Menopause

What is Menopause?

Menopause is a natural decline in hormonal function. A woman is considered to be in menopause once she stops menstruating for 12 months.

Menopause doesn't occur overnight; it's gradual, and most women experience it between 45 and 55.

Cause of Menopause

Menopause is a natural process in every woman as she reaches her early forties or fifties.

The production of the hormones by ovaries that regulate the menstrual cycle, namely oestrogen and progesterone, decreases. Eventually, the ovaries stop producing eggs and menstruation stops.

Symptoms of Menopause

Menopause may lead to physical and emotional changes, such as

• Hot flushes,
• Emotional changes, including irritability or mood swings,
• Vaginal changes, including dryness, itching, or burning
• Sleep disturbances and night sweats
• Weight gain or change in weight distribution
• Headaches, general aches and pains
• Forgetfulness, declining ability to focus and concentrate
• Reduced sex drive
• Tiredness & lethargy
• Irregular menstrual periods
• Thinning hair
• Slow metabolism
• Urinary frequency

Several chronic medical conditions tend to appear after menopause. Women need to become aware to minimise the risk.

Health practitioners sympathetic to natural therapies, like Dr George Samra, are often experts at testing and treating both menopause and perimenopause using Bioidentical hormone therapies. Bioidentical hormones are identical to natural human hormones. They are sourced from plant matter such as wild yams and soy and, in labs, are made to be identical to human hormones. Advantages, risks, disadvantages and possible side effects need to be discussed. Prescriptions are usually dispensed by compounding pharmacists.

Stages of Menopause

Menopause is unavoidable, but not every woman experiences unpleasant symptoms.

Women who experience hot flashes, sweats at night, rapid changes in mood or sleep disturbances may be going through menopause.

The time leading into menopause is called perimenopause and can last several years. This is when the menstrual cycle may change but has not yet completely stopped, and women experience some menopausal symptoms.

Menstruation will fluctuate and may become longer, shorter, lighter or heavier. Eventually, the hormone levels fall to a point where menstruation ceases altogether.

Menopause Awareness

Things to be conscious of include the following:

• During and after menopause, there is an accelerated loss of bone strength. Your bones may become brittle and weak, increasing the risk of fractures. It is important to maintain regular, weight-bearing exercises to keep your bones strong. A diet high in calcium and Vitamin D-containing foods is also beneficial.
• As your oestrogen levels decline, your risk of cardiovascular disease increases. Make sure to get regular checkups with your doctor.
• Some women may experience urinary incontinence. As the tissues of your vagina and urethra lose their elasticity, you may experience urine leakage when coughing, laughing or lifting.

Premature Ovarian Insufficiency (POI)

This is commonly referred to as premature menopause. POI is diagnosed once women have stopped menstruating for 12 months before age 40, with blood tests supporting this diagnosis.

Some factors that can induce early menopause include the following:

• Cancer treatment: Chemotherapy (treatment with chemical agents) and radiotherapy (treatment by exposure to radiation) can cause menopause symptoms and a temporary or permanent stop to your menstruation.
• Failure of ovaries: Autoimmune diseases or genetic factors can cause your ovaries to produce less than normal reproductive hormones. This is known as primary ovarian insufficiency and can lead to premature menopause.
• Surgery: Surgery such as total hysterectomy and bilateral oophorectomy that involve the removal of your uterus and both ovaries will immediately stop menstruation.

Diagnosis of Menopause

The diagnosis of menopause is primarily based on a woman's symptoms and medical history. Menopause is a natural biological process that marks the end of a woman's reproductive years, and it is typically diagnosed when a woman has gone through 12 consecutive months without a menstrual period. This period is known as "menstrual amenorrhea."

To confirm the diagnosis, blood tests may be ordered to check the follicle-stimulating hormone (FSH) and oestrogen (oestradiol) levels, as a decrease in the level of Oestrogen hormone can project menopause.

Treatments for Menopause

Menopause does not need treatment, but it may be required to control its signs and symptoms.

Menopause is usually natural, so it's best to let it run. Lifestyle changes can often help to improve symptoms of menopause. If this alone is not enough, you may seek medical advice.

Recommended treatments include

• A healthy diet. Choose various foods, including plenty of fresh vegetables, fruits, cereals, whole grains and small portions of lean meat, fish or chicken.
• Increase your intake of fluids and low-fat dairy foods with high calcium content.
• Limit caffeine and alcohol.
• Exercise regularly - at least 45 minutes three times per week.
• Avoid smoking due to the associated risk of osteoporosis, coronary heart disease and lung cancer.
• Menopausal hormone therapy (MHT), previously called Hormone replacement therapy or HRT, can effectively reduce many unpleasant menopause symptoms.

Be sure to stay on top of your regular breast screening mammograms and cervical screening tests.

Lifestyle Remedies for Menopause

Some of these lifestyle remedies can also help you reduce or prevent the symptoms of menopause.

• Cool off hot flushes by drinking cold water or staying in a cool room. Identify factors that trigger your hot flushes, like hot beverages, alcohol, caffeine and spicy foods, and try to avoid them.
• Use vaginal lubricants to help you with vaginal dryness and discomfort.
• Reduce stress, get adequate sleep, eat healthy, stay active and don't smoke
• Exercise regularly. Pelvic floor muscle exercises can help you strengthen your pelvic floor muscles and reduce urinary incontinence.
• Some women find Yoga / Pilates/ Meditation useful.
• Some women also find dietary changes helpful.

Hormone replacement therapy (HRT)

Treatment with hormones, including oestrogen and progestin, may be recommended for hot flushes and bone loss. It may also help prevent cardiovascular problems if started within five years of menopause.

Vaginal oestrogen

Small doses of oestrogen in cream or pessaries can help you manage vaginal dryness, urinary symptoms and discomfort during intercourse.

Antidepressants

Low-dose antidepressants can help you manage hot flashes when hormone replacement therapy is not advisable and will also help improve your mood. Some other non-hormonal medications can be used as an alternative to HRT.

Other Medications

You may also be prescribed medications to reduce your bone loss and risk for fractures if you are high risk or already have developed osteoporosis.

Complications of Menopause

Some of the possible complications associated with menopause include the following:

• The risk for heart and blood vessel (cardiovascular) diseases increases with decreased oestrogen production.
• Bone density may decrease, making them brittle and leading to a condition known as osteoporosis. This can make you more prone to fractures.
• Vaginal and urethral tissues will begin to lose their elasticity, and you may experience the sudden urge to urinate or develop  (urge incontinence or stress incontinence). You may also become more prone to urinary tract infections.
• The loss of moisture and elasticity in your vagina can cause discomfort during intercourse and affect your sexual desire (libido).
• As your metabolism rate slows down, you may start gaining weight.

Benefits of Menopause

Several women report no major negative menopausal side effects; some experience benefits. With the absence of periods, women may notice a reduction in hormonal headaches, no longer having to manage heavy and painful periods, no more PMS and a reduction in symptoms related to conditions such as uterine fibroids, adenomyosis and endometriosis. No longer having to worry about pregnancy can also be liberating.

It's not uncommon for postmenopausal women to report feeling empowered, partly because of the biological changes in menopause and partly because of the point in life at which menopause occurs.