Menopause

Introduction

Few things remind a woman of her advancing age more vividly than the approach of menopause. Some women dread the impending cessation of the monthly periods and look upon it as the end of femininity and sexuality. Others welcome the end of the monthly nuisance and the freedom from the worry of unwanted pregnancies.

Far from something to be feared, menopause is the last stage of a gradual natural process which leads to menstruation stopping permanently.

Many women continue to live active and interesting lives as they had before menopause. Others have discovered new challenges at a time when their "change of life" coincides with their retirement from full-time work or the end of child-raising responsibilities as adult children become independent.

The average life expectancy of a Singaporean woman is about 78 years. Hence, you have a whole third of your life ahead of you on reaching menopause. You will cope better with menopause if you know and understand the changes in your body and are prepared for them.

The following information is aimed at helping you cope with the physical and emotional changes before and during menopause, so that you can be healthy both physically and emotionally, to live the fullest possible life in the decades ahead.

What Is Menopause?

Starting from puberty, a woman's body undergoes a gradual biological process which leads eventually to the end of her menstruation. When a woman has not menstruated for a year, her menopause is considered to have completed, and she is said to have gone through a "change of life". This usually happens around the age 50. However, just as puberty starts at different ages for different people, so too the start of menopause. Smokers, though, tend to reach menopause earlier than non-smokers.

What Exactly Happens?

Your ovaries have many follicles which are like tiny pouches, each containing an egg. You are born with about a million eggs but by puberty, you would just have 400,000. Of these, only about 400 to 500 mature fully to be released during the menstrual cycle. The rest degenerate over the years.

During your fertile years, a gland in the brain produces hormones which cause a new egg to be released from its follicle once a month. The follicle then produces two sex hormones called oestrogen and progesterone. These cause the inner lining of the womb to thicken.

If the egg is fertilised and you become pregnant, this thickened lining would receive and nourish the fertilised egg, which would in turn develop into a baby. If the egg is not fertilised, the level of the hormones falls and the lining of the womb would break down, causing you to menstruate.

As you approach the age of about 40, your body produces less of these hormones. This period is the transitional phase called climacteric, or perimenopause. The amount of hormones produced at this time may be uneven. When that happens, your periods may become irregular and the bleeding may be unexpectedly heavy in some months. Eventually, the bleeding stops.

After menopause, your ovaries continue to produce oestrogen but in smaller quantities. Oestrogen is also produced by fat cells with help from a gland near the kidney called the adrenal. In fact, women who are overweight sometimes do not experience symptoms of menopause because of the oestrogen produced by their fat cells.

How Does It Affect You?

Apart from the biological changes, the menopausal years can affect you physically and emotionally, depending on how quickly the production of oestrogen in your body is reduced, your lifestyle and whether you are under stress, your relationship with your partner and the support from your doctor.

It is important that you recognise the changes as they happen and whether they are caused by hormonal changes or circumstances around you. Whatever the cause, you can learn to deal with it.

What Are The Symptoms?

Each woman experiences menopause in her own special way. That is because although oestrogen and progesterone affect almost all tissues, everyone is influenced by them differently. Some women hardly notice any difference in their bodies or moods, while others find the change extremely uncomfortable and disruptive.

Irregular Periods

This is usually the first sign of menopause. Heavy bleeding, inter-menstrual bleeding or spotting and bleeding after intercourse should NEVER be ignored. As it is still possible for you to become pregnant, you should continue using contraception for at least a year after the final period.

Hot Flushes & Night Sweats

These are common symptoms of menopause. They are caused by the decreasing oestrogen level. When there is no oestrogen, your glands release other hormones which dilate blood vessels and affect your body temperature. Hot flushes can be embarrassing but never dangerous.

As its mildest, you may feel warm on a hot day. More often, it is a feeling of sudden intense heat in the upper part or all over your body. It can happen at any time of the day, and may vary from a mild and occasional feeling of body heat to frequent, florid redness and heat in the face and the neck.

Red blotches may also appear on your chest, back and arms, often accompanied by sweating, rapid heartbeat, nausea and dizziness. Shivers may follow as your body temperature returns to normal.

A hot flush may last from a few seconds to 30 minutes or more. It may be severe enough to wake you from deep sleep. It may lead to insomnia and cause you to feel tired and irritable. It could affect your relationship with your partner because his sleep may also be affected.

Hot flushes may start to occur before menopause and are more frequent after menopause. They may persist for several years.

