MENOPAUSE

 

What is menopause ?

Menopause is the last period in a women’ s life. It is the phase when the reproductive life of the women is coming to an end. The hormonal changes which lead to this may start as early as five years prior to this. Derived from a Greek term, it actually means ‘ ‘cessation of periods’.

It is not a disease, it is a transitional phase of life. However, it carries with it a different internal hormonal milieu which may in fact be detrimental to the female body in the long run. Just as puberty is a transitional phase where a girl steps into womanhood, menopause is the transitional phase when a women steps out into a phase of coalescence and senescence. The ovaries (the female counter part to the testes in men) pack up. The quantity of female hormones produced by them decreases significantly. Drastic as it may sound, a gradual process of natural castration begins.

In some women, menopause may be marked by changes and drama. In others, it may be quiet and go unnoticed. It may have a positive impact on her life style or may create havoc. To some extent her basic personality and socio-cultural background may colour her attitudes, reactions and behavior at this time. Either way, it is imperative for women, men and children to understand the changes wrought in a women at this stage of her life. It eventually concerns everyones lives. So even if you are not menopausal or not a woman, do not stop reading this. You need to know, too.

 

What are the problems (the symptoms) faced by women at menopause?

Until quite recently many doctors believed that women going through the menopause did not require treatment and those who complained of symptoms were making much ado about nothing, Lamentalbly, few doctors were well informed about menopause. Today more gynaecologists and doctors in our country are aware. The public is also more educated about menopause and Hormone Therapy (HT). Ignorance about menopause, shrouded in myth and folklore, is being shed. It is time a fresh look is taken at the hard scientific evidence available about menopause, its associated problems and their management.

The symptoms at menopause which women may experience may be short term that may only last for a few months, or could extend to a few years. These eventually disappear on their own when the body has adjusted to the new low levels of the hormones. If distressing to the women, these symptoms should and may safely be treated to make the transition easier.

Some of the common symptoms at menopause:

Vasomotor symptoms

• Episodes of hot flushes. In India, many women just say they feel feverish.
• Episodes of sudden sweating and night sweats
• Palpitations
• Bouts of feeling, excessively cold

Muscle & joint symptoms

• Muscle, joint and bone pains
  

Genito urinary symptoms

• Irregularity in periods that get less and further apart
• Dry vagina
• Painful intercourse
• Decrease in libido
• Recurrent vaginal infections
• Worsening or onset of vaginal prolapse urinary symptoms
• Urinary incontinence and inability to hold urine
• Recurrent bouts of urinary infections
• Worsening episodes of sudden urinary leaks
  

Symptoms related to the brain

• Emotional and psychological symptoms
• Depression and irritability
• Tiredness and lethargy
• Sleeplessness
• Forgetfulness
• Forgetfulness and impaired memory
• Loss of concentration
• Thin, dry skin
  

What are the long term problems that may arise as a result of menopause?

When there is no oestrogen for over 2 years or more the bones may get brittle, the risk of heart disease goes up, the vagina becomes less moist, the skin becomes dry and the lining of the passage from the urinary bladder (called the urethra) becomes thin and more prone to infections. These are real problems which may or may not result in symptoms. Even worse is that sometimes even doctors may be unable to disentangle the web of these symptoms and trace them back to menopause

The problems that may result in varying degrees in different women from the long term deficiency of oestrogens may be :

• Osteoporosis, brittle bones and multiple fractures with gradual development of that often seen Dowager’s hump’ or bent spine.
• Heart attacks and coronary artery disease
• Stroke
• Urinary and genital tract atrophy with resultant infections
• Emotional and psychological problems
• Skin thinning, wrinkling and brittleness
  

Upto their reproductive years, women unlike men are relatively protected against most of these problems because of the natural female hormones-oestrogens and progestrones-circulating in their body. These provide a balanced internal hormonal environment. However, with the advent of menopause these hormones decrease and degenerative processes may get accelerated in almost all parts of the body. Women, who are relatively more protected against most physical ailments compared to men of the same age group, lose this protection after menopause.

 

Do all women suffer from problems at menopause ?

