By Doris Obinna
Menopause is a natural, biological process that occurs in every woman’s life. It marks the permanent end of monthly periods (menstruation) and fertility. This means she is no longer able to have children.
An expert explained that during this transition period, a woman’s ovaries stop making eggs and her body produces less oestrogen and progesterone. Menopause is confirmed when a woman has no period for 12 months in a row.
Women past a certain age will experience menopause. Menopause is defined as having no menstrual period for one year. The age you experience it can vary, but it typically occurs in your late 40s or early 50s.
Menopause can cause many changes in your body. The symptoms are the result of a decreased production of oestrogen and progesterone in your ovaries.
According to a gynaecologist, Dr. Gabriel Omonaiye, menopause is established when menses have been absent for one year. It could be physiologic (natural) due to decreasing ovarian function or iatrogenic as a result of surgical removal of the ovaries to cure certain gynaecological problems such as cancer of the ovaries:
“The average age for menopause is 51 years, the range being 35 and 55 years. During the few years before and into menopause, the fertility of the woman drops, oestrogen and progesterone levels fall and the ovarian size reduces.”
A report by the National Institute on Ageing (NIA) states that the average onset of menopause is age 51, but the normal range is between 45 and 55: “Some women enter this stage of life before the age of 40.
This is called premature menopause. Many different factors can cause premature menopause, such as: autoimmune disorders, smoking, damage to the ovaries and surgery (such as a hysterectomy).”
The report states that the average age for onset of menopause is 51while the majority of women stop having periods somewhere between ages 45 to 55; the beginning stages of declining ovary function can start years before that in some women and others will continue to have menstrual periods into their late 50s:
“The age of menopause is thought to be genetically determined, but things such as smoking or chemotherapy can accelerate ovary decline, resulting in earlier menopause.
“Also, note that conditions related to your heart may arise during menopause, such as dizziness or cardiac palpitations. Decreased oestrogen levels can prevent your body from retaining flexible arteries. This can impact blood flow. Watching your weight, eating a healthy and balanced diet, exercising, and not smoking can reduce your chances of developing heart conditions.”
Stages of menopause
NIA disclosed that from the time a woman begins puberty until she enters menopause, she generally has a period around the same time every month: “Of course, irregular periods happen from time to time. Pregnancy and other medical conditions interrupt your period.
“During the first half of a woman’s normal menstrual cycle, the ovaries, two glands located on either side of the uterus, produce higher levels of the hormone oestrogen. This causes the lining of the uterus to thicken to prepare for possible pregnancy. An egg in one of the ovaries also starts to mature during this time.
“Near the middle of a woman’s menstrual cycle (typically day seven to 22, or day 14 for women on a standard, 28-day cycle), the mature egg is released in a process known as ovulation. After the egg is released, the ovaries make more of the hormone progesterone. If the egg is not fertilized, the levels of oestrogen and progesterone decrease, leading the body to shed the lining of the uterus. This causes a period.
“As a woman approaches menopause, her ovaries produce less oestrogen, which can cause irregular periods. The term ‘menopause’ is defined as a woman’s last menstrual cycle. After a woman’s final period, a year without further periods confirms the permanent end of fertility.”
Defining the three stages of menopause, Omonaiye said these stages happen over a series of months or even years: “Pre-menopause happens a few years before menopause; menopause, during menopause and postmenopause, a few years after menopause.
“In the pre-menopause, the menses begin to be irregular, initially more frequent followed by a decrease (oligomenorrhea), but any pattern is possible. Conception is possible during pre-menopause.
“Climacteric refers to a longer phase in which women loose reproductive capacity; it begins before pre-menopause.
“The physiologic explanation for the phenomenon of menopause is the unresponsiveness of the aging ovaries to the pituitary gonadotropins follicle stimulating hormones (FSH) and luteinizing hormone (LH).
“The woman has fewer ovulations. Eventually, the ovarian follicles do not respond, producing little oestrogen. The level of androgen reduces, but has little or no effects on her.
