Menopause is the time in a woman’s life when menstruation stops permanently. This is a retrospective diagnosis and a woman is said to have gone through menopause if she has not had vaginal bleeding, including spotting, for a full year after her last period. If your mother or an elderly woman in the household is at this stage of life, you should make her aware of the effective methods of menopause management.
The average age of menopause in India is 47 years, compared to 51 years in the West. However, in recent times, women in India are also going through a later stage of menopause, which is around the fifties.
For a lot of women, getting rid of periods is a huge relief, especially if they are suffering from heavy painful periods. However, along with it come unpleasant symptoms.
What are the symptoms of menopause?
Menopause symptoms may start suddenly and may be very noticeable or they may be transient and mild. They can start about 6 years before menopause and continue for many years after menopause.
1. Irregular menstruation.
2. heavy or light periods
3. Hot flushes – feeling hot and sweating even in cold temperatures
4. Weight Gain and Bloating
5. Mood swings, trouble sleeping and depression
6. Vaginal Dryness and Loss of Libido
7. Frequent urination, increased urinary infection, urinary incontinence
8. Loss of balance and increased frequency of falls
Other changes include decreased bone density, leading to brittle bones and an increased risk of fractures, especially hip fractures. During this period, the risk of heart attack and stroke also increases due to the decreasing levels of the hormone estrogen.
What Can Be Done for Menopause Management?
The objectives of menopause management are:
*Relief from hot flushes*
*Reduce the risk of disease
*Improving quality of life*
What is hormone replacement therapy and how does it help?
It is the most commonly used drug therapy for the management of menopause. It may help prevent menopausal symptoms such as hot flushes, night sweats, mood swings, vaginal dryness, low sex drive and osteoporosis.
Types of Hormone Replacement Therapy (HRT)
Hormone replacement therapy includes the hormones estrogen and progesterone. Estrogen can be used alone if the woman has had a hysterectomy. If the uterus is intact then estrogen and progesterone are used in combination. Estrogen therapy (with or without progesterone) is the best treatment for hot flushes and night sweats. It also helps in reducing vaginal dryness and prevents bone loss. These drugs are available as tablets, gels, patches, implants and vaginal inserts such as creams, rings.
Side effects of hormonal replacement therapy for women going through menopause
* breast tenderness
* Vaginal bleeding – monthly or irregular
* stomach ache
What are the risks of hormonal replacement therapy
The benefits of this therapy usually outweigh the risks for most women. The risks are usually very small, and depend on the type of therapy, how long it is taken and the individual health risks.
1. Breast Cancer
There is little or no change in breast cancer risk if you only take estrogen HRT. Combined HRT may be associated with a small increase in breast cancer risk. The increased risk is related to how long you take HRT, and it falls off after you stop taking it. Because of the risk of breast cancer, it is especially important to get regular breast cancer screenings if you are taking HRT.
2. Blood Clots
Evidence suggests that: There is no increased risk of blood clots from HRT patches or gels, although taking HRT tablets may increase your risk of blood clots – but this risk is still small
3. Heart Disease and Stroke
HRT does not appear to significantly increase the risk of heart disease and stroke when started before age 60. In fact, it may reduce your risk. There is a small increase in the risk of stroke from taking HRT tablets, but the risk of stroke for women under 60 is generally very low, so the overall risk is still small.
Who should avoid hormone replacement therapy?
Women with History:
*Breast cancer/Ovarian cancer/Uterine cancer
* blood clots
* Increased risk of heart attack, stroke or vascular disease
* liver disease
* untreated high blood pressure
Is Tibolone Good for Menopause Management?
It is similar to combined HRT. It is suitable for women who have had their last period more than a year ago. The risks of tibolone are similar to those of HRT.
Non-hormonal drugs such as ‘selective estrogen receptor modulators’ -SERMS act like estrogen in some parts of the body and as anti-estrogens in some others. They are very useful in improving bone density and can reduce the risk of fractures. However, they do not reduce hot flushes. There are newer SERMs available that help reduce hot flushes and night sweats.
Alternative medicines such as plant estrogens include isoflavones and lignans. They are found in soybeans, lentils, chickpeas and other legumes. However, whether they help ease the symptoms of menopause remains to be proven. Similarly, bioidentical hormones, black cohosh, yoga, acupuncture and hypnosis are advocated for symptom control, but their efficacy is not clinically proven.
Lifestyle changes women should make for menopause management
You may choose to make these lifestyle changes during menopause:
* Wear cotton clothes.
* Take a glass of cold water and find a cool place to go.
*Avoid hot drinks, caffeine, stress, spicy foods, alcohol, hot rooms and hot weather.
* Eat a balanced diet and drink at least 2.5-3 liters of water per day * Include calcium and vitamin D supplements in your diet
* exercise regularly
* Get at least 8 hours of sleep
* Lower your stress level
* Practice relaxation techniques
Menopause is a natural transition in a woman’s life and cannot be avoided. Whether it is a blessing or a curse, stay here. The good news is that the symptoms associated with menopause are temporary. There are medications and lifestyle changes that can help you cope with the symptoms of menopause and shorten this transition period.