Menopause is extremely idiosyncratic. Just as every one is different as they enter puberty, the change of life as they leave the reproductive phase is even more individual. Yet, just as it is easy to spot a pubertal girl, it is easy enough for a discerning eye to spot the mature woman undergoing the change of life! Those woman with the genetic good fortune of making oestrogen from sources other that ovaries such as body fat, are lucky and may make enough to keep themselves healthier for a longer period. The need and the fitness to receive HT should be assessed by people with experience in this aspect of health care.

 

Can these problems arising from menopause be tackled?

Yes. Each complaint or symptom that a women experiences can be helped individually. However, the root cause of the various symptoms and the long term problems that arise is a result of estrogen lack at menopause. It can be definitely corrected if the deficiency of the female hormones in a women body is made up by replacing them by using the same or similar hormones. This is known as ‘Hormone Therapy’ or HT. Change in life- style with adequate and appropriate exercise and diet alterations go a long way in helping

 

Awareness

It is important for all women to be well informed about menopause. It happens to every woman. It is her right to go into this stage of life knowing as much as she can. Women must become informed and active consumers of good health care. Most important the fear of the unknown is taken away.

What is Hormone Therapy or HT?

Gynaecologists all over the world now agree that replacing these hormones in the form of giving hormone therapy (HT) provide the most effective form of treatment of menopausal symptoms. HT gives dramatic relief of symptoms as well as protects against osteoporosis. It must be understood that the associated changes from aging, of course would be unaffected by giving hormone therapy.

Most of the hormones used are ‘natural’ hormones. It must be clearly understood that these are quite different from those used in the oral contraceptive pill. Just because women are unable to take the pill, it does not mean that they cannot have hormone therapy of menopause. However, hormone therapy needs careful monitoring the current recommendation is that it should be used for symptom control.

Hormone therapy is designed to provide the necessary hormones to top up the body’s waning natural supply. These may be taken either in the form of tablets or applied as patches on the skin or even used vaginally. All these forms are now available in India.

 

What is the role of Hormone Therapy (HT)?

Long years of experience and research in medical science has eventually lead to better understanding of differences in the various forms of hormone therapy and the problems with each of these. The unfortunate experiences of the past with oral contraceptive and synthetic hormones had been and continues to be the basis of bias against natural hormone replacement therapy. It should be clearly understood that the two are totally different forms of therapies. The acceptable established forms of hormone therapy use natural oestrogens and progestogens or other similar products . These hormones are not given in pharmacological abnormally high doses

To enable women to get maximum benefit from this acceptable form of therapy and to prevent hormone therapy from getting into disrepute, It should be ensured and stressed that hormone therapy should be started only after careful and thorough evaluation of women. However, not all women are fit or suitable to receive. This treatment and consultation with a specialist will exclude those who simply cannot be prescribed this treatment.

It is mandatory that the presence of oestrogen dependent tumors and cancers is ruled out prior to starting hormone replacement therapy. Equally important is the monitoring only by specialists. Though hormone therapy certainly is not a cure all, elexir of life, it has a distinct role in tackling the short term problems arising from lack of hormones. Medical literature has established the improvement in quality of lives of millions of women for symptom relief with these.

 

SOMES DOS AND DON’Ts at Menopause

 If you get ‘hot flushes’:

• Wear cotton clothes rather than those made of synthetic fibres like polyester
• Wear clothes in layers, so you can drop outer layers one by one as temperature rises.
• Take as many cool showers as possible. And apply anti-perspirant.
• Avoid hot drinks and spicy food, especially at night
• Avoid smoking and alcohol since it may make the symptoms worse.

 

If you have painful periods

• Use a lubricant K-Y jelly which is easily available at most chemists. In an emergency, any oil or cream or even saliva is better than nothing.
• Avoid intercourse when you have active vaginal infection or your partner has penile infection
• Have regular intercourse. Long periods of abstinence can result in painful sex again. Certain chemicals are released in the brain during intercourse which can relieve tensions, elevate the mood and be good physically for the body.
• Use good quality condoms to avoid sexually transmitted diseases and allergies
• Avoid vaginal douches. They do not really cure the source of any infections and may actually lead to further problems
• Check with your doctor if you have vaginal thrush or your partner any penile infection. If you do, exclude diabetes in yourself and your partner.

