With no more periods, no more PMS and certainly no more pain—menopause does sound like the dream for every woman with painful or heavy periods. However, there can be many detours and complications till a woman truly hits menopause.
Heard of almost as much as menstruation, this phase which usually occurs between the ages of 45 and 55 is where a woman stops menstruating reaching the end of her fertility.
Let’s deep dive.
What is Menopause? When does it begin?
A normal part of the process of aging, menopause is defined as the end of a woman’s menstrual cycle. The word menopause literally means "end of monthly cycles" and comes from the Greek words mēn meaning month and pausis, meaning pause. The word was specifically coined for human females, though females of a few other mammals also experience the phenomenon in a way.
Commonly the word menopause can define any of the changes that occur before, during or soon after the end of your reproductive years. Medically, menopause is said to have occurred when a woman does not experience any menstrual bleeding for upto a year.
Women are born with all their eggs stored in their ovaries. These organs—present in a pair, connected to the uterus by the fallopian tubes—also make the hormones estrogen and progesterone which control the monthly release of their eggs (ovulation) and their period cycle (menstruation). Every month the uterus builds a lining to receive an egg released by an ovary. The egg awaits fertilisation failing which the uterine lining tears leading to menstrual bleeding.
This cycle comes to a natural stop with menopause, usually once a woman reaches the age of 45. For some women, especially those who have their ovaries removed due to cancer, chemotherapy or other complications, menopause may be induced earlier than the mid-40s. If menopause occurs before the age of 40 it is referred to as premature menopause or primary ovarian insufficiency. Early menopause is if the process occurs between the ages of 40 and 45.
Most menopause symptoms start showing up about four years before a woman’s last period continuing for about four to five years after. A handful of women however may experience menopausal symptoms for up to 12 years before their last period.
Types of Menopause:
The process of menopausal development, the final period and side effects caused due to it are determined by genetics, ovarian health and actions such smoking or drinking. The median age for menopause across the world is 51-years, but this may be shifted earlier depending on one’s genetic build.
During this long phase of change—that can last anywhere from 7 to 14 years—the female body’s production of progesterone and estrogen vary greatly resulting in various physical changes including:
- Variations in how the body processes energy as fat cells change and weight gain, (especially around the belly), becomes more probably
- Bones become less dense, making women more prone to osteoporosis and fractures.
- Changes in hormone levels may affect a woman’s sex drive.
Broadly all of these premenopausal symptoms and signs of menopause can be group into three main phases.
PHASE 1: PERIMENOPAUSE
The beginning of the menopausal transition is called Premenopause, a stage which begins many years prior to menopause and lasts up to the point where your ovaries stop releasing eggs. Gradually over this phase, especially in the first two years your ovaries begin to produce lesser and lesser estrogen.
Premenopause has a slimmer subsection called Perimenopause which is signified by higher occurrences of hot flashes, night sweats, difficulty sleeping, mood swings, vaginal dryness or atrophy, incontinence, osteoporosis, and heart disease. During this phase, estrogen levels are about 25% higher than the initial perimenopause phase, which is what causes the wide array of symptoms.
PHASE 2: MENOPAUSE
This period is followed by menopause, which is marked a year from when a woman has had her last period. By now the ovaries have stopped releasing eggs completely and estrogen is produced in minute quantities. Lower estrogen levels require a lot of adjusting on the body’s part. This may express itself as a lowering in one’s sex drive or may even affect one’s brain functioning.
PHASE 3: POST MENOPAUSE
After menopause, women enter into the post-menopause period. This is a period of great change. The body begins to adapt various deficiencies including that of calcium, and begins to process fat differently. Post-menopausal women are also at a higher risk of osteoporosis and heart disease.
As mentioned earlier, the signs of menopause are easy to read and spread over a large area in the menopausal age. While smokers or heavy drinkers may get to menopause earlier than others, most perimenopause symptoms (especially if the patient does not have a history of uterine complications) start gradually and express themselves over a period of time.
Menopause Signs & Symptoms
Menopause is signified a lowering in levels of hormones such as progesterone, estrogen, testosterone, follicle stimulating hormone and the luteinizing hormone. Another organ that is affected are the ovarian follicles—structures that release eggs from the ovarian wall triggering menstruation and allowing for fertility. These become less active and women begin to notice that their period is becoming less frequent and less consistent but longer and heavier.
The signs and symptoms of menopause most commonly observed are:
- Hot flashes with sweating
- Sudden feelings of warmth in the upper body
- Vaginal soreness and dryness
- Thinning of hair
- Dry skin
- Mood changes
- Slowed metabolism
- Weight gain, especially around the belly
- Fatigue and depression
- Elevated heartbeat
- Moodiness and crankiness
- Changes in one’s sex drive
- Pains in the muscle, bone density issues
While intensity of these menopause symptoms may differ from woman to woman, what is common to all is the gradual disruption of period cycles. A woman may skip her period for months together, but then have one month with extremely heavy flow for several days. A common misconception that menopause naturally mean infertility is unfortunately not true. As some eggs continue to exist in the ovaries, it is possible that a woman displaying perimenopause symptoms may also be impregnated by unsafe sex. Thus it is advised that is one has simply skipped a period, but aren’t sure if they are straddling menopause, they must continue to perform intercourse using contraception.
