
- The menopausal transition is a trying time for the maintenance of weight. Many women gain weight during this period because their metabolism slows down. It is also related to aging, many lifestyle changes (e.g fewer activities), and other genetic factors. Therefore, you may need to reduce your calories (eat a healthy diet) and exercise more just to maintain your current weight.
Medications
- Menopausal hormone therapy (MHT) is an option. Hormone treatment has benefits as well as risks. It must be considered on a patient-by-patient basis.
- Medications to prevent and/or treat loss of bone density may be prescribed, depending on the bone mineral density assessment (BMI) and the risk factors for osteoporotic fractures.
- Take calcium and vitamin D supplements every day. Discuss with your doctor regarding the types and the dosage required.
- Antidepressants may be effective for treating hot flashes.
- For vaginal dryness, moisturizers such as Replens may be effective. It comes in a pre-filled applicator and makes it easier to introduce the moisturizer into the vagina.
You should see your doctor immediately if you have:
Any unexplained vaginal bleeding, new or unexpected symptoms develop during the menopausal period. Drugs used in treatment may produce side effects and you should discuss these with your doctor.
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