The World Health Organization defines menopause as the termination of menstruation or monthly period. Menopause is confirmed when a woman has missed her periods for 12 consecutive months naturally, without any medical intervention.

Perimenopause is the transition phase that begins years before a woman actually hits menopause and ends 12 months after the final menstrual period or FMP. Due to hormonal changes, a woman may experience irregular periods, hot flushes, night sweats, vaginal dryness, poor bladder control, weight gain, joint pains and mood swings during this phase. Postmenopause refers to all the years after Perimenopause.

Menopause age

Most women reach menopause between 40 and 58 years, averaging at 51 years. Menopause at less than 40 years of age is said to be premature menopause. Women who smoke are known to experience menopause about 2 years earlier than women who don’t smoke.

Findings by the Indian Menopause Society (IMS) reveal that menopausal age in urban Indian women is rising, now averaging between 47 and 52 years. Some causes are improved diet, obesity and prolonged use of birth control pills. About 7% Indian women experience premature menopause.

Complications of menopause

Just like puberty, menopause is a natural phenomenon in every woman’s life. As ovarian function stops and estrogen levels dip, a woman’s body becomes prone to certain medical conditions, some of which are:

Osteoporosis: As estrogen plays an important role in bone renewal, low estrogen leads to weak bones which become prone to breakage. This condition is known as osteoporosis.

Heart disease: Weight gain and hormonal changes make women more susceptible to cardiovascular conditions.

Postmenopausal bleeding: A condition in which vaginal bleeding may occur after one year from the last period. This bleeding can be a sign of an underlying problem such as polyps, endometrial atrophy or uterine cancer. Immediate medical advice should be sought in this case.

Effect of menopause on sex life

Low estrogen levels can lead to vaginal atrophy, or drying and thinning of vaginal tissue. This can cause pain, soreness or burning making sexual intercourse difficult. The desire to have sex may also diminish.

Your doctor can prescribe a vaginal lubricant to ease moderate vaginal dryness while severe vaginal atrophy may be treated with topical estrogen.

FSAD: Some women may develop Female Sexual Arousal Disorder (FSAD), also known as Candace syndrome. FSAD is a condition marked by the inability to attain or sustain sexual arousal until completion of sexual activity. Menopausal reduction in estrogen levels is a known cause of FSAD. It can be treated with sex counselling.

Hormone Replacement Therapy (HRT) or Menopausal Hormone Therapy (MHT)

HRT is a treatment for relieving symptoms of menopause by giving hormones estrogen and progesterone. HRT can be given in several ways: oral pills, skin patches, topical estrogen creams and implants surgically inserted under the skin.

A woman can begin HRT as soon as the symptoms begin (at Perimenopause) and continue till the symptoms disappear, which could take 2-5 years. While HRT is known to cause side effects such as headaches, fluid retention, tenderness of breasts, indigestion and depression, it can help prevent bone loss and significantly improve quality of life.

Controversy surrounding HRT

A 2002 U.S. study showed that combined HRT with both estrogen and progesterone increased women’s risk of developing heart disease, stroke and cancer. The findings caused concern worldwide and led to a sharp decline in combined HRT.

Recently new findings show that “hormone therapy can prevent heart disease, hip fractures, and osteoporosis, and that it cuts the risk of developing diabetes by 30% in younger women,” as reported by Shelley R. Salpeter, MD, a clinical professor of medicine at Stanford University’s School of Medicine.

Today, most experts agree that in short term HRT (5 years or less), the benefits outweigh the risks.

Living with Menopause

During and after menopause, a woman needs all the iron and calcium she can get. She also needs to eat a healthy diet rich in natural foods. Phytoestrogens found in plant foods have been known to help relieve some menopausal symptoms such as hot flushes and high cholesterol. Here are some tips to manage menopause.

  • Take 2-4 servings of dairy products and other calcium foods every day.
  • Eat at least 3 servings of iron-rich foods daily. Some examples are red meat, poultry, fish, eggs, leafy greens, fortified cereals and nuts.
  • Drink 8-10 glasses of water and avoid taking processed and carbonated beverages.
  • Reduce portion size if trying to lose weight and avoid foods high in sugar, salt and fat.
  • Reduce intake of saturated fat as it raises cholesterol levels. Some examples are whole milk, whole curd, cheese, ice cream, and processed foods.
  • Reduce alcohol intake to no more than twice a week.
  • Quit smoking.
  • Exercise for 30-40 minutes at least thrice a week.
  • Yoga and meditation are helpful in relieving discomfort.
  • Get regular Pap smear, mammograms, breast and pelvic exams.
  • Ask your doctor for calcium and vitamin D supplementation to fight osteoporosis.

Menopause marks the beginning of a new phase of life, which, with some effort, can turn into a wonderful journey of new discoveries.