Menopause is a natural phenomenon which occurs in all women when their finite number of eggs becomes depleted and their monthly flow ceases or pauses for at least 12 months.
The eggs/ovaries are responsible for the production of estrogen and progesterone hormones and as the eggs declined the levels of these hormones fall, causing the monthly flow to first become erratic and eventually stop. Consequently, most menopausal complaints or symptoms are as a result of the decline of these two hormones on the woman’s body physically and mentally.
95 percent of women become menopausal between the ages of 45 to 55 years and factors which can affect the age at which women have their final period includes;
- Age at first menses
- Number of children
- Previous use of oral contraceptives
- BMI- Weight
- Ethnicity and
- Family history/Genetics
The experience of menopausal symptoms for women varies widely; some symptoms begin while still menstruating and others not until a year or more after their last period. Symptoms of the menopause last far longer than most women anticipate; for example, night sweats and hot flushes, persist in more than half of women for more than seven years.
Common menopausal symptoms
1. Menstrual irregularities: The typical presentation of some women is to see the GP to rule out they are pregnant. Irregularities to the menstrual cycle may last for up to four years and the cycle may lengthen or shorten with a slight increase in the amount of menstrual blood. For few, the flow stops abruptly.
2. Hot flushes and sweats: The face, head, neck and chest and body suddenly becomes hot. Some describe this as internal heat, and the symptoms may last for several minutes and feel like the chill of a fever. Many women think they are coming down with Malaria or Typhoid.
3. Genitourinary syndrome of menopause (GSM): Steroid hormones decreases can lead to changes in certain areas of her body, like the vagina, vulva, and bladder. For example, estrogen helps keep the vagina moist and flexible. But when estrogen levels decline, the vagina can become dry and tight.
GSM is thought to affect about half of postmenopausal women. Symptoms include:
• Dryness, burning sensations, and irritation in the genital area
• Poor vaginal lubrication during sex, discomfort or pain with intercourse, and impaired sexual function
• An urgent need to urinate, painful urination, or recurrent urinary tract infections (UTIs)
GSM is chronic and progressive. It does not get better over time. However, symptoms can be managed with treatment.
4. Sleep disturbance: The new and different feeling of menopause adds to other psychosocial factors like dissatisfaction, depression, irritability and this affects sleeping patterns and concentration.
5. Mood changes: Anxiety, nervousness, irritability, memory loss and difficulty concentrating.
6. Low back pain with generalized joint aches: Many women complain of this. Estrogen helps to maintain the strength of bones and the decline allows the bones to become more brittle.
Health Screens For menopausal women
Once a woman is 45, she must become aware of other diseases that can mimic menopausal symptoms as well as understand the diseases she’s also at risk of contracting.
- Thyroid Function Tests – can help differentiate thyroid disease symptoms from menopausal symptoms.
- Blood glucose (FBG and HbA1c)- as diabetes, especially associated with PCOS can cause similar symptoms, it is important to screen for type two diabetes as the age of onset begins from 30.
- Blood cholesterol and triglycerides – Estrogen interestingly reduces the risk of hypertension in women. Cardiovascular risk factors such as being overweight or having a sedentary lifestyle must, therefore, be screened immediately a woman enters menopause.
- Cervical screening (Pap smear) and mammograms
- A pelvic scan – may be considered for those women with atypical symptoms.
- Other screenings are selected by the physician based on the complaints. They may include renal function test with serum electrolytes including calcium, liver function tests, a Xray/MRI of the lower back or joints.
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A healthy lifestyle; Stopping smoking, losing weight and limiting alcohol are beneficial. Also, regular aerobic exercise and adequate calcium intake (around 700 mg/day) help.
HRT is the most effective treatment to relieve the symptoms caused by the menopause completely. In addition to relieving hot flashes, it also helps;
●Mood lability/depression – HRT, alone or in combination with an antidepressant
●Joint aches and pains
●Genitourinary symptoms of menopause (GSM) – The epithelial linings of the vagina and urethra are very sensitive to estrogen, and estrogen deficiency leads to thinning of the vaginal epithelium.
●Osteoporosis – Bisphosphonates are best for this, however, in the occasional patient with persistent menopausal symptoms who cannot tolerate first and second-line therapies for osteoporosis, estrogen may be a reasonable option.
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- Cognitive behavioral therapy (CBT) can also be beneficial.
Genitourinary syndrome of menopause (GSM)
Because genitourinary syndrome of menopause (GSM) refers to a number of different symptoms, treatment depends on a woman’s individual situation.
Pain during sex due to vaginal dryness can be alleviated with lubricants, moisturizers, or low-dose vaginal estrogen treatment. Or, if she has urinary problems, she might try pelvic floor physical therapy.
Women who suspect they’re having GSM-related should speak to their doctor. Many women don’t realize that treatments are available, but some symptoms can be easily managed.
Alternatives to HRT
Herbal or complementary treatments
- Phyto-oestrogens are naturally occurring compounds found in plant sources, that are structurally related to estradiol. Foods such as soybeans, as well as nuts, wholegrain cereals and, igbo-ora yam, are the foods most rich in phytoestrogens.
- Sex! Regular intercourse prior to the onset of symptoms may contribute a great deal to the alleviation of menopausal symptoms. Although no studies have been conducted to confirm this, several studies show that intravaginal steroids administration was able to rapidly and efficiently achieve correction of all the signs and symptoms of vaginal atrophy, improve sexual function and caused no or minimal changes in serum sex steroid levels, guess what? All these steroids are abundant in the male semen!