Dr Dulcy deals with menopause

IT MAY OCCUR AS EARLY AS AGE 30 OR AS LATE AS AGE 60 Many of the signs, symptoms associated with these changes are temporary.

Menopause is defined as the absence of menstrual periods for 12 months. It is the time in a woman’s life when the function of the ovaries stops. It does not occur overnight, but rather is a gradual process. This so-called perimenopause transition period is a different experience for each woman.

The average age of menopause is 50 years old, but menopause may occur as early as the 30s or as late as the 60s.

There is no reliable lab test to predict when a woman will experience menopause. Contrary to popular belief, the age at which a woman starts having menstrual periods is not related to the age of menopause onset.

Although it also ends fertility, you can stay healthy, vital and sexual. Some women feel relieved because they no longer need to worry about pregnancy. Even so, the physical symptoms, such as hot flashes and emotional symptoms of menopause, may disrupt your sleep, lower your energy or for some women, trigger anxiety or feelings of sadness and loss.

Many effective treatments are available, from lifestyle adjustments to hormone therapy. Starting at perimenopause, schedule regular visits with your doctor for preventive healthcare and any medical concerns. Continue getting these appointments during and after menopause. Preventive health care can include recommended screenings at menopause, such as a colonoscopy, mammography, lipid screening, thyroid testing if suggested by your history and breast and pelvic exams. Always seek medical advice if you have bleeding from your vagina after menopause.

Signs and symptoms of menopause are usually enough to tell most women that they’ve started the menopausal transition. If you have concerns about irregular periods or hot flashes, talk to your doctor. Further evaluation may be necessary.

1. SYMPTOMS

In the months or years leading up to menopause (perimenopause), you might experience these signs and symptoms: Irregular periods. Vaginal dryness. Hot flashes. Night sweats. Sleep problems. Mood changes.

Weight gain and slowed metabolism. Thinning hair and dry skin. Loss of breast fullness. It’s possible, but very unusual, to menstruate every month right up to your last period. More likely, you’ll experience some irregularity in your periods.

Skipping periods during perimenopause is common and expected. Often, menstrual periods will occur every two to four months during perimenopause, especially one to two years before menopause.

Pregnancy is still possible, though, during perimenopause.

2. CAUSES

Natural decline of reproductive hormones. As you approach your late 30s, your ovaries start making less oestrogen and progesterone, the hormones that regulate menstruation, and your fertility declines. In your 40s, your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent; until eventually on average by age 51 you have no more periods.

Hysterectomy. A hysterectomy that removes your uterus but not your ovaries (partial hysterectomy) usually doesn’t cause immediate menopause. Although you no longer have periods, your ovaries still release eggs and produce oestrogen and progesterone. But surgery that removes both your uterus and your ovaries does cause menopause, without any transitional phase. Your periods stop immediately and you’re likely to get all the menopausal signs and symptoms. Chemotherapy and radiation therapy. These cancer therapies can induce menopause, causing symptoms such as hot flashes during or shortly after the course of treatment. The stopping of

menstruation after chemotherapy is not always permanent, so birth control measures may still be needed. Primary ovarian insufficiency. About 1% of women experience menopause before age 40 (premature menopause). Menopause may result from primary ovarian insufficiency – when your ovaries fail to produce normal levels of reproductive hormones – stemming from genetic factors or autoimmune disease. But often no cause can be found. For these women, hormone therapy is typically recommended at least until the natural age of menopause in order to protect the brain, heart and bones.

After menopause, your risk of certain medical conditions increases. Examples include:

Heart and blood vessel (cardiovascular) disease. When your oestrogen levels decline, your risk of cardiovascular disease increases.

Osteoporosis. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Postmenopausal women with osteoporosis are especially susceptible to fractures of their hips, wrists and spine. Urinary incontinence. As the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence). You may also have urinary tract infections more often. Strengthening pelvic floor muscles with Kegel exercises and using a topical vaginal oestrogen may help relieve symptoms of incontinence. Sexual function. Vaginal dryness from decreased moisture production and loss of elasticity can cause discomfort and slight bleeding during sexual intercourse. Also, decreased sensation may reduce your desire for sexual activity (libido). Water-based vaginal moisturisers and lubricants may help. Weight gain. Many women gain weight during the menopausal transition and after menopause because metabolism slows. You may need to eat less and exercise more, just to maintain your current weight.

4. TREATMENT

Menopause requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and preventing or managing chronic conditions that may occur with aging. Before deciding on any form of treatment, talk to your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change. Treatments may include:

Hormone therapy. Oestrogen therapy remains, by far, the most effective treatment option for relieving menopausal hot flashes. If you still have your uterus, you will need progesterone in addition to oestrogen. Oestrogen also helps prevent bone loss. And hormone therapy may benefit your heart if started within five years after your last menstrual period.

Vaginal oestrogen. To relieve vaginal dryness, oestrogen can be administered directly to the vagina using a vaginal cream, tablet or ring. This treatment releases just a small amount of oestrogen, which is absorbed by the vaginal tissues. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms. Low-dose antidepressants. Certain antidepressants related to the class of drugs called selective serotonin re-uptake inhibitors (SSRIs) may decrease menopausal hot flashes. A low-dose antidepressant for management of hot flashes may be useful for women who can’t take oestrogen for health reasons, or for women who need an antidepressant for a mood disorder. Gabapentin (Neurontin). Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes. This drug is useful in women who can’t use oestrogen therapy and in those who also have migraines. Medications to prevent or treat osteoporosis. Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis. Several medications are available that help reduce bone loss and risk of fractures. 3. COMPLICATIONS

5. LIFESTYLE REMEDIES

Fortunately, many of the signs and symptoms associated with menopause are temporary. Take these steps to help reduce or prevent their effects:

Cool hot flashes. Dress in layers, have a cold glass of water or go somewhere cooler. Try to

pinpoint what triggers your hot flashes. For many women, triggers may include hot beverages, caffeine, spicy foods, alcohol, stress, hot weather and even a warm room. Decrease vaginal discomfort. Use over-the-counter, water-based vaginal lubricants or moisturisers. Staying sexually active also helps by increasing blood flow to the vagina. Get enough sleep. Avoid caffeine, which can make it hard to get to sleep and avoid drinking too much alcohol, which can interrupt sleep. Practise relaxation techniques. Techniques such as deep breathing, paced breathing, guided imagery, massage and progressive muscle relaxation can help relieve menopausal symptoms. Strengthen your pelvic floor. Pelvic floor muscle exercises, called Kegel exercises, can improve some forms of urinary incontinence.

Eat a balanced diet. Include a variety of vegetables and whole grains. Limit carbohydrates (starches and sugars). Ask your provider if you need calcium or vitamin D supplements.

Do not smoke. Smoking increases your risk of heart disease, stroke, osteoporosis, cancer and a range of other health problems.

Exercise regularly. This helps protect against heart disease, diabetes, osteoporosis and other conditions associated with ageing.