Dr Tariq Jagnarine
Fam Medicine, Endocrinology/Diabetes
Menopause is a transition into a new phase of life. It begins when the menstrual cycle finishes. Menopause is not a health problem, and some experience it as a time of liberation. However, hormonal changes and other factors involved can cause discomfort. Menopause usually starts between the ages of 40 and 58 years in developed countries, where the average age is 51 years. For some, it will occur earlier due to a medical condition or treatment, such as the removal of the ovaries.
Around the time of menopause, many females experience physical symptoms such as hot flashes, night sweats, vaginal dryness, and a reduced sex drive. It can also lead to anxiety, changes in mood, and a reduced sex drive. These symptoms may start before menstruation ends, and they can last for several years. The impact on a person’s quality of life can range from mild to severe. However, there are ways of managing these symptoms.
Each person will experience menopause differently. Many have full, active lives throughout the transition and afterward, and some feel relieved by no longer having to deal with menstruation or birth control. Maintaining a healthful diet and getting regular exercise can help a person feel better and boost their overall health in the long term. For those who experience menopause symptoms, treatments and support are available.
It can last for several years, and there are three stages:
• Perimenopause is the transitional time that starts before menopause and includes the 12 months that follow a person’s last period.
• Menopause starts either 12 months after the last period or when menstruation has stopped for a clinical reason, such as the removal of the ovaries.
• Postmenopause refers to the years after menopause, although it can be difficult to know when menopause finishes and postmenopause starts.
CAUSES
Menopause is a stage in life, not an illness. Most women experience natural menopause during midlife. However, surgery and other factors can cause menopause to start earlier.
• Natural menopause
A female’s reproductive years last from puberty to menopause — from one natural transition to another.
Toward menopause, the levels of the hormones estrogen and progesterone in the body fall because they are no longer necessary to support reproduction. These changes trigger menopause.
• Surgery and treatment
If a person undergoes surgery to remove their ovaries (hysterectomy), they will experience menopause. If this happens before middle age, this may be referred to it as “early menopause.”
• Medically Induced
Some treatments, such as chemotherapy and radiotherapy, can cause the ovaries to stop working either temporarily or permanently. The likelihood of this happening depends on the person’s age and the type and location of the treatment. A person who experiences menopause because of a clinical treatment will experience the same symptoms as a person who experiences natural menopause. However, the symptoms may appear more abruptly, because the physical change is more sudden. A person may also experience sadness or depression about an early loss of fertility.
• Premature menopause
Some people experience menopause earlier than others for reasons other than medical interventions. Menopause is considered to be “premature” if it develops before the age of 40 and “early” if it starts between the ages of 40 and 45. Early menopause naturally occurs in around 5% of females.
Sometimes, menopause develops early if a person has:
• A genetic condition that affects the chromosomes, such as Turner’s syndrome
• An autoimmune disease
• An infection, such as tuberculosis, malaria, or mumps
SIGNS AND SYMPTOMS
Around menopause, various physical and mental changes can occur, causing symptoms. Some of these start before menopause, and some continue after it.
The changes involved in perimenopause and menopause include:
• Lower fertility
As female approaches the end of the reproductive stage, but before menopause begins, estrogen levels start to fall. This reduces the chances of becoming pregnant.
• Irregular menstruation
The first sign that menopause is approaching is usually periods occurring less regularly. They may come more or less frequently than usual, and they may be heavier or lighter.
• Vaginal dryness and discomfort
Vaginal dryness, itching, and discomfort may start during perimenopause and continue into menopause. A person with any of these symptoms may experience chafing and discomfort during vaginal sex. Also, if the skin breaks, this can increase the risk of infection.
Atrophic vaginitis, which involves thinning, drying, and inflammation of the vaginal wall, can sometimes occur during menopause.
Various moisturizers, lubricants, and medications can relieve vaginal dryness and associated issues.
• Hot flashes
Hot flashes are common around the time of menopause. They cause a person to feel a sudden sensation of heat in the upper body. The sensation may start in the face, neck, or chest and progress upward or downward.
A hot flash can also cause:
• Sweating
• Red patches to form on the skin
Some people experience night sweats and cold flashes, or chills, in addition to or instead of hot flashes. Hot flashes usually occur in the first year after menstruation ends, but they can continue for up to 14 years after menopause.
• Sleep disturbances
Sleep problems can arise during menopause, and they may stem from:
• anxiety
• night sweats
• an increased need to urinate
Getting plenty of exercise and avoiding heavy meals before bedtime can help with managing these issues, but if they persist, contact a healthcare provider.
• Emotional changes
Depression, anxiety, and low mood are common during menopause. It is not unusual to experience times of irritability and crying spells. Hormonal changes and sleep disturbances can contribute to these issues. Also, a person’s feelings about menopause may come into play. For example, distress about low libido or the end of fertility can contribute to depression during menopause.
An published in 2018 suggests that there may, in some cases, be a link between menopause and suicide.
• Trouble focusing and learning
In the lead-up to menopause two-thirds of women may have difficulty with concentration and memory.
Keeping physically and mentally active, following a healthful diet, and maintaining an active social life can help with these issues. For example, some people benefit from finding a new hobby or joining a club or a local activity.
