MENOPAUSE AND SYMPTOMS OF MENOPAUSE

Menopause is a natural biological process. Every woman living on earth goes through it about the age of 45-55, the average being 51. When a woman stops having periods for at least 12 months it is called menopause. The period before this time also shows changes in our menstrual patterns being irregular in timing and amount, this is called Peri Menopause or Menopause Transitionor or Climactric a Greek word meaning 7.  This can often last for 6-7 years or some women may skip this phase. The menopause happens because our ovaries stop to function.  They no longer have any eggs left over to mature, we are born with a set number of eggs, when they finish, and that is it. Sometimes they finish when a woman is still very young say 30, then it is called premature ovarian failure or insufficiency or even premature menopause. Besides this natural menopause, it can be surgical, if a woman has a hysterectomy then no more periods. If the ovaries are removed at the same time the menopausal symptoms can be intense as they are sudden. Radiotherapy and chemotherapy can also cause menopause because of its effects on the ovaries.

Menopause is not a disease or a syndrome but once we are caught into it we are there forever. It is amazing how many women suffer from the effects of menopause in different phases of their lives, there is no coming back ,no artificial lens that can be implanted; like in your eye. Although some new research is being started in this area. The number of menopausal women is expanding exponentially. In 1990 there were 467 million (M) women worldwide, 47M new entrants each year, it is estimated  that by 2030 there will be 1.2 billion postmenopausal women. Although menopause is not a disease as already mentioned, it can cause innumerable problems in most women. Imagine the health cost to women herself and international health systems.

As mentioned the symptoms of menopause start long before true menopause sets in women start having irregular menstrual cycles, heavy periods or too little bleeding. Other causes of abnormal uterine bleeding such as fibroid cancer, pregnancy problems have to be ruled out.

Different women respond to menopause in different ways about 20% women do not suffer at all why we do not know?

Hot flush or flash is the main bother some symptom, along with anxiety lack of sleep, dizziness, fatigue, mood swings, weakness, and heart palpitations. Hypothalamus is a key nerve centre in the brain secretes, FSH LH under feedback from oestrogens, it controls the body functions, such as body temperature, metabolism, sleep, mood and stress response. Reduced ovarian function leads to impending peri menopause and menopause leads to decreasing oestrogen levels, irritates the neuroreceptors and hypothalamus. It goes into overdrive and secrets more FSH and LH hormones; this in turn sends signals to the blood vessels of the skin to dilate.  The increased blood flow through the skin raises the local temperature and woman get a hot flush/flash. It starts at the chest and spreads over the face, head and neck, and gives a feeling of hot a flush or flash, not only that the face appears flushed. The body temperature drops by a few degrees. There is a feeling of chill. The bodies stress response takes over. The adrenal gland relieves, adrenalin which constricts the blood vessels, hot flush/flash goes away. Hot flush and night sweats are an integral part of menopause and peri menopause. Often when hot flush  occurs during the night cold sweats occur following this, one may not notice the hot flush in your sleep, as much as you notice ,drenching cold sweats .However they are the part of the same activity. Hot flushes vary in different women.  They can undermine a woman’s confidence and if you are in a position of power and start happening at an in appropriate moment it can be very embarrassing. Fatigue can be a part of hot flashes, lack of sleep. Mood swings also happen, irritability starts as the ovaries fail there is irregular ovulation as a result women have irregular periods and can be very heavy, or very light. During this time the risk of pregnancy is still there, so take adequate care. I have discussed this in my previous blog. Menstrual cycles frequent become infrequent and then stop. If a woman has had no period for 12 months she is menopausal. During this time other causes of abnormal bleeding should be excluded such as, fibroids, polyps, cancer, and bleeding disorders.

Muscle and Joint Aches and Pains

With the decrease of oestrogen muscles and ligaments which connect our joints, lose their elasticity and strength as a result we start getting aches and pains. At the same time many of us start getting arthritis and may be osteoporosis (This is also a result of Menopause) all this together makes life painful and limiting. A lack of oestrogen, physical activity, obesity, can aggravate these symptoms.

Formication

Meaning a feeling of insects crawling under your skin is another strange feeling many menopausal women get. This is due to the changes in the blood vessels. Other symptoms women feel are tingling in the ears, dizziness, painful cramps in the legs and a bloated feeling. As at menopause there is more testosterone as compared to oestrogens, some women get acne, and mild hairiness. Elasticity of the skin decreases, the skin gets wrinkles and dryness. Some women get a male type of baldness.

As menopausal years progress, the symptoms of a dry vagina, frequency of urination and urinary incontinence increases; so are the psychosexual problems. This group of problems are now given a specific name of genitourinary syndrome. This is due to lack of oestrogens, the vagina losing its elasticity, and gets repeated infections. These can partly be due to lack of testosterone as well.  Emotional disturbances at this time are also common. This could be due to lack of oestrogens, as at other times of lacking oestrogen, women suffer these symptoms such as post partum and premenstrual. These feelings can also be due to stresses of life such as problems with children, parents, personal stress due to work, partner’s problems, divorce and separation. These are common and happen in almost 50 % of the population. Loss of self confidence, changing body shape, weight gain, and wrinkles worry many women; particularly women in upper socioeconomic groups. Loss of memory, forgetfulness also often happens; oestrogen alone cannot be blamed for this as this happens to men as well. Three main long term effects of menopause are increased risk of heart disease, osteoporosis and genitourinary syndrome.

In summary, menopause is not a transitory phase in your life; as it happens due to lack of oestrogen which continues forever. You cannot ever have a baby unless there is some freak anomaly. Menopausal symptoms are many and varied. The most important are hot flushes / flashes, dry vagina causing genitourinary syndrome, psychosexual, some alteration in brain activity e.g: forgetfulness, depression.  There is no conclusive evidence that oestrogen deficiency causes these symptoms, although many women claim that HRT helps them. The health of a woman’s skin, heart and bones, is related to her oestrogen levels and any other associated health problems. These menopausal like symptoms can occur for many other reasons. They should be excluded before HRT is started. The symptom of menopause is not a universal experience for all women. I will discuss the management of these problems in my next blog.