Menopause is a period in a woman’s life when the periods are no longer happening.
Background
Menopause (climacteric) – is a normal physiological process of ageing of the female’s body that is caused by the cessation of ovarian functioning and the end of the reproductive period in a woman’s life when menstrual periods stop permanently (the date set retrospectively, i.e. after 12 months of absence of the menstruation).
Although menopause is not a disease, it may be accompanied by several disturbing symptoms, affecting the performance and well-being of a woman. However, women have to remember that it is impossible to avoid menopause. It is often referred to as climacteric or the climacteric period and symptoms that arise during the period are called climacteric syndrome.
Normally menopause happens between 45 and 55 years of age, and the decline of reproductive system functioning develops gradually. Before complete cessation, a woman’s periods may become irregular, last for a longer or shorter time, and become lighter or heavier in terms of the amount of flow.
Definitions
The period of menopausal transition includes the actual menopause and post-menopause. The early stage of menopause transition is characterized by an increase of variability in menstrual cycle length, as the cycles differ from each other at 7 days or more. The stable character of menopause has a similar picture in the range of 10 cycles after the first cycle increased in duration. The late stage of transition is different by the appearance of menopause amenorrhea with a duration of 60 days or more and characterized by increased blood levels of FSH of more than 25 IU / L and lasts for about 1-3 years. Early postmenopause lasts 5-8 years, followed by a period of late menopause.
According to the WHO classification, menopause can be distinguished as:
- Natural (physiological) menopause;
- Artificially induced menopause (after removal of the uterus, chemotherapy, radiation exposure);
- Premature menopause (before age 40);
- Premature ovarian failure (premature ageing of the ovaries);
What causes menopause?
- Age (natural decline of reproductive hormones) – when a woman reaches 35 years ovaries begin to change the amount of oestrogen they produce, later the production of oestrogen decrease even further up until menstruation stops and a woman loses her fertility.
- Premature ovarian failure is diagnosed by identifying high blood levels of follicle stimulating hormones (FSH) and luteinizing hormone (LH) on at least 3 occasions at least 4 weeks apart, this happens when the ovaries stop producing oestrogen as needed.
- Surgical intervention – menopause occurs after bilateral oophorectomy (removal of ovaries) when the oestrogen is no longer produced in the body.
Signs and symptoms of menopause
The symptoms may occur months or years before it (perimenopause) and include:
- Irregular or skipped periods
- Abnormal vaginal bleeding
- Hot flashes
- Vaginal dryness and pain with intercourse
- Frequent urination or urinary incontinence
- Mood changes
- Urinary tract infections
- Insomnia
- Fatigue
- Depression
- Weight gain and slowed metabolism
- Vaginal atrophy
- Decreased libido
- Dry hair and skin
Osteoporosis in menopause
It is known that menopause increases the loss of bone tissue and hence the risk of developing osteoporosis raises significantly in the postmenopausal period. In turn, osteoporosis is associated with increased fractures (mainly hip and spine) incidence in older women.
Diagnosis
Usually, the diagnosis is made upon signs and symptoms of the menopausal transition. Anyway, every woman should have an appointment with a doctor to discuss all details.
In certain cases, a woman may be recommended blood tests such as:
- Follicle-stimulating hormone (FSH) and oestrogen (estradiol);
- Thyroid-stimulating hormone (TSH) as hypofunction of the thyroid gland (hypothyroidism) can cause symptoms similar to those of menopause;
- Other tests may include a coagulation blood test, mammography to check for any every 2 years, pelvic ultrasound, and bone densitometry as low oestrogen levels are associated with osteoporosis risk.
Treatment
Menopause on its own doesn’t require any medical intervention, although women may need some medications to relieve bothersome symptoms. To relieve hot flashes woman is recommended to stick to a diet with plenty of fluids, limit alcohol intake and avoid spicy foods, soy products, exercise regularly, and maintain a healthy weight.
Since the flashes and other climacteric symptoms are caused by a lack of oestrogen, the effective treatment option to provide symptomatic relief is hormone replacement therapy with drugs, containing oestrogen, in the form of gels, tablets, and patches. Other treatment options include low-dose antidepressants particularly selective serotonin reuptake inhibitors (SSRIs). To address vaginal dryness, the doctor may advise applying topical oestrogen cream to the vagina.
Women who enter menopause tend to develop osteoporosis, therefore, although hormone replacement therapy reduces the risk of fractures, specific medications called biphosphonates may be indicated.