Menopause: What to expect

FOR most women, menopause, often referred to as “the change of life”, is the end of a journey. It signals a permanent end to a woman’s reproductive years. And, while many women anticipate these new adjustments to their lives, consultant obstetrician-gynaecologist at ICON Medical Centre, Lady Musgrave Road, Dr Keisha Buchanan, said that there are also some not-so-pleasant side effects of menopause.

Not to worry, though, she advises that they can be managed.

“Menopause is the cessation of the menstrual periods for one year — the average age being 51.5 years. However, it may be premature, occurring prior to 40 years old, which may be due to the ovaries prematurely failing to produce the sex hormones and ovulating as a result of some medication, conditions such as chemotherapy, or due to surgical removal of the ovaries such as in the treatment of ovarian cancer,” Dr Buchanan explained.

“To be certain that one has entered menopause, the period would have stopped for 12 months or longer. If the period returns prior to that it means menopause is not present, which also means that, while your fertility may have declined with your age, there is always the small risk of pregnancy as eggs may be present in the ovary and ovulation may still occur,” Dr Buchanan underscored.

She noted further that the climacteric, which describes the period of life when fertility and libido are in decline, may be six to eight years before the onset of menopause or the last period. These, Dr Buchanan said, may be marked by the onset of hot flushes, mood swings and irregular periods, for example.

“Along with the cessation of menses, there are hot flushes which are caused by the low levels of sex hormones, especially oestrogen. Hot flushes are the sudden onset of a feeling of heat within the body, palpitations, dizziness, the face may also look flushed, and excessive sweating may occur. It generally lasts for less than five minutes and reoccurs throughout the day, sometimes for no apparent reason, while at other times it may be because the woman becomes emotionally upset,” Dr Buchanan said.

Sometimes, too, hot flushes may manifest alongside other symptoms which can make menopause much more uncomfortable for women. Dr Buchanan said commonly it presents with other symptoms such as insomnia, which may trigger mood swings, irritability and, at times, depression and anxiety.

Below is a list of other symptoms — many of which Dr Buchanan has linked to a reduction in hormones such as oestrogen — that you may want to be on the lookout for as you make your journey towards menopause.

1. One of the common changes that many women will see in their bodies is dryness. “The eyes, as well as the skin, will become much drier. In the case of the skin, this happens over time and results in a decrease in its elasticity,” Dr Buchanan said.

2. Not only do the eyes and skin get dry during menopause, but vaginal dryness is a common feature as well. “The lack of oestrogen in the vagina may result in vaginal dryness and irritation and discomfort during sex and increased vulnerability to infections. Shrinking in the vaginal orifice may happen after several years of menopause, making intercourse more uncomfortable,” Dr Buchanan said.

3. As fertility wanes, one common characteristic will be the reduction in the sex hormone levels, oestrogen in particular. Oestrogen is often only highlighted for its contribution to the reproductive cycle, but it also has an important function in protecting the heart. With a reduction in its production, Dr Buchanan said that within 10 years following menopause the risk of heart disease in a woman may parallel that in men.

4. Your metabolism increasing or decreasing may result in weight loss or weight gain, respectively.

5. Hormones such as oestrogen are also important to the hair, nails and skin. With them on the decline, women may also experience hair thinning, including in the pubic region; this, however, varies in each woman.

6. “Some women may have stress urinary incontinence over time due to the lack of oestrogen on the pelvic supports,” Dr Buchanan said. She said that this may result is an involuntary loss of urine on coughing or lifting heavy objects, for example.

7. A decrease in the bone mineral density may occur and this increases the risk of fractures.

While the prognosis may seem a little daunting, Dr Buchanan said that there are a number of lifestyle, dietary and medical adjustments that you can include to make the process less of a burden.

“The changes in menopause are not all bad, as many women go through menopause without feeling any or just a few of these changes, or may have these changes temporarily that resolve on their own or with treatment. The fact that the chances of pregnancy are virtually gone causes the woman to have more sexual freedom without the fear of pregnancy,” Dr Buchanan said.

Among some of her recommended changes are:

1. Exercise at least three times per week for 40 minutes or more. “Weight-bearing exercises can help to prevent osteoporosis (thinning of the bones). You should also add supplemental calcium and Vitamin D in the diet, which can help to prevent osteoporosis and consider doing a bone mineral density test which can assess for the presence of osteoporosis,” she said.

2. “Dietary changes including the consumption of phyto-oestrogens can help to decrease hot flushes,” Dr Buchanan added. She also noted that herbs such as black cohosh and evening primrose may help to alleviate hot flushes.

3. Low dose antidepressants can treat hot flushes, such as the category of drugs called the selective serotonin reuptake inhibitors (SSRIs). These have to be prescribed by your doctor.

4. Treatments such as hormone replacement therapy may help to manage hair thinning.

5. Vaginal water-based lubricants or Premarin vaginal cream can improve vaginal dryness.