MENOPAUSE

Dr Tariq Jagnarine
Family 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. World Menopause Day is observed every year on the 18th of October. The purpose of the day is to raise awareness of menopause and the support options available.
Menopause usually starts between the ages of 40 and 58 in developed countries, where the average age is 51. For some, it will occur earlier, due to a medical condition or treatment, such as removing 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 and changes in mood. 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 would 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 healthy diet and 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.

STAGES OF MENOPAUSE:
• Perimenopause is the transitional time that starts before menopause, and includes the 12 months that follow a person’s last period.
• Menopause starts 12 months after the last period, or when menstruation has stopped for a clinical reason, such as the removal of the ovaries.
• Post-menopause refers to the years after menopause, although it can be difficult to know when menopause finished and post-menopause starts.

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 a woman has approached the end of the reproductive stage, 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. In addition, 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.
• 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. While feelings of sadness, irritability, and tiredness are common during menopause, they do not necessarily indicate depression. Research 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.
• Physical changes
Various physical changes can develop around the time of menopause.
• A build-up of fat around the abdomen
• Weight gain
• Changes in hair colour, texture, and volume
• Breast reduction and tenderness
• Urinary incontinence
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. Use of vitamin D supplements is recommended, along with eating more calcium-rich foods to maintain bone strength.
• Cardiovascular disease: The American Heart Association (AHA) notes that, while a decline in oestrogen 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 the hormonal changes involved appear to increase the risk.
• Skin changes can also occur around the time of menopause.

LIFESTYLE TIPS
Tips for managing the challenges of menopause include:
• Getting regular exercise.
• Practising relaxation and deep breathing exercises.
• Having a healthful diet that includes 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.
• Doing 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.
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, in order 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.