Fam Medicine, Endocrinology/Diabetes
Natural menopause is the spontaneous, permanent ending of menstruation that is not caused by any medical treatment. Menopause is a normal, natural event. It’s defined as the final menstrual period, and is confirmed when a woman has not had her period for 12 consecutive months.
PHYSICAL CHANGES
Various physical changes can develop around the time of menopause. People may experience:
* Excess fat around the abdomen
* Weight gain
* Changes in hair colour, texture, and volume
* Breast reduction and tenderness
* Urinary incontinence
However, the link between these changes and menopause is not always clear. Some may occur independently at the same time as the transition, and age and lifestyle can also play a role.
INCREASED RISK OF SOME HEALTH CONDITIONS
After menopause, the risk of certain health issues appears to increase. Menopause does not cause these conditions, but the hormonal changes involved may play some role.
* Osteoporosis: This is a long-term condition in which bone strength and density decrease. It is recommended that vitamin D supplements be taken and more calcium-rich foods be eaten to maintain bone strength.
* Cardiovascular disease: The American Heart Association (AHA) notes that, while a decline in estrogen due to menopause may increase the risk of cardiovascular disease, taking hormone therapy will not reduce this risk.
* Breast cancer: Some types of breast cancer are more likely to develop after menopause. Menopause does not cause breast cancer, but hormonal changes involved appear to increase the risk.
Skin changes can also occur around the time of menopause.
DIAGNOSIS
Menopause is not an illness, but many people benefit from seeing their doctors when menstruation ends.
Health care providers can confirm whether the reason for the changes is perimenopause or menopause by asking questions. They may also test hormone levels and perform other analyses of the blood and urine to rule out health issues. No test, however, can conclusively indicate that menopause has begun.
TREATMENT
Menopause is not a health problem, but a natural transition. However, it can involve unwanted physical and mental changes. Anyone who has concerns about these changes should seek medical advice:
* Hormone therapy
This treatment helps balance the body’s hormone levels by providing supplemental estrogen and a synthetic version of the hormone progesterone. Hormone therapy comes in various forms, including skin patches and topical creams. It can help reduce the occurrence of hot flashes and other menopausal symptoms.
However, using it may increase the risk of developing certain diseases and health conditions. A person should not use hormone therapy if they have risk factors for the following health problems, or if they have a personal or family history of these issues:
* Heart disease
* Blood clots
* High levels of triglycerides in the blood
* gallbladder disease
* Liver disease
* Stroke
* Breast cancer
* Other treatments
A person may find that the following can also help relieve symptoms:
* Over-the-counter gels and other products for vaginal dryness
* Prescription pills, creams, and rings for vaginal dryness
* Low-dose hormonal birth control pills for hot flashes, vaginal dryness, and mood changes
* Low-dose antidepressants for hot flashes, even among people who do not have depression
LIFESTYLE TIPS
Tips for managing the challenges of menopause include:
* Regular exercise
* Practising relaxation and deep breathing exercises
* Health diets that include plenty of fresh fruits, vegetables, and whole grains
* Quitting smoking and avoiding second-hand smoke
* limiting the intake of alcohol
* Seeking counselling for anxiety, mood changes, and relationship concerns
* Establishing good sleeping habits, and getting plenty of rest
* Kegel exercises to strengthen the pelvic floor
* Talking to friends and family about the experience of menopause
* Exploring new ways of enjoying intimacy with a partner
* Joining a club, volunteering, or taking up a new hobby.
KEEPING AN ACTIVE SEX LIFE
Menopause can reduce a person’s sex drive and lead to vaginal dryness, but it also removes the need for birth control. For some, this can make sex more enjoyable. Having sex often can increase vaginal blood flow and help keep the tissues healthy.
Some tips for maintaining sexual health and activity during menopause include:
* Staying physically active
* Avoiding tobacco products, recreational drugs, and alcohol
* Taking the time to become aroused, which will improve lubrication
* Kegel exercises to strengthen the pelvic floor
* Not using any strong soaps around the vagina, as these can worsen irritation
Also, menopause symptoms lead some people to find satisfying forms of sex that do not involve the vagina as much or at all.
It is worth remembering that, while a woman cannot become pregnant once menopause starts, it is still important to use barrier protection during penetrative sex to protect against sexually transmitted infections. Often, sexual partners will be getting older, and may be experiencing menopause at the same time. They, too, may be feeling a drop in sex drive. Opening up about any concerns can help both partners feel better, and explore new forms of intimacy.
For many people, menopause is not the only transition that occurs during middle age. Changes in relationships and work or home life — such as children moving away — can also have a significant impact. When more than one of these changes occurs in a short period, it can feel overwhelming.
However, many people live active, healthy lives throughout menopause, and for many decades afterward, and midlife can often be the start of a new chapter.
