There are different Epochs in the life of a woman such as transition from childhood to womanhood is adolescence and transition from reproductive life to the non reproductive years of life is climacteric. Menopause is one of the events in the phase of climacteric.
Menopause is the permanent cessation of menstruation at the end of reproductive life. A woman is said to be in menopause following stoppage of menstruation for six consecutive months. The age at which menopause occurs varies between 45-55 years. The average age for menopause in Indian woman is 47.5 years. There are three ways in which a normal menopause can be attained by a woman. These are:-
Sudden cessation of menses.
Scanty flow at regular intervals.
Prolonged intervals between two periods or infrequent menstrual cycles.
Any irregular periods with or without excessive bleeding are a part of abnormal menopause and one should not ignore it. It is important to rule out malignancy (cancer) of the genital tract in such cases. Also, any bleeding or unhealthy, foul smelling vaginal discharge which may be blood-stained after attainment of menopause should arouse suspicion of malignancy unless proved otherwise.
Physical changes following menopause
All genital organs shrink, become thinned out and lumens become narrow. Breasts becomes flat and flabby. Urinary bladder and urine outlet pipe undergo similar changes and became more prone for urinary infections leading to frequent, painful urination and even retention or incontinence. There is loss of muscle tone in the pelvic muscles and ligaments and therefore a lady can manifest with prolapse of uterus at this stage.
Two major catastrophic events which could prove life threatening are osteoporotic changes in the bones whereby bones lose their calcium content and hence the bone mass by 3-5% every year resulting in the post menopausal women being at a higher risk of fractures of the bones. Also there are changes in good and bad cholesterols which predispose post menopausal women to heart attacks and stroke and the incidence of these diseases in women become equal to that in men at this stage while in earlier years they are well protected by their body hormones.
Symptoms of menopause
In majority of women there may be no symptoms at all.
Hot flushes - These are characterised by a sudden onset of feeling of warmth over the head, neck and chest which lasts only for 1-2 minutes and may be followed by sweating.
Genital and urinary symptoms - These include painful sexual life. Urinary symptoms include painful urination, frequent urination, recurrent urinary infection and stress incontinence.
Overactive urinary bladder - whereby the lady has very frequent urge to pass urine especially at night which disturbs the night sleep. In some cases the lady has to go to the toilet every half to one hour, more so in the night then in the day. This can be corrected by medical treatment only.
Psychological symptoms: include anxiety, headache, lack of sleep, irritability and mood swings.
Skin changes: Skin becomes think and wrinkled and is prone to easy damage and infection.
The symptomatic relief for patients suffering from various problems associated with menopause can be achieved either by:
Non hormonal treatment
Hormonal treatment or hormone replacement therapy (H.R.T.)
a) Non hormonal treatment: includes
Nutritious diet - A balanced diet rich in proteins and calcium is important.
Daily intake of 800-1000 mg of calcium is recommended.
Exercise such as walking and jogging.
Vitamin D3 - is an important vitamin as intake of 400 units per day along with calcium can reduce thinning of bones and fractures. Exposure to sunlight enhances synthesis of vitamin D3 in the skin.
Biophosphonates, flourides, calcitonin are some other agents useful for the same purpose.
b) Hormonal therapy or hormone replacement therapy (HRT)
It is used to overcome the short-term and long term consequences of oestrogen deficiency (the hormone that is lost after menopause). This prevents thinning of bones, cardiovascular disease, changes in the genital tract and the skin.
It should be taken by woman who have premature ovarian failure or early menopause or ladies who have risk factors for heart disease such as high BP, prediabetic or diabetic state, high cholesterol levels, smoking habit etc. Women who are at risk for thinning of bones are those who have a family history, elderly age group women, lean body weight, low intake of dietary calcium and vitamin D3, high intake of caffeine, history of smoking, women on steroid therapy and women with thyroid disorders etc.
- HRT is cardioprotective. Also, it prevents bone loss and stimulates new bone formation. But ladies with undiagnosed vaginal bleeding, hormone dependent tumours in the body, history of thrombosis or blood clot formation, active liver disease and gall bladder disease should not opt for HRT. Also included are cases of uncontrolled high blood pressure and women with history of breast or uterine cancers.
- The doctor has to weigh the risk benefit ratio in each patient, and it should be given to patients where the benefits far out weigh the risks.
Health hazards with menopause
With the longevity of life increasing, most of the women spend almost one third of their lives after menopause. The major health hazards are osteoporosis and fractures, cardiovascular ailments like ischemic heart disease, coronary heart disease and stroke. Skin is also more prone to infection and damage. Also the incidence of uterine cancer/ovarian cancer increases in this age group.
Any bleeding after established menopause should not be ignored. Routine pap smear, colposcopy and endometical sampling should be done in relevant cases.
Healthy life in the postmenopausal years is a boon and a bonus. So, the postmenopausal health should not be ignored.