Herald Café: What
is menopause?
Dr Gauri R Gauns: Menopause is a point in time that follows
one year after the complete cessation of menstruation. Post menopause years are
the years following that point.
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Menopause is a normal phase in a woman’s life and is not
considered a disease.
HC: At what age does menopause set in?
Dr GG: The average age of women experiencing their final menstrual
period is 51.5 years.
Most women will reach menopause between 45 and 55 years of age.
The years leading up to menopause are called ‘Menopausal transition’ phase.
This phase mostly begins with menstrual cycle irregularity and it typically
spans 4 to 7 years before menopause.
HC: Are there any factors that influence age of menopause?
Dr GG: Several environmental, genetic and surgical influences may alter
ovarian aging. For example, smoking hastens the age of menopause by
approximately 2 years. Chemotherapy, pelvic radiation (as in treatment of
cancer) and ovarian surgery may also lead to earlier menopause.
HC: What are the most common symptoms of menopause?
Dr GG: Each woman’s menopause experience is different. Some of the
common symptoms seen in Menopausal Transition and Menopause are:
Irregular menstrual cycles: This is a common sign of menopausal
transition. Interval between cycles may become shorter initially and then may
be progressively longer (increase in gap between 2 periods). Periods may be
scanty or heavy. Although these changes are normal during peri menopause, they
still have to be reported to the doctor.
Hot flushes: A hot flush is a sudden sensation of heat that
spreads over the body, particularly the upper body and face. It can also be
accompanied by palpitations, anxiety, irritability and panic. 5 to 10 minutes
after a hot flush begins, the core body temperature drops (due to heat loss
from sweating) and the woman may experience chills. Hot flushes begin on an
average 2 years before the final menstrual period and majority of women who
experience them, may do so for more than 1 year.
Vaginal dryness: Dryness, itching and discomfort of the vagina
are common due to thinning and shrinking of tissues, as well as decreased
lubrication.
Sleep disturbances: Many women report difficulty falling asleep
and an overall decrease in quality of sleep.
Urinary problems: Menopause causes the tissues of the vagina and
urethra to lose their elasticity. This can result in frequent, sudden and
overwhelming urges to urinate. These urges can be followed by involuntary loss
of urine after coughing, sneezing, laughing or lifting heavy objects.
Emotional changes: Women can experience low mood and depression
during menopause
Fatigue and decreased sexual drive.
Hair loss and thinning of hair.
Increase in abdominal obesity.
Decline in memory.
HC: What is the link between osteoporosis (brittle bones) and
menopause? Can it be prevented?
Dr GG: A small amount of bone loss after age of 35 years is normal for
both men and women. But during one year preceding, and 4 to 8 years after
menopause, women lose bone more rapidly. This rapid loss occurs because of the
decreased levels of estrogen hormone. If too much bone is lost, it can increase
the risk of osteoporosis. Osteoporosis increases the risk of bone fracture. The
bones of the hip, wrist and spine are most commonly affected.
Lifestyle plays a key role in preventing osteoporosis. Exercise,
healthy diet, taking calcium supplements and avoiding smoking / alcohol can
help bones remain healthy.
HC: Is it true that menopausal ladies are more prone to develop
heart disease?
Dr GG: Yes. The estrogen produced by the women’s ovaries before
menopause, protects against heart attacks and stroke. When less estrogen is
made after menopause, women lose much of this protection. Midlife is also the
time when risk factors for heart disease, such as high cholesterol levels, high
blood pressure, and being physically inactive, are more common. All of these
factors in combination increase the risk of heart disease and stroke.
HC: Is bleeding after menopause normal?
Dr GG: No. If a woman has already had menopause (no menses for 1 year)
then even spotting or scanty bleeding is considered abnormal and warrants
evaluation.
Some of the common causes of postmenopausal bleeding are: polyps
(in uterus or cervix), vaginal atrophy, thickened endometrium, cancer of uterus
or cervix.
Also patients with uncontrolled hypertension and those on blood
thinners can present with post menopausal bleeding.
HC: What is hormone replacement therapy (HRT)? Do all menopausal
women need it?
Dr GG: HRT involves the administration of synthetic estrogen and
progestogen to replace a woman’s depleting hormone levels and thus alleviate
menopausal symptoms. HRT can be administered as local preparations (creams,
pessaries, ring) or as oral medicines, trans dermal patches , gels and
implants.
It is important to note that all women may not need HRT. It is
most useful for women with vasomotor symptoms (hot flushes and palpitations)
and for symptoms of vulval and vaginal atrophy. It is usually prescribed in the
lowest doses and for the shortest duration.
HRT has to be strictly taken under doctor’s guidance and
supervision. There are significant side effects like breast cancer, venous
thrombosis (blood clots), cardiovascular disease and cancer of uterus if taken
in an unregulated manner.
HC: What can I do to stay healthy after menopause?
Dr GG: A healthy lifestyle can help you make the best of the years
after menopause. The following are some ways to stay healthy during mid life:
Nutrition: Eating a balanced diet will help you stay
healthy before, during and after menopause. Include enough calcium and vitamin
D in your diet to maintain strong bones. Some of the Calcium rich foods are
dairy products, dark green leafy vegetables, ragi, sesame seeds, fish like
sardines and salmon etc. Sunlight is the best source of vitamin D. Fish and egg
yolk are the other sources.
Exercise: Regular exercise slows down bone loss and
improves your overall health. Weight bearing exercises such as walking, can
help keep bones strong. Strength training strengthens muscles and bones by
resisting against weight such as hand held weights, resistance bands or body
weights. Exercise also helps to maintain balance and proper posture thus
preventing falls. Yoga and meditation help to keep a calm mind.
Routine
health checkup: Routine health check up visits, help to detect problems early,
even when we don’t feel sick. Blood investigations for diabetes, thyroid,
cholesterol etc, should be done at regular intervals. ECG/ ECHO, ultra
sonography should be done at least once a year Mammography, Pap smear test, eye
check and dental evaluation should be done as advised by the treating doctor.
