Menopause, a Natural Phenomenon by Bobo Bode-Kayode

nmaNature has a way of regulating and limiting the number of offspring a woman can bear in her lifetime. And this process is known as MENOPAUSE.

Menopause is a universal and irreversible part of the overall aging process involving a woman’s reproductive system, after which she no longer menstruates.  Menopause is a natural process that every woman goes through and every woman’s experience of the menopause is different.

Perimenopause refers to the time before menopause when physical changes , and irregular menses often commence.  Perimenopause can start 5-10 years or more before menopause. Menopause, by definition, begins 12 months after the final menses and is characterised by a continuation of noticeable  symptoms and by urogenital symptoms such as vaginal dryness and dyspareunia.  A woman “in menopause “or “going through menopause “is actually describing the period before the actual menopause, or a period of Transition.

It is the point in time when a woman reaches 12 consecutive months without having a menstrual period. If you’re like many women, you may assume that menopause is the end of fertility and that, without a period, you couldn’t possibly become pregnant. While both are mostly true, it’s important to know that the term menopause might be somewhat misleading.
Pregnancy just before menopause:
Perimenopause can last as long as six or more years in some women. It begins with the onset of menstrual cycle changes and other menopause related changes, usually in a woman’s mid-40s, and extends into menopause (the last menstrual period), which typically occurs about age 51.

So, yes, while menopause does mark the permanent end to your fertility, until you’ve truly reached it, there’s still a chance you can conceive.  While it is definitely possible to get pregnant in perimenopause, it’s less likely than in earlier years. Fertility declines significantly in a woman’s mid- to late 30s, that is 10 to 15 years before the average age of menopause, which generally occurs in a woman’s early 50s.

Menopause and fertility. —
If you are like many women, you may assume that menopause is the end of fertility and that, without a period, you couldn’t possibly become pregnant. While both are mostly true, it’s important to know that the term menopause might be misleading.

Can You Get Pregnant?
It’s also harder to get pregnant during the perimenopausal transition,. Women are born with 1 to 2 million eggs, and as menopause nears, only about 100 eggs remain. The declining number and quality of these eggs, as well as age-related uterine changes, contribute to reduce fertility, perhaps even before signs of perimenopause are noticeable.

But even if you’ve missed your period for a few months and have lots of menopausal symptoms, you should be aware that you are not completely protected from an unplanned pregnancy until you’ve officially reached menopause.

Caution ! pregnancy can occur:
Every once in a while a woman in her late 50s makes headline news for having a baby. You may find yourself wondering if it’s at all possible to get pregnant postmenopausal. Yes, you can, but it won’t happen naturally. After menopause, the only way a woman can get pregnant is through a donor egg and in vitro fertilization.

Reaching  menopause:
The menopause usually happens between the ages of 45 and 55, although it can be earlier or later. The average age for the menopause to occur is 51 years old. There can sometimes be a family pattern so it may be worth asking your mother, sister or grandmother when it happened to them.

No matter what age you are, having a hysterectomy (in which both ovaries are removed) causes the menopause to happen instantly. If the ovaries are destroyed by chemotherapy or radiotherapy for cancer of the cervix, this can also bring on an immediate menopause. The symptoms of the menopause can be more severe when the menopause takes place prematurely or abruptly. Cigarette smokers often reach the menopause earlier than non-smokers.

Causes and why:
  Decline in number of eggs produced:
Every baby girl is born with all the eggs in her ovaries that she will ever produce in her lifetime. There is a steady reduction of these eggs over time as some never mature and others are released each month as your period. By the time most women have reached their late 40’s the supply of eggs remaining in the ovaries has fallen to low numbers.

Hormonal changes:
The pituitary gland produces a substance called follicle stimulating hormone (F.S.H.), which is the main hormone involved in producing mature eggs but the eggs that now remain are unable to respond as well to F.S.H. as they did when they were younger. As a result the ovaries will start failing to release eggs and there will be a greatly reduced production of the sex hormones oestrogen and progesterone. However, the hormone F.S.H. which is always present in the body, will increase dramatically as the pituitary gland makes more F.S.H. in an attempt to encourage the ovaries to respond and cause the remaining eggs to mature. At this time your periods will probably become irregular and unpredictable until they stop altogether.

The hormones oestrogen and progesterone control your monthly cycle and prepare your body for pregnancy every month. When pregnancy does not occur, your body releases an egg and you have a period. It is the reduced levels of these hormones, which produce the symptoms of the menopause. The menopause is simply a period of adjustment to lower hormone levels in your body.
Oestrogen has many functions; it is needed to keep your body ready for a possible pregnancy and controls sexual development of female characteristics such as the breasts, genitals and womb development. When the supply of eggs runs low, oestrogen is no longer required and so the levels drop causing many effects on the body.

Typical symptoms:
Around 80% of women will experience some symptoms of the menopause with only around 20% of women not having any symptoms at all, except for the fact that their periods might become irregular. The symptoms of the menopause result from reduced levels of oestrogen and some women might have severe problems that affect their lifestyle. Symptoms of the menopause may include any of the following:

•     Regularity of periods :  Most women’s periods will become unpredictable for several months and in some cases for a few years before they actually stop. The blood flow may also vary from light one month to heavy the next.

•    HOT FLUSHES:   – the most common symptom of the menopause. Hot flushes are sudden intense waves of heat, sometimes accompanied by redness and sweating. They can occur at any time and some women find that these flushes disrupt their sleep. Hot flushes can last anything from a few seconds up to several minutes and at the start of the menopause can occur as frequently as several times an hour. Hot flushes can be triggered by spicy foods and alcohol. Hot flushes can be uncomfortable, but they are not harmful.

