We all know what menopause is, and for those who do not know: menopause is a natural process of the female body, it occurs when the ovaries stop producing hormones, which means that when menopause is established as part of the life of a woman, she will stop having her period and, therefore, can no longer get pregnant. No longer having the period after a life suffering the pain that it brings with it sounds wonderful that it simply stops, doesn’t it?
However, the moment the menopause symptoms begin to manifest, you will most likely prefer to take a trip back to your youth, when you did not have to worry about the fact that your body goes from choking to chill and that your mood can change from happiness to bitterness in a single second and without any specific reason.
Cause
Menopause is when the menstrual cycle of a woman ends indicating that bearing a child is no longer possible. Menopause is defined as the occurrence where a woman hasn’t had menstrual bleeding for a year. Menopausal transition usually commences between the ages of 45 and 55, however, this age range can vary.
Menopause can occur naturally but, in some cases,, they are induced.
Natural menopause
In the natural occurrence of menopause, as the woman ages, there is a decline in the production of reproductive hormones viz. estrogen[1], progesterone[2], testosterone, luteinizing hormone (LH)[3].
Many changes happen during the menopausal phase of which the primary is the loss of ovarian follicles that are responsible for producing and releasing eggs that lead to either menstruation or pregnancy.
Age
The onset of menopause begins around the mid to late 40s, with infrequent menstrual cycle accompanied by longer and heavier blood flow. Most women in the United States attain menopause by the age of 52.
The average age at which menopause occurs is 51 though it has been observed that for African-American and Latina women, the onset is earlier at an age of 49.
Menopause symptoms are mostly observed about four years prior to a woman’s last period. However, a lesser percentage of women experience these symptoms for about 10 years before the actual onset of menopause.
These symptoms usually persist for up to four years after a woman’s last period for most women and up to 12 years for 0.1% of the women population.
Primary Ovarian Insufficiency or premature menopause is when women before the age of 40 attain menopause. However, this is seen in only about 1% of women.
5% between the ages of 40 and 45 experience menopause, also known as early menopause.
Induced menopause
Induced menopause occurs as a result of surgical removal of ovaries (oophorectomy), pelvic radiation, a pelvic injury that damages the ovaries, or radiotherapy.[5]
Symptoms
Menopause symptoms vary from one woman to the other. The common signs and symptoms of menopause include the following[6]:
- Symptoms associated with the uterus and vagina
- Irregular periods
- Symptoms associated with mood and memory
- Depression
- Inability to concentrate
- Forgetfulness
- Other physical symptoms include insomnia, hot flashes, painful intercourse, chills, and night sweats. The other symptoms include weight gain, dry skin, and increased urination. You might also suffer from headaches, UTI (Urinary tract infections)[7], joint stiffness, hair thinning and increase hair growth.[8]
Long term impediments
Long term complications that can occur during menopause include the following:
- Vulvovaginal atrophy
- Osteoporosis
- Cataracts
- Urinary incontinence
- Heart diseases
- Periodontal disease
Menopause phases
Perimenopause
Perimenopause is the phase that occurs prior to menopause. In this phase, the hormones start to change in preparation for the oncoming menopause. Irregular periods and changes in flow are observed in perimenopause.[9]While this can last anywhere between months to several years, some women skip perimenopause entire and enter their menopause phase.
Stages of the reproductive aging workshop (STRAW) simplified to show the relevant stages and ages that precede the final menstrual period (FMP). MT, menopausal transition. The speed bump sign indicates the transition period from early to late MT, which is typically associated with an increase of the commonly observed menopausal symptoms: hot flashes, poor sleep, adverse mood, and vaginal dryness.[10]
Menopause
Menopause is when a woman has not experienced menstruation for one complete year
Postmenopause
The years following the menopause is referred to as Postmenopause.
Diagnosis
- PicoAMH Elisa diagnostic test is a blood test – approved by the FDA – helping determine whether a woman has entered or is about to enter the menopause phase.[11]
- Blood tests that measure FSH and Estradiol levels are also used to diagnose menopause. Elevated FSH levels with an absence of menstruation for a year, is the usual confirmation of menopause.
- Additional tests that can be done to confirm menopause includes:
- Thyroid function tests
- Blood lipid profile
- Kidney function tests[12]
Treatments
Menopause is a natural process and usually does not require any kind of medication. However, if the symptoms are severe and interfering with daily life quality, treatment may be required.
Some of the medications used to treat menopause symptoms include
- Topical minoxidil 5%, for hair thinning
- Eflornithine hydrochloride topical cream that helps avoid hair growth
- Prophylactic antibiotics for UTI[13]
Menopause symptoms can also be managed by:
- Wearing light clothing for hot flashes. Having portable fans can also help relieve the symptoms if experienced on the go.
- Exercising for up to 30 minutes a day and reducing calorie intake can help boost energy and improve mood.
- Taking supplements rich in Magnesium, Calcium and Vitamin D can help reduce the risk of osteoporosis.
- Yoga and meditation can help relax the body.
- Dry skin can be treated using skin moisturizers.
- Sleep medications or sleeping aids can be used to increase the quality of sleep and thus prevent insomnia.
- Exposure to smoking and alcohol can increase the severity of the symptoms. Limiting alcohol intake and avoiding smoking can help to keep the symptoms at bay.
- Natural supplements like Soy, Vitamin E and Flax seeds also help limit menopause symptoms[14]
If any of the menopause symptoms persist, it is best to meet a doctor and get advice on the same. Similarly, feelings of depression and anxiety are common during menopause. Do not hesitate to consult a therapist or a psychologist to discuss these changes.
Communicating with close friends and family will also help them know how to support you during this phase.[15]
Summary
Menopause marks the end of fertility in a woman, which usually happens by mid-50s.
Symptoms experienced during menopause include hot flashes, weight loss, hair thinning, and palpitations. Symptoms can persist for years after menopause has occurred. There are medications that can help relieve the symptoms. Additionally, lifestyle changes can also promote a healthy living.
[1] Keating NL, Cleary PD, Rossi AS, Zaslavsky AM, Ayanian JZ. Use of hormone replacement therapy by postmenopausal women in the United States. Ann Intern Med. 1999;130:545–553. [PubMed]
[2] Williams C L, Stancel G M. Elmsford, Oxford: Pergamon Press; 1996. Estrogens and Progestins; pp. 1411–1440. [Google Scholar]
[3] https://www.ncbi.nlm.nih.gov/books/NBK539692/
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660717/
[5] ACOG Committee on Practice Bulletins- Gynecology. ACOG practice bulletin no. 89. Elective and risk-reducing salpingo-oophorectomy. Obstet Gynecol. 2008;111(1):231–241. [PubMed]
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722518/
[7] https://www.gov.uk/government/publications/urinary-tract-infection-diagnosis
[8] Santoro N., Epperson C.N., Mathews S.B. Menopausal Symptoms and Their Management. Endocrinol. Metab. Clin. N. Am. 2015 doi: 10.1016/j.ecl.2015.05.001. [PMC free article] [PubMed] [CrossRef]
[9] Guthrie JR, Dennerstein L, Taffe JR, Donnelly V. Healthcare-seeking for menopausal problems. Climacteric 2003;6:112–117 [PubMed] [Google Scholar]
[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834516/
[11] https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-diagnostic-test-aid-determination-menopausal-status
[12] https://europepmc.org/article/med/10936902
[13] https://europepmc.org/article/med/6310460
[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890704/
[15] Guthrie JR, Dennerstein L, Taffe JR, et al. Health care-seeking for menopausal problems. Climacteric. 2003;6:112–117. [PubMed] [Google Scholar]