The right age and the right tapering down of periods are important for women as they transit from perimenopause to menopause
In any woman’s life, 40-60 is a very important age. Many of the physiological changes associated with menopause happen at this stage. Though menopause is an inevitable phase, it has long lasting effects due to hormonal decline.
The ovaries stop functioning and the release of estrogen-type hormones is reduced. This causes changes in the body, both physically and mentally.
Perimenopause is a period of transition when the ovulation process starts slowing down and there is a decline in the production of eggs.
This leads to a wide range of symptoms and changes to their bodies.
“In the initial stages of the menopausal period, the progesterone is reduced and the estrogen is relatively in excess,” says Dr Meera Ragavan, Senior Consultant, Obstetrician & Urogynecologist, Apollo Hospitals, Chennai.
Called unopposed estrogen, it can lead to atypical endometrial hyperplasia, causing abnormal vaginal bleeding. This can cause irregular cycles, or even abnormal thickening of the womb lining, which could become precancerous or even early stage of endometrial cancer.
Such effects are more prominent in women who had an early menarche or are overweight because of the excess fat tissue and the metabolic changes which happen on the hormones. We need to understand that this is the underlying cause for all menopause related health issues.
Estrogen reduction can affect a woman’s health from head to toe, with common symptoms being night sweats, hot flushes, intolerance for cold, high irritability, depression, mood swings, slight memory loss, feeling of emptiness and insecurity at times.
“The confidence level reduces, and this is the time it is further exacerbated by physical limitations,” she says.
Many people become osteoarthritic or osteoporotic due to calcium depletion. Thereby they can have differences in their stance or gait, with heaviness or swelling in the knees, thereby having difficulty in motility.
Urogenital symptoms also happen significantly during this time due to estrogen deficiency, which causes vaginal dryness. There is a constant urge to urinate, a sense of irritation and itching, a predisposition to recurring urinary tract infection, emergency related symptoms of the bladder, lack of control of the urine stream, leading to incontinence.
Many women, if they have had multiple vaginal deliveries or are overweight, can suffer from stress incontinence – where they leak when they cough or sneeze.
“This can be quite distressing for women and a matter of social embarrassment as well which they suffer in silence because it is quite difficult to discuss, even with their spouse,” the doctor points out.
Sexual dysfunction, again, is a predominant symptom in the menopausal age group and primarily because of lack of libido and somatic symptoms such as vaginal dryness, where vaginal pain can ensue when they have intercourse - dyspareunia.
It can make them abstain from sexual intercourse, further leading to excessive vaginal dryness due to disuse. That is a predominant complaint in this age group.
This can also cause mental depression and marital disharmony. This is an unsaid problem related to menopause.
To cope, it is very important to recognise the symptoms of menopause. “It doesn’t cause an abrupt cessation of periods, but happens over six months to two years,” Dr Ragavan explains.
Menopausal women should have irregular, infrequent cycles with scanty periods. Any heavy bleeding lasting for more than a week, continuous bleeding or bleeding between periods is a warning sign of early cancer or precancer.
It should be checked out immediately. Bleeding after intercourse is also a red flag which should be attended to.
Managing menopausal health in terms of taking adequate vitamins and calcium supplements is mandatory to avoid bone depletion and further tissue loss so that further fractures can be avoided.
Good urogenital hygiene has to be maintained. If needed, local estrogen cream can be used to get rid of the urogenital symptoms.
Not all patients need oral hormonal replacement therapy, which should be taken only on being prescribed, and under medical supervision.
Intake of fibre in the diet, 1.5-2 litres water a day at least, avoiding caffeinated drinks, regular physical activity, avoiding smoking and tobacco usage in any form, plenty of fruits of vegetables and low carb diet in this period will go a long way in tackling the long-lasting effects of menopause.
Age of menopause is shifting more towards the right, i.e., menopause is getting delayed with women having periods till they are 54-55.
A study shows that overweight and obese women had more than 50 per cent higher risk of experiencing late menopause while those who are underweight tended to have early menopause, when they are under 36.
This is also very deleterious for women’s health because women are then exposed to prolonged period of hormonal decline.
The risk of developing cancer increases with age. Early menopause seriously affects bone status, and depletes the bone of the calcium and protein, leading to a predisposition to fractures even due to mild stress.
Osteoporotic factors are a health hazard because they can be fatal, especially when they happen on the neck of the thigh bone – the femur. That is something to watch out for as it is a lifestyle issue cause by stress.
Lack of sleep is underestimated, and can affect biological rhythm severely.
“In general, to lead a healthy life and to age with grace, physical activity is a must, adequate hydration, plenty of naturally available foodstuffs, avoid processed foods, smoking, vitamin supplementation, adequate sleep of seven hours a day, and mechanisms to cope with stress,” Dr Ragavan stresses.
Some signs that suggest you to consult a gynecologist are, any breast lump, or discharge from the nipple, any abnormal bleeding pattern or bleeding after menopause, bleeding after intercourse, recurrent UTI and incontinence.