•    VAGINAL DRYNESS: – your vagina may become dryer and much thinner, making sex painful and uncomfortable. The thinning of the vagina walls also puts you at an increased risk of vaginal infections like thrush and cystitis Remember, if you do notice any unusual discharge or bleeding from your vagina, a visit to your doctor may be needed.

•    Loss of sexual interest – 
You may lose interest in sex, or your sexual desire may be diminished. This, like the other symptoms, is primarily due to hormonal changes. This lack of interest may or may not improve post-menopause.

•    MOOD SWINGS -Some women feel moody, depressed or irritable during menopause. This is thought to be related to hormonal changes and usually improves post-menopause.

•    BLADDER WEAKNESS   — bladder weakness. This is due to the area around the bladder becoming thin. You may notice that you have to void more often or that you experience mild pain when you urinate. You may have difficulty getting to the bathroom in time or you may have accidents when you laugh, cough or sneeze. This symptom does not improve post-menopause.

•    INSOMNIA – Some women are disturbed by insomnia during menopause. You may have difficulty falling asleep or going back to sleep after awakening. This may be exacerbated by hot flashes during the night or needing to void at night. Insomnia should resolve post-menopause.

•    EMOTIONS AND DEPRESSION   :  the menopause can make many women experience headaches, forgetfulness and make them irritable – having unexpected mood swings. Many women go through similar emotions and even though you may not think so, people will understand and make allowances.

•    FEELING TIRED    :  this can often be due to difficulties in sleeping.
Other related issues —
It is important to realise that when most women go through the menopause they could also be trying to cope with problems at home. For example, adolescent teenagers, children that are growing up and leaving home, elderly relatives, boredom at work or in personal relationships or they just be finding it difficult coming to terms with their reduced fertility. The menopause does not cause these problems though it can make them seem worse, it is important to try and keep a sense of proportion about what is going on around you.
If you are feeling depressed , no matter what, please see a doctor.  The menopause does not happen overnight and symptoms of the menopause can continue for an average of four years. However, the majority of women continue to function well during the menopause.  For some women the menopause brings a sense of freedom since the end of fertility means no more birth control and dealing with periods, which may have been heavy or painful. After a woman has had her last menstrual period she can no longer bear children naturally.

Other effects —
Other physical changes that some women notice include increased fat around the abdomen and decreased fat in the breasts. Some women experience hair thinning and feel that their skin is more fragile. You may notice that your muscles and joints ache more often than usual. These issues usually do not resolve post-menopause.

Dryness of the skin —- As oestrogen levels fall, a woman’s skin becomes thinner so you may find your skin is drier and your hair may also become thinner.

As mentioned previously the lining of the vagina will become thinner and the womb will also become smaller and the lining thinner.

This thinning can also affect the bones and a condition called osteoporosis can develop, approximately one in four women are at risk. Osteoporosis tends to occur after the menopause when the bones have lost much of the calcium they need to remain strong and firm.

After the menopause you are also more at risk of heart disease as oestrogen appears to protect the blood vessels, as oestrogen levels fall so does this protection.

Diagnosis   —-   
Doctors will usually diagnose the menopause from your symptoms and age alone. Doctors may also check your hormone F.S.H. levels.
If you are experiencing problems or are unsure of your symptoms you should always discuss with your doctor. There are various tests that can indicate raised FSH levels in urine.
Treatment for associated symptoms:

HORMONE REPLACEMENT- These low-dose hormones are also helpful in treating such perimenopausal symptoms as hot flashes, irregular cycles, and PMS, and they are sometimes continued through the menopausal transition, primarily from ages 52 to 54. Medical treatment which is designed to make up for the loss of oestrogen is available for women who are troubled by symptoms of the menopause. This treatment is called Hormone Replacement Therapy [HRT] and can help ease or prevent some of the symptoms of the menopause.

    Lifestyle changes – Many symptoms of the menopause can be reduced with certain lifestyle changes such as exercise and diet. Exercise, such as walking for 20-30 minutes, 3-4 times a week, will help maintain general fitness, reduce the risk of you developing heart disease and will strengthen the bones.

You should ensure that you eat a well balanced diet containing foods which provide calcium, such as milk products, cheese, sardines, salmon and green leafy vegetables. A good intake of calcium will slow down bone thinning and help to prevent bone fractures. In moderation a small glass or 2 of red wine can reduce the risk of heart disease and cancer.

•    If you are suffering from vaginal dryness, try using a vaginal lubricant like KY jelly available from most pharmacies.

•    If you are suffering from hot flushes and sweating you should wear layers of clothes that you can peel off when hot. If you experience night sweats ensure you bring a glass of water to bed with you, wear cotton night wear and sleep with the window open.

•    You should also get out in the sun when you can. Exposure to the sun stimulates the production of vitamin D in the skin, however, ensure you don’t get burnt! Vitamin D helps the body absorb calcium from foods and so is essential for healthy bones and teeth.
•    If you smoke you should now stop, smoking can make menopause symptoms worse and increase the loss of bone density.

•    Supplements – The menopause can be relieved with treatment.  Consult your doctor about taking supplements, (e.g. evening primrose oil and vitamin D) as these can help some women cope with symptoms of the menopause.

Others – Other treatments that are available for the menopause include antidepressants, tranquillizers and sleeping pills. If you have any symptoms that are causing you concern or discomfort then you should seek your doctor’s advice.

Despite all of the great fuss about menopause, a woman reaching menopause, can live a perfectly normal, healthy life. Enjoy great sexual relationship with her husband, relate normally with those she interacts with, be confident and get the best out of your later years. I personally believe , that you are as old as you think you are. And invariably, behave and feel likewise.