Menopause is the time that marks the end of your menstrual cycles. It can be defined as cessation of women’s natural menstrual cycle clinically diagnosed as absence of menstruation 12 months after the final menstrual period marking the end of fertility. Menopause can happen as early as 45 years and around the aged of 50s but average age of menopause is 52 years old. Some women goes through menopause with breeze with no or minimal symptoms but some may experience various unpleasant symptoms. This is attributed by decline in the level of estrogen produced by the ovary in the body.
Menopause is a natural biological process. However, several physical symptoms such as hot flushes and mood symptoms can affect your performance and energy level. In the months or years leading to menopause (perimenopause), you might experience several signs and symptoms such as:
- Irregular periods
- Vaginal dryness
- Urinary frequency and incontinence
- Hot flashes
- Night sweats
- Insomnia and sleeping difficulties
- Mood irritability
- Weight gain and slowed metabolism
- Thinning hair and dry skin
- Loss of breast fullness
- Sexual dysfunction
- Joint pain
Usually there is no need for testing to confirm diagnosis of menopause. It can be done through clinical assessment from the symptoms and menstrual history. However, in younger patient, hormonal testing needs to be done to rule out other causes of absence of menses such as pregnancy, thyroid, PCOS and premature ovarian failure. Pelvic ultrasound can be performed to assess endometrial thickness. In menopause, the thickness of the endometrium is typically less than 5mm.
It is also important to do a full-health screening to screen for cardiovascular risk factors such as high blood pressure, diabetes and high cholesterol. Cervical screening with pap smear and breast mammogram is also recommended. Bone mineral density (BMD) can also be perform to assess bone mineral profile and screen for osteoporosis.
Treatment of menopause is dependent on patient’s preference or severity of symptoms after receiving adequate information on the benefits and risks of the treatment given. Supplementation includes use of Evening Primrose oil (EPO), phytoestrogens from soybeans and Cimicifuga extract (black cohosh).
Hormonal replacement therapy (HRT) is an effective treatment for relief of various menopausal-related symptoms especially when symptoms adversely affect the quality of life. However, the lowest dose should be used for the shortest period of time and individualized treatment must be tailored to patient’s need. The are various preparations available including topical (cream, patch, vaginal tablets) and oral tablets which can be given as cyclical or continous replacement. HRT also has an added benefit in term of prevention of osteoporosis. However, risk of blood clots (venous thromboembolism), breast cancer, stroke and heart attack need to be discussed with patient prior to initiation.
It is very important to maintain healthy lifestyle by regular exercise and eating a balanced meal with plenty of wholegrains, fruits and vegetables. It is also important to ensure regular intake of calcium- rich foods such as milk and dairy products or supplement with calcium and vitamin D tablets to strengthen the bone. It is also important to do regular weight-bearing exercises like walking and jogging and strength- training exercises.
Use of vaginal lubricants can ease dryness and pain associated with sexual intercourse. Regular pelvic floor exercises can also help with prolapse and urinary symptoms.
It also recommended to avoid thick clothing in layers and factors that can trigger hot flashes such as exposure to a hot environment, hot drinks, spicy food, alcohol, and stress. It is also important to get enough sleep, about 8 hours a day.
The physical, psychological and emotional changes related to menopause can be unpleasant and challenging but it should not define you. Menopause should be seen as another chapter in your life’s journey. A time to reflect and assess your lifestyle and health and a reminder to prioritize time for yourself.