 

If you are prone to getting urinary infection:

• Drink plenty of fluids all through the year – about 10 glasses a day! In summer, particularly if you perspire, double this intake. Not only will this prevent urinary infections but also prevent constipation and do wonders for you skin.
• Have at least 2 glasses if fresh, pure orange or Mosambi’ juice or Nimbu-paani’ (fresh lime juice). One gram of vitamin C is good substitute for those who can not take ethier.
• If you have excessive and dirty vaginal discharge, get it treated. Sometimes it can be the source of recurrent urinary infections.

 

If you have period problems

• If your periods are getting heavier or occurring more frequently do get yourself checked out by a gynaecologist. Though heavier frequent or delayed periods can also happen from hormone imbalances these are also signs of pre cancerous changes in a perimenopausal women. So have yourself seen.
• If you continue to have bleeding or spotting, you will again need a gynaecological consult.
• Bleeding after intercourse is not normal either. Ensure you have a pap smear check and rule out an infection.

 

If you get body aches, bone and joint pains

• Ensure you are getting adequate calcium in your diet (milk, milk products, pulses and vegetables). See diet chart or check with you doctor if you need calcium supplementation
• If you are overweight, try to loose weight by exercising and dieting. Dieting alone is not advisable or helpful. Remember thinning bones cannot easily take increasing weight without complaining
• Instead of resting, increase physical activity. Take a pain killer and regularly undertake physical exercises and go for walks. If possible join exercise classes. If you enjoy dancing, dance. After the intial week of pain, it should settle down and get much better. Keeping physically fit will improve your agility and also help prevent fractures by improving your responses when and if you fall.
• If you have backache, before embarking on an exercise programme, check with a orthopedic specialist whether you ca gohead.

 

If you are feeling low:

• Talk to someone who is willing to listen. Airing feelings can be an antidote in itself.
• Reflect on your daily activates and check if you are keeping aside at least half an hour totally for yourself. Reserve sometime of the day for yourself. Switch off from the household chores, responsibilities, work and social commitments to either just rest or do anything which you enjoy.
• Are you dressing well? Have you groomed yourself with age and menopause as physical assets decrease, self confidence may begin to drop. It is important to improve your physical self image and pep yourself.
• If you get mood swings explain to your family that these may be related to menopause and will pass. Enrol their support and understanding.
• Develop a hobby, start something creative or just take time off to entertain yourself at least once in a fortnight.       If you can involve your partner, there is nothing like enjoying things together but if you cannot, better flavour it alone than not at all.
• If there are any relationship or other problem in the household discuss them frankly. However, try to resolve them without confrontation and aggression. If you are getting nowhere with this approach, drop the issue. Your own peace of mind is most important. Petty problems are sometimes best ignored in such situations.
• Daily physical exercise and brisk walking can be invigorating. Exercise also results in secretion of mood elevating chemicals in the brain and improves a sense of well being.
• Avoid tranquilisers. They do not solve problems, but mask them. A sympathetic doctor and supportive husband, family or friend are far more helpful. A short course of antidepressants rather than tranquilisers may be more appropriate but must be prescribed by an expert. So see a psychiatrist, it will help

 

IF you are on Hormone Therapy (HT)

• You should be clear in your mind as to the reason why you are talking HT. Is it for symptomatic relief ? If you are taking it for purely cosmetic reasons, you should think again
• Are you aware of the slightly increased risk of breast cancer with prolonged (10-15 years) use of HT?
• Do you appreciate the benefits?
• Before starting HT did you have a complete gynaecological check? Was your blood pressure, blood sugar, blood cholesterol and triglycerides checked? Did you have mammorgraphy and ultrasound of the pelvis? If not, go back and discuss it with your doctor.
• Self examine your breasts once a month
• Maintain regular annual follow-ups with your doctor
• Report any irregular or unusual vaginal bleeding or a lump or pain in the breast to your doctor
• If you read or hear anything new, alarming or disconcerting about HT, discuss it with your doctor, who will be able to check and put things in perspective. Your doctor will give you balanced answers based on scientific rather than sensational facts
• Age in itself increases the chances of developing certain age related diseases like diabetes, hypertension, heart disease, arthritis, hypothyroid or certain cancers. You should be aware that these can develop despite HT.
  

 

Prior to considering taking HRT purely as a prophylactic measure to prevent long term problems like brittle bones completion of the two attached questionnaires would be helpful. This would identify those patients at real risk and could be used whilst considering and discussing risk-benefits ratio before starting on HT. Women at Cardiac risk should only take hormone therapy after proper assessment.