What is the menopause?
The menopause is the end of menstruation, which in most women occurs between the ages of 45 and 55, with an average age in Australia of 51 years. However, the term is used in a broader sense to describe the months or years before and after the last period, during which the periods become irregular and the body adjusts to reduced levels of female hormones. This may last 2-5 years or sometimes longer.
What are causes of Menopause?
The female hormones, oestrogen and progestogen, are no longer produced by the ovary because of a decline and finally a complete absence of maturing eggs (ova).
What are the symptoms?
Due to small amounts of oestrogen being produced in the adrenal glands, symptoms (other than the cessation of periods) may be mild or absent.
- menstrual period changes
Periods may stop abruptly or after a prolonged irregular pattern such as lighter periods occurring further apart or heavier frequent periods. Fertility is greatly reduced, far more unpredictable and finally absent.
- hot flashes
These symptoms are a sensation of heat, usually in the face and neck, but can be experienced from head to toe and last from seconds to minutes. They may be accompanied by sweating, palpitations, headache, faintness and disturbed sleep, and can be aggravated by alcohol, hot foods and drinks, and stress. In themselves they are harmless, but they can cause embarrassment, tiredness and anxiety. They may continue from a few months to many years after the periods cease.
- vagina and bladder symptoms
The normally moist tissue of the vagina and base of the bladder can become dry and inelastic. This can result in uncomfortable intercourse and an increased chance of infection of the bladder or vagina.
- emotional problems
A woman may experience fluctuating levels of energy and concentration with tiredness, irritability, lack of confidence and loss of interest in sexual activity. Occasionally anxiety and depression can be a problem.
Other symptoms may include aches and pains in the muscles or joints, dryness of the skin and hair, and a ‘creepy crawling’ feeling over the skin.
Is osteoporosis (fragile bones) is a common problem?
It has been shown that reduced levels of oestrogen cause increased loss of calcium from bone tissue, which causes osteoporosis of varying degrees. Certain drugs and medical conditions and smoking can aggravate it. Hormone replacement therapy, which may continue for the rest of life, can certainly prevent osteoporosis. If you are slightly built or have a family history of osteoporosis, speak to your doctor about this potential problem.
What should be done?
While it is important to accept that the menopause is a natural fact of life and nothing to be embarrassed or worried about, you should discuss any unpleasant problems with an understanding friend or your doctor. It is important to lead a healthy life: follow a correct diet, avoid obesity, get adequate relaxation and exercise, and reduce the use of cigarettes, caffeine and alcohol. It is normal and healthy to continue sexual relations, but a vaginal lubricant such as KY jelly may be necessary if your vagina is too dry. Contraception is advisable for 12 months after the last period.
What is a hormonal treatment?
If you have troublesome symptoms, hormones (both oestrogen and progestogen) can be given. Usually special skin patches or tablets are prescribed, but long-acting injections and pellets implanted under the skin can be used. Caution is required in women with previous breast cancer and those with a strong family history of breast cancer (2 first degree relatives). A vaginal cream or tablet containing oestrogen is available for a dry vagina.
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