WHAT IS MENOPAUSE? – Here is what Every Woman Needs To Know
This seems to me, to be a very “simple” sentence for an event that -while 100% normal- is actually quite a complex bodily transition.
I prefer this description from The North American Menopause Society: “Ahh, the menopause journey. No clear starting or ending point, odd diversions, and an estimated time of arrival that could span years. Menopause is certainly a trip. And needless to say, you could use some turn-by-turn directions.”
The title ‘menopause’ is used to describe a myriad of complicated changes that a woman goes through before she has stopped releasing eggs and producing certain levels of hormones. The hormones in question being oestrogen (the main one), progesterone and testosterone. ‘A lot of the changes we see in the female reproductive system are a direct result of these changing hormone levels’. (We will discuss these ‘changes’ a little later.)
As women, we are born with a finite number of eggs (ovum) stored in our ovaries. When there are no more eggs to release and menstruation or bleeding stops: menopause occurs.
Just like most women will begin menses or menstruation cycles as a teenager, so will many women, go through the transitional menopausal phase or the “change” into menopause. It is, therefore, a natural event, with the key factor being age.
WHEN DOES IT OCCUR
Menopause is a direct result of changing hormone levels and ‘generally’ occurs in a woman’s late 40’s to early 50’s, with the average age being 51.
FACTORS THAT MAY AFFECT IT
However, as well as age, other factors may influence when a woman goes through menopause.
- Family History
- Smoking – “Women who smoke are known to have an earlier menopause than those that do not smoke” (Dr Jennifer Ashton).*
- Genetic and Medical Conditions (such as Cancer -the biggest one- can cause early menopause).
- Menopause may also be induced or influenced by surgical removal of the ovaries (bilateral oophorectomy), hysterectomy, chemotherapy, and pelvic radiation therapy.
PERI-MENOPAUSE, MENOPAUSE OR POST MENOPAUSE
Gynaecologists often refer to the three phases of menopause.
1st Phase: Peri-menopause
- means ‘around menopause and occurs when a woman begins to have symptoms of the “change”
- some of the more common and unpleasant symptoms being irregular periods, hot flushes, night sweats, sleep disturbance, vaginal dryness, fatigue and mood swings just to name a few.
- This phase lasts an average of 4-8 years, (for some women, it can be only a few months and for others, it may continue for 10 years.)
- During perimenopause, the ovaries gradually rebalance their estrogen and progesterone production as a way to prepare the body for the final cessation of periods.
- The typical age for peri-menopause is usually in your thirties – forties and is medically diagnosed by a drop in estrogen.
- Progesterone production may also drop due to stress.
- Menstrual cycles may lengthen or shorten and you are still fertile.
2nd Phase: Menopause
- This is the official end of your female reproductive years.
- It’s defined as the final menstrual period and is confirmed when a woman has not had her period for 12 consecutive months.
- Symptoms may continue, and even increase in severity during this phase.
- Age: forties-fifties
- No cycle and not fertile
- This occurs when the ‘menopausal symptoms’ stop
- There is no way of knowing how long these symptoms will continue. Most women will cease symptoms within 2-5 years of menopause, but a significant number of women continue to have hot flushes and night sweats and many other changes for many years.
Symptoms related to decreasing estrogen, progesterone and testosterone levels in my body
(Get ready for the JOYS!)
‘There is no one size fits all’ when it comes to menopausal symptoms.
