Menopause

Symptoms Of Menopause

Menopause can bring in different kinds of signs and symptoms. You may experience the following symptoms as you come closer to menopause such as:

• Vaginal dryness 

• Mood changes 

• Sleep problems 

• Night sweats 

• Decrease in metabolism 

• Weight gain 

• Loss of breast fullness 

• Thinning of hair 

• Dry skin 

• Difficulty in concentrating 

• Increased irritability

• Mild depression

• Joint aches

• Decreased libido or sex drive

• Increased heart rate

• Loss of bladder control

• Urinary tract infections

Women who are transitioning to menopause (perimenopause) may also experience the following symptoms such as:

• Irregular periods

• Skipping periods

• Periods that are heavier or lighter

• Breast tenderness

• Worsening of premenstrual syndrome (PMS)

Not all women experience these symptoms, whereas some may experience more than one. Women affected by urinary changes, racing heart, or new medical problems should consult a doctor to rule out other possibilities. 

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Causes Of Menopause

Your reproductive cycle starts from puberty and ends near the age of 40-50. Various complex methods and hormones control the process. Hypothalamus is a brain structure near the pituitary gland that produces certain chemicals that release essential sex hormones called estrogen and progesterone.

These hormones stimulate the release of eggs from the ovary. If the egg fails to fertilise, the thickened lining of the uterus is shed through the vagina in the form of periods. As women age, their reproductive cycle starts to slow down and eventually stops. 

When your body starts nearing menopause, the ovaries start producing less of a hormone called estrogen. This decline in the hormone leads to changes in the pattern of your menstrual cycle. It starts becoming irregular, or there might be changes in the flow of your period. With these hormonal changes, your body also undergoes some physical changes as it tries to adapt to the new level of hormones. 

The symptoms that women experience during this transitory phase or menopause are part of their body’s attempt to adjust to these changes. For women undergoing natural menopause, the process occurs in three stages. 

Perimenopause

This can start ten years before the onset of menopause. This is the time when your ovaries gradually begin producing less and less of the hormone estrogen. Women in their 40s generally experience menopause, but some may start experiencing it in their 30s. 

The period of perimenopause lasts until menopause when ovaries completely stop producing eggs. Before that, the fluctuating level of hormones causes various symptoms in women. Women undergo different hormonal fluctuations during this transitory period, hence each woman experiences perimenopause in a different manner. 

The increased levels of progesterone and estrogen during anovulatory cycles (absence of menstrual cycle) may lead to endometrial cancer or hyperplasia (thickening of the uterus lining), uterine polyps (growths attached to the inner wall of the uterus), and leiomyoma (also known as fibroids) in women of perimenopausal age.

Menopause 

Menopause is the stage when your ovaries stop producing eggs and most of its hormone estrogen. It is diagnosed when a woman has gone 12 months without any occurrence of periods. 

The conditions that can cause premature menopause include:

• Primary ovarian insufficiency: Premature menopause may result from the failure of ovaries to produce normal levels of reproductive hormones , which can stem from genetic factors or autoimmune disease. For these women, hormone therapy is typically recommended until the natural age of menopause.

• Induced menopause: This can happen, if ovaries are removed due to for medical reasons such as uterine cancer or endometriosis.

Cancer therapies like chemotherapy and radiation therapy can induce menopause if they cause damage to the ovaries. Symptoms such as hot flashes can be experienced during or shortly after the course of treatment. The halt to menstruation (and fertility) is not always permanent following chemotherapy, so birth control measures need to be taken. Radiation therapy only affects ovarian function, if radiation is directed at the ovaries. Radiation therapy to other parts of the body such as breast tissue or the head and neck does not premature menopause.

Postmenopause

After going through menopause, you will be in the post-menopause phase for the rest of your life. Since, the body has nearly stopped producing estrogen, postmenopausal women are at an increased risk of various health conditions such as heart diseases, osteoporosis (weakening of bones), and urinary tract infections. 

Many women may also experience relief in the symptoms they were undergoing during the perimenopause phase. Hot flashes may ease after some time, but some females continue experiencing these symptoms for ten more years or longer. Every women’s risk and experience post menopause is different. It is essential to learn more about the potential risks and consult your doctor for the same. 

Risk Factors For Menopause

It is natural for every woman to go through menopause. However, some women may experience premature menopause. This means that their menstrual cycle would stop earlier than the expected mean age. Premature menopause occurs when a woman is 40 and early menopause occurs at the age of 45. 

