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Understanding menopause

EVE WOMAN
By | January 23rd 2011

Menopause is a term that sends shivers down the spines of many women, thanks to the myths and misinformed stories that pass around concerning this natural and unavoidable period, writes Njoki Chege

While it may be accompanied by severe and uncomfortable symptoms, menopause could be the most enjoyable time of your life...if only you get the facts right.

Just what is menopause and how can we transform it from a period of anxiety and uncertainty to a completely pleasurable time?

Menopause is the total cessation or termination of the functions of the ovaries, which include the ripening and release of ova and hormones that cause the creation of the uterine lining and the menses. There is a gradual reduction of the production of the oestrogen and progesterone hormones, hence the ceasing of menstrual periods.

"After 12 consecutive months of not having the monthly periods or spotting, and the woman is neither pregnant nor lactating, then we can safely conclude that the woman has completed one year of menopause," says Dr Marsden Solomon, a reproductive health advisor at the Family Health International.

Menopause occurs in women during their mid-life, in their late 40s or early 50s and this is usually the end of a woman’s fertile phase. These changes not only occur in the physical realm, but also in the mental and psycho-social realm. This period occurs over a period of years. It is completely a natural process, which cannot be delayed or stopped, but can be treated if the symptoms are severe .

Severe symptoms

Just like any other natural process, menopause has its signs and symptoms. However, Dr Solomon warns that the symptoms are not specific to all women.

"Women are different. While others may experience severe symptoms, others experience mild ones, which might even go unnoticed," he says.

Catherine Mathenge 56, and a retired high school teacher says the issue of menopause never crossed her mind, considering the fact that she had her last born at 46.

"Yes, even my doctor was perplexed at this, but I think nature has its exceptions, and I was one of them. Two years after she gave birth, she slowly slipped into menopause although she did not have the frequent hot flashes and night sweats she read about. However, she had bouts of fatigue and nausea, and it worsened due to the nature of her job (she was a teacher at Maina Wanjigi Secondary School) and raising her son also drained her physically.

"As I would soon realise, menopause is no big deal. Everywhere I look, I see women my age enjoying life. I have a friend though, a former colleague, who had serious backaches to a point where she had to see a doctor. Though she has never completely healed, the doctor advised her to exercise a lot and eat foods rich in minerals and vitamins to keep her bones strong and healthy," she says.

Catherine adds that her sex drive, isn’t as ‘heated up’ as it was in her 20s, "but I cannot complain. I think the loss of libido also has a lot to do with your lifestyle, in terms of the foods you eat, and also your relationship."

"Although I am not much of a fitness fanatic, I walk and move around a lot in my business, which I began after my retirement, and I think that is good exercise," says Catherine.

Ageing process

She concludes by telling women that menopause is not a big deal, that it is just the monthly periods that stop and a few changes in the body. But as long as they eat well and keep fit, they have nothing to worry about.

Dr Solomon says that women need to understand that it is a natural consequence of the ageing process rather than a disease and they should seek professional help in case of severe symptoms. This is especially so, with the increase of life expectancy in Kenya, which translates to a bigger population of women in the post-menopausal time.

So, what are some of the signs that women in this age bracket ought to look out for?

Bearing in mind that menopause is a response to the dropping levels of oestrogen and other hormones; the symptoms are therefore hormonal. They include irregular periods where the ovaries are ‘shutting down’ due to the gradual decrease in production of the oestrogen and progesterone hormones, hence irregular periods. However, Dr Solomon advises women at this age to continue using contraception until they have missed their periods for 12 consecutive months.

A woman will at this point experience hot flashes and night sweats. A hot flash is the sensation of ‘flushing’ or a sudden feeling of heat, often accompanied by sweating. When they occur during sleep they are called night sweats. They are mainly caused by lack of adequate oestrogen that interferes with the control centres of temperate in the brain.

As oestrogen and progesterone decline, some women describe themselves as ‘emotional’. They report being more easily triggered into strong emotional responses. Because they see themselves as suddenly unpredictable, women find this unsettling, and are likely to seek help.

Migraine and tension headaches may increase during menopause. Since migraine headaches are vascular in nature, they can become more frequent and difficult to manage. Many women at this age report a greater tendency to stay awake at night, insomnia.

Oestrogen plays an important role in maintaining the tone and moisture of the vagina since one may experience vaginal dryness and urinary problems. As oestrogen is less available, the walls of the bladder, urethra and vagina become drier and less flexible. This makes the tissue more easily damaged and more prone to infections. It also leads to painful sex and this could affect relationships.

Fat deposits

Your metabolism will slow with age, and weight gain is common in menopause. The combination of changing patterns of fat deposit, less muscle mass and a slower metabolism can give you a larger abdomen and ‘flabby’ arms and legs.

Memory and cognitive changes distress many women. While some loss of memory is normal with aging, if cognitive changes interfere with your ability to do everyday things, it is a good idea to seek help.

Some women experience a profound fatigue. It is usually temporary and is your body’s adjustment to lower oestrogen. If it prevents you from doing your daily activities, or if it lasts more than two months, visit your doctor.

Many women notice that their sexual desire lessens when they become menopausal. Sometimes this is a temporary response to hormone shifts; sometimes it is a reaction to other things like stressors or difficult life situations. For most women this age, their backbones and thigh bones are susceptible to fractures a condition known as osteoporosis.

With all these symptoms, it goes without saying that this is the most infertile period of a woman’s life. Bearing this in mind, many women who are on contraception tend to forego contraception, with the assumption that they will not get pregnant.

Pre-mature menopause on the other hand is a rare case when a woman’s ovaries stop working before the age of 40. Some known causes of premature menopause include auto-immune disorders, thyroid diseases, diabetes mellitus, tumours of the ovaries, radiotherapy, chemotherapy and surgical menopause.

Peri-menopause

Dr Solomon urges women in the peri-menopause period to continue with their contraceptive methods, until they have missed their period for a consecutive 12 months.

"Although chances of conceiving are minimal, it does not go to zero due to the bouts of ovulation. Therefore we cannot say that a woman is completely safe until the 12 consecutive months of missed period are over," Dr Solomon says.

He also advises that women who have irregular periods during the peri-menopausal phase may have difficulty in using Fertility Awareness methods reliably.

"Peri-menopause is a natural stage of life. It is not a disease and therefore it does not automatically require any kind of medication. However, in cases where the physical, mental and emotional effects disrupt the everyday life of the woman, medical therapy is appropriate," he adds.

The consequences accrued to menopause can be irritating, and sometimes inconveniencing, particularly to the sex life. There are certain treatments that attempt to reduce the severity of the symptoms, but they do not promise to make the process ‘disappear’. One of the landmarks in the medicine world as far as menopause is concerned is the Hormone Replacement Therapy (HRT). It involves taking small doses of one or two female hormones, oestrogen and progesterone.

In addition to relief from hot flashes, hormone therapy can alleviate vaginal dryness; improve sleep quality and joint pain. A woman and her doctor should review her situation, complaints and relative risk before determining whether the benefits of HRT or other therapies outweigh the risks.

Vaginal moisturisers that help women with overall dryness can correct lack of lubrication. Low-dose prescription vaginal oestrogen products are a safe way to use oestrogen topically, to help vaginal thinning and dryness problems.

Hot flashes can be managed by drinking cold liquids, staying in cool rooms, using fans and removing excess clothing layers when a hot flash strikes. Counselling or support groups can sometimes be helpful to handle depressed women.

You may be encouraged to note, that women are not the only ones who go through a tough mid-life period.

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