What is Menopause?

It refers to a point in time that follows one year after the cessation of menses. It is a normal and routine physiology that every woman attains menopause, the time of which varies with each woman. The average age at menopause is 51.5 yrs. However, a number of factors influence the age of menopause. It includes environmental, genetic and surgical influences, chemotherapy, radiation etc.

Does a woman have irregular cycles before menopause?

Yes. Women experience, irregular cycles and decreased length, duration of flow prior to menopause and this phase is called as perimenopausal period. This period usually lasts up to 4 to 7 yrs. However if there is bleeding between menstrual periods or bleeding after sex, they should not be taken as menopausal changes and medical attention should be sough without delay.

What are the symptoms associated with menopausal transition and menopause?

• Changes in menstrual patterns
• Hot flushes, night sweats and sleep disturbances, vaginal dryness
• Depression, irritability, mood swings, loss of concentration and poor memory
• Decrease in sexual desire
• Discomfort and pain with sexual intercourse
• Headache, dizziness, palpitations, joint aches and back pain
• Dry skin and urinary disturbances
• Weight gain

What are the complications of menopause?

While menopause is a normal physiological phenomenon, it is associated with increase in risk of certain problems as the hormonal support of estrogen is lost with menopause.

• Heart and blood vessel disease. Estrogen has a protective effect on the heart and blood vessels. It is believed to be one of the reasons that ischemic heart disease is more prevalent among young men than young women. With menopause this protective effect is lost and the risk of cardiovascular disease increases. It is therefore important to maintain a good diet and exercise routine after menopause.

• Osteoporosis. Postmenopausal osteoporosis may affect as many as 1 in 3 women above 50 years according to some estimates. Without the support of estrogen, bones lose their strength and place women at risk of sustaining fractures of the wrist, spine and hips.

• Urinary incontinence. With loss of estrogen support, the muscles of the pelvic floor lose their tone. Woman may develop the inability to control the urine and pass urine without control (incontinence). Please refer to our section on stress urinary incontinence for more information. They may also develop frequent urinary tract infections.

Management options available for menopause

In order to age gracefully, it is important for women to visit a gynecologist even after menopause and take appropriate preventive measures and, if necessary, medicines.

Cancer screening:

During perimenopausal transition the most common thing we see is the fear of cancer due to the irregular cycles or coital bleeding. We examine the patients and ensure that the changes are related to menopause. If there are features that are not consistent with normal menopause, we perform the required investigations to rule out any underlying problem.

Some women with risk factors also require screening for cancer of breast, cervix and uterus and ovaries which are common in this age group.

Dietary measures:

We prescribe a diet that is suitable for menopausal women. Post-menopausal diet should have adequate quantities of calcium and vitamin D to guard against osteoporosis. It should also be low in saturated fatty acids, cholesterol and simple carbohydrates and rich in fiber and natural antioxidants to guard against cardiovascular problems.

Osteoporosis prevention:

If osteoporosis is suspected, DEXA scan may be done to ascertain the bone strength and appropriate medicines including calcium, vitamin D and bisphosphonates may be initiated to strengthen the bone. It is also essential for postmenopausal women to do regular weight bearing exercises such as brisk walking or jogging to maintain bone health.

Treatment of menopausal symptoms:

Women with bothersome hot flushes, night sweats and sleep disturbances or other irritative symptoms may require cyclical hormonal support for some time.

Post-menopausal women with vaginal dryness and discomfort during sex or urinary incontinence may benefit from the use of estrogen ointments.

Urinary problems:

Urinary incontinence or passing of urine without control requires to be investigated and the exact cause found out. Kegel's exercises that improve the strength of pelvic floor muscles and vaginal estrogen are beneficial in such patients. Symptomatic urinary infections require prompt treatment with antibiotics.

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