You are at an increased risk of developing early menopause, if you:

• Had surgery to remove the ovaries 

• Are a chronic smoker

• Underwent surgery to remove the uterus (hysterectomy)

• Have side effects of chemotherapy or radiation

• Have a family history of early menopause 

• Have certain medical conditions such as rheumatoid arthritis, inflammatory bowel disease, epilepsy, thyroid disorders, HIV/AIDS or chromosomal abnormalities

• Have certain infections such as mumps

Diagnosis Of Menopause

The tests that are essential for diagnosing menopause are:

1. Physical exam

Before visiting your doctor, you can try tracking your symptoms and noting them somewhere. You can also record their frequency and severity along with your last period and any irregularities in your cycle. Talk to your doctor about any medications or supplements that you might be taking. 

Usually, the described symptoms are enough evidence for the diagnosis of menopause. 

2. Vaginal swab 

Your healthcare provider may direct you to take a vaginal swab. This will help them test your vaginal pH. The vaginal pH is around 4.5 during your reproductive years and can rise to a pH balance of 6 during menopause. Reduced estrogen during menopause affects a woman’s vaginal pH. 

3. Follicle-stimulating hormone (FSH) test 

Your doctor may order a blood test to check the levels of FSH along with estrogen. When women undergo menopause, their FSH levels tend to increase, and estrogen levels decrease. 

FSH is responsible for stimulating the maturation of eggs and for producing estradiol, a form of estrogen. Estradiol has several functions, including regulating the menstrual cycle and protecting the female reproductive system. When a woman’s FSH levels have constantly been elevated to 30 mIU/mL or higher, and she hasn’t had periods for over 12 months, it is generally diagnosed as menopause.

However, a single FSH rest with elevated results does not necessarily indicate menopause. Multiple subsequent tests are needed to establish the diagnosis. Along with this, the FSH tests can detect signs of pituitary disorder since the anterior pituitary gland releases FSH. 

4. Thyroid-stimulating hormone (TSH) test 

Your doctor may order a TSH test since the symptoms of hypothyroidism often resemble those of menopause. Hypothyroidism is a medical condition in which the thyroid gland produces less than the average amount of thyroid. The TSH test also indicates how much T4 hormone is being made. 

A high TSH level means that the thyroid gland is making excessive T4 because there isn’t enough T4 available in the body. This indicates hypothyroidism. The result of this test will help your doctor rule out the possibility of hypothyroidism. 

5. PicoAMH Elisa diagnostic test 

This recent test allows a diagnostician to evaluate if you have reached menopause or are likely to reach it. It measures the levels of anti-mullerian hormone (AMH) in the blood, a protein hormone released during pregnancy. The test alone is not enough for the diagnosis of menopause. It can be used along with bone mineral density tests and hormonal tests. 

Along with this, your doctor may order some other tests such as a lipid profile and tests for liver and kidney functions. Women experience a change in their lipid profile during menopause that can help with the final diagnosis. 

6. Inhibin A and inhibin B

The fall in inhibin A and inhibin B  may also be useful for assessing reproductive ageing. Studies have shown that the disappearance of these hormones is an important indicator of the approaching menopause.

Prevention Of Menopause

Menopause is a natural biological process of a woman’s body in response to age. There is no method of preventing menopause, and it should be accepted as a part of your body’s natural cycle. You can prevent the onset of early menopause by making lifestyle modifications such as:

• Having balanced meals

• Avoiding smoking

• Exercising daily

• Reducing weight

If you have a family history or a relevant medical history that can cause early menopause, talk to your doctor about the same. 

Specialist To Visit

You should visit a doctor if you are experiencing symptoms such as racing heart, loss of urinary control, hot flashes, heart palpitations, and weakening of bones. It is advisable to visit your doctor once you start noticing the onset of menopause. This will help you manage your symptoms and prevent any complications related to menopause. You can consult the following doctors for a diagnosis:

• General physician 

• Gynaecologist 

• Endocrinologist

Note: Always consult your doctor if you have bleeding from your vagina after menopause.

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Treatment Of Menopause

Menopause doesn't require any treatment. There are certain medications and therapies available to relieve and manage the signs and symptoms of menopause. Your doctor will also help you with treatment modalities to prevent the development of any chronic medical condition resulting from menopause. 

1. Hormone therapy

Doctors recommend taking the estrogen hormone as it's an effective way to manage menopausal hot flashes. A hot flash is a sudden feeling of warmth over the upper body that is more intense over your face and neck. To relieve your symptoms, your doctor can provide you with a low dosage of estrogen for a limited time. The dosage will be decided based on your family history and personal medical history.

In some, cases your doctor may also prescribe you progestin along with estrogen. Definite benefits of hormone therapy include improvement in symptoms of menopause, increase in bone mineral density and decrease in fracture risk.

