Menopause - Are We Ready for the Transition?

HEALTH COLUMN

Menopause essentially occurs twelve months after a woman's last period. When a woman's follicle-stimulating hormone blood level is consistently elevated to 30 m IU/ml or higher and she has not had a menstrual period for a year, it is generally considered that she has reached menopause. The raised FSH and low estrogen levels appear to cause the characteristic hot flashes. The years leading up to the point when a woman may have changes in her monthly cycles, hot flashes or other symptoms are called the menopause transition phase or perimenopause.

Some women do not have any trouble with menopausal symptoms and may feel relieved when they no longer need to worry about painful periods or getting pregnant. For other women, the menopausal transition may be very difficult with moodiness, irritability, depression, hot flashes etc. The menopausal transition most often begins around 42 to 47 years. Menopause can also be triggered surgically by the removal of the uterus and the ovaries on account of certain diseases. The best way to cope with menopause is to visit a doctor and take his/her advice as we all need to rule out other causes of illness.

The symptoms of menopause are varied. These include:

1. A change in the menstrual period - The woman's period can be shorter or longer, irregular, and bleeding may be more or less than usual. There may be spotting in between.

2. Hot flashes - A hot flash is a sudden feeling of heat in the upper part or all of the body. The face and neck may become flashed. Red blotches may appear on the chest, back and arms. Heavy sweating and cold shivering can follow. Most hot flashes last between 30 seconds and 10 minutes.

3. Bladder control - One may have a sudden urge to urinate or urine may leak during exercise, sneezing or laughing.

4. Sleep - Many women start having trouble getting a good night's sleep.

5. Vaginal health and sexuality - After menopause, the vagina may become drier which can make sexual intercourse uncomfortable

6. Mood changes - Women become moodier and more irritable around the time of menopause. Scientists feel stress, growing children, aging parents, etc. may cause mood changes.

7. Weight gain, dry skin and hair loss - Women seem to gain weight around this time and start hating their bodies. It brings in depression. The skin becomes dry and the woman starts losing her hair.

When to see a doctor: We should always keep up with regular visits with our doctor for preventive health care and any medical concerns. So menopause is no different. Whether or not we have a symptom, it's recommended to visit a gynac once menopause sets in. Most women require counselling and assurance from the doctor to overcome the stress of menopause. Along with this the doctor initially prescribes some herbal remedies and supplements like black cohosh, red clover, evening primrose oil, maca, soy, flax seeds, ginseng etc. Menopause is a natural process with treatments that focus on symptomatic relief. Vaginal dryness is treated with topical lubricants or estrogens. Medications can reduce the frequency and severity of hot flashes. In special circumstances, oral hormone therapy becomes the first line of treatment.

Role of hormone therapy: Achieving good quality of life is a prime target in menopause. Medicine is as important as counselling. There is no argument that hormone therapy (estrogen or estrogen with progestin) is the first choice and best modality to improve the quality of life and sexuality in symptomatic postmenopausal women. Like all medicines, HT needs to be used appropriately. Cardiovascular events, thrombo embolism and breast cancer are some serious adverse reactions of HT. HT in women aged 50-59 years does not increase the risk of coronary heart disease (particularly in otherwise healthy women if used for less than five years). It is currently believed that overall, the risk of long-term (more than five years) use of HT outweighs the benefits. Therefore the physician always has to weigh the potential benefits and risks of treatment.

Other medications: Sometimes, local vaginal estrogen, low-dose antidepressants, gabapentin, clonidine, vitamin D, vitamin E etc. are used. Sometimes plant estrogen called Phyto estrogens are also used by doctors.

I would like to conclude in the words of a post-menopausal woman, "I don't have hot flashes, I have short, private vacations in tropical-like conditions."

Dr. Shobhasmita Borthakur

Senior Medical Officer

Obstetrics and Gynecology

Dhirenpara Hospital

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