July 29 2021
The natural cessation of a women’s menstrual cycle is termed as menopause. It marks the termination of the ability to get pregnant and the end of fertility. It is considered as menopause if a woman has not had her period in twelve consecutive months. The onset of menopause is usually between the ages of 45 to 55 but can occur either before or well after this age range. Pelvic injury causing internal organ damage, surgery such as removal of ovaries in hysterectomy, damage to the ovaries during chemotherapy or any underlying genetic conditions may prepone the onset of menopause in some women. Hot flashes and weight gain can be some of the uncomfortable symptoms characteristic of menopause which generally does not require any treatment.
In most women, the first menopausal symptoms gradually start to get noticed around four years before the actual menopausal period. These symptoms may continue to appear even after about four years after the last menstrual cycle. Women are born with a large number of eggs in the ovaries which get released in the absence of fertilisation every month during menstruation. When ovaries no longer release an egg, menstruation ceases and menopause occurs.
Natural menopause is a slow process and consists of the following three stages:
- Perimenopause - The onset of this phase starts gradually several years before the menopause with the slowing down of estrogen production by the ovaries. This stage lasts till menopause. A few women experience some menopausal symptoms from this stage itself as there is a faster fall in the rate of estrogen production. Sometimes, there may be a late or complete absence of a period for a month or two.
- Menopause - This stage occurs after the ovaries have stopped the release of eggs and stop most of the estrogen production. Menopause is said to occur a year after the stopping of the last menstrual cycle.
- Postmenopause - This phase forms the years after menopause. There is a gradual decrease in the symptoms of menopause such as hot flashes.
Symptoms of menopause
The symptoms experienced in menopausal women may vary and the various conditions which can affect the severity and the duration of these symptoms include the health of the ovary or hysterectomy and lifestyle influences like smoking. The most frequently associated early signs of perimenopause are less frequent menstruation, heavier or lighter bleeding than the normal, vasomotor symptoms such as hot flashes, night sweats and flushing.
Other common symptoms that can occur during menopause are insomnia, vaginal dryness, weight gain, depression, anxiety, difficulty in concentrating, memory loss, reduced sex drive, dryness of mouth, skin and eyes, increased frequency of urination, tender breasts, headaches, palpitations, urinary tract infection, decrease in muscle mass, painful and stiff joints, less full breasts, excessive hair loss, increased hair growth on other areas of the body like face, neck, chest and back.
The common complications of menopause are vulvovaginal atrophy, painful intercourse or dyspareunia, slower metabolic reactions, weakening of bones in osteoporosis, mood swings, cataracts, periodontal disease, urinary incontinence and onset of heart disease.
Menopause is a natural phenomenon which occurs in response to several changes in the body such as lower production of estrogen, progesterone, testosterone, follicle-stimulating hormone ( FSH), luteinizing hormone (LH) etc. There is the loss of activity of the ovarian follicles which stop the release of eggs which inturn causes cessation of the menstrual cycle.
In some women, menopause is induced or caused as a result of injury to the pelvis or surgical removal of the ovaries. A few of the common causes of induced menopause include bilateral oophorectomy which is the surgical removal of ovaries, the shutdown of ovarian function or ovarian ablation brought about by hormone therapy, surgery or radiotherapy in women who have estrogen-receptor-positive tumours. It can also be caused by pelvic radiation or pelvic injury that result in damaged ovaries.
Diagnosis of menopause
The PicoAMH Elisa diagnostic test is a breakthrough which is used to determine if or not a woman has entered menopause or is close to entering menopause. This test can also be helpful in the early diagnosis of perimenopause and thus we can prevent the onset of associated conditions like osteoporosis, fracture, heart disease, cognitive degeneration, vaginal dryness, mood swings and loss of libido by timely intervention.
Blood tests that measure the levels of hormones like follicle-stimulating hormone and estradiol can also be used for diagnosing menopause. Presently, consistently elevated follicle-stimulating hormone levels in the body of 30mlU/mL or higher along with a timeline of the absence of a menstrual cycle for a year is confirmed as menopause. Other common blood tests that can be used to confirm menopause are thyroid function tests, blood lipid profile, liver function tests, kidney function tests and chorionic gonadotropin (hCG)tests.
Treatment is warranted if the symptoms are severe and affect the quality of life. Hormone therapy is recommended for the reduction of symptoms like hot flashes, night sweats, flushing, vaginal atrophy and osteoporosis. To treat specific symptoms like hair loss and vaginal dryness, additional medications can be used such as - topical application of minoxidil for prevention of hair thinning, use of anti-dandruff shampoo for hair loss composed of ketoconazole and zinc pyrithione, eflornithine hydrochloride for unwanted hair growth, paroxetine which is a selective serotonin reuptake inhibitor for hot flashes, anxiety and depression, vaginal lubricants composed of estrogen in the form of a cream, ring or a tablet, ospemifene for vaginal dryness, prophylactic antibiotics for the treatment of recurrent urinary tract infection, sleep-inducing medications to treat insomnia, denosumab, teriparatide or calcitonin for the relief of symptoms of postmenstrual osteoporosis.
For minor to moderate symptoms of menopause, lifestyle modifications, home remedies and alternative forms of treatment can be used for symptoms relief. By keeping cool, avoiding heavy blankets at night and by staying comfortable, hot flashes can be managed. Moderate exercise daily for about half an hour can help in increasing energy, provides good quality sleep and improves mood. Stopping smoking and cessation of alcohol may also be beneficial. Other natural remedies like vitamin E, melatonin and flax seeds are found to reduce hot flashes and night sweats. Evening primrose oil supplements by Alvizia healthcare contributes to the symptomatic relief in menopause.