Menopause is the time in a woman's life when her menstrual cycle stops completely and the periods do not re-occur for more than a year. The underlying reasons behind menopause are reduced secretion of estrogen and progesterone hormones; hence, ovulation stops. Generally, it happens around the age of 45-55 years.
Natural Menopause and Surgical Menopause
Natural menopause happens around middle age. However, the exact time varies depending on the physiology of the person.
Some women might have to undergo surgeries that induce early menopause. These could be hysterectomy- uterus removal surgery or oophorectomy- ovaries removal surgery. A hysterectomy procedure without the oophorectomy would not bring menopause immediately.
Some medications can also lead to early menopause. These could be medicines for an overactive thyroid, hormonal birth control pills containing prolactin or the milk-producing hormone, or when the body undergoes excessive radiation.
Phases of Menopause
Menopause can be broadly divided into three phases- pre-menopause, menopause, and post-menopause period. The duration of pre-menopause and post-menopause ranges between 8-10 years each, and the body experiences many physical changes and symptoms reflecting those changes.
Indicators of the Onset of Menopause
Let us discuss ten signs that might indicate the start of pre-menopause. These signs are collectively termed as Genitourinary Syndrome of Menopause (GSM). Research suggests that the vaginal milieu or microbiota of the vagina plays a vital role in vaginal immunity and the severity of these symptoms (1).
1. Changes in the Menstrual Cycle
You might have periods at irregular intervals for an irregular duration. Also, you might have slight spotting or a heavy flow during your periods. The pre-menopause or the menopause transition can also be marked by breast tenderness and worsening premenstrual syndrome or PMS.
2. Hot Flashes or Cold Chills
Women might experience episodes of hot flashes and redness over the body. Cold chills can follow hot flashes in some cases. These symptoms could last for minutes to days together. You should understand the triggers that make you more prone to hot flashes. If these occur, particularly during the night, you can keep your bedroom cool and wear easily removable clothing to deal with them.
3. Urinary Incontinence
As estrogen production also affects the lining of the bladder and urethra, some females undergoing menopause can have urinary incontinence or leaky urine while sneezing, performing any physical activity or at random. Another reason behind incontinence is weak pelvic floor muscles. Other related health issues are dysuria- painful urination and nocturia- getting up frequently at night to urinate.
4. Change in Libido
Due to falling hormone levels, some women complain of a reduced sex drive due to vaginal dryness, making sex painful. Some others report increased sex drive during the post-menopause period as the fear of getting pregnant goes away. You can have an orgasm during menopause, but to ease pain, increased foreplay and the use of lubricants can help.
5. Sleep Irregularity
Women can have sleepless nights due to hot flashes, night sweats, or just like that. They might not be able to fall back to sleep once they wake up, might have difficulty sleeping, or start waking up very early in the morning. This sleep irregularity might bring up many other health problems.
6. Acute Moodiness
Menopausal women can have a greater degree of mood swings, feel a lack of motivation, and become more irritable than normal. These signs can indicate other health issues too. In extreme cases, menopause can also cause depression and anxiety in postmenopausal women (2). You can deal with this moodiness by joining support groups of the same age women going through menopause to vent your emotions.
7. Gaining Weight
Women might start losing muscles and gain fat, particularly around the waist, with the start of the menopause transition. It is because there are changes in the way the body uses energy, due to which there are many physiological changes that lead to obesity issues.
8. Cognitive Changes
Some females also experience forgetfulness and other such memory problems. It is suggested to avoid passive activities like watching TV during this time and be more active in your routine. You can also indulge in activities that stimulate the brain, such as playing sudoku or crossword puzzles.
9. Aching Bones and Joints
Women also complain of sore joints and tiredness with the changes in the body composition and structure of fat cells. Studies suggest post-menopausal women have greater chances of osteoporosis and coronary artery diseases due to falling estrogen levels (3). Doctors recommend an adequate intake of calcium during this time.
10. Facial Hair Growth or Hair Loss
If the testosterone levels in the body become higher than estrogen levels, women might spot more hair on the face. You can use hair removal techniques such as waxing to deal with them.
Recommended Tests
It is natural to confuse menopause symptoms with other health issues. Doctors might suggest getting your estradiol levels (E2) and follicle-stimulating hormone (FSH) checked during the menopause transition to understand if the symptoms are menopause-related.
Pregnancy and Menopause
Pregnancy can occur during the pre-menopause time even when the periods are irregular until the periods stop completely. It is advised to take all birth-control measures such as using condoms, copper intra-uterine devices, etc., to avoid pregnancy. Once the ovaries stop releasing eggs in the uterus after menopause, there is no chance of getting pregnant.
Hormone Therapies to Deal with Menopause
Majorly, two types of hormone therapies are used to deal with menopause symptoms.
Estrogen Therapy
The estrogen used in estrogen therapy is recommended in low dosage and can be administered through a patch or a pill. Other ways of taking estrogen are using vaginal rings, creams, estrogen gels, or sprays. This therapy is mostly recommended after the removal of the uterus.
Estrogen Progesterone Therapy
The Progesterone hormone is released in the ovaries in the natural form; the synthetic form of progesterone is called progestin. This hormone can relieve vaginal dryness, mood disorders, and hot flashes.
However, these therapies come with their own set of risks. People become prone to gallstones, blood clots, pulmonary embolism or blockage, deep vein thrombosis, stroke, etc. Estrogen therapy is only recommended to females who have gone through a hysterectomy; otherwise, they should always get estrogen-progesterone therapy. Otherwise, there is an increased risk of endometrial cancer.
A point to note is that extreme hot flashes can be a sign of heart disease in the future; it is recommended to start these therapies within ten years of menopause (4).
Other Ways to Deal with Menopause Symptoms
Due to medications taken for other diseases such as breast cancer, hormonal therapies might not be recommended to certain patients. However, you can go for symptomatic treatment to treat your symptoms. Also, the duration and intensity of these symptoms can vary depending on your age, race, and ethnicity. You can undoubtedly deal with menopause symptoms with a proper diet, a healthy lifestyle, and avoiding excessive alcohol and smoking.
Consumption of less caffeine and spicy foods can help relieve hot flashes. You can also eat isoflavones-rich food to ease your symptoms. Isoflavones are plant sources of the hormone Estrogen, and sources include chickpeas, flax seeds, soybeans, lentils, beans, grains, vegetables, and fruits. A regular exercise routine is inevitable to maintain the body's overall functionality at all stages of life, definitely during menopause.