Menopause Questions & Answers , Dr. Rekha Thote
What is menopause and how to handle it.
As we all know, menopause signifies the cessation of menstruation. By definition, it is once menstruation stops for one year, it is termed as menopause. It is characterized by depletion of the hormones oestrogen and progesterone, which are essential for the regulation of the menstrual cycle. So once the ovaries are depleted of these hormones, they stop functioning and it results in no ovulation and cessation of menstruation. So, menopause can be divided into 4 phases. The first is premenopause that is just a little before the actual menopause sets in, then is the menopauses proper that is 12 months of amenorrhea, which is complete cessation of menstruation, and the perimenopausal period is that between 45 to 55 years of age, it can be for 5 years also or it can last up to 7-10 years. And then we have the postmenopausal period that is 1 year after menopause sets.
It’s very important to understand the changes that take place during menopause because once there is a complete understanding, only then can the issue be handled with sensitivity and proper counselling. So what exactly happens during menopause besides the menstrual changes, there is also a change in the elasticity of the skin. Because of depletion of oestrogen, the skin becomes thinner, wrinkles start setting in, and also the vaginal as well as the urethral mucosa becomes thin which results in irritation, dryness, it can result in frequency of micturition and also complete burning when there is micturition. The other thing is hot flashes, these are vasomotor symptoms and these are characterized by a sudden feeling of warmth. It starts from the face, it goes on to the neck, and then it can also break out in sweat. If this happens at night, this is called night sweats. Sometimes, the woman wakes up while sleeping suddenly, with something like a panic attack and palpitations. This needs to be addressed because there is profuse sweating and complete flushing of the face, redness, which can be very embarrassing because it takes you by surprise and women are often very distressed by this, especially when they are out somewhere, either in a meeting or in a social function, so this can result in a lot of embarrassment.
The other important thing which happens is bone loss. Calcium as we know is very important for the bone integrity. There is increased loss of calcium from the bones, results in reduced bone mineral density. And we have seen women who are a little older, they are predisposed to what is called as fractures. We often see women with dislocations and hip fractures, so this is something which they need to understand. And emotional ability, that is what we are facing in most of our patients today. They have because of the appearances, the change in appearance, thinning of the hair because of again diminished oestrogen, this causes a lot of lower self esteem, so women tend to get emotionally labile, there are sometimes mood swings, anger, frustration, depression, and also indulgence in eating wrong to counter all these psychological deficiencies. If they eat wrong, as we all know, there is a decrease in metabolism as we age, so if there is a high lipid profile in a woman and she eats high fat containing food or excess of carbohydrates, this can lead to metabolic disorders, diabetes, hypertension, altered liquid profile, and also we have seen excess weight gain in these women, so eating right is important. We always stress that it is imperative to keep your water intake optimum, at least say 6-8 glasses of water daily are essential turgidity of the cells and to prevent wrinkling of the skin. Along with water, it is important to understand that one should avoid caffeinated drinks, spicy food, alcohol, and excess of tea or other aerated drinks also, like soda. So, it is important that you can have coconut water if you need to or plain water will do well and also even lemonades or buttermilk or other such normal which can be made at home, these liquid drinks which can be made easily. Then, we also say that besides the home food, it is important to see that when you are eating outside, do not indulge in a high amount of caloric intake or too much of fat and sweets, especially salt intake also should be restricted.
Then, vitamin D is very important for the women to maintain the bone density and it also supplements the calcium intake in the bones. So exposure to sunlight, this is another thing which is deficient in the woman today because they are spending a lot of time indoors and they do not exercise or do not expose themselves to the Sun. So vitamin D supplementation in case there is a deficiency can correct these to a large extent. Calcium supplementation, if there is a low calcium, serum calcium level, or if there is a decreased bone density mineral.
So what is important? The take-home message is exercise well because metabolism is low, form a support group for exercise, indulge in a hobby which collectively gives you pleasure as well as keeps you happy and also keeps your joints and bones in motion, and also get your periodic health checkups done. It is imperative to visit your orthopaedician, physician, and gynaecologist because breast examination, pelvic examination, pap smears, mammography, pelvic ultrasound are very important at this age. We see a lot of malignancies surfacing off the reproductive tract.
So, it is essential to keep yourself in the loop, get your yearly checkups done, and also get your blood profiles and all your parameters in shape. The important part is to understand the problem and then it can be targeted very effectively. So stay happy, menopause is not the end of life, it is just a phase of life. So you can face it with confidence and dignity if you follow these simple rules and principles.