Menopause: A Bumpy Ride?
Menopause comes from the Greek word ”menos” which means month and “pausis” for pause. In some cultures, the word menopause translates to “time for your husband to get another wife” or “age of being useless”!
Menopause is somewhat a mystery to most women and a taboo for others. At 62, I know my mother must have been menopausal a while back. But I do not recall her ever mentioning her experience to her two daughters. Most women do not discuss their troublesome symptoms with anyone. Unfortunately, a great deal of our knowledge about menopause is from cartoons or caricatures of older women being portrayed as irritable or ugly!
Just as we go through menarche (starting of periods), we have to experience menopause. It is an inevitable natural process.
This topic has been a passion for me, not only because I myself am inching towards it but also because it is an experience linking all women, like a sisterhood. I would encourage us not to label menopause as a suffering but rather welcome it by being prepared and understanding our bodies and their complex processes.
I will try to give you a small insight into menopause and what you should expect when it knocks on your door. Do you need to see your doctor? What questions should you ask your health care provider?
What is menopause?
Menopause is a time when your ovaries stop producing eggs causing your monthly periods to stop. It is more of a retrospective term, which means that when you don’t have a period for more than 12 months, you have just completed menopause. And then begins the post-menopausal stage.
At what age can we expect changes?
Any time over the age of 45, your body can show changes to herald the coming of menopause. Most women achieve menopause between ages 45- 55 with the average age being 51. It usually starts with changes in your periods, with the interval between your periods getting longer, scantier or sometimes even heavier (it’s the periods that get heavier not the interval). Some months may be fine, but then others your cycles go crazy! This phase of unpredictable menstrual changes can often last for 3-5 years before you actually reach menopause.
This time is often called the Peri-Menopause or Transitional Stage. Most bothersome symptoms of menopause occur during this transitional stage.
Why does the Transitional Stage happen and for how long?
The length of the transitional stage can vary from person to person. There is no way to predict it. Our ovaries are not built to work a lifetime. They begin functioning at about age 11-12 and then they plan retirement at about age 45 (45-55)! When they finally decide to quit functioning varies from woman to woman and the transitional stage typically lasts about 3-5 years before you achieve menopause (12 months of no periods).
Do I need to see a doctor to diagnose menopause?
If you are over 45 and there are changes to your periods, you generally do not need a doctor to diagnose. However you could take a blood test to measure a hormone called FSH, but the levels of this hormone may not be abnormal till much later. If you are younger than 45 and experiencing menopausal symptoms then it is advisable to see your doctor.
Always make sure to get a pregnancy test with any changes to your periods.
Why do these symptoms occur?
During our menstrual years (the time when we are capable of having children), the ovaries are constantly producing hormones that prep the uterus for pregnancy if it were to happen. If you do not get pregnant that month then the uterus sheds its lining and you bleed for 3-5 days (periods) and the preparation starts all over again.
When the ovaries start wearing out, the levels of these hormones fluctuate, causing interruptions in the pattern of your menstrual cycle.
Estrogen, which is one of the hormones that is produced by the ovaries, is responsible for causing most of the symptoms.
What are the common symptoms of menopause?
Hot flashes are the number one complaint amongst peri-menopausal women, although menstrual irregularities often precede most symptoms.
Other symptoms include depression, weight gain, bone pain, vaginal dryness, urinary symptoms and skin problems.
Is there any treatment for menopause?
Menopause is a natural phenomenon and it does not require treatment. But the symptoms associated with menopause such as hot flashes, vaginal dryness and depression can be treated. Talk to your doctor about options available for you.
Is hormone replacement good for me?
At present, hormone replacement therapy or HRT is only indicated for treatment of severe hot flashes and vaginal symptoms. You and your doctor should determine if this is the right choice of treatment for you. It is not for all women, as your personal and family history is important in determining the use of HRT. Also HRT is not for long term use. It is typically recommended only for up to 3-5 years.
Will I lose my sex life after menopause?
Loss of libido is often noted at menopause but it is due to various factors. Estrogen does not directly affect libido but the effects of low estrogen on the body, such as vaginal dryness and mood swings can lead to decreased libido. You can discuss treatment options with your doctor.
Can I get pregnant after menopause?
Although the chances of getting pregnant after age 45 diminishes, you should continue to use protection or birth control until age 50 or until menopause (12 months of no period) is achieved, whichever comes first.
You could get pregnant during the transitional or peri-menopausal period.
How can I be prepared for menopause?
Knowing that changes could happen after the age of 45 is important. I advise maintaining a healthy weight, following a healthy diet and exercising at least 3-5 days a week. Also note that that calcium and vitamin D deficiency occur after menopause and this accelerates bone loss, increasing the risk of developing osteoporosis or thinning of bones.
Have yearly physical exams with your doctor and get all the recommended screening tests for your age such as mammogram, pap tests, colonoscopy and dexa scan. Discuss with your doctor ways to cope with menopausal symptoms. Make sure your immunizations are up to date.
Ask your doctor before you take any herbal or over the counter medication labelled for menopausal symptoms. Some of these medications might not be tested or studied and may actually cause harm.
Dr. Anju Menon is an experienced family medicine physician with special interest in women’s and children’s health, currently based in Cairo, Egypt.