Menopause
What is Menopause?
Menopause is the permanent end of cyclic functioning of the ovaries and thus of menstrual periods.
At what age does menopause occur in the life of a women?
In developed countries menopause usually occurs around 50 years. In Bangladesh it appears around the age 45. However menopause may also normally occur in women as young as 40.
Why and how does menopause occur?
Menopause occurs because as women age, the overies produce smaller and smaller amounts of oestrogen and progesterone. Oestrogen and progesteron are the hormones that control the monthly cycle of egg release (Ovulation) thus, as women approach menopause, an egg is released in fewer and fewer cycles, and eventually, egg release stops. As a result, menstrual periods end and pregnancy is no longer possible.
A womans last period can be identified only later, after she has had no periods for at least 6 months, (Women who do not wish to become pregnant should use birth control until 1 year has passed since their last menstrual period).
What is peri-menopause?
A distinctive transitional period called peri-menopause occurs before and just after menopause. During menopause estrogen and progesteron levels fluctuate widely.
Estrogen levels may be high at the beginning of this transitional period, but for short intervals, no estrogen may be produced. These fluctuations explain why many women in their 40s report bouts of menopausal symptoms, which may subside without treatment.
What is menopausal symptoms?
These are symptoms which women experiences some months or years after the cessation of menstruation (ovarian function).
The symptoms are:
(i) Neurotic and psychotic: depression, excitability, nervousness, irritability, headache, insomnia, paresthesia of hands and feet etc. (ii) Gastro intestinal: Change of appetite, dyspepsia, intestinal distension and constipation
(iii) Cardiovascular: hot flushes, profuse sweating, cold shiver etc.
(iv) Genital and sexual: decreased libido, dyspareunia due to dryness of vagina, sometimes increased sex desire
(v) Other sign/symptoms: painful and tender breast, joint pains, pigmentation of skin etc.
What is pre-mature menopause?
Pre-mature menopause (Premature ovarian failure) is the permanent end of the cyclic functioning of the ovaries and thus menstrual period before age 40. Hormonally, pre-mature menopause resembles natural menopause. Estrogen levels are low.
How to diagnose menopause?
In about three-fourths of women, menopause is obvious. If menopause needs to be confirmed (Particularly in younger women), blood tests are performed to measure levels of estrogen and follicle-stimulating hormone (which stimulates the ovaries to produce estrogen and progesteron).
Medical and family history of the concerned women is very important. The physical examination is undertaken which includes breast and pelvic examination and blood pressure is measured.
Blood tests mammography, bone densitometry may be done. The information obtained from all these examinations and tests help the doctor determine the womans risk of developing disorders after menopause.
What is the management?
(i) Explanation (that it is a physiological process) and reassurance. Advise for physical exercise and rest. (ii) If dyspareunia - a water soluble lubricant can be used to overcome dryness of the vagina. (iii) To alley anxiety - tranquilizer (phenobarbitone) (iv) Avoidance of alcohol, coffee, hot bath etc. (v) If there is hypertension - use hypotensive agents. (vi) Estrogen therapy - may be given to relieve symptoms.
