Sunday January 13, 2013
Process and implications of menopause
By FIONA HO
Topics surrounding hot flashes and vaginal dryness are not the sexiest ones around, to be sure. Yet, menopause is a stage of life that will inevitably roll around as a woman ages. It is hence important to understand the process and implications of menopause so that women may continue living normal, productive lives towards their sunset years.
CONVERSATIONS surrounding menopause are not the kind that usually find their way around the coffee table. Hot flashes and vaginal dryness are not the most comfortable topics to talk about after all.
Then we have Madonna, who at 54, still finds it appropriate to routinely flash her lady parts at tens of thousands of people during her recent MDNA world tour.
To her credit, the legendary singer is in incredible shape. Madonna, hailed as the queen of pop, has a killer physique that has defied the ravages of time, and more importantly, the all-too-common, if unforgiving, symptoms of menopause that include weight gain, thinning hair and dry, itchy skin.
If anything, the American singer, known for her flamboyant and hypersexual performances, makes menopause look like an urban myth.
Unfortunately, most of us in the real world do not have access to Madonna’s team of top stylists, dieticians and personal trainers (not to mention plastic surgeons, but let’s not go there).
Worse, menopause is a phenomenon that affects all women, and more often than not, has deeper implications beyond just waking up to tighter pants or physical discomfort.
The advent of menopause heralds a confusing period of time that can affect a woman’s health, relationships and overall quality of life.
Essentially, menopause marks a time in a woman’s life when her periods (menstruation) eventually stop, and the body undergoes changes that no longer allow her to conceive.
It is a natural event that normally occurs in women aged between 45 and 55.
In the process, periods occur less often, and eventually stop, signalling an end to a woman’s fertility. Sometimes, this happens suddenly, butusually, periods stop slowly over time.
In all accounts, menopause will bring about adverse and permanent changes to the female body.
Dr Teresa L. Knight, CEO of the Women’s Health Specialists Centre of St. Louis, Missouri, United States, details the process of menopause during a recent talk at the American ambassador’s residence in Kuala Lumpur.
“Women are born with all the eggs that they will ever have. These eggs age with us, and are eventually used before the end of our lives,” she tells the female-majority audience at the talk.
Most women will experience changes in mood, weight, food cravings and breast tenderness throughout the month during their active reproductive years, which typically begins from ages 12 to 14 years, with menarche, a girl’s first menstrual period.
“These symptoms occur due to the hormonal changes that occur in the female body following the release of an egg during ovulation and the body’s preparation for possible fertilisation and pregnancy,” she says.
This monthly process that begins in adolescence will end in middle age as menopause when a woman literally runs out of eggs to grow and ovulate.
“When there are no more eggs present to grow, women experience symptoms from the lack of hormones. These symptoms are what we refer to as menopause.”
During menopause, a woman’s ovaries stop making eggs, and they produce less oestrogen and progesterone. Changes in these hormones result in menopausal symptoms.
These symptoms vary from woman to woman, although the first thing that most would notice is their menstrual cycles starting to become irregular.
Other changes that normally follow include decreased sex drive, mood changes, difficulty in sleeping (insomnia), hot flashes, night sweats and extreme fatigue.
More severe changes like vaginal infections and vaginal dryness can take a toll on a woman’s sex life and relationships, Dr Knight points out.
According to a study done by Universiti Kebangsaan Malaysia ‘s Department of Obstetrics and Gynaecology, the average age for menopause in Malaysian women is 51.
However, some women experience menopause earlier due to natural causes, or following surgery, illness or treatments that destroy the ovaries, says Dr Knight.
When you have not had a menstrual period for more than 12 consecutive months, you are considered postmenopausal.
Menopause can last up to five years or more, and symptoms such as weight gain could translate to more serious health problems, including high blood pressure and heart diseases, Dr Knight elaborates.
Other physiological changes that may occur due to the decrease in hormones include changes in cholesterol levels and loss of bone density.
“Women of Asian descent are particularly vulnerable to losing bone density or developing osteoporosis after menopause,” the doctor notes.
Although osteoporosis can strike at any age, women are at the greatest risk for the disease after menopause.
This is mostly due to decreased oestrogen levels in a woman’s body after menopause, as oestrogen plays a vital role in helping to prevent bone loss.
Because the bone density of Asian women who are over the age of 50 and are postmenopausal is significantly lower than any other group, they have the highest incidence of osteoporosis.
The National Osteoporosis Foundation (NOF) recently reported that up to 20% of Asian women over the age of 50 display symptoms of osteoporosis, compared to only 10% of non-Asian white females.
In the case of African American women, only 5% of those examined showed any symptoms.
In the first five to seven years following menopause, a woman can lose up to 20% of bone mass.
Despite the various challenges faced by menopausal women, many chose to suffer in silence, especially in Asia, where topics on sex are still deemed taboo, says Dr Knight.
“Women tend not to share these problems with other women. They stop feeling sexy and feel unfeminine,” she adds.
Some of these symptoms can be alleviated by making certain dietary changes, such as avoiding caffeine, alcohol and spicy foods, and eating soy products, as soy contains oestrogen.
Antidepressants have also been known to help with mood swings and hot flashes.
However, Dr Knight recommends hormone replacement therapy (HRT) for those who are experiencing severe hot flashes, night sweats, mood issues, or vaginal dryness.
HRT are medications containing female hormones to replace the ones the body no longer produces after menopause.
Generally, women who experience menopause naturally are typically prescribed oestrogen, along with progesterone or progestin (progesterone-like medication).
This is because oestrogen alone, when not balanced by progesterone, can stimulate growth of the lining of the uterus, increasing the risk of uterine cancer.
Incidentally, women who have had their uterus removed (hysterectomy) do not need to take progestin.
The benefits of hormone therapy are very much dependant on whether you take systemic hormone therapy or low-dose vaginal preparations of oestrogen.
Systemic hormone therapy or systemic oestrogen comes in pill, skin, patch, gel, cream or spray form.
This type of treatment remains the most effective treatment for relief of menopausal symptoms such as hot flashes and night sweats.
Oestrogen can also ease vaginal symptoms of menopause, such as dryness, itching, burning and discomfort with intercourse. As such, low-dose vaginal preparations of oestrogen, whether in cream, tablet or ring form, can effectively help minimise such discomforts.
Despite the benefits of HRT, some studies have looked at the risks of hormone therapy, including the risk of developing breast cancer, heart attacks, strokes and blood clots.
While current guidelines support the use of HRT for the treatment of hot flashes, the standard rule remains that HRT may only be started in women who have recently entered menopause. It should not be used in women who started menopause many years ago.
Women who wish to take HRT should also have a low risk for stroke, heart disease, blood clots or breast cancer. Also, the medicine should ideally not be used for more than five years.
“Hormone supplementation or replacement will halt the symptoms that result from the lack of hormone production,” says Dr Knight.
To mitigate the risks of oestrogen therapy, a lower dose of oestrogen or a different oestrogen preparation – such as a vaginal cream or skin patch, rather than a pill – may be administered.
Regular physical exams and Pap smears are also recommended to detect any complications that may arise as early as possible.
Understanding menopause is more important than ever as woman are now living longer.
The average lifespan of Malaysian women today is 77 years, compared to just 54 years in the 1960s.
Advances in medicine and better nutrition have contributed to a longer lifespan, and most women will now live beyond the age of menopause.
It is hence, imperative for women everywhere to understand the process of menopause, as well as treatment options, so that they can continue living normal, productive lives.