Symptoms:
Affects Sexual life, Hot Flashes, Night Sweats, Disturbed Sleep, Urinary
Problems, Moodiness, Hair loss, Depression.
Managing
Menopausal Symptom
At
some point in every woman’s life, her hormone production drops below the level
required to continue her periods. Some women welcome the end to monthly
bleeding, bloating, and inconvenience. But others find that menopause:
Triggers
mood swings
Causes
debilitating hot flashes
Can
take them down the road to bone and heart problems
Affects
their sex life
Menopause
that happens suddenly because of breast cancer treatment can cause
uncomfortable and extremely upsetting side effects, including affecting your
ability to have children, sometimes temporarily, sometimes permanently. All of
which can be stressful and upsetting.
There
are different kinds of menopause. If you’ve been diagnosed with breast cancer,
it’s important to understand which kind of menopause you may be experiencing:
natural
menopause, a normal part of the aging process
medical
or surgical menopause that is the result of chemotherapy or ovary removal
“cold
turkey” menopause from being taken off hormone replacement therapy (HRT) after
you were diagnosed with breast cancer
The
good news is that there are ways to manage symptoms and live more comfortably
with menopause.
You
can do many things to help ease your way through menopause. Lifestyle
modifications (diet, exercise, smoking cessation, attitude) may be just as
important and effective as medications in helping you feel better and live
longer.
Many
women find themselves in their menopause irritable, sad, depressed, anxious,
angry, fearful, forgetful, unfocused, and in tears for no reasons
Menopause
is the medical term for the end of a woman’s menstrual periods. It is often
called the “change of life” and marks the transition between a woman’s
childbearing years and her non-childbearing years.
Menopause
is a natural part of aging and occurs as a result of the gradual loss of
estrogen, a hormone produced in the ovaries. During a period known as “per
menopause,” (before real menopause started) estrogen production declines and
women often develop irregular periods, hot flashes, mood swings and fatigue.
These symptoms often develop 3 to 5 years before a woman’s last period.
Menopause is diagnosed when a woman has been without a period for one year. The
average age of menopause is 51 but varies from person to person. In The Gambia
arrange age of 39-43 years. A variety of factors that affect ovarian function
may cause premature menopause.
Menopause
in African Women
Menopause
affects all women regardless of race or socioeconomic background. However,
recent studies have shown that the experience of menopause is different among
racial groups. African and Americans African women have more estrogen related
symptoms (hot flashes, night sweats, vaginal dryness, urine leakage) than all
other ethnic groups. Additionally, African women are less likely to have
somatic symptoms (headaches, difficulty sleeping, racing heart, stiffness and
soreness in joints) than all other ethnic groups.
What
are the Signs and Symptoms of Menopause
Menopause
is a very individualized experience. Some women find the “change” extremely
bothersome while others notice little difference. Research has proven, however,
that low estrogen levels are responsible for a variety of uncomfortable
symptoms, which will be outlined below.
Technically
the menopause is confirmed when a woman has not had a menstrual period for one
year. However, the symptoms and signs of menopause generally appear well before
the one-year anniversary of the final period. They may include:
Irregular
periods - this is usually the first symptom; menstrual pattern changes. Some
women may experience a period every two to three weeks, while others will not
have one for months at a time.
Lower
fertility - during the peri-menopausal stage of a woman’s life her estrogen
levels will drop significantly, lowering her chances of becoming pregnant.
Vaginal
dryness - this may be accompanied by itching and/or discomfort. It tends to
happen during the peri-menopause. Some women may experience (pain during sex).
The term vaginal atrophy refers to an inflammation of the vagina as a result of
the thinning and shrinking of the tissues, as well as decreased lubrication,
caused by a lack of estrogen.
There
are cases of women who experience more than a decade after their final period.
The majority of post-menopausal (time after menopause) women are uncomfortable
talking about vaginal dryness and pain and are reluctant to seek medical help
Hot
flashes - this is a sudden feeling of heat in the upper body. It may start in
the face, neck or chest, and then spreads upwards or downwards (depending on
where it started). The skin on the face, neck or chest may redden and become
patchy, and the woman may start to sweat. The heart rate may suddenly increase,
or it may become irregular or stronger than usual (palpitations). Hot flashes generally
occur during the first year after a woman’s final period.
Night
sweats - if the hot flashes happen in bed they are called night sweats. Most
women say their hot flashes do not last more than a few minutes.
