Menopause is a biological stage in a woman’s life that occurs when she stops menstruating and reaches the end of her natural reproductive life. Medically speaking, menopause occurs due to a reduction of oocytes located in the ovaries and in extension the female hormones, oestrogen and progesterone. The normal age range of occurrence is between 43-57 years of age with an average age of 51 years.
STAGES IN MENOPAUSE YOU SHOULD KNOW
- Perimenopause/menopause transition: the menstrual cycle and hormonal changes that occurs a few years before and 12 months after the final menstrual period resulting from natural menopause.
- Menopause: the last menstrual period.
- Natural/Physiologic menopause: diagnosed after 12 months of amenorrhoea (i.e. absence of menstruation) with no obvious pathologic cause.
- Induced/Artificial menopause: permanent cessation of menstruation after the surgical removal of both ovaries or the ablation of ovarian function through chemotherapy or radiotherapy.
- Premature menopause: menopause reached at or before the age of 40 years. It can be natural or induced. It is otherwise called premature ovarian failure.
- Post menopause: refers to the phase of life that comes after the menopause.
DIAGNOSIS OF MENOPAUSE
The diagnosis can only be made retrospectively after a minimum of 1yr (12mths) amenorrhoea. There are 3 classical ways in which the menstrual period ceases:
- Sudden cessation.
- Gradual diminution in the amount of blood loss with each regular period until menstruation stops.
- Gradual increase in the spacing of the periods until they cease for at least an interval of six months.
SYMPTOMS OF MENOPAUSE
Some women may show no symptoms (asymptomatic). However, most women present with any or all of the following symptoms:
1) Immediate (0-5yrs):
- Vasomotor symptoms (e.g. hot flushes, night sweats)
- Psychological symptoms (e.g. labile mood, anxiety, tearfulness)
- Loss of concentration
- Poor memory
- Joint aches and pains
- Dry and itchy skin
- Hair changes especially hair loss
- Decreased sexual desire/libido
2) Intermediate (3-10yrs):
- Vaginal dryness
- Vaginal soreness
- Dyspareunia (pain during sexual intercourse)
- Regression of breast size
- Urgency of urine
- Urinary incontinence
- Recurrent urinary tract infection
- Haematuria (blood in urine)
- Urogenital prolapse
- Weight gain
3) Long term (> 10yrs):
- Cardiovascular disease
It should be noted that some symptoms like hot flushes could start manifesting years before menopause finally occurs. Some symptoms are self-limiting, hence will resolve with time.
Some diseases may mimic the common symptoms seen in menopause. As such a review by a Medical Practitioner may be required to help rule out an underlying pathology. Some of them include:
- Extreme weight loss in anorexia nervosa
- Galactorrhoea in hyperprolactinemia
- Hirsutism and obesity in women with polycystic ovarian disease
- Hot flushes
- Carcinoid syndrome
- Diabetes mellitus
- Tuberculosis and other chronic infections
- Trichomoniasis infection
- Candidiasis infection
- Back pain
- Gastric ulcer
- Renal colic
- Acute back strain
- Herniated intervertebral disk
WHEN TO SEEK HELP
Menopause just like pregnancy is a physiological process which occurs in the life of a woman and hence is not a disease process. Women who are not symptomatic do not necessarily seek medical advice. Help could be sought from a medical practitioner when symptoms become distressing and affects the quality of life.
CAN MENOPAUSE BE PREVENTED?
Nothing can prevent physiologic menopause and nothing can be done to postpone its onset or slow its progress. However in artificial menopause, consideration can be taken to the mode of treatment being offered to patients, most of whom have cancers so that the ovaries can be preserved and hence prevent menopause from occurring.
Nevertheless, Osteoporosis which is one of the late symptoms of menopause can be prevented by the intake of adequate amounts of calcium (minimum of 1,200mg elemental calcium per day), Vitamin D, smoking cessation, avoidance of excessive alcohol intake and participation in regular exercises.
TREATMENT FOR MENOPAUSE
As mentioned earlier, menopause is a physiological process and occurs on account of a reduction in the amount of female hormones in the body. Treatments being offered currently only help to alleviate the symptoms that occur but do not stop the overall process of menopause.
Other modes of treatment are directed at the particular symptom which is causing more distress to the patient and as such requiring a review by a medical practitioner. Remember every individual is unique in their own right, meaning that a treatment given to one person may not work in another. For this reason, kindly desist from self-medication
While being considered an unwelcome phenomenon in some women in whom fertility had been a source of status and self-esteem and those who have delayed child bearing, menopause is welcomed by others who see it as an end to monthly periods. Menopause should not be feared but should rather be understood not only by the affected female folk but also the men in their lives in order to provide the needed emotional support during this stage.
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