Around 20% of women experience moderate to severe symptoms, which can include any, or all of the following
- Hot flushes (4 out of 5 women experience these, they can occur during Summer and Winter)
- Increase in body odour
- Night sweats
- Problems with falling asleep, staying asleep and sleep quality (Insomnia)
- Breast tenderness
- Itchy/crawly/dry skin/’Electric shock’ sensations
- Mild to severe aches and pains and muscle tension
- Burning tongue
- Increased susceptibility to UTI’s/bladder and vaginal infections
- Urinary frequency and incontinence
- Vaginal dryness, loss of lubrication and painful intercourse
- Change in bowel habits
- Loss of libido (sex drive)
- Migraines, headaches
-Cognitive issues are associated with a drop in the hormone progesterone which causes symptoms such as:
- Brain-fog, dizziness, forgetfulness/concentration, brain overload
- Mood changes (teary, irritable),severe mood swings, increased PMT
- Anxiety, depression
- Heart palpitations/irregular heartbeat
- Weight gain, (especially around the middle) despite no changes to diet or exercise. (Due to a drop in testosterone level)
- A physiological slowing of a woman’s metabolism and bloating
- A decrease in lean muscle
- An increase in some food hypersensitivities
- Weakening of bones/osteoporosis
- Laxity in skin tone, change in skin texture, hair thinning, hair loss
- Irregular Periods, (Bleeding from the uterus can be all over the place: In some women, as they approach menopause, their periods will just fade off into the sunset and bleeding will completely stop. In other women, their bleeding can get more erratic, in some cases-heavier, in some cases closer together. There is no way to predict vaginal bleeding. It is very individual.)
- Lastly, there can be a weakening in the muscles that support the uterus and all the pelvic/gynecologic organs of a woman. This is called “Pelvic Organ Prolapse” and is characterised by a weakening of pelvic floor muscles. This goes onto affect the functions and musculature of the bladder, the vagina, the uterus and the rectum.
There is not any one cause of prolapse. However, risk factors that are associated with it include:
- Women who have had multiple vaginal deliveries and many pregnancies
- Females who smoke
- Women who have pulmonary conditions where they are coughing a lot can be at higher risk
- Ladies who are suffering from severe obesity
**Just to keep things interesting in medicine, you can have none of these factors: you can have just one pregnancy, one vaginal delivery and still have uterine prolapse.
The most common symptom with a prolapse is the sensation of pressure. Some women might have to urinate more often and empty their bladder more often.
In terms of management. It depends on the severity or grade of prolapse. There are devices that women can use to help uterine prolapse, and then there is surgery some extreme cases. However, it depends on the woman, her age, lifestyle and how severe the prolapse is.
Most often women diagnose menopause themselves with changes that occur to their body, the onset of hot flushes, night sweats sleep interruptions and changes in her menstrual cycle patterns. However, your GP can provide a diagnosis through a blood test- although this can read false for various reasons.
COMMON Q’s & A’s REGARDING THE MENOPAUSE JOURNEY
Am I Having a Hot Flush?
If you are feeling your body temperature rise suddenly without warning and it largely affects the upper part of the body and you are in your perimenopausal phase, then yes most likely you are experiencing a hot flush! These can occur once or many times in a day and often last between 30 seconds to 10 minutes. This can cause some physical signs like blotchy skin or redness of the neck and face, heat palpations and dizziness.
Physiologically this is a vasomotor or blood vessel symptom due to the brain (hypothalamus or your thermostat) reacting to the fluctuating levels of hormones. Stimulants like caffeine, spicy foods, alcohol and external heat sources like a hot bath or a fireplace can induce a hot flush. Some women get more frequent hot flushes due to stress, anxiety and tension.
A few tricks you can try are dress in layers to help with hot flushes and use a fan in your home or office space. Do breathing exercises during a hot flush to try to minimise it and medical interventions such as birth control pills, hormone therapy, or even other prescriptions may help you reduce hot flushes.
**See your doctor if you’re having difficulty managing hot flushes on your own.
What Happens to My Bone Health?
Decreasing levels of estrogen may affect the amount of calcium in your bones, leading to a significant decrease in bone density and a condition called osteoporosis. Many women experience accelerated bone loss in the first few years after their last menstrual period.
Help prevent further damage to your bones by eating foods with lots of calcium, such as dairy products or dark leafy greens, use vitamin D supplements, exercise regularly and include weight training in your exercise routine, reduce alcohol consumption and avoid smoking.
There are prescription medications you may want to discuss with your doctor to prevent bone loss as well.
Does Menopause Affect My Heart?