Long-term usage of hormones can increase the risk of endometrial cancer, pulmonary embolism, deep vein thrombosis, breast cancer, or gallbladder disease.

However, taking these medications for a limited time period has proven to be beneficial for women going through the symptoms of menopause. It is essential to talk to your doctor about your medical and family history, along with the risks and benefits of taking hormonal therapy. 

2. Vaginal estrogen

It is common for women to experience increased vaginal dryness during perimenopause and postmenopause. To relieve that, estrogen hormone can be administered directly into the vagina. This is done through a vaginal cream, tablet or a ring. The vaginal estrogen modalities work by releasing low amounts of estrogen directly into the vagina that is absorbed by the vaginal walls. It helps in relieving vaginal dryness and manages discomfort associated with intercourse and urinary problems. 

3. Antidepressants

Certain medications from the class of selective serotonin reuptake inhibitors (SSRIs) can relieve menopausal hot flashes. A low dose antidepressant is helpful for women looking for ways to manage their hot flashes. It is usually prescribed for women who cannot take estrogen due to allergy or other health reasons. Women who are suffering from mood disorders due to menopause are also prescribed low dosages of antidepressants. 

Paroxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant which works by increasing the levels of serotonin, a chemical messenger in the brain. This improves mood and physical symptoms of depression and also relieves symptoms of panic and obsessive disorders.

4. Anti-seizure medications

Gabapentin is an anti-seizure drug that is used to treat seizures. It has also shown promising results in managing menopausal hot flashes in women who can't use estrogen therapy. It is also helpful for women who have hot flashes at night.

5. Clonidine

This drug is an adrenergic agonist and has been found to reduce the frequency of hot flashes significantly. It is widely used as a non-hormonal treatment for hot flashes in breast cancer patients too. Your doctor will observe the effectiveness of the drug for two to four weeks. If there is no significant reduction in hot flashes, then the drug usage will be reviewed. 

6. Vitamin D supplements

The decline in estrogen level after menopause is known to affect bone density in women. Depending on your needs, you may need treatment to prevent or treat osteoporosis. There are several medications available that can improve osteoporosis and reduce the risk of fractures. Several women are also given Vitamin D supplements to strengthen bone density. 

Home-care For Menopause

If you have started noticing signs and symptoms of menopause, note down your symptoms and record your menstrual cycle with its irregularities. Your doctor will be able to give you a diagnosis based on these observations. 

If you have been experiencing hot flashes, talk to your doctor about getting medications to help you manage these symptoms. In the case of hormonal pills, make sure to take your medicines on time. 

Do not take the medications for longer than the recommended time without the advice of your doctor. You can keep your pills in a marked case to ensure that you don't skip taking the medications regularly.

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Complications Of Menopause

The decline in estrogen hormone increases the risk for women developing various health complications. However, estrogen is solely not responsible for these diseases. Age and other factors also play a role in their development. 

1. Heart diseases 

The risk of developing heart conditions increases after menopause. Postmenopausal women are more likely to have a heart attack than men. The steep decline in estrogen levels post-menopause increases the risk of having irregular heartbeats (palpitations). If a woman suffers heart palpitations, it is pertinent to meet a doctor to decide the best course of action. 

2. Osteoporosis 

The decline in estrogen levels puts postmenopausal women at an increased risk of developing osteoporosis. Estrogen plays a vital role in supporting the production of new osteoblasts responsible for creating bone. After menopause, the osteoblasts are not able to get an ample amount of estrogen hormone. This eventually leads to the cells failing to regenerate new bone structures. Ultimately osteoclasts responsible for absorbing bone overpower the rate of bone regeneration leading to the weakening of bone. Osteoporosis can lead to an increased rate of fractures in the hips and spine. Having a fracture at an older age is a serious problem since the body recovers at a slower pace. 

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3. Urinary problems 

Urinary incontinence occurs when women experience an involuntary release of urine. It is common in aging and postmenopausal women. The reduced estrogen level causes the thinning of the lining of the urethra (the tube that joins the bladder to the body's exterior) and the vaginal wall. This can lead to urinary leakage and often occurs during sudden movements such as sneezing or laughing. 

4. Sexual problems

Vaginal dryness from decreased moisture production and loss of elasticity can cause discomfort and slight bleeding during sexual intercourse. Also, decreased sensation may reduce your desire for sexual activity (libido). Water-based vaginal moisturisers and lubricants may help. If a vaginal lubricant isn't enough, many women benefit from the use of local vaginal estrogen treatment, available as a vaginal cream, tablet, or ring.

