Menopause corresponds to the end of menstrual periods and is defined as occurring one year after the last menstruation. It signals the end of the reproductive cycle, as ova (eggs) are no longer released by the ovaries leading to end of fertility.
It usually occurs when a woman is in her late 40s or early 50’s (average age is 51 years) and is preceded by the perimenopause, a transitional period during which the initial hormonal fluctuations are responsible for various symptoms.
Although the complaints during the perimenopause markedly differ among women, a better understanding of the hormonal changes can help individuals better comprehend and accept their physical transformation and behaviour during this period.
During the fertile period, the ovaries and the uterus undergo cyclical changes in anticipation of a possible pregnancy. Two hormones (FSH and LH) released by the pituitary gland (a small gland located in the brain) stimulate the production of oestrogens and progesterone, the two main female hormones present at different stages of the menstrual cycle. Testosterone, the so-called “male hormone” is also found in women and is produced by the ovaries and the adrenal glands (situated on top of the kidneys).
Starting from the age of 40, the blood level of oestrogens start to swing from one cycle to another due to the natural ageing of the follicles nestled within the ovaries. This initial hormonal variation triggers subsequent hormonal changes, affecting both progesterone and testosterone levels.
The most common symptoms reported are hot flashes and nocturnal sweats, both of which can contribute to sleep disturbances. These complaints are present in up to 80 per cent of women older than 45 years of age. Emotional symptoms are also common, with mood changes and irritability often reported. Menstruation become irregular, more abundant and lasts longer due to a thicker uterine mucosa induced by lower levels of progesterone. This erratic bleeding may be a source of concern, due to the potential risk of uterine tumours around 40 to 50 years of age.
Dryness of the vagina is another indication of the lower circulating oestrogens. This may lead to pain and dissatisfaction during intercourse and can result in a lower libido. The decline in the level of testosterone in women is not well understood but may contribute partly to a drop in sexual desire.
Importantly, the lack of oestrogens negatively impacts the skeletal system exposing women to higher risks of osteoporosis with bone fractures as main complication. With low oestrogens, the physiological bone remodelling is impaired and bone density and strength is markedly reduced. In addition, the risk of developing cardiovascular problems is increased, as very low levels of oestrogens mean that women are no longer protected from heart related illnesses.
Very few women can manage without any medications during the pre-menopausal and menopausal periods. But because each woman has a specific medical background and handles the symptoms in a different way, the treatment needs to be individualised. Hormone Replacement Therapy (HRT), usually a combination of oestrogens and a progestin (synthetic progesterone medication) is often proposed to alleviate hot flashes, sweats and to improve the sleep patterns. The duration of HRT for pre and menopausal women remains controversial due to the potential risk of cancers (breast and other cancers) associated with its prolonged use.
The issue of bone loss must also be addressed in a proactive manner before abnormal bone density occurs. A calcium supplement must be taken daily together with vitamin D as this substance is indispensable for the absorption of calcium by the bone tissue.
Exercise, including resistance training exercise, is also highly recommended to prevent bone loss. In most cases, the specialist gynaecologist will assess the overall condition and propose a specific treatment with regular monitoring.
Finally, as for all aspects of women’s health, adopting a healthy lifestyle with no tobacco, moderate alcohol consumption, a balanced diet, maintaining a healthy body weight and taking regular exercise will help life to go more smoothly through this transitional period.
Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at firstname.lastname@example.org