Menopause or Climacteric is the permanent stoppage of menstrual periods in most women’s lives and they are no longer fertile. Medical professionals consider this state to occur when a woman has not had any vaginal bleeding over a year. Usually, it occurs between 49 and 52 years of age. It may also be considered as shrinkage in hormone production by the ovaries in a woman, whereas if someone goes for a surgery to remove their uterus but they still have ovaries then menopause may be sighted at the time of surgery or when their hormone production level shoots down. In case of surgical eviction of the uterus, symptoms of menopause would symbolically occur at an earlier stage with an average of 45 years of age.
Common Symptoms of Menopause
At an early stage of Menopause, menstrual cycle remain regular but the time period between two cycles start increasing. Women can experience a wide range of symptoms during menopausal transition and after menopause.
A community based study of 589 Caucasian women from middle to upper-middle class was conducted by Denise Goldani (1995) in Rancho Bernado, California. Results states that at the time of menopause 55% of the women reported that they felt life was getting better and 57% were happy and joyful. The most observed symptoms were 74% hot flushes, 45% propensity to weight gain, 35% night sweats, 32% tiredness, and 28% insomnia. Depression was reported by one-fifth and irritability by one-fourth. Anxiety about looking older was reported in nearly 11%. The subjects with weepiness, hot flushes, tiredness and irritability did not vary by current age but younger women were significantly more likely than older women to have experienced visible flushes, night sweats, depression, insomnia and anxiety about looking older. Principal components factor analysis yielded four main independent factors that contains 21% of the variance psychological symptoms, 14/% of vasomotor symptoms, 11% of positive feelings and 8% of negative self-image. The four symptom categorisation suggests different causal mechanism and 42% reported past and 27% reported current use of estrogen therapy but both past and current hormone users were significantly more likely to report menopause symptoms than others.
Causes of Menopause
The typical age of menopause is between 40 and 61 in western countries and the average age for last period is 51 years and the average age of natural menopause in Australia is 51.7 years, whereas in India and the Philippines the intermediary age of natural menopause is considerably earlier at 44 years.
Rarely, a woman’s ovaries may stop working at a very early age which can range anywhere from the age of puberty to age 40 and this is known as premature ovarian failure and affects 1 to 2% of women by age 40. Further studies about early menopause states that it can be related to cigarette smoking, racial and ethnic factors, higher body mass index, illnesses, and the surgical removal of the ovaries with or without the removal of the uterus from a female. Undiagnosed and untreated coeliac disease is a risk factor for early menopause. Coeliac disease can be presented with several non-gastrointestinal symptoms and under most cases, escape timely recognition and go un-diagnosed, leading to a risk of long-term complications. A strict gluten-free diet reduces the risk and women with early diagnosis and treatment of coeliac disease present a normal duration of fertile life span. Menopause can be surgically induced by removal of ovaries or bilateral oophorectomy which is often done in conjunction with removal of the Fallopian tubes and uterus. Discontinuance of bleeding as a result of removal of the ovaries is called surgical menopause, which lead to the sudden and complete drop in hormone levels usually produces extreme withdrawal symptoms such as hot flashes, tiredness, weight gain, etc.
Treatment of Menopause
Premenopause is a term that mean the years leading up to the last period when the levels of reproductive hormones are becoming more variable and lower. The effects of hormone withdrawal are present and it starts some time before the monthly cycles become noticeably irregular over a period of time.
Perimenopause is a term that means around the menopause and refers to the menopause transition years, a time before and after the date of the final episode of menstrual cycle. It is not a disease or a disorder, rather it is a natural stage of life. It does not automatically require any kind of medical treatment but in those cases where the physical, mental, and emotional effects of perimenopause are strong enough that they significantly disrupt the life of the woman experiencing them then palliative medical therapy may sometimes be appropriate.
Hormone Replacement Therapy(HRT):
Hormone replacement therapy is the use of estrogen in women without a uterus and estrogen plus progestin in women who have an intact uterus to increase hormone level. This treatment may be reasonable for the menopausal symptoms such as osteoporosis and hot flashes. HRT when used for symptoms of menopause it should be used for the shortest time possible and at the lowest dose possible and the response to the treatment in each postmenopausal woman may vary. In hormone therapy, adding Testosterone has a positive effect on sexual function in postmenopausal women. It may be accompanied by acne, hair growth and a reduction in high-density lipoprotein (HDL) cholesterol.
Selective Estrogen Receptor Modulator (SERMs)
These are a category of drugs that act selectively as agonists or antagonists on the estrogen receptors throughout the body and are produced either synthetically or derived from a botanical source. Raloxifene and tamoxifen are the most commonly prescribed SERMs. Raloxifene exhibits oestrogen agonist activity on breast and the endometrium, and bone and lipids. It prevents vertebral fractures in postmenopausal and osteoporotic women, also reducing the risk of invasive breast cancer. Tamoxifen is used worldwide, on a large scale, for treatment of hormone sensitive breast cancer as well.
During and after perimenopause, lack of lubrication is a common problem and vaginal moisturizers can help women with overall dryness. Lubricants can help with lubrication difficulties that may be present during intercourse but those who need only lubricants do well using them only during intercourse. Apart from lubricants, a low dose prescription vaginal estrogen products such as estrogen creams are generally a safe way to use estrogen to help vaginal thinning and dryness problems while only minimally increasing the levels of estrogen in the bloodstream of the user.
Mühlen, D.G. von and Silverstein, D.K. (1995) ‘A community-based study of menopause symptoms and estrogen replacement in older women’, Maturitas, 22(2), pp. 71–78.