MENOPAUSE

INTRODUCTION
Menopause is the time that marks the end of a woman’s menstrual cycles. It is a natural biological process. The years leading up to that point, when women may have changes in their monthly cycles, hot flashes, or other symptoms, are called the menopausal transition or perimenopause. The menopausal transition most often begins between ages 45 and 55. Menopause occurs when a woman has not seen her monthly period for 12 months.
Premature or early menopause is menopause that occurs before the age of 40 years.Early menopause can be induced by some medical treatments such as surgery or chemotherapy.Women that experience early or premature menopause may need hormone therapy to reduce the risk of diseases such as osteoporosis and cardiovascular disease.

SYMPTOMS OF MENOPAUSE
• Hot flushes/flashes
• Sweats
• Sleep disturbance
• Urinary problems, such as increased frequency of urination or incontinence
• Vaginal dryness
• Increase in mood changes
• Increase or decrease in weight
• Aches and pains.

COMMON HEALTH COMPLICATIONS OF MENOPAUSE

• Vulvovaginal atrophy
• Dyspareunia, or painful intercourse
• Slower metabolic function
• Osteoporosis, or weaker bones with reduced mass and strength
• Mood or sudden emotional changes
• Periodontal disease
• Urinary incontinence
• Heart or blood vessel disease
• Weight gain

PREMENOPAUSAL PERIOD
In the months or years before menopause, a woman’s periods typically become irregular, which means that periods may be longer or shorter in duration or be lighter or heavier in the amount of flow. During this time, women often experience hot flashes. Hot flashes typically last for 30 seconds to 30 minutes and are characterised by shivering, sweating, and reddening of the skin. Occurrence of hot flashes (or hot flushes) can last from four to five years. They occur due to hormonal changes in the period before/around menopause. Premenopausal period terminates with the last menses.
Weight gain and slowed metabolism, thinning hair, dry skin and loss of fullness of breast may occur.There is decreased sexual drive. Estrogen is the major hormone responsible for controlling a woman’s sexual drive. Decreased estrogen levels can affect a woman’s sexual drive.

PERIMENOPAUSAL PERIOD
This is a period lasting from 4 to 8 years starting from when menses become irregular to 12 months after the last menses. During this period a woman may have hot flashes, sleeping difficulty, night sweats, and mood changes. Depression is common during this period.

POSTMENOPAUSE
This is the period from 12 months after the last menses. Any vaginal bleeding during this period requires investigations to rule out endometrial cancer. A woman is infertile during this period.

PREMATURE MENOPAUSE (EARLY MENOPAUSE)
This refers to menopause before the age of 40 years. The symptoms of early menopause are the same as for menopause.
Premature menopause means a woman’s ovaries have spontaneously stopped working before she has reached the age of 40 years. Women can be affected in their teens or early 20s. About one in 1000 women reach menopause before the age of 30. Menopause can be specifically induced for medical reasons, such as cancer surgery. For example, a woman with ovarian cancer will require surgery to remove her ovaries.
Premature menopause can be emotionally devastating. Some of the common issues women may face include:
• grief at the prospect of not having children
• fear of ‘growing old before their time’
• concern that their partner won’t find them sexually attractive anymore
• self-esteem problems.
Psychological counselling and support groups may help women come to terms with their experience of early or premature menopause.

LATE MENOPAUSE

A woman still experiencing menstrual cycle in her late 50s to 60s is said to be experiencing late onset of menopause. Some of the causes may include:
Genetics: Genetics determines the onset of menopause about half of the time. This factor is most relevant if your mother entered menopause naturally rather than from surgery or an illness.
Obesity: Overweight and obese women have a 50% higher risk of late menopause than other women. Fat tissue produces and stores estrogen, which delays its depletion.
Menstrual cycle patterns: Women who started menstruating late, had lifelong irregularities, or have naturally high estrogen levels may experience later menopause.
Pregnancies: The timing and number of pregnancies you have had may determine
onset of menopause.

INDUCED MENOPAUSE

This is menopause arising as a result of some therapeutic procedure, medication, or surgery. It can be induced by:
• Chemotherapy
• Radiotherapy
• Oophorectomy (removal of ovary)
• Hysterectomy (removal of uterus)

POSSIBLE HEALTH PROBLEMS AT TIME OF MENOPAUSE

Some health conditions unrelated to menopause are common at the age when women experience menopause. These include:
• Stroke
• Endometrial cancer
• Breast cancer
• Genitourinary problems
• Osteoporosis
• Hypertension
• Uterovaginal prolapse
• Depression
• Diabetes
RACIAL DIFFERENCES IN THE AGE OF MENOPAUSE

Many factors come into play to determine when women enter menopause, making each woman’s experience unique. However, various studies show that women of African, Asian and Hispanic races tend to enter perimenopause and menopause at earlier ages than their white peers; they also have longer transition (perimenopause) periods and experience more intense hot flashes and vaginal symptoms.

REMEDIES AND LIFE CHANGES NEEDED FOR MENOPAUSE

• Managing hot flashes, keeping body cool, and staying comfortable
• Exercise to check weight gain
• Communicating your needs to medical personnel, psychologists and other therapists. Attention to issues such as depression, anxiety, superstitions, and fears, will require proper management by various experts.
• Supplementing diet: Calcium, vitamin D, and magnesium supplements help reduce risk of osteoporosis and improve energy levels and sleep.

https://www.mayoclinic.org/diseases-
https://www.healthline.com/health/menopause
https://en.wikipedia.org/wiki/Menopause
https://www.betterhealth.vic.gov.au/health/
https://www.verywellhealth.com/late-menopausehttps://www.everydayhealth.com/menopause