Menopause
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What is menopause? Menopause is a term used to describe the permanent cessation of the primary functions of the human ovary. The ovary functions by releasing ova and hormones, both of which are stopped with menopause. Hormones produced by the ovary are oestrogen and progesterone. Both these hormones normally cause menstruation by their effect on the uterine lining, called the endometrium. Thus, when ovary sort of shuts down, with menopause, the effect of both these hormones cease. When does menopause occur? Natural menopause occurs anywhere between ages of 45 and 55. Better nutrition may delay the onset of menopause. Menopause can be artificially induced if both ovaries are surgically removed. Rarely, menopause may occur at a young age, prematurely. It is surgically induced if both ovaries are removed for some reason. What are the changes that trigger the menopausal transition? Natural menopause is associated with lack of functioning of ovaries, which are two hormone producing organs situated near the womb or the uterus. Normally, these ovaries produce 3 hormones,viz: oestrogen, progesterone and androgens. When they stop functioning, a woman faces many physical and mental changes What is the significance of menopause for a woman? Menopause can have the following effects for a woman. Irregular heavy bleeding: Before the actual cessation of periods, the periods may get delayed by 7 days or longer. Gradually a cycle may sometimes be missed and these periods of absence will finally lead to stoppage of menstruation. In some women, these changes may be accompanied by heavy bleeding. This requires medical help if it is very heavy, otherwise, she may become anaemic. Heavy bleeding also requires medical evaluation to rule out pathological causes of bleeding. Hot flashes: The sudden sensation of extreme heat in the upper body, particularly the face, neck, and chest is referred to as a "hot flash." Perspiration, flushing, chills, clamminess, anxiety, and occasionally palpitations can occur. They last anywhere between 1-5 minutes. Osteoporosis: Osteoporosis literally means porous bones. Many years after menopause, the process of bone formation is not as fast as the process bone loss and this leads to less strong bones. In women, this is partly attributed to lack of the hormone oestrogen. Loss of cardioprotection : It is known that women who have not undergone menopause have less chance of getting a heart attack as compared to men of the same age. However, once her ovaries stop functioning, the odds that a woman may get a heart attack are the same as for men of comparable age. The protection provided by oestrogen is no longer there. Hypothyroidism as a consequence of menopause. There is reduced production of a hormone called thyroxine, normally produced by the thyroid gland , situated in the neck. The woman as a consequence, may tire easily, may get water logging in her body, and in extreme cases may not be able to tolerate cold. Depression: Women in their menopausal period may suddenly develop depressive symptoms, like easy crying, easy irritability, or sleeplessness. These symptoms are caused in some women due to fluctuating oestrogen levels, which has secondary effects in the brain. Usually at this time, the woman also faces an "Empty nest syndrome". This means, till about 40 years, her house was filled with echoes of her children asking her for something or screaming for something not done. But suddenly they leave her and fly away to be on their own. She suddenly feels unwanted and this negative feeling adds to her symptoms of depression. If it is severe, along with medicines to replace deficient hormones, she may need antidepressant medications. Vaginal symptoms: Due to lack of the hormone oestrogen in late menopausal years, there is dryness in the vagina. There also can be itching and burning sensation. There may be small breaks in the vaginal skin in extreme cases. This can be treated with local oestrogen creams or tablets. Questions and Answers compiled by: Dr.Shobhana Mohandas. MD.DGO.FICOG. Consultant Gynaecologist, Elite Hospital, Thrissur, Kerala. Email: shobhanamohandas@yahoo.co.in References: 1. Bharadwaj JA, Kendurkar SM, Vaidya PR. Age and symptomatology of menopause in Indian women. J Postgrad Med 1983;29:218 |