Menopause
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By Dr. Devaki Srinivasan
(This is a informative article related to Women problems at certain Age)
What is Menopause: Stoppage of Menstruation
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As age advances, the function of ovaries decrease. Two main functions (1) production of ovum (egg) for procreation (2) secretion of ovarian hormones – which maintain the menstrual and reproductive function.

I. Ovum production stops few years before menopause giving rise to a condition called Anovular Menstruation which is characterized by irregular and heavy menstrual bleeding – commonly noted before menopause. Sometimes may end up in Hysterectomy.
II. Stoppage of ovarian hormones – two types of harmones – harmone progesterone secretion stopped few years before menopause giving rise to anovular menstruation. When the other harmone estrogen is not secreted by the atrophic ovary menopause sets in.

When does menopause occur? When menstruation is stopped for 1 year. It occurs usually around the age of 52. Range is 45 to 55 years. Sometimes menstruation stops for 6 months and again starts having bleeding albeit small quantity and infrequent intervals once in 4 to 6 months. Then we have to calculate onset of menopause one year after the last menstruation. Very rarely pregnancy can occur during this period due to occasional ovum production called “Flash in the frying pan”.

In contrast to Natural Menopause, surgical menopause occurs when Hysterectomy with removal of ovaries when the symptoms appears suddenly requiring Harmone replacement therapy.

Third condition called Premature Menopause occurs when ovaries fails to function early i.e. 3rd decade or early 4th decade.

How does my body change? Because of aging and menopause, whole body shows changes. The very first symptom may be shown as hot flashes and night sweating. Episodes of sporadic flushing with sensation of heat that may or may not be associated with sweating – associated with palpitation and chills.

Night sweat are sleep thieves. Vary in intensity from woman to woman. At times keeps awake throughout the night. Changes noted almost all the systems of the body.
I.Brain-Mood and memory changes;irritability,depression and anxiety.
Emotional changes will be noted as the following symptoms:
1.Less motivated and less confident because you feel you have lost your energy due to stoppage of reproductive function.
2. More easily picking up quarrel with family members more often.
3. More anxious and irritable.
4. More aggressive and hostile –common cause of fights between mother-in-law and daughter-in-law.
5. Mood swings more common.
6. Feeling of apprehension and sense of insecurity.
7. Forgetfulness and lack of coordination.
8. More fatigued.

With the above symptoms we need not get upset-there are remedies like self help techniques; lifestyle choices; natural therapies and anti-depressants. We can pursue our hobbies for which we had no time earlier. We can join clubs meet more people and join more social gathering –like picnics, pilgrimages, spend time on discourses and meditation. Nutritional changes also help to some extent. Finally try HRT and other alternative therapies.

II . Physical changes:
1. More wrinkles and lines around mouth and eyes.
2. Skin has more spots and pimples.
3. Skin over arms and legs less toned and wrinkled.
4. Hair more brittle and lackluster and falling of hair.
5. Nails tend to split and crack.
6. Teeth more sensitive and brittle will crack easily due to enamel wear.
7. May develop facial hair.
8. Eyes feel more gritty and dry.

The above symptoms can be relieved to some extent by medicines-HRT and nature therapy. Exercises and special massages for toning muscles. Nutritional changes also help to some extent.

3. Sexual function -I don’t want to go into details about this condition as it varies from woman to woman. Usually less responsiveness to sexual acts and also feel less attraction to the partner. Physical, psychological and emotional reasons for this condition.

4. Cardio vascular system the protection given by ovarian hormones in prevention of heart attack during reproductive period is lost in Menopause and they are susceptible to hear problems equivalent to men after menopause.

Proper nutrition, regular exercise minimum of 20 mts – three times a week, maintaining healthy weight along with HRT and other medicines help to get over this problem.

5. Lungs – More chance of developing asthma and COPD. Can be controlled to some extent by PACED respiration – pranayam, healthy diet and weight.

6. Digestive system – lowered intestinal mobility leading to constipation and bloating. Proper diet, more fiber food, less spicy and oily food, more liquids and regular timing can help.

7. Bones and Joints – Important changes seen as osteoporisis – when bone mass reduces and density decreases due to changed calcium metabolism caused by hormonal changes. It is mostly seen in big bones such as hip, spine and wrist. Fractures occur more commonly with less than normal injury. Gait and posture affected. Radiating pain along the hands and giddiness due neck bone problems called cervical spondylosis. Consult the orthopedician – proper diet maintaining regular weight and exercises avoiding strenuous work along with special medical treatment such as calcium tablets, calcitonin, bisphosphonates and also HRT.

8. Genito –Urinary system is one of the main system affected. Vagina shrinks ,its walls become thinner and drier. Bladder wall thins and sphincter control is weakened. Supporting muscles to the bladder, rectum and uterus get weakened leading to prolapse of these organs.

Vaginal symptoms include a) dryness b) itching c) burning d) irritation e) sexual discomfort.

Physical, psychological and emotional reasons cause the above symptoms. Following points to be remembered a) never use vaginal douche as it encourages infection b) wash the genital from front to back to avoid spreading bacteria from anal area c) avoid using soap or gel to wash the bottom d) use mild detergents to wash undergarments e) use loose fitting clothes made from natural fibers f) when indicated use of local estrogen therapy advised.

Urinary symptoms 1) Urinary tract infection 2) stress incontinence 3) urge incontinence.

Points to observe to prevent infection a) urinate after intercourse (b) when ever there is urge to urinate c) wear underwear of natural fibers to reduce moisture retention d) avoid tight jeans and other pants e) stop using douches, hot tubs or chlorinated pools f) don’t use perfumed toilet paper g) drink cranberry juice to maintain urinary pH. h) don’t use tampons or diaphragm i) eat yogurt frequently

Apart from urinary infection, stress incontinence and urge incontinence and prolapse of uterus, bladder and rectum can be controlled to some extent by pelvic floor exercises. In severe cases surgical treatment is needed. Vaginal cones, local hormone therapy is also useful.

Prevention and treatment consists of 1) exercise 2) maintain healthy weight 3) follow healthy diet 4) avoid excessive amount of caffeine.

Prescription medicines consisting of HRT – two types of hormone therapy a) estrogen alone (premarin) b) estrogen and progesterone for women with uterus (prempro).

Osteoperosis drugs – 1) Bisphosphonates s 2) Calcitonin 3) Calcium tablets

Annual pap smear and mammograms.

In spite of physical, psychological and emotional changes the benefits of menopause are 1) not to worry about menses and changing sanitary pads 2) fear of unwanted pregnancy 3) more time to spend with friends and relatives 4) more time to spend doing hobbies like knitting, sewing and art classes.
(Writer is a Doctor Specialized with women related problems)
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