(Part 1 of a 3 part series on menopause)
Tharangini is 49 years old. Her periods have become irregular over the past year and she gets them sporadically now. Her last period was almost five months ago. Even in an air-conditioned room, she sometimes feels hot and starts sweating profusely. She feels exhausted, has difficulty in sleeping and sometimes feels like crying for no reason at all. Tharangini is nearing menopause. If she has no period for a year, she will be considered as having attained menopause.
What is menopause?
When a girl attains puberty, it means that her ovaries have matured and have started producing eggs. The hormones released from the ovaries cause the girl to have periods. These hormones, estrogen and progesterone, continue to be produced regularly from the ovaries for the next 30 to 40 years. Usually, after the age of 45, the ovaries will gradually produce less estrogen and will ultimately stop producing it. When the ovaries shut down estrogen production, it results in the cessation of periods. This is called menopause.
Menopause in most Indian women occurs around the age of 50 to 52 years. If the periods stop before age 40, it is called premature menopause .
What are the signs of approaching menopause?
The three to four years leading up to menopause are termed perimenopause . The symptoms that you experience during this time are due to decreasing levels of estrogen.
Changes in the menstrual cycle
One of the earliest and most common signs that menopause may be nearing is a change in the menstrual cycles. You may miss one or more periods. The flow may become lighter or heavier. Bleeding may last a shorter or longer time than is usual for you.
Hot flushes (hot flashes)
As you near menopause you may start having hot flushes (hot flashes) . As many as 75 per cent of menopausal women will have them. During a hot flush, there is a sudden rush of heat over the face and upper body. You may start sweating profusely even if you are in an air-conditioned room. Some women feel hot over their palms and soles. A hot flush may last from a few seconds to several minutes. Hot flushes can occur during the day or night. They may happen a few times a month or several times a day. They can be mild and may not cause more than a mild discomfort. Some women can have severe flushes.
Hot flushes may last for a few months to a few years. Hot flushes are not harmful even though they can be bothersome, and may interfere with daily life.
Difficulty in sleeping
Around menopause, many women find it difficult to get a good night's sleep. Hot flushes, palpitations and anxiety attacks may cause disturbances in sleeping.
Emotional ups and downs
Unfortunately, menopause occurs at a stage in life when a woman may already be undergoing stresses. There may be pressure due to children's education and marriage, parents who are unwell and personal health problems. At this stage, lack of estrogen seems to aggravate feelings of anxiety and may leave you exhausted and very irritable. A combination of life stresses and lack of estrogen may make you want to cry for no reason at all. This is a time that puts a lot of strain on family relationships and requires support and understanding from the rest of the family.
Changes in the vagina and urinary tract
Lack of estrogen causes changes in the lining of the vagina. The vaginal lining may become thin and dry. These changes can cause pain during sexual intercourse. There is also an increased risk of infections that can lead to burning and itching. The urinary tract also changes with age. Some women may need to urinate more frequently, and the ability to control urine may also be affected. Women may have an increased risk of bladder infection after menopause.
Changes in the bones
After menopause, the rate of bone loss increases. This leads to osteoporosis, increasing the risk of breaking bones in older women. The bones of the hip, wrist, and spine are most affected.
Risk of heart attacks and strokes
One of the important functions of estrogen is that it protects the heart. It also protects women from stroke. When estrogen levels drop after menopause, women lose much of this protection, increasing the risk of heart attack and stroke.
The author is an obstetrician and gynaecologist practising in Chennai and has written the book 'Passport to a Healthy Pregnancy'.
www.passport2health.in