Diagnosis of Menopause
The most obvious symptom of menopause is disruptions in one’s period cycles that begin to appear as one enters their 40s. You may suspect that you’re going into menopause, or your doctor may indicate the same based on symptoms you cite to them. It is best to keep track of your periods, perimenopause symptoms and chart the changes you see your body undergoing.
If you suspect you have entered into perimenopause visit your doctor for a quick chat. Your doctor may test your blood for levels of certain hormones to confirm that you have indeed reached menopause. These may include tests for:
- Estradiol: This test helps record how much estrogen your body is making.
- Thyroid hormones: Fluctuations in the functioning of the thyroid gland may lead to symptoms which look very similar to menopause symptoms.
- Anti Mullerian Hormones: This is made by your reproductive organs and can help your doctor learn more about how many eggs you may have in reserve in your ovaries.
- Follicle Stimulating Hormones: FSH increases in levels to 30 mIU/mL or higher as one nears menopause. It is usually elevated FSH tests along with a lack of menstruation for a year that is considered a confirmation of menopause.
Depending on your symptoms and your history the doctor may also recommend a blood lipid profile, liver and kidney function tests and tests to check on testosterone, progesterone, prolactin, and chorionic gonadotropin (hCG) levels.
Menopause comes with many changes including a higher risk of medical conditions such as:
- Cardiovascular diseases: Decline in estrogen levels cause greater cardiovascular risk. It is important to maintain a healthy weight through a healthy diet and regular exercise. Those suffering from high blood pressure or cholesterol, must also keep those in check.
- Urinary incontinence: As the muscles and tissues of the vagina and urethra lose elasticity women may develop urinary incontinence. This is classified as the sudden strong urge to urinate perhaps followed by involuntary urine leakage following actions such as coughing, laughing, or aerobic exercises. This phase may also put one at a higher risk of UTIs.
- Osteoporosis: in the first few years of menopause, a woman’s bone density is affected at a rapid rate, causing bones to become brittle and weak leading to an increased risk of fractures and osteoporosis. If a woman already has osteoporosis she may become especially susceptible to fractures in the spine, hips and wrists.
Other effects include:
- Changes in sex drive: Decreased moisture production in the vaginal canal along with loss of elasticity may lead to vaginal dryness and cause discomfort during sexual intercourse. The whole process may result in a reduced desire for sex.
- Weight gain: Menopause also brings with it a definitive slowing down of the metabolism. One may have to exercise more and eat less just to keep excess weight at bay.
In case you are experiencing vaginal atrophy, night sweats, hot flashes, osteoporosis or hair loss speak to your doctor for individual treatments to these symptoms. Your doctor can prescribe medication that can help manage these symptoms and also keep mood swings and depression at bay. Lubricants can be used to ease the sexual experience while prophylactic antibiotics can help with recurrent UTIs. Insomnia can be treated using sleeping pills. It is always recommended that one pay more attention to dietary habits and exercise as frequently as possible to keep the body in its best possible shape.
It is important to understand that as the female body steps out fertility (for which it has been gearing up for most of one’s life) there are many new phenomenon one may have to experience. At this point the body is vulnerable and adapting. It is best to keep checking for any complications such as unnatural bleeding or lumps in the breast through this phase to make sure all symptoms are related to natural menopause and no other complication.
Home Remedies for Menopause
- Exercise and manage weight:
Reduce your regular calorie intake by 500 to 600 calories. It is also recommended that one gets moderate exercise for up to 30 minutes a day. This can better your sleep, improve your mood, increase energy and help maintain muscle and bone strength.
- Understand your mental wellbeing:
Hormonal changes can lead to mood swings and phases of anxiety, depression, isolation, sadness and insomnia. Don’t shy away from discussing these with your partner, kids, close friends; and should you need to, do consider reaching out to a therapist who can help talk you through this phase. This is especially important so that women can adjust back to their lives which are full of work and responsibility.
- Vital vitamins:
Supplementing your diet with magnesium, calcium and vitamin supplements can help better sleep, energy levels and keep the risk of osteoporosis at bay.
- Have a conversation about sex:
Sit your partner down and explain the changes in your body that may hamper sexual activity. Together you can find solutions to keep sex fun and relaxing.
- Care for your skin:
Moisturizing always helps. Avoid excessive swimming or bathing in harsh water, which could irritate your skin.
- Quit smoking and drinking:
Exposure to cigarette smoke may make your menopause symptoms even worse. Heavy drinking in this phase can lead to additional health concerns including that of breast cancer.
- Stay cool and comfortable:
This can help especially in case you are having trouble sleeping at night due to constant sweating or are having hot flashes by day. Drinking cold water, dressing in loose clothes, sleeping near a fan or a dryer or without a heavy blanket at night can help with managing symptoms.
- Pelvic exercises:
Strengthen your pelvic floor muscles with kegel exercises to prevent urinary leakage.
Menopause can seem overwhelming, especially with all this information at hand. However, keeping in touch with your body and a good doctor can go a long way to ease the pain.