Menopause is a biological process that happens to every woman at some point in her life indicating the end of the menstrual cycle. Menopause begins between the ages of 45 and 55. During this period, the chances of a woman getting pregnant naturally are reduced.
It is premature when it occurs before the age of 45 years. It affects about 1% of women under the age of 40 and 0.1% of women under the age of 30. Menopause is diagnosed when a woman does not menstruate for 12 consecutive months.
It is caused by reduced circulating levels of estrogen in the body as a result of reduced ovarian activity. Menopause can also be caused by the surgical removal of the ovaries, radiation exposure, chemotherapy, and infections such as tuberculosis, mumps, malaria, and varicella.
Most women have a progressive change in menstrual pattern in the years leading up to menopause as ovarian activity fluctuates, which can be accompanied by uncomfortable symptoms; this is known as perimenopause.
Women may experience fluctuations in their menstrual period during perimenopause. Other symptoms of menopause include:
- Hot flushes
- Night sweats
- Sleep problems
- Depressed mood
- Loss of memory and concentration
- Overwhelming tiredness
- Reduced libido
- Hirsutism (male-pattern growth of hair on the face, neck, chest, and back)
Some women experience no symptoms, however others tend to experience some uncomfortable symptoms throughout the menopausal period.
Short-term Effects: These occur between 0-5 years. They include:
- Vasomotor symptoms such as hot flushes and night sweats.
- Psychological symptoms, e.g. labile mood, anxiety, tearfulness
- Loss of concentration, poor memory
- Joint aches and pains
- Dry and itchy skin
- Hair changes
- Decreased sexual desire
Intermediate (3-10 years):
- Vaginal dryness
- Painful sexual intercourse
- Recurrent urinary tract infections
Long term Effects (>10 years)
- Osteoporosis: This is a disorder of bone quality and density that predisposes women to an increased risk of fracture. It occurs in menopause as a result of reduced estrogen levels.
- Heart diseases: Menopause is linked to a number of potentially harmful metabolic changes, including an increase in total and LDL cholesterol as well as a decrease in HDL cholesterol. Oestrogen has a protective effect against heart diseases and reverses these alterations.
- Dementia: Many women experience memory problems during menopause, and early menopause is linked to a higher risk of dementia later in life.
A diagnosis of menopause is made when a woman does not menstruate for 12 consecutive months. Hormone blood test are also performed to confirm the diagnosis. The most important is the Follicle Stimulating Hormone (FSH) levels in the blood. This hormone is essential for the stimulation of the ovaries to release estrogen.
This test is best performed on day 3-5 of the menstrual cycle. Serum levels greater than 30U/L is diagnostic of menopause. Other hormone blood tests like thyroid function test are also essential. Screening and assessment for heart disease, breast cancer, endometrial cancer and fractures are further investigations that should be done
Menopause is a normal physiological condition that occurs in every woman’s lifetime. For some women, the symptoms are not so severe to be treated and only require lifestyle changes including diet and exercise.
Hormone Replacement Therapy (HRT) is an available option for women who go through unbearable menopausal symptoms. This involves replacing hormones that are reduced during menopause. It however increases the risk of breast cancer, endometrial cancer, heart diseases, and stroke.