(Part 2 of a 3 part series on menopause)

It is a year since Taruna has had a period. She is 50 years old and is relieved to not have any more periods. She has reached a stage of her life where she needs to make sure that she continues to stay healthy. She has hot flushes, feels tired and sometimes feels emotionally wrung out. How can Taruna manage menopause and continue to maintain her health?

In Indian women, the average age for menopause is 50 years. Most of today's women will live for 25 to 30 years after attaining menopause. This constitutes almost one-third of their lives. The better you take care of your health at this stage, the better you can safeguard your health in the coming years.

Premature menopause

Tamilselvi is 34 years old. She had irregular periods for six months and now has not had a period for the past four months. Her gynaecologist checked her hormones and has found out that her follicular stimulating hormone (FSH) is very high. This means Tamilselvi has had premature menopause

What is premature menopause? 

When periods cease before the age of 40, it is called premature menopause.  Since this happens at an early age, the lack of estrogen can cause severe symptoms such as hot flushes, emotional problems, vaginal dryness, and decreased sex drive. The lack of estrogen will also cause wrinkling of the skin and will have long-term repercussions on bone health. For a young woman, premature menopause can be devastating.

Fortunately, hormone replacement therapy can help alleviate the symptoms of premature menopause. Regrettably, premature menopause also means that no eggs are being formed, so pregnancy is not possible without donor eggs.

Causes of premature menopause 

Chromosome defects and a family history of early menopause can lead to premature menopause. The body's immune system, which normally fights off diseases, may mistakenly attack its own ovaries — this is called autoimmune disorder, and causes the ovaries to stop functioning. Surgical removal of both ovaries, also called a bilateral oophorectomy, causes immediate menopause. That is why the ovaries should not be removed in women younger than 45 years unless there is cancer or some other major disease. If the ovaries are removed, the woman must be placed on hormone replacement therapy to avoid complications of early menopause.

Managing menopause 

It is important to remember that menopause is a natural part of life and must not be viewed with alarm. Today's woman is healthier, feels younger and is very active when she enters menopause. Many women are pursuing careers and peaking professionally. There are many productive years ahead. In fact, Margaret Mead, the eminent anthropologist, famously coined the term ‘postmenopausal zest'.  It is a time when a woman is not worried about pregnancy, is freed from the miseries of premenstrual syndrome and has no more heavy or painful periods. “This”, Margaret Mead said, “is freedom”. It is a stage of life that can be filled with wonderful possibilities. It is therefore important to proactively take care of your health at menopause.

Relief of symptoms 

Hot flushes can be distressing. Try to stay cool by dressing in suitable light clothing. Make sure you have a fan at the home or workplace. Avoid situations where the ambient temperature is high. If the hot flushes are very distressing, your gynaecologist may prescribe hormone replacement therapy for one or two years.

Sleep disturbances can be one of the consequences of lack of estrogen. To ensure a good night's sleep, get at least 30 to 45 minutes of physical exercise on most days of the week. Avoid stimulants such as coffee and too much television close to bedtime.

Vaginal dryness can be treated with a water-based vaginal lubricant. Estrogen replacement creams also can help restore moisture. Your gynaecologist can prescribe what is best suited for you.

Forgetfulness and lack of concentration can seem to be aggravated around menopause. It is usually because your life at this age is so full of different stresses that you feel overwhelmed. Do not worry and make sure that you keep your mind intellectually stimulated.

Mood swings may cause stress within the family. Physical exercise is a great way to keep your moods on an even keel.  Yoga and meditation also help.

The next column will have pointers for staying healthy after menopause.

 The author is an obstetrician and gynaecologist practising in Chennai and has written the book 'Passport to a Healthy Pregnancy'.

www.passport2health.in

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