Menopause
Menopause is the time when a woman permanently stops having menstrual periods. It is not a disease, but merely life's natural transition, from the reproductive to the non-reproductive phase of a woman's life.
However, menopause cannot be satisfactorily defined as a “permanent stopping of menstrual periods” because it is what happens to the ovaries that is key to menopause, as opposed to what happens to the uterus (which is secondary).
To illustrate, let us say the uterus of a young woman is surgically removed. She would no longer be able to have any menstruation, but she is not menopausal, because her ovaries continue to produce hormones. On the other hand, if both her ovaries are removed surgically, or destroyed through chemotherapy, she would immediately be in menopause.
Thus, menopause occurs with the the cessation of hormone production by the ovaries.
ASSOCIATED PROBLEMS
1. MENOPAUSAL SYMPTOMS (see Peri-Menopausal Symptoms)
2. OSTEOPOROSIS
Rapid bone loss occurs during the perimenopausal and postmenopausal years. Bone loss in itself is painless, but it can lead to osteoporosis with increased fracture risk.
3. ISCHAEMIC CARDIOVASCULAR DISEASE
Non-smoking pre-menopausal women rarely suffer from cardiovascular disease. However, within 10 years of menopause, they catch up with the heart attack incidence of their male counterparts.
PERI-MENOPAUSAL SYMPTOMS
Symptoms can range from mild to severe, with each woman experiencing it differently. Some symptoms will be very bothersome, whilst others are quite manageable. The most common symptoms include hot flushes, mood changes and vaginal dryness.
1. Vasomotor Symptoms
• Hot flushes
• Night sweats
• Palpitations
• Headaches
2. Atrophic Tissues
• Vaginal dryness
• Dyspareunia (pain during intercourse)
• Vaginitis (inflammation of the vaginal wall)
• Breast changes
• Thinning of skin
• Urinary incontinence and burning on urination
• Post-menopausal Bleeding
3. Psychological
• Depression
• Lethargy
• Loss of concentration
• Irritability
• Insomnia
• Decreased libido
WHAT CAUSES MENOPAUSE?
Natural or physiological menopause:
Occurs as part of a woman's normal aging process. It marks the end of a woman's potential childbearing years, brought on by the ovaries gradually slowing down their function. FSH (follicle-stimulating hormone) is a hormone produced by the brain, and it is responsible for stimulating the growth of the woman's eggs.
As menopause approaches, the remaining eggs become resistant to FSH (hence FSH levels increase) and the ovaries reduce their production of estrogen significantly (hence, estrogen levels decrease). It is these fluctuating and rapidly declining estrogen levels that are responsible for many of the symptoms associated with menopause.
Induced Menopause:
This can be caused by surgical removal of both ovaries or disruption in normal ovarian function due to chemotherapy or radiotherapy.
DIAGNOSIS & INVESTIGATIONS
The diagnosis of menopause is usually made in retrospect – once it has been 12 months since your last menstruation, you are deemed to be in menopause.
Occasionally, your doctor may do some laboratory tests to check the levels of certain hormones. This would include Follicle Stimulating Hormone (FSH) and Estradiol levels.
Other tests which may be done include:
• Thyroid Stimulating Hormone – because thyroid disease can mimic the symptoms of menopause.
• Cardiovascular Risk assessment – cholesterol levels, checks for diabetes, echocardiogram etc.
• Assessment of Osteoporotic risk – DEXA scan for those at increased risk of osteoporosis.
TREATMENT
Menopause is not a disease, and so it should not be viewed as something which requires treatment. However, short term Hormone Replacement Therapy may be prescribed in women with severe symptoms.
Treatment is also prescribed for the associated effects of menopause eg. Osteoporosis, increased cardiovascular risk, urinary incontinence etc.
The article above is meant to provide general information and does not replace a doctor's consultation.
Please see your doctor for professional advice.