Yes: some conditions such as dizziness and heart palpations or a fast-beating heart are symptoms of menopause. The low levels of estrogen produced can stop your body from retaining flexible arteries which in turn can restrict blood flow.
Is Menopause Making Me Gain Weight?
Changing hormones may cause weight gain as we age unfortunately. Trying to keep a balanced diet and exercise regimes will help you control your weight.
Foods to eat include: dairy – milk, yogurt and cheese contain calcium, phosphorus, potassium, magnesium, zinc and vitamins D, B, C and K — all of which are essential for bone health. Healthy fats, such as omega 3 fatty acids, benefit women going through menopause. Foods highest in these include: fatty fish like mackerel, salmon and anchovies, and seeds like flaxseeds, chia and hemp seeds.
A visit to a nutritionist may help if you are finding you are becoming hypersensitive to some foods (Which can also be a bonus -LOL- symptom of menopause!)
Am I Going to Experience the Same Symptoms as My Mother, Sister, or Friends?
Maybe or maybe not! You are a genetic hybrid of both your parents and hence you may not have the same menopause journey as your maternal relatives. The symptoms of menopause vary from one woman to another, even in the same families. This means you’ll need to manage your menopause individually. What worked for your mother or best friend may not work for you, and you need to find your own path to travel down.
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.
How Will I Know if I’m Going Through Menopause after I’ve had a Hysterectomy?
If your uterus was surgically removed through a hysterectomy, you may not know you’re going through menopause unless you experience hot flushes/flashes.
This can also happen if you’ve had an endometrial ablation and your ovaries weren’t removed. Endometrial ablation is the removal of the lining of your uterus as a treatment for heavy menstruation.
If you are NOT having any symptoms (lucky you), a blood test can determine if your ovaries are still functioning. This test can be used to help doctors find out your estrogen level, which may be beneficial if you’re at risk of osteoporosis. That’s because knowing your estrogen status may be important in determining whether you need a bone density assessment.
Is Hormone Replacement a Safe Option for Management of Menopausal Problems?
Several hormone therapies are FDA-approved for the treatment of hot flushes and prevention of bone loss. The benefits and risks vary depending on the severity of your hot flushes, bone loss, and your health. These therapies may not be right for you.
- Talk to your doctor before trying any hormone therapies.
Are There Non-hormonal Options for The Management of Menopausal Symptoms?
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 reasons. Changes to your lifestyle may help you relieve many of your symptoms without the need for hormonal intervention.
Alternatives you may want to try include:
- lifestyle changes such as weight loss
- incorporating regular exercise (yoga, tai chi etc…)
- altering room temperature (fans, aircon)
- sorting your diet: make every nutrient you consume count, include superfoods and mood-boosting nutrients, map your diet and avoid foods that aggravate symptoms (See our post on Mood-Boosting Superfoods for a list of foods and nutrients essential for supporting the body during menopause)
- dressing in light cotton clothing and wearing layers to be able to regulate body temperature,
- other treatments such as herbal therapies, self-hypnosis, acupuncture, aromatherapy and other medications may help decrease hot flushes and help reduce other symptoms
- You may find over-the-counter lubricants, estrogen creams, or other products help with vaginal dryness.
- Reducing stress and menopausal symptoms by incorporating a self-care regimen
- Communing with nature, get some vitamin D in the morning sunshine
The Wrap on Menopause
- Menopause is considered a ‘natural part’ of growing older as a woman.
- It’s a time when your estrogen, progesterone and testosterone levels decrease.
- Following menopause, your risk for certain conditions like osteoporosis or cardiovascular disease may increase.
- To manage your symptoms, maintain a healthy diet and get plenty of exercise to avoid unnecessary weight gain.
- You should contact your doctor if you experience adverse symptoms that affect your ability to function, or if you notice anything unusual that might require a closer look.
- Please remember to check in with your doctor during this time and have regular gynaecological exams as you begin to experience menopause.
- It is really important for women and for the men in their lives to understand that things will not be the same as they were before menopause. They will be different. But that doesn’t mean it won’t be as good, and in some cases maybe even better. It is just different.