5. Weight gain 

Several women experience weight gain after hitting menopause. This is also the result of aging, along with the effects of menopause. With increasing age, it's harder to maintain muscle mass, and the decreased muscle mass further reduces metabolism. This makes the process of weight gain easier than before. Women often end up gaining weight around the abdominal region after menopause. This increase in fat increases the risk of heart diseases. 

6. Visual disturbances

Estrogen gives more elasticity to the corneas of the eyes. In menopause and perimenopause, when estrogen levels are reduced, the corneas do not get as much estrogen. Thereby, the corneas begin to stiffen which can affect how light travels into your eyes. This can also lead to blurred vision. 

Dry eyes can also be experienced during menopause. Symptoms may include itchiness, a burning sensation, eye pain, certainly dryness, mucus discharge from the eye, and it may even feel like there’s a foreign body actually on your eyeball. Wearing contact lenses can also get uncomfortable.

7. Central nervous system problems

Alzheimer's disease is more common in women after menopause. It is possible that estrogen plays a role in protecting the brain from the damage caused by Alzheimer's.

Alternative Therapies For Menopause

1. Diet 

Make sure to include a variety of fruits and vegetables in your diet. You should also increase the amount of fibre and whole grains in your food. Take calcium and Vitamin D supplements to meet your daily requirements. 

2. Exercise regularly 

With an increased risk of developing cardiac problems and gaining weight, it is essential to living an active lifestyle. After menopause, it is common for women's metabolism to slow down. This further increases the chances of gaining weight. To avoid that, you can try walking every day for at least an hour. Other than that, menopausal women can try doing Kegel exercises that focus on strengthening the pelvic floor. This can help reduce urinary incontinence. 

3. Talk to a therapist

Talk to a therapist or a doctor about any mood changes or irritability you may experience after menopause. Several women display signs of depression, anxiety, and isolation after going through menopause. Try talking to your family members and loved ones about your increased feelings of anxiety or irritability. It is important to communicate your feelings to let people know your needs. 

4. Practice relaxation techniques

Due to the increased risk of experiencing mood changes and becoming more irritable, it is vital to practice relaxation techniques that can help you manage stress. You can try indulging in light yoga or meditation. Yoga has proven health benefits that can help you manage weight and control stress levels. 

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5. Manage sleep issues 

If you are experiencing sleep issues, opt for natural sleeping aids like drinking chamomile tea before sleep. If you still have problems sleeping, then do consult your doctor to know the cause and get it treated.

6. Natural supplements 

Some natural supplements are said to manage menopause symptoms such as soy, Vitamin E, isoflavone, melatonin, and flax seeds. 

7. Cognitive behaviour therapy (CBT)

It is a non-medical approach that can be helpful for a range of problems associated with menopause such as anxiety, stress, depression, hot flushes, night sweats, sleep issues and fatigue. CBT helps people to develop practical ways of managing problems and provides new coping mechanisms and useful strategies. 

8. Hypnotherapy

Hypnotherapy has been shown to reduce the frequency and intensity of hot flashes along with helping with mild depression and anxiety. Hypnotherapy tools like focusing on cooling imagery and flash control dial have been found to be effective to control hot flashes and can help prevent them altogether.

Living With Menopause

Menopause is a natural cessation of a woman's fertile cycle. It brings a lot of physical and emotional changes to the body. Several women find it hard to adapt to these different changes and feel confused about the sudden changes in personality and physical appearance. But menopause can be managed by implementing certain lifestyle modifications and medications. It is important to be aware of the complications that arise after menopause and take timely action to prevent them.

1. Maintain a healthy weight 

A decrease in the level of estrogen increases your rate of weight gain. It also leads to a decline in the basal metabolic rate. This leads to weight gain, especially around the abdominal region. To prevent this, it is important to stay physically active and eat healthily. You can restrict your calorie intake by 400 to 600 to compensate for your body burning fewer calories. 

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2. Quit smoking and limit your alcohol intake 

Quitting smoking is an essential step towards leading a healthy life after menopause. Smoking increases your risk of developing heart disease, stroke, and osteoporosis. It also increases the frequency of hot flashes after menopause.

3. Get enough sleep

Avoid drinking caffeinated drinks that can make it harder for you to fall asleep. Exercise during the day instead of the night to ensure proper sleep. If you experience hot flashes during sleep, talk to your doctor about finding ways to manage them. 

4. Cool your hot flashes 

Dress in cool layers and keep yourself hydrated. Drink a glass of cool water or shift to a cooler room. Try to pinpoint the triggers behind your hot flashes. These triggers may include beverages, caffeine, alcohol, or heat. 

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