Menopause: Symptoms, management tips, unknown facts and more revealed by doctors

The natural suspension of a woman’s menstrual cycle that marks the end of fertility is known as menopause. It marks the end of periods as a hormonal milestone and though most women experience menopause by the age of 52, certain genetics, underlying conditions or pelvic or ovarian damage may cause sudden menopause earlier in life.

In an interview with HT Lifestyle, Dr Anagha Chhatrapati, Consultant- Gynaecology at Mumbai’s Global Hospital, explained, “Menopause marks the important milestone in woman’s reproductive life. It is when the ova in ovary get over and woman stops menstruating. This phase is marked by huge hormonal changes which will bring about secondary turmoil in woman’s body.”

Echoing the same, Dr Asha Dalal, Director of Obstetrics & Gynaecology at Sir HN Reliance Foundation Hospital, shared, “When you do not get a period for 1 year it is called menopause. This does not happen suddenly but symptoms are present for some time before a menopause and this period is the peri menopause.”

Symptoms:

According to Dr Asha Dalal, commonly the symptoms include hot flashes, night sweats, irritability, mood swings and inability to sleep. They do not last throughout. These peak in a year or two, then plateau for 2-3 years and decrease.

Along with these, Dr Anagha Chhatrapati pointed out that some women can have few psychosomatic manifestations like backaches, body ache and headache. She said, “Hot flushes or feeling of extreme heat in body is also seen. All these symptoms generally decrease within 1-2 years of onset of menopause. Counselling and a good family support is all that is needed in this delicate phase of woman’s life. Estrogen helps in maintaining the bone strength.”

Dr Bhavini Shah Balakrishnan, Consultant – Obstetrician and Gynaecologist at Mumbai’s Masina Hospital, echoed the same and said, “Menopause is not a disease but the hormonal changes that accompany it can cause symptoms such as hot flashes, night sweats, insomnia, vaginal dryness, decreased libido, and extreme mood swings.”

Unknown facts about menopause:

Asserting that menopause is not a one-time event, Dr Bhavini Shah Balakrishnan said, “It’s vital to understand that menopause is a gradual process. As menopause approaches, it is a natural process that involves numerous hormonal and physiological changes. The perimenopausal phase can span anywhere from 2 to 8 years.

Sharing some unknown facts, she shared that Osteoporosis can develop as a result of menopause. She explained, “Estrogen, the female hormone, helps to limit bone loss, and women lose more bone than they rebuilt during menopause (when oestrogen levels drop). After the age of 40, calcium supplements play an important role to replenish and compensate for the lost bone.”

Next, she pointed out that hot flushes can be very distressing. She said, “It makes you feel wonderful to believe that menopausal Hot Flushes would pass in a heartbeat. Hot flushes, on the other hand, might linger anywhere from 6 months to 2 years on average. It could even be longer for some. Numerous studies have shown that combining yoga and meditation has helped many women fight hot flushes and retain their sanity during their perimenopausal phase.”

Dr Anagha Chhatrapati revealed, “The main hormonal changes are brought about by deficiency of estrogen. Estrogen is normally secreted by the ovary during ovulation process. Estrogen is a pro-metabolic hormone. In menopause as the ova in ovary are exhausted, there is marked decrease in production of estrogen hormone. Low estrogen will lead to mood swings, irritability and depression.”

Post-menopausal osteoporosis or weakening of bones make women prone for easy fractures from a trivial trauma. At this stage, Dr Anagha Chhatrapati recommends getting BMD (bone mineral density) studied helps as appropriate treatment for strengthening bones along with tibolone and calcium supplements is advocated.

She added, “Other serious side effect of menopause is increased risk of coronary atherosclerosis and cardiovascular events like heart attack or stroke. This is also due to estrogen deficiency. Improvement in diet patterns and lifestyle modification along with appropriate medications for lowering cholesterol levels help. Only in premature menopause (menopause occurring before age of 40), estrogen supplements are given to prevent these side effects.”

Management tips and treatment for side effects of menopause:

As per Dr Asha Dalal, the symptoms of menopause can be treated by Menopausal Hormonal Therapy (MHT). “These hormones are given in the smallest possible dose for the least amount of time. This can be started if you do not have any family history of cancer of breast, ovary or uterus and the basic tests to be done, like Pap smear, mammography and pelvic USG are normal. If you cannot take oestrogen you can take plant oestrogens or other non-hormonal medication,” she advised.

Dr Asha Dalal highlighted, “Post Menopause you are prone to urinary urgency, frequency and this is managed by drinking more fluids and medication. Stress Incontinence may require surgery. You are also at risk of osteoporosis and increased risk for cardiovascular disease. There is a perception that people put on weight but it is not much in women who exercise. In case there is any post-menopausal bleeding it needs to be investigated to rule out cancer. You may have sleep disturbances. To sail through menopause you need to exercise, have calcium supplements, healthy diet, sleep, sunlight and laughter and friends.”

Given that other side effects are due to decreased skin turgidity, leading to wrinkling and easy bruising, Dr Anagha Chhatrapati pointed out that it leads to vaginal dryness, which can result in dyspareunia (painful coitus), perineal injuries, recurrent vaginal and urinary infections. She said, “This all may make woman feel distressed and decreases her libido. Treatment for such patients can be in the form of local vaginal estrogen cream application. Overall menopausal transition is also the same age for development of cancers. So, women should be encouraged to get mammography once a year, pap smear testing once every 3 years and pelvic Ultrasonography. Emphasis on regular exercise and good lifestyle helps to cope up with the symptoms in easy ways.”

Revealing that a majority of patients experience some or the other form of menopausal discomfort in the initial period, Dr Bhavini Shah Balakrishnan reassured, “Treatment is available for all symptoms associated with perimenopause and menopause. Minor but long-term lifestyle modifications with regular exercise, yoga and meditation on the other hand, have proven beneficial results.”

She listed some tips for effective menopause management without medication. These include regular exercise, joining a relaxation or yoga class, planning every day so that execution is easy, finding a balance between responsibilities and personal interests as much as possible, staying in touch with friends and family, sharing your menopause experiences with others facing similar issues and seeking help if you are concerned about memory loss, anxiety, depression, or any other issues.