What is Menopause?
Menopause – this occurs when the monthly periods stop. If a woman has not had her menopause for one year, she is than said to have reached menopause.

Menopause will occur to every woman. The usual age of menopause is around 50 years, with a range from 45 years to 55 years. Menopause can occur early in some instances such as in women with a family history of early menopause, those who smoke and those who have undergone chemotherapy or radiotherapy for any kind of cancer. Women who have had both their ovaries taken out also reach menopause. If one ovary is left behind, this ovary functions as a normal ovary and she will continue producing her hormones till the normal age of menopause.

Normal female organs and how they are situated inside a woman

Many women undergo a hysterectomy (removal of uterus) for reasons such as fibroids and bleeding. Just removing the uterus alone does not mean that the woman has reached menopause. She will not have monthly bleeding anymore, because her uterus has been taken out, but her ovaries remain and will continue working normally till the age of her menopause.

Menopause occurs when there are no more eggs in the ovary to function any more. Women are born with a certain number of eggs and she is supposed to use all these eggs in her lifetime. She does not produce new ones as time goes on. Every month, when she has her periods, she uses a certain number of eggs, and this goes on till there it is all over. It is these eggs which produce the hormone estrogen. No eggs, no estrogen – MENOPAUSE!

How do I know I am going through menopause?
Women may undergo all sorts of changes in their body when they go through menopause. Even before menopause, when the hormone estrogen is already getting lesser, they might experience certain changes. They may find that their periods are getting more irregular (sometimes the cycles get more frequent and then further apart), they start feeling hot and sweaty mainly over the upper part of their body (hot flushes), their moods get cranky, they feel tired and listless, even a small chore becomes so tiring. They are not themselves at all. Some women are lucky – they may go through menopause without any problems – some are unlucky and have all sorts of problems. It varies woman to woman and one should not compare their problems with their friends and even same family members. This period of time when changes are taking place even before the last period is reached is called “perimenopause”.

Some early symptoms of menopause

It is during perimenopause that many women approach the doctor for help. Sometimes just talking about these problems and knowing that this is just part of the “aging” process may help make the woman feel better. Other remedies such as supplement therapies in the form of vitamins, routine gym or other forms of exercise, changing lifestyles to be less stressful all go a long way in helping cope with menopause.

What do I do if I am having these problems?
Of course, hormone replacement therapy (HRT) would be the best form of treatment. But HRT is always advised along with other forms of therapy such as exercise and lifestyle changes. Everything works hand in hand to get the best results.

HRT is basically a form of treatment where one replaces the lost or decreasing hormones in the body. With menopause, it is the estrogen hormone that gets less, so this is replaced in a small amount, just enough to get everything working well again. However, if a woman has a uterus, another additional hormone called progestin has to be added to minimize problems such as bleeding or thickening of the lining of the uterus. This means that if a woman has had her uterus taken out for some reason or the other, she only needs estrogen hormone replacement therapy.

There are many ways to take the HRT and the doctor would be the best person to advice you. You might have some initial problems such as breast tenderness (which is very normal and not to be alarmed), water retention, headache or even bleeding problems. If there are bleeding irregularities, it is probably because of a missed pill. Otherwise seek advice from the doctor. There are also ways where HRT can be given so that one does not bleed at all.

The scare towards HRT is never ending. There is always some thing or other that makes a woman hesitant to take it. Initially was the fear of breast cancer. The risk of getting breast cancer is very, very, very small. After 4 years of therapy there may be 8 out 10,000 woman who have breast cancer due to HRT. This is compared to the number of women where HRT has given them a quality of life which is not comparable.  One  can get breast cancer even without taking

HRT. Many women forget this and think that it is only HRT that causes breast cancer. These days breast cancer is found, in younger and younger women i.e. women less than 50 years. These women are still having their periods!. So there must be something else which is more worrying as a cause of cancer than HRT.

The next issue with HRT is its effect on the heart. Recently it was reported that the risk of dying of a heart attack increases with HRT use. Again the risk is small and is 8/10000. More importantly, it is felt that every woman should be individualized. If a woman has a strong risk for cardiovascular disease, then HRT is not advised. However if her risk is small and she is facing bad symptoms, and more importantly if she feels that HRT will improve her quality of life, we strongly advice it.

Around the world, the general consensus regarding HRT in view of the latest data has stressed the fact that every woman should be assessed on an individual basis. If she is going through a bad perimenopause stage, she will probably benefit from HRT. However how long one should be on HRT is still being questioned. It is generally felt that 2-3 years is sufficient and by then she is able to take stock of her life and start other measures to make her transition into menopause much easier.

How will I be in my 60’s and 70’s?

Osteoporosis – causing problems with the spine.

At this stage, there would be severe backache. The long term complications of menopause is initially to the bladder and vagina. Infections such as urinary tract infection and vaginal infections increase. She may not be able to hold her urine and may actually ”leak” when she feels the urge to urinate or even cough, and sneeze. Her vagina becomes dry and sex becomes painful She may also have a very low libido. Later the effects are to her bones - “osteoporosis”. This means that her bones are slowly losing the inside matter and over a period of time, she may end up with a bone which is thin and “hollow”. It then becomes very easy to fracture a bone. The commonest areas of fracture are to the spine (even with just a bad sneeze or a cough), wrist (fall on an outstretched hand) or in the worst cases, a fall in the bathroom causing a fracture to the hip.  This  requires  long

treatment usually in the form of surgery and physiotherapy. Women are 3-5 times more likely to fracture their bones than men. Unfortunately it has been shown that around 25% of women die in the first year after a hip fracture. Of the remaining, many will have to forever live with a supporting frame or crutches.

The heart is of course badly affected with menopause. The cholesterol levels increase and the ratio of the bad to the good cholesterol makes it more likely for the woman to have a heart attack after menopause. It is important that she then looks after her diet and does a moderate amount of exercise. Keeping an eye on her cholesterol levels and starting on cholesterol lowering medication if necessary may also help.

The final effect of menopause is to the brain. Memory loss and even Alzheimer’s disease has been connected to the menopause.

Unfortunately, many women regard menopause as “old age” and tend to get depressed about it. There is no necessity for this. Menopause is just a phase in one’s life. Facing it positively is important. Being prepared for menopause is also important as one would then be able to face the changes in a more positive light.

It is important that a woman should have an annual check up with the doctor. This entails taking a detailed history of her problems, a general and systemic examination, including a breast examination. A pap smear should be done every year along with a pelvic ultrasound to rule out fibroids or ovarian cysts. She should also be taught how to examine her breast. A mammogram is recommended every two years unless she has a high risk of breast cancer and has to do it every year. She should also have a bone mineral density test done to make sure her bones are fine. A routine yearly blood test to check on cholesterol, the kidneys and liver is also important.

Self breast examination

The phase after menopause should be regarded a golden phase. Finally one has time for oneself! Look after yourself for this stage in your life and live well to enjoy it!