Menopause
What is Menopause?
Menopause is a natural process that marks the permanent end of a woman’s ovulation and menstrual cycles. Every woman is born with a set number of ovarian follicles. During the period known as “reproductive activity”, the ovarian follicles mature and are released cyclically. If the ovarian follicle remains unfertilised, it is flushed out of the woman’s body during the next menstrual period. These cycles continue until the stock of ovarian follicles has been depleted. Once there are no more ovarian follicles and ovulation has ceased, production of progesterone and oestrogen hormones slows down and eventually stops. The slowing down of hormone production marks the beginning of menopause
At what age does menopause start?
Menopause usually starts between the ages of 45 and 55. A woman enters menopause after 12 consecutive months without a period. There is a time period of between 2 to 4 years known as perimenopause which usually manifests as irregular periods, premenstrual syndrome or PMS (breasts become sensitive just before a period starts, irritability) and the first hot flushes and night sweats. Perimenopause symptoms usually appear around the age of 47 and are due to a deficiency in progesterone while oestrogen production continues.
Diagnosis
The principal criteria is the absence of menstruation during at least 12 consecutive months in women who are near or over the age of 50. In such cases, further tests are usually deemed unnecessary. If in doubt, a physician could prescribe a test of progesterone levels. The patient takes progesterone 10 days per month during 3 consecutive months. If she is menopausal, her periods will not return.
Symptoms of Menopause
Menopause symptoms are “climacteric” which means they are closely linked to diminishing hormone levels as ovular production shuts down. It’s important to note both the number and intensity of symptoms vary from woman to woman. No two women’s symptoms are exactly alike and some women report no symptoms at all.
Symptoms
- Hot flushes or nausea may appear only from time to time or up to several times in a single hour. They often show up at night, disturbing sleep patterns. They may also appear during the day and are often provoked by ambient heat, eating a meal, alcohol, exercise or strong emotions. Hot flushes are the most common symptom and are noted by 8 out of 10 menopausal women;
- Night sweats;
- Headaches, fatigue, insomnia, irritability and anxiety;
- Joint pain, fleeting and changing from joint to joint, often more intense in the morning hours;
- Genital symptoms including vaginal dryness, pain during sexual intercourse (“dyspareunia”), vaginal inflammation (“vaginitis”) and reduced libido;
- Unitary tract infections, irritations, urine leaks or more frequent bouts of acute cystitis;
- Weight gain (especially around the belly) due to reduced oestrogen levels and a lower metabolism rate.
Increased risk of certain diseases
Menopause raises the risk of developing certain diseases like osteoporosis (heightened risk of fractures and vertebral compression) or of cardiovascular diseases. The risk is even higher for smokers and the overweight.
What is Premature Menopause?
Premature menopause is when the symptoms of menopause appear before age 40. It may manifest naturally or be provoked by treatment for another condition (Removal of the ovaries, chemotherapy or radiation therapy for example).
Treating Menopause
During Perimenopause
Perimenopausal women should take steps to avoid unwanted pregnancies during this period. A low-dose oral contraceptive like Cerazette or installing an intrauterine contraceptive device will not only prevent pregnancy but could also reduce symptoms. A progestin-based treatment like Utrogestan or Progesterone may also be prescribed.
Living with Menopause
As the intensity of symptoms varies considerably, there are many women who need no treatment at all. However, if symptoms begin to affect your quality of life, there are treatments your physician can prescribe to lessen them:
- Hormone Replacement Therapy (HRT) is a hormonal replacement therapy that locally administers oestrogen and progesterone. For example the combination of Oestrodose (topical gel) and Utrogestan (pill). HRT should be re-evaluated monthly to make adjustments depending on patient health.
- Other treatments like beta-alanine for hot flushes and vaginal lubricants or hydration.
Any treatment should be combined with advice on living on a healthier lifestyle, such as quitting smoking, reducing alcohol consumption, a varied diet and regular physical activity.
Article written by Camille Dauvergne, 4th-year Pharmacy student.
Published 19 Mar 2019