Menopause – An opportunity to age gracefully

Menopause is a normal phase that all women pass through as they age. It is defined as the point in time when menstrual cycles permanently cease due to the natural depletion of ovarian oocytes from aging. The diagnosis is typically made retrospectively after the woman has missed menses for 12 consecutive months. It marks the permanent end of fertility and the average age of menopause is 51 years.

Although the diagnosis can be made by the patient’s history, laboratory testing may be performed to confirm the diagnosis of menopause. Elevated follicle stimulating hormone (FSH) and low estrogen (estradiol) are consistent with menopause. Any hormonal therapy, such as birth control pills, will invalidate the FSH and estradiol tests. Because certain medical conditions can result in the lack of menses hence it is necessary to check thyroid function, prolactin level, and other tests based on history and physical examination.

Effect of Menopause

Since menopause is due to the depletion of ovarian follicles/oocytes and severely reduced functioning of the ovaries, it is associated with lower levels of reproductive hormones, especially estrogen. Low estrogen can result in vasomotor instability (such as hot flushes and night sweats), psychological changes (such as mood swings, depression, and difficulty concentrating), insomnia, genital tract atrophy (such as vaginal dryness, painful intercourse, and urinary incontinence), skin changes (such as thinning and decreased elasticity). Lower androgen levels (male hormones) can contribute to the loss of sex drive. Women often report a variety of thinking (cognitive) and/or emotional symptoms, including fatigue, memory problems, irritability, and rapid changes in mood. It is difficult to determine exactly which behavioral symptoms are due directly to the hormonal changes of menopause.

Later Medical Problems

The lower reproductive hormones associated with menopause will increase the risk of osteoporosis, bone fractures, and cardiovascular disease (such as myocardial infarction and stroke).

Management of menopausal health

Menopausal medicine includes general health screening, including pelvic examination with PAP smear, clinical breast exam, mammography, dual-emission X-ray absorptiometry ( DEXA) to screen for osteoporosis, fecal occult blood testing, sometimes sigmoidoscopy/colonoscopy, and blood tests including lipid and thyroid screening.

A healthy lifestyle including a nutritious diet, supplementation with vitamin D and calcium, regular weight bearing exercise, and elimination of smokingand alcohol can help lower risk of osteoporosis, bone fractures, and cardiovascular disease.

 Hormone replacement therapy consists of estrogen, progesterone, and possibly testosterone may help alleviate or reduce the menopausal symptoms. However, it is recommended to use the lowest possible dose for the shortest duration possible to reduce the risks of breast cancer, blood clots, myocardial infarction, and stroke. Non-hormonal medications for vasomotor instability include low dose selective serotonin reuptake inhibitor (SSRI) antidepressants (such as fluoxetine, paroxetine, citalopram, and sertraline), gabapentin, and clonidine.

The effects of increased dietary intake of phytoestrogens (such as soybeans, chickpeas, and flaxseed) on vasomotor relief are controversial and there is some concern about cancer risk due to weak estrogen-like effects. Osteoporosis can also be treated with non-hormonal bisphosphonates (such as alendronate, risedronate, and ibandronate) or selective estrogen receptor modulators (SERMs; such as raloxifene). There is no evidence of consistent benefit of alternative therapies for menopausal symptoms despite their popularity.

Although menopause is a normal phase in woman’s life, the severity of problems may lead it to be manifested as an agonizing disease. Careful understanding and management is required to alleviate the social, psychological and physical impact of menopause on woman’s health. Appropriate handling can turn it into an opportunity for graceful ageing.