Overview of menopause
The menopause is a natural part of aging that usually occurs between 45 and 55 years of age, as a woman’s estrogen levels decline. In the UK, the average age for a woman to reach the menopause is 51. However, around 1 in 100 women experience the menopause before 40 years of age. This is known as premature menopause or premature ovarian insufficiency.
Most women will experience menopausal symptoms. Some of these can be quite severe and have a significant impact on your everyday activities.
Everything you need to know about menopause
- Menopause marks the end of a woman’s fertility.
- Symptoms of menopause include night sweats, hot flashes, mood fluctuations, and cognitive changes.
- A reduction in estrogen levels can lead to the symptoms of menopause.
- There are a number of medical treatments and home remedies that can help with symptoms, including hormone replacement therapy (HRT) and self-management techniques.
- The average age of menopause in the United States (U.S.) is 51 years and in Nigeria is 48
Signs and symptoms
While menopause is not a disease or disorder, it does trigger some profound changes in a woman’s body.
Perimenopause is the 3-to-5-year period before menopause.
During the perimenopausal stage, a woman’s estrogen levels will drop significantly. This reduces her chances of becoming pregnant.
Dryness, itching, and discomfort of the vagina tend to occur during perimenopause.
As a result, some women may experience dyspareunia, or pain during sex . Women experience this pain due to lowering estrogen levels. These lower levels cause vaginal atrophy.
Hot flashes: A hot flash is a sudden sensation of heat in the upper body. It may start in the face, neck, or chest, and progress upward or downward.
The skin may become red and patchy, and a woman will typically start to sweat. Her heart rate may suddenly increase, strengthen, or become irregular. Hot flashes generally occur during the first year after a woman’s final period.
Night sweats: Hot flashes that occur during the sleep cycle are called night sweats. Most women say their hot flashes do not last more than a few minutes.
However, studies have confirmed that moderate-to-severe night sweats and hot flashes may pose a problem for around 10.2 years.
Disturbed sleep: It can be difficult for women to fall asleep and stay asleep as they progress through menopause.
In some cases, night sweats can lead to discomfort during the night and difficulty sleeping. Sleep disturbance may also be caused by insomnia or anxiety.
Emotional changes: Women can experience depression and low mood during menopause. Hormonal changes can often trigger depressed feelings and mood swings. In many cases, these emotional symptoms also go hand-in-hand with sleep disturbance.
Some women may also experience short-term memory problems and difficulty focusing for long periods.
- a buildup of fat in the abdomen, sometimes leading to overweight and obesity
- hair loss and thinning hair
- breast shrinkage
Menopause can lead to the development of complications, including:
- Cardiovascular disease: A drop in estrogen levels has been associated with an increased risk of cardiovascular disease.
- Osteoporosis: A woman may lose bone density rapidly during the first few years after menopause. Low bone density leads to a higher risk of developing osteoporosis.
- Urinary incontinence: Menopause causes the tissues of the vagina and urethra to lose their elasticity. This can result in frequent, sudden, and overwhelming urges to urinate. These urges can be followed by involuntary loss of urine. Women may involuntarily urinate after coughing, sneezing, laughing, or lifting during menopause.
- Breast cancer: Women face a higher risk of breast cancer following menopause. Regular exercise can significantly reduce the risk.
Causes of menopause
A reduction in levels of the hormones estrogen and progesterone triggers the effects of menopause. Estrogen regulates menstruation, and progesterone is involved with preparing the body for pregnancy.
Perimenopause begins when the ovaries start producing less of these two hormones. By the time a woman reaches her late thirties, the ovaries start producing less progesterone and estrogen. Fertility starts to decline long before the onset of any menopausal or perimenopausal symptoms.
The ovaries produce less estrogen and progesterone over time until they shut down completely. Menstruation will then stop completely. This change is gradual in most women, but some find that their menstrual cycle continues as normal and then suddenly stops.
Ovaries tend to stop producing eggs after the age of 45 years, but they may cease production before then. This is known as premature menopause. Although rare, this can occur at any age. A number of underlying conditions can cause premature menopause, including:
- enzyme deficiencies
- Down’s syndrome
- Turner’s syndrome
- Addison’s disease
Certain surgeries and procedures may also lead to premature ovarian failure, such as:
- surgery to remove the ovaries
- surgery to remove the womb
- radiotherapy to the pelvic area
- chemotherapy to the pelvic area
There is no way to prevent menopause, but its symptoms and effects can be managed.
Diagnosis of menopause
A doctor should be able to diagnose menopause or perimenopause in a woman using her age, questions about her menstrual patterns, and feedback about any physical signs.
Since October 2018, anyone who wishes to know if they have entered menopause, or when they will do so, may be able to undergo a test to find out. The test works by measuring anti-Müllerian hormone (AMH) in the blood, according to the U.S. Food and Drug Administration. This hormone is a marker of ovarian function. Used with other clinical evaluations and laboratory findings, it can give a better idea of a woman’s menopausal status than was previously possible. The test may also help those who have symptoms of perimenopause, which is the stage before menopause. At this stage, too there may also be adverse health impacts. Early menopause is associated with a higher risk of:
- osteoporosis and fracture
- heart disease
- cognitive changes
- vaginal changes
- loss of libido
- mood changes
Another types of test is for follicle-stimulating hormone (FSH). During menopause FSH levels rise.
However, FSH is also not always a reliable indicator of menopause, as levels tend to fluctuate during menopause and perimenopause.
A study of 96 patients that was published in 2015 concluded that the AMH serum levels were more sensitive than FSH serum levels in tests. A doctor can also use the AMH test at any time during the menstrual cycle, unlike the FHS test.
Under certain circumstances, a doctor may order a blood test to determine the estrogen level. Low thyroid activity can cause similar symptoms to those seen in menopause, so a doctor may recommend a blood test to determine the level of thyroid-stimulating hormone.
Treatment of Menopause
During menopause, women can pursue a number of treatments to maintain comfort.
Most women do not seek medical advice during this time, and many women require no treatment. However, a woman should visit a doctor if symptoms are affecting her quality of life.
Women should choose the type of therapy dependent on their menopausal symptoms, medical history, and personal preferences.
Hormone replacement therapy (HRT)
Women can keep the symptoms of menopause at bay by supplementing their estrogen and progestin levels.
Hormone replacement therapy can be received through a simple patch on the skin. This patch releases estrogen and progestin. HRT is highly effective for many of the symptoms that occur during menopause.
There are benefits to HRT, but be conscious of the risks:
Benefits of HRT
- HRT effectively treats many troublesome menopausal symptoms.
- It can help prevent osteoporosis.
- HRT can lower the risk of colorectal cancer.
Risks of HRT
- HRT raises the risk of breast cancer, ovarian cancer, and uterine cancer.
- It increases the risk of coronary heart disease risk and stroke.
Hormonal therapy slightly accelerates loss of tissue in the areas of the brain important for thinking and memory among women aged 65 years and over.
There are other medicines available to help reduce the effects of menopause.
Selective serotonin reuptake inhibitors (SSRIs) have been shown to decrease menopausal hot flashes. Drugs include:
- venlafaxine (Effexor)
- fluoxetine (Prozac, Sarafem)
- paroxetine (Paxil, others)
- citalopram (Celexa)
Drug treatment for hot flashes
Hot flashes can be treated using gabapentin, available under the brand name Neurontin, and clonidine, which is often sold as Catapres.
Clonidine can be taken either orally as a pill or placed on the skin as a patch. It is effective in treating hot flashes, but unpleasant side effects are common, including constipation, dry eyes, and nightmares,