“Premature menopause also known as premature ovarian failure is cessation of menses due to non-iatrogenic (non medical) ovarian failure before the age of 40. The contributory factors may include smoking, living at high altitude and under nutrition.
“Lactogenic (artificial) menopause results from medical interventions such as oophorectomy (removal of the ovaries), chemotherapy and pelvic irradiation.”
Signs and symptoms
According to him, although menopause is a completely natural stage of a woman’s life cycle and not a disease, a series of uncomfortable physical and emotional symptoms usually accompany it: “Various forms of treatment can typically lessen these symptoms. Symptoms may include hot flashes, weight gain, or vaginal dryness. Vaginal atrophy contributes to vagina dryness. With this, there can be inflammation and thinning of the vaginal tissues, which add to uncomfortable intercourse.
“Menopause can also increase your risk for certain conditions like osteoporosis. You may find that getting through menopause requires little medical attention. Or you may decide you need to discuss symptoms and treatment options with a doctor.
“In her 40s, pre-menopausal changes start. Irregular menstruation, missed menses. The large fluctuations in oestrogen levels cause the symptoms of pre-menopause.
“Hot flushes and sweating due to vasomotor instability affect 75 to 85 per cent of women. This begins before the menstruation ceases. Hot flushes may continue from less than one year to more than five years. The severity varies in different women.
“The woman feels hot, or warm, may sweat and the core temperature increases. The skin becomes warm and red especially the head and neck region. The episode of the flush could last between 30 seconds to five minutes and may be followed by chills. Flushes may manifest at night as night sweats.
“Flushes could be triggered by smoking, alcohol, hot beverages, caffeine, spicy food and food containing nitrites and sulphites.
“Neuropsychiatric changes include; lack of sleep, poor concentration, loss of memory, depression and anxiety. Decrease oestrogen levels cause vaginal and vulva dryness and thinning, vaginal atrophic vaginitis.
“The atrophy causes irritation, difficulty in having sexual intercourse (dyspareunia), painful urination. The clitoris, labia menorah, uterus and ovaries reduce in size. Some have periodic light-headedness, palpitations and paraesthesia.
“Nausea, constipation, diarrhoea, joint and muscle pain, cold hands and feet do occur. Weight gain, abdominal obesity and decreased muscle mass do happen. Other may experience fatigue and irritability.
“The bone density may reduce (osteoporosis) with the risk of pathological fracture. The diagnosis of menopause is clinical. Hormonal assay could be carried out.”
Study also shows that the symptoms of menopause vary from one woman to another, even in the same families: “The age and rate of decline of ovary function differ tremendously. This means you’ll need to manage your menopause individually. What worked for your mother or best friend may not work for you.
“Talk to your doctor if you have any questions about menopause. They can help you understand your symptoms and find ways to manage them that work with your lifestyle.”
Treatment
“In the treatment of menopause, counselling plays a significant role. The explanation of the physiologic changes occurring in her body is important. For hot flushes, avoiding the triggers is helpful. Regular exercise and the use of multivitamins are useful.
“Hormonal Replacement Therapy (HRT) is used for moderate to severe menopausal symptoms. Antidepressants are also used to combat hot flushes.”
The United States Food and Drug Administration (FDA), disclosed that several hormone therapies are approved for treatment of hot flashes and prevention of bone loss: “The benefits and risks vary depending on the severity of your hot flashes and bone loss, and your health. These therapies may not be right for you. Talk to your doctor before trying any hormone therapy.
“For non-hormonal, hormone therapy may not be the right choice for you. Some medical conditions may prevent you from safely being able to use hormone therapy or you may choose not to use that form of treatment for your own personal reasons. Changes to your lifestyle may help you relieve many of your symptoms without need for hormonal intervention.
“Lifestyle changes may include; weight loss, exercise, room temperature reductions, avoidance of foods that aggravate symptoms and dressing in light cotton clothing and wearing layers. Other treatments such as herbal therapies, self-hypnosis, acupuncture, certain low-dose antidepressants, and other medications may be helpful in decreasing hot flashes.”