Disturbed
sleep - sleeping problems are generally caused by night sweats, but not always.
Sleep disturbance may be caused Difficulty falling asleep and staying asleep
increase as women go through menopause.
Urinary
problems - women tend to be more susceptible to lower urinary tract infections.
Having to urinate may also occur more frequently.
Moodiness
- this often goes hand-in-hand with sleep disturbance. Experts say that most
mood disturbances are triggered by poor sleep.
Problems
focusing and learning - Some women may also have short-term memory problems, as
well as finding it hard to concentrate on something for long.Women may not be
able to learn as well shortly before menopause compared to other stages in
life.
More
fat building up in the area of stomach.
Hair
loss (thinning hair).
Loss
of breast size
If
left untreated, these symptoms will usually taper off gradually over a period
of two to five years. However, some women may experience symptoms for much
longer. Most women who experience vaginal dryness, itching or discomfort may
find symptoms either persist or get worse with time if left untreated.
Irregular
Menstrual Periods: Episodes of heavy bleeding and/or of infrequent cycles.
Cycles may be longer or shorter. Irregular menstrual cycles may occur 2-8 years
before the end of your periods. However, not all cases of irregular bleeding
are caused by menopause. Discussion with the Doctor or nurses will determine if
further evaluation is necessary.
Complications
of Menopause
We
have already discussed many of the changes a woman goes through during
menopause. It is important to realize that there are long-term complications
linked to the decreased levels of estrogen that accompany menopause. We will
discuss the most important ones below.
Osteoporosis:
(thinning of the bones) Deficiency of estrogen results in loss of bone mass. A
decrease in bone mass may lead to curvature of the spine, fractures of the
vertebrae, loss of height and pain.
Cardiovascular
Disease: Disease of heart and blood vessels, many studies have shown that the
risk of cardiovascular disease, including heart attacks and strokes, are
increased in postmenopausal women. This is thought to be caused by estrogen
related changes in levels of cholesterol and other blood lipids (fats).
Vaginal/Urinary
Changes: vaginal tissues and tissues of the bladder are estrogen sensitive.
Without estrogen, these tissues start to degenerate, resulting in symptoms of
vaginal dryness, painful intercourse, painful urination and incontinence.
How
can you be evaluated for Menopause
Menopause
is diagnosed primarily by its symptoms. If a woman who is almost 50 years old
or older stops menstruating completely, a presumptive diagnosis of menopause
can be made without further testing. Diagnosis is slightly different in a
younger woman who has signs and symptoms of menopause. Special hormonal blood
tests may be necessary to confirm the diagnosis. Your doctor will be happy to
discuss this with you further.
Treatment
Options
Calcium
supplementation for prevention of osteoporosis. Postmenopausal women on HRT
should take 1,000 mg of calcium daily. Women not on HRT should take 1,500 mg of
calcium daily. Ask your physician regarding other bone sparing medications
including vitamin D, and phosphorous containing medications.
Nutrition:
Eating a reasonable diet will help you throughout and after menopause. Choose
foods low in fat, saturated fat and cholesterol. Eat fruits, vegetables and
whole grain cereal products, especially those high in vitamin c and carotene.
Eat very little salt-cured and smoked foods such as sausages, smoked fish and
ham, bacon and hot dogs. Avoid food and drinks containing processed sugar.
Exercise:
Regular exercise benefits the heart and bones, helps regulate weight and
contributes to a sense of overall well-being and improvement in mood. Weight
bearing exercises such as walking and running help to increase bone mass.
Moderate exercise preserves bone mass in the spine, helping reduce the risk of
fractures. Consult your doctor before starting a rigorous exercise program. He
or she will help you decide which types of exercises are best for you. An
exercise program should start slowly and build up to more strenuous activities.
Hormone
Replacement Therapy (HRT): As stated earlier, many of the symptoms and
complications of menopause occur as the result of a deficiency in estrogen.
Most women will eventually need to decide whether or not to take hormone
replacement therapy (HRT). HRT can have beneficial effects for many women, but
it is not for everyone.
Where
in The Gambia you can get more information? You can be provided with
information, diagnosed and treated in the EFSTH, other Governments Clinics,
MRC, NGO and Private Clinics, E mail azadehhassanmd10@gmail.com,
or Text only DR AZADEH on 7774469/3774469 between 3-6 pm
Author DR AZADEH Senior Lecturer Medical School UTG, Senior Consultant in Obstetrics and Gynaecology, Clinical Director at Medicare Clinic
