LIFE AROUND MENOPAUSE
Certain important definitions with respect to Menopause are -
Premature menopause - Cessation of periods under 35 years which is associated with specific problems:- increased incidence of heart disease, osteoporosis, Alzheimer’s disease.
Climacteric :- ongoing changes and symptoms at the age of 40 years onwards up to menopause which may last for 15 to 20 years ( 40 to 60 years)
Late Menopause - Menstruation persisting after 55 years of age . Common causes of this are :- obesity, and fibroids. This is associated with the problem a slight increase in the risk of uterine and breast cancer
SYMPTOMS TIME TABLE IN THE MENOPAUSE
Early symptoms :- are experienced when the periods become irregular and erratic. The symptoms include hot flushes, night sweats, anxiety, irritability, loss of interest in sex, itchiness of the skin, insomnia, mood changes, loss of memory, loss of confidence and self esteem, headache ,dry vagina, genital itching, painful sex.
Intermediate symptoms:-mainly affects the bladder and genitalia and occurs after the period stops i.e. late pen menopause.
Symptoms during this period include vaginal dryness, pain on intercourse, genital itching, urgency frequency & burning sensation on passing urine, loss of bladder control, generalised muscle aches and pains, thinning of skin and hair,
Late Symptoms:- occurs over the age of 60 years.
• High blood pressure and angina indicating arterial and heart disease and risk of stroke related to atherosclerosis
• General aches and pains, backache, joint stiffness and swelling and bone fractures — all related to osteoporosis
WHY DO SOME WOMEN SUFFER MORE THAN OTHERS
Characters associated with high sufferers are :-Married, women who are Mothers and have undergone premature menopause ( natural or surgical), suffered painful periods, suffered severe Premenstrual symptoms and have a lower than average , amount of body fat.
Characters associated with low sufferers are :-Un married, had children after the age of 40 years, or never been pregnant, late menarche, Reasonably high income and relatively well educated, above and average amount of body fat
COMMON SYMPTOMS ASSOCIATED WITH THE MENOPAUSE ARE
Occurs in 85% of women. Degree and frequency varies individually during a hot flush, a woman can perspire so profusely that perspiration runs down her face neck and back. Her skin will rise in temperature, her heart will beat faster and she may experience palpitations. Very occasionally a woman may faint during a hot flush but this is rare. Hot flushes occur because the brain decides that the body is overheated. The discomfort of hot flush is unique and cannot be reproduced artificially. Hot flush can be aggravated by hot weather
Management by self help is to wear loose clothing and discover ways of cooling down, as well as keep the rooms well ventilated. Limit food and drinks which triggers hot flushes i. e, Eat plenty of citrus foods that is orange and lime which contain bioflavonoids. Vitamin E taken with C & B are useful
Medical therapy with hormone replacement therapy is 98% helpful.
NIGHT SWEATS WHICH ARE HOT FLUSHES IN THE NIGHT
The lady wakes up hot and drenched in perspiration. Keeping the bedroom temperature fairly cool and wearing light night cloths and using light bed linen may help.
Relaxation is therapeutic as is meditation and yoga. Hormone replace therapy is beneficial.
VAGINAL AND URINARY SYMPTOMS
• Anatomically the Vagina and lower urinary tract ( bladder and urethra)lie very close. They both are separated by just a few layers of cells. They both respond to lack of Oestrogen by becoming thin and dry.
• Urinary symptoms typically include discomfort in passing urine, frequent & urgent urination with small amount of urine in the bladder.
• Some dribbling due to weakness of sphincter muscle at the bladder neck becoming weak due to lack of Oestrogen i.e. stress incontinence.
• Genital dryness may be present
• Vaginal soreness during or after intercourse, because the vagina fails to lubricate , is also common among menopausal and post menopausal women.
• Kegals exercise i.e. stopping the flow of urine midstream when emptying the bladder will help. Draw up the vaginal muscles, hold for a count of five and then relax. Repeat the process 5 times. Whole routine should be done at least 10 times a day.
• Wear loose cotton underwear to prevent irritation of urogenital tract. Avoid using perfumed additives in your bath.
Hormone replacement therapy is the final answer. In 25% of cases systemic HRT is not sufficient and Vaginal creams! vaginal tablets are needed
MUSCLE AND JOINT SYMPTOMS
• Collagen is the protein that provides the scaffolding for every tissue in the body.
