Menopause is a time when women stop menstruating and the ovaries stop their function. The time before menopause is called perimenopause. Perimenopause is a signaling time to menopause with high to low (uneven) fluctuations of hormones, estrogen, and progesterone along with the onset of various clinical symptoms that impact the quality of life and behavior of women. The symptoms are,
- Irregular or unusual menstrual flow (hemorrhagic)
- Hot flashes
- Vaginal or sexual symptoms
- Sleep and mood changes
- New onset of or worsening of mood disorders.
The symptoms are not limited to those mentioned.
The first or early stage is identified either with the persistent difference in menstrual cycle length (≥ 7 days) or one or more skipped cycles. This irregularity progresses to the next stage.
The late menopausal transition, which has longer periods of an amenorrhea of 60 days or more lasting for 1-3 years and dramatic fluctuations in hormones. This stage is associated with vasomotor symptoms (VMS) [the highest prevalence is found after final menstrual period (FMP)]. VMS is also known as “Hot flashes” or hot flushes. Other symptoms are, vaginal disturbances, sleep disturbances, mood changes, urinary incontinence, cognitive decline, weight gain and sexual dysfunction. These last for 1-2 years after menopause, but can be longer in a few women for up to 10 years.
The hormonal chaos
Early menopause is associated with an increased risk of Cardiovascular Diseases and osteoporosis, and a decreased risk of breast cancer. These are based on the levels of estrogen. The hormonal changes in the transition of menopause are an increase in the follicle stimulating hormone (FSH) and luteinizing hormone (LH) and a decrease in estrogen, progesterone, testosterone, androstenedione, DHEA, thyroxine (T3), triiodothyronine (T4), and growth hormone (GH).
Risks associated with menopause
Along with the other health factors, menopause also influences changes in body composition leading to decreased muscle and bone mass with increased fat mass, hence gaining weight. It also increases chances of metabolic disorders and other bone diseases like osteoporosis. Abnormal bleeding in the menopause phase poses a challenge by either mimicking or masking pathological diagnosis like reproductive cancers. A thorough evaluation has to be done by a medical physician by assessing various factors like BMI, thyroid, uterus, cervix etc.
Menopause is when women enter into another stage of life. Women should understand that it is not a medical issue & each woman may encounter it in an unexpected and different way. They can either improve their lifestyle habits and deal with the symptoms. Few of the tips can be included, but not limited to,
- Lifestyle changes like avoiding alcohol, caffeine & smoking.
- Maintaining a healthy body weight by consuming balanced nutrition. Avoid trigger foods and consume adequate vegetables and fruits.
- Try practicing mind & body calming techniques like yoga, deep breathing & meditation.
- Non-hormonal medications or antidepressants to treat the hot flushes.
- Kegel exercises to strengthen the pelvic floor muscles to prevent urinary incontinence.
- Adequate hydration is important.
- Wearing loose & comfortable clothing while going to bed.
- Limiting the screen time to avoid sleep problems & practice good sleeping habits.
- Staying socially & mentally active by participating in activities that help build concentration & focus.
- De-stressing by avoiding undue load of tasks.
- For vaginal problems such as dryness, a vaginal moisturizer or lubricant is available over
The most effective treatment for menopausal symptoms is hormonal replacement therapy (HRT) but it is often associated with side effects leading to breast, endometrial cancer and vaginal hemorrhage. Hence, alternative methods have been developed on demand to minimize the above effects. Foods rich in antioxidants, in particular polyphenols (flavonoids like soy and green tea) might help decrease menopause symptoms. Polyphenols are found to alleviate VMS (hot flashes) during perimenopause, and they have proved to improve bone mineral density, more at the lumbar spine in postmenopausal women. A study suggests that a combination of isoflavones, calcium, vitamin D may exert a favorable effect on menopausal symptoms, sexual function and quality of life.
Menopause is also a period of psychological difficulties changing the lifestyle of women in multiple ways. Menopausal women need to know about their physical and psychosocial needs. Empowerment during the menopause can contribute to improving the perception of this stage and the importance of self-care. Most interventions for menopause women focus on educational intervention, physical activity/exercise, improving a healthy diet, stress management, healthy behaviors, preventing certain diseases and osteoporosis.
References:
- Abay H, Kaplan S. Current Approaches in Premenstrual Syndrome Management. Bezmialem Science 2019;7(2):150-6.
- Anand, T. and Garg, S. (2015) ‘Menstruation related myths in India: Strategies for combating it’, Journal of Family Medicine and Primary Care, 4(2), p. 184. doi: 10.4103/2249-4863.154627.
- Critchley, H. O. D. et al. (2020) ‘Menstruation: science and society’, American Journal of Obstetrics and Gynecology, 223(5), pp. 624–664. doi: 10.1016/j.ajog.2020.06.004.
- Carroll, R. G. (2007). Female Reproductive System. Elsevier’s Integrated Physiology, 177–187. doi:10.1016/b978-0-323-04318-2.50020-0
- Kumar, A., & Srivastava, K. (2011). Cultural and Social Practices Regarding Menstruation among Adolescent Girls. Social Work in Public Health, 26(6), 594–604. doi:10.1080/19371918.2010.525144
- Suling Li RN, MSN, Dorothy Lanuza RN, PhD, FAAN , Meg Gulanick RN, PhD , Sue Penckofer RN, PhD & Karyn Holm RN, PhD, FAAN (1996) Perimenopause: The transition into menopause, Health Care for Women International, 17:4, 293-306, DOI: 10.1080/07399339609516246
- VERRILLI, L., & BERGA, S. L. (2020). What Every Gynecologist Should Know About Perimenopause. Clinical Obstetrics & Gynecology, 63(4), 720–734. doi:10.1097/grf.0000000000000578
