Ask the doctor: What does menopause do to your ageing body?

What is menopause?

Menopause is the cessation of menstruation that happens at the average age of 50 due to the marked decrease of female reproductive hormones such as oestrogen and progesterone and this marks the end of a woman’s reproductive life.

Are there cases where women go through menopause in their 30s?

There are some women who are affected by a condition called premature ovarian failure. It is the loss of normal function of the ovaries before the age of 40. Women who have undergone surgery to remove the ovaries and uterus before the age of 40 or have undergone radiotherapy or chemotherapy that permanently damages the ovaries are also said to be in menopause.

What’s the difference between perimenopause and menopause?

Peri-menopause is the time leading to menopause where the events leading to or symptoms of menopause begin to set in. Menstruation may not have completely ceased at this point, although it may be very scanty and irregular. Menopause is an event that is diagnosed, in retrospect, when menstruation has ceased for a year.

What are the symptoms of menopause?

There are many symptoms, some of which include:

i. Bone weakness and osteoporosis

ii. Cardiovascular events like heart attack (myocardial infarction), stroke etc

iii. Urinary incontinence, frequency and urgency

iv. Hot flashes

v. Vaginal dryness

vi. Painful sexual intercourse, low libido

vii. Emotional changes

viii. Insomnia

ix. Hair loss

What can be done to improve symptoms during menopause?

Some options include hormonal replacement therapy, treatment of osteoporosis with Vitamin D and calcium replacement as well as bisphosphonates, treatment of cardiovascular conditions, treatment of hot flashes, weight loss, regular exercise, emotional support and counselling

Do women have sexual problems after menopause? How can they be remedied?

Yes. Menopausal women experience vaginal dryness, low libido, pain during sexual intercourse, vaginal laxity and even psychological problems that prevent them from a satisfying sex life. This is due to low levels of oestrogen hormone which is responsible for maintenance of vaginal lubrication and elasticity among other benefits. There are therapies available such as hormonal replacement therapy, where oestrogen is reintroduced into the body in either oral, cream or patch formulations in order to remedy sexual dysfunction. These require to be prescribed by a gynecologist as they can have serious adverse effects. There are also options for treatment of female sexual dysfunction offered in the realm of cosmetic gynaecology. These include vulvovaginal platelet rich plasma therapy and the O shot, and vulvovaginal rejuvenation and vaginal tightening using radio-frequency, laser and ultrasound therapy.

What are hot flashes?

Hot flashes are a form of vasomotor symptom induced by oestrogen withdrawal that occurs in menopause. Typically, the woman feels a wave of hotness, accompanied by profuse sweating and a subsequent resolution

How can hot flashes be prevented?

It is difficult to prevent hot flashes but they can be treated to some extent with medications such as Clonidine and Gabapentin. Hot flashes also begin to spontaneously resolve five years into menopause on average

Is hormone replacement a safe option for management of menopausal side effects?

Hormonal replacement therapy is safe if initiated under the age of 60 and for less than six years. It is also important that the therapy is initiated by a gynaecologist who can rule out coexisting conditions that may make the patient a poor candidate for HRT, such as cardiovascular disease.

Are there non-hormonal options?

Non-hormonal options of treating symptoms of menopause include exercise, weight loss, osteoporosis treatment and calcium and vitamin D replacement, treatment of hot flashes with Clonidine and Gabapentin, non-surgical cosmetic gynecology solutions to female sexual dysfunction such as vulvovaginal PRP and radiofrequency, laser and ultrasound vulvovaginal rejuvenation, cardiovascular disease treatment and psychological support.

Can menopause cause psychological effects?

Yes. Many women experience mood changes and lability, depression and hence require a lot of emotional support.

By Dr Kristina Sule as told to Rosa Agutu. Dr Sule is an obstetrician and cosmetic gynaecologist and founder of Allora Medical Practice.