Menopause

There’s a Shona proverb that says, ‘Chisingapere chinoshura’, loosely translated it means ‘Everything has an end‘.

This ladies is also true for Aunt Flo, she does have an expiry date and that date is MENOPAUSE.

But as we already know, she won’t go down without a fight.

Menopause is the time at which a woman permanently stops menstruating and is diagnosed after 12 months of no Aunt Flo (amenorrhea).

The journey to menopause comes in a series of stages.

1)Perimenopause or menopausal transition.

This is the time period from the first instance of climacteric symptoms caused by fluctuating hormonal levels to one year after menopause. It begins several years before menopause, usually starting in women in their 40s but can also start in their 30s or even earlier.

The duration can vary greatly in women but the average length of this transition is 4 years.

During this phase, there is a gradual degradation of ovarian function meaning ovaries gradually begin to produce less estrogen. This causes a decrease in fertility and sexual activity and can also cause some physiological and psychological symptoms to appear. These symptoms are what I termed above as climacteric symptoms. In short, these are symptoms brought about by the gradual changes in ovarian function.

2)Premenopause

This is from when the first irregular menstrual cycle starts to the last cycle.

Onset is usually 45-55 years of age. This phase is characterized by increasingly infrequent menstruation.

3)Menopause

The time at which menstruation stops permanently. This is confirmed after 12 months of not seeing Aunt Flo (amenorrhea). The age range is usually 49-52 years but in people who smoke, it happens earlier.

4)Postmenopause

Begins 12 months after the last visit from Aunt Flo.

One other variant of menopause is Surgical menopause. This is due to the removal of ovaries (usually after hysterectomy with bilateral salpingo-oophorectomy).

Now that we have broken it down into phases, let us now take a look at the symptoms.

I myself haven’t started experiencing this so I had to turn to my mother for more detailed intel. For her, menopause happened earlier which I believe was very welcome as in the previous blogs I mentioned how she and Aunt Flo weren’t the best of buddies.

The most important symptom is irregular menses which are characterized by reduction inflow quantity and duration and are usually a light pink color. Associated with;

i)Mild to no cramping.

ii)Autonomic symptoms: increased sweating, hot flashes (also triggered by stress), intolerance to heat, dizziness, headache

iii)Mental symptoms: insomnia due to night sweats, mood swings, low mood, irritability, anxiety, loss of sexual appetite, social withdrawal

iv)Weight gain, bloating.

v)Fluctuating appetite

vi)Mastodynia (breast pain), breast tenderness, and reduction in size

vii)Vaginal dryness

viii)Urinary incontinence

Symptoms may begin 6 years before the final menstrual period and continue for a variable number of years after the final menstrual period.

As the post-menopause years go by, symptoms of menopause also decline.

Diagnosis is usually clinical with the aid of certain tests to help confirm perimenopause;

1. Hormone profile: reduced oestrogen and progesterone & FSH (follicle stimulating hormone) increased.
2. Testosterone and prolactin levels will be within normal ranges
3. Lipid profile: increased cholesterol and decreased HDL (high-density lipoprotein)

Treatment is not necessary for all women approaching or undergoing menopause. It may be considered however if:

a) the symptoms are severe enough to affect functional capacity and quality of life.

b) In surgical menopause

c) In premature menopause (so as to avoid an increased risk of osteoporosis)

For hot flashes: avoid triggers (stress, emotional triggers, bright light). Regulate the temperature by using fans or an air conditioner.

Impaired sleep (insomnia): exercise, relaxation techniques.

Bone loss accelerates in the late menopausal transition and continues for a few years after menopause and might lead to osteoporosis so early treatment or intervention is advised.

Prevention of osteoporosis: smoking cessation, adequate vitamin D intake, calcium, regular exercise.

Hormone replacement therapy (HRT) can be used on a short-term basis for the treatment of menopausal symptoms. 2 types can be used, either; (i) estrogen therapy for women who have had a hysterectomy or (ii) estrogen plus progestin therapy for women still having a uterus.

NB; Taking HRT does however increase the risk of endometrial cancer, and heart diseases such as coronary heart disease. It is contraindicated to use HRT in pregnancy, cancer (breast/endometrial), stroke, hyperlipidemia, and chronic liver disease.

For women who do not want to use hormonal medications or have contraindications, Non-hormonal therapy is available.

(i) Some selective estrogen receptor modulators such as Tamoxifen, Ospemifene, and, Raloxifene can be used.

(ii) For hot flashes and other symptoms of vasomotor; Paroxetine, Gabapentin can be used.

NB: IT IS NECESSARY TO CONSULT WITH YOUR DOCTOR BEFORE TAKING ANY OF THESE MEDICATIONS.

If you are already in your mid-30s, it is time for a lifestyle modification so as to make menopause easier.

• Eat a balanced diet with plenty of calcium
• Limit your alcohol and caffeine intake
• Exercise regularly
• Learn stress management techniques (these will become handy when the hot flashes start kicking in)
• Know your triggers (emotional, food, etc)

That is all for now and if you’re already experiencing your perimenopause symptoms, take heart and know that these are just the last kicks of a dying horse, Aunt Flo.

Hope you all learned something new!

SEE YOU SOON!!