MENOPAUSE
The average age of menopause is about 50 years, with women having a life expectancy of about 80 years, they will spend a significant time of their lives during menopause. A lot of women forget about gynae check-ups once they have completed their families and perhaps done a tubal ligation. A lot of women may have a smooth transition to menopause with minimal hot flashes and no abnormal uterine bleeding or mood swings. That was my mother who is currently 64 years old and she experienced minimal symptoms.
Premature ovarian failure is defined as cessation
of menses before the age of 40. It can be idiopathic but can be seen in women
who had chemotherapy or radiation, previous pelvic surgery, or hysterectomy.
The perimenopausal stage is where the Estrogen
levels are declining and women sense a change in their body with weight gain,
decrease in libido, decrease in bone density, and mood swings. It is important
to emphasize that the changes are not merely physical but many
mental changes. It can mostly manifest with sleep disturbances and low mood. At
times if the healthy diet, relaxation, and exercise don’t help a trial of
antidepressants can be helpful.
Menopause hormone therapy significantly improves
the hot flashes and improves the bone density. The products come in different
forms such as oral tablets, transdermal gel, and patches. Ideally, they should be
started within five years after the cessation of menses. It is vital
for women who have a uterus to use both estrogen and progesterone to prevent
endometrial hyperplasia. There is a small risk of an increase in breast cancer and
thromboembolic disease in women on hormone therapy. It is advised for women to
do regular mammograms and self-breast examinations. The aim to is to try and
taper the hormones within a couple of years so women can cope better with the
symptoms. I have encountered several women in their 70s who had the uterus
and ovaries removed in their 40s and were refusing to even taper the hormones.
Calcium and vitamin D supplementation, weight-bearing exercises, and smoking cessation improve bone density and prevent
pathological fractures.
A decrease in estrogen levels causes vaginal
dryness, urinary frequency, or even dysuria which is now known as the
genitourinary syndrome of menopause (GSM) and along with decreased libido, it
may negatively affect the sex life of many women in this age. The use of
vaginal estrogen creams and lubricants can help. The regular use of vaginal
estrogen can prevent severe vaginal atrophy in later years.
Women should continue with regular gynae check-ups although the majority of women are managed by their general practitioners and family medicine doctors. We can stop doing pap smears in women over 65 if the previous smears have been normal. I try to explain all the aspects of menopause to women in their gynae visits, so they understand better what is happening to their bodies. The take-home message is that women must continue being active and lively and enjoy this new phase of life. I want to do better than my grandmother and my mother when I get to that age.
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