World Menopause month: Is menopause, a boon or bane?

Bengaluru: World Menopause Month is an annual designation observed in October. Menopause simply refers to the time in a woman’s life that she stops menstruating. Menopause affects every woman differently, but it is generally a difficult and uncomfortable time. Usually, it occurs between the ages of 45 and 55, but there are rare cases in which it can start as young as 30.

What is the Menopause?

Menopause is that time in a woman’s life when the periods stop permanently. This is a retrospective diagnosis and a woman is said to have gone through the menopause if she has not had any bleeding including spotting for one full year after her last period. The average age of menopause in India is 47 years as opposed to the west where it is 51 years. However, in recent times women in India are also going through the menopause at a later stage i.e early fifties.

For a lot of women freedom from periods is a huge relief, especially if they have been suffering from heavy painful periods. Along with this come the not so pleasant symptoms as detailed below.

What are the symptoms of Menopause?

Menopausal symptoms may begin suddenly and maybe very noticeable or they may be transient and mild. They may begin about 6 years before the menopause and continue for several years after the menopause.

The symptoms are:

·         Irregular menstrual periods.

·         Heavy or light periods

·         Hot flushes - feeling hot and sweating even in cold temperatures

·         Weight gain and bloating

·         Mood swings, sleeplessness and depression

·         Vaginal dryness and loss of libido

·         Frequent urination, increased incidence of urinary infection, urinary incontinence

·         Loss of balance and increased frequency of falls

The other changes include loss of bone density giving rise to brittle bones and increased risk of fractures especially hip fractures. During this period the risk for heart attacks and strokes are also increased because of the declining levels of estrogen hormone.

How can the menopause be managed?

The aims of management are:

·         Relief of Hot Flushes

·         Reduce the risk of Disease

·         Improve the quality of life

Drug Therapy: Hormone therapy is the most commonly used drug therapy for the management of menopause.  Hormone Replacement Therapy (HRT) includes the hormones Estrogen and Progesterone which are used singly as estrogen therapy, if the woman has had a hysterectomy or estrogen and progesterone in combination if the uterus is intact. Estrogen therapy (with or without progesterone) is the best treatment for hot flushes and night sweats. It also helps alleviate vaginal dryness and protects against bone loss. However, these drugs are associated with a small increase in the risk of breast cancer, heart attacks, stroke and deep vein thrombosis.

So, it is important to speak to your doctor before starting these drugs.

Non-hormonal medications such as selective estrogen receptor modulators –SERMS act like estrogens in some parts of the body and as anti-estrogens in some others. They are very useful in improving bone density and thus reducing the risk of fractures. They do not however alleviate hot flushes. Newer SERMs are available which help reduce the hot flushes and night sweats eg. Duavive.

Alternative medicines like plant estrogens, include isoflavones and lignans. These 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 medically proven.

Lifestyle Changes:

·         Dress in cottons.  Have a cold glass of water and find a cooler place to go to. Avoid hot beverages, caffeine, stress, spicy food, alcohol, warm rooms and hot weather

·         Consume 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

·         Sleep for at least 8 hours

·         Practice relaxation techniques

·         Avoid smoking

Menopause is a natural transition in a woman’s life and cannot be avoided. And “boon or bane” it is here to stay.

The good news is that the symptoms associated with the menopause are temporary. There are drugs and lifestyle changes that can help you cope with menopausal symptoms and ease this transition period.

(Author — Dr Prathima Reddy, MBBS, MRCOG (London), FRCOG (London), FACOG (USA) is the director, senior obstetrician and gynecologist at Fortis La Femme Hospital, Richmond Road, Bengaluru)