What to do:

In most cases, hormone therapy will help to relieve the discomfort. However, if that is not for you, there are other ways to cope with hot flushes :

• Wear cool clothing such as cotton, to let your skin "breathe" and keep you cool
• Drink a glass of cold water or juice at the onset of a flush
• Shower with tepid water instead of taking warm baths
• Avoid alcohol, coffee and spicy food as they tend to bring on a flush

Poor Sleep

Interrupted sleep is frequently caused by night sweats but it can be an underlying symptom of anxiety or depression. See the section on psychological changes.

Aches, Weakness & Stiffness

As your oestrogen level falls, you may notice a loss of muscle strength. This can be aggravated by other factors. For instance, emotional stress and tension may also cause aches in the back and neck. Lack of exercise can also leave you feeling stiff all over and cause fluid to collect in the legs

What to do:

Regular exercise and relaxation can do wonders to relieve aches and stiffness and improve circulation.

Weight Gain

When you reach menopause, you may need only around two-thirds of the calories compared to before. This is because your body does not burn up calories as fast as it used to.

Hormonal changes play a part as oestrogen is responsible for the female shape. So, after menopause, fat tends to settle around the waist and your abdomen becomes rounder. You also retain water more easily.

What to do:

You can control your weight by cutting down on your calorie intake and exercising regularly. Consult a qualified dietitian if you need assistance in losing weight. See the section on Nutrition.

Gas & Constipation

When your oestrogen level falls, your entire digestive tract may slow down. As a result, you may suffer from gas, indigestion and constipation.

What to do:

Eat more high-fibre foods such as fruits wholemeal bread and fresh vegetables. If the symptoms persist, consult your doctor.

Psychological Changes

You may experience changing moods, and feel unable to cope with the normal stresses of daily life. You may become more forgetful or suffer from low-esteem. As these changes occur, you may feel tired and lethargic. This may affect your daily routine and you may become depressed. These symptoms may be worsened by other physical symptoms of menopause such as hot flushes.

Studies show that in many cases, such depression is related more to the stresses of life such as mid-life crisis than to menopause. They include changes in family roles, such as when your children grow up and leave home (the so-called "empty-nest" syndrome); personal losses such as when a parent, spouse or a close relative dies; as well as your own aging and the beginning of physical illness. Menopause may aggravate underlying anxiety and depression, making you more "vulnerable" emotionally.

What to do:

• People respond differently to stress and crises. Your friend's response may be negative, causing her much emotional distress and depression. Yours, however, may be positive, thus helping you to achieve your goals.
• Try a simple relaxation exercise if you feel a little down or when the stresses are getting to you. You can sit quietly by yourself, close your eyes for 5 or 10 minutes and free your mind. Or, you could give yourself a long, soothing soak in a bath.

Vaginal / Urinary Tract Changes

re is no reason why you should not be sexually active after menopause. However, at this time, the vaginal lining becomes drier, thinner, less elastic and is more vulnerable to infection. You may find sexual intercourse uncomfortable or painful, and so lose interest in sex. Loss of sexual desire may also be a symptom of depression or underlying illness.

There may be minor irritations. The skin around the vaginal opening is also dry. With time, it becomes thin and may shrink, causing vaginal discomfort or itching.

Changes around the vagina may cause the passage for urinating (called the urethra) to become inflamed or irritated. This may cause frequent urination, a feeling of wanting to urinate urgently, or pain on urination.

Coughing, laughing, exercising or carrying heavy things may cause urine to leak. This condition is known as incontinence. It can also be caused by the lack of exercise. It is important to know that incontinence is not a normal part of aging, to be masked by using adult diapers. Rather, it is a condition that can be treated.

What to do:

Most women find it useful to lubricate the vagina before sexual intercourse. A water-soluble lubricant is recommended as it helps to reduce the chance of infection. Oestrogen treatment can also effectively reverse the changes seen after menopause.

Personal hygiene is important in reducing infections and other discomforts. Infections are easily treated with antibiotics, but they tend to recur.

To help prevent infection, urinate before and after intercourse, drink a lot of water, avoid keeping a full bladder for long periods, and keep your genital area clean. Douching is not effective in preventing infections.

There is a higher chance of vaginal or urinary tract infection 4 - 5 years after your last menstrual period. If symptoms such as painful or frequent urination occur, consult your doctor.

To prevent incontinence, exercise regularly. You may train your bladder by contracting the muscles that stop urine flow. You can do this at any time and anywhere. However, if infection and incontinence persist, consult your doctor.

Skin & Hair Changes

With age comes some wrinkling of the skin. However, reduced oestrogen levels worsen it by causing the skin's connective tissue (the layers under the surface) to be less elastic. The skin becomes thinner and drier and there is more frequent bruising and itching. Hair growth also slows down and your hair becomes thinner and less manageable.

What to do:

There is little you can do about wrinkling. However, oestrogen treatment may restore some thickness to the hair and moisture to the skin.