• When collagen disintegrates at menopause, muscle loose their bulk, strength and coordination, and joints become stiff.
• Muscle become more prone to soreness and stiffness after exercise, and joints may swell so that their mobility becomes restricted.
• Carpel tunnel syndrome occurs due to fluid retention in the wrist pressing on the nerve to the hand and fingers.
• Osteoporosis causes aches and pains all over the body especially upper back due to the thinning of the vertebral bones.
General fatigues may be common. Besides under used muscles and joints, other causes of chronic fatigue includes low blood sugar, anaemia, and underactive thyroid
Self Help Exercise to main muscles, aerobics stretching, wait bearing, and yoga, keeps muscles and joins supple. Complementary treatment hormone replacement therapy
SKIN, HAIR, EYE, MOUTH AND NAIL SYMPTOMS
•Oestrogen deficiency causes disintegration of collagen and weakening of the protein elastin which gives connective tissue its strength & suppleness. Lack of collagen leads to a decrease in skin thickness and suppleness, dry hair , brittle nails, sore eyes, mouth dryness, gum shrinkage and increase in joint stiffness.
• Reduction in the blood flow in the skin and subcutaneous tissues contributes to the loss of skin firmness, as does shrinkage of underlying muscles.
• Deterioration of the nerve endings in the ageing skin can lead to itchiness and a condition called formication. Formication is a common symptoms in 20% of women within 12 to34 months after menopause. Eventually disappears but the mechanism not known.
SELF HELP MOISTURISING THE SKIN IS IMPORTANT
• Moisturising the skin is important.
• Moisturising the skin is important. Avoid soaps that will strip the natural oils and use special cleansing oils and lotions
• Give manicure and pedicure every 6 to 8 weeks.
• Guard your skin from the Sun. Avoid direct sun at all times, wear a sun block due to lack of melanocytes (15% reduction)
• A multivite/ mineral complex is useful.
Ultimate treatment is hormone replacement therapy
• Lack of sleep is common if you are depressed, anxious, or suffering from night sweats.
• Women who have normal levels of Oestrogen, or who take HRT fall asleep faster than women who don’t.
• Oestrogenised women also spend more time in the deepest ( dream) stage of sleep and they feel more refreshed when they awake.
• Dreaming is important for the feeling of rest and renewal that comes from sleeping.
• Without Oestrogen, we can sleep for a whole night but still feel tired on waking Self help walk or exercise before bed may help
• Breast symptoms –Mastalgia (Breast pain and discomfort)
• Breast pain ( Mastalgia) is common in 70% of women at some stage in life over the age of 40 before Menopause.
• Breasts become hard, tender and extremely painful, especially intense In the nipple.
• Commonest reason is abnormal sensitivity of breast tissue to the fluctuation of the female hormone oestrogen at the menopause.
• Women with pain tend to have lower levels of unsaturated fatty acid and high levels of saturated fatty acids in their blood.
Self Help-Treatment includes wearing a good supporting brassiere; cutting down on the fat that is eaten may help. If there is no response medical help should be sought. Weight gain is common after the menopause, exercise is thus extremely important as is a healthy and sensible diet with plenty of fruits, vegetables and less starch and fats.
• Measure the waist at its narrowest point when one stands relaxed.
• Measure the hips at the widest point
• Divide the waist measurement by the hip measurement to obtain the waist hip ratio
• Ratio above 0.8 in a woman is associated to a greater risk of diabetes, heart disease, high BP, osteoporosis, and arthritis.
• By eating healthy food and exercising regularly, one can control weight gain.
Mood changes, anxiety, irritability are common .Treatment self health, youga, exercise and hormone therapy
• Forgetfulness is one of the commonest symptoms most women experience even long before period stops.
• You may forget where you put something, miss appointments, and things that used to be easy to remember can suddenly require enormous effort.
Ability to concentrate also becomes difficult.
• All above makes it hard to carry out work that involves complex assessments and major decision making.
• Even minor decisions can sometimes be quite paralysing
INTELLECTUAL SYMPTOMS - MANAGEMENT
• Any sort of work or studying will go a long way to preserve your intellectual ability.
• Never too late to get a job.
• Many universities provide employment retraining.
• Vitamin B complex, calcium and potassium taken together will help
• Most intellectual skills improve as soon as you start to take HRT.
• You feel more self confident about making decisions, more assertive, better able to concentrate and you are less forgetful.