What do you know about female menopause

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 your 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 azadehhassan@yahoo.co.uk, or Text DR AZADEH on 7774469/3774469 between 3=6 pm

Author DR AZADEH Senior Lecturer Medical School UTG, Senior Consultant in Obstetrics and Gynaecology