The other day around 11 PM I received a Phone call from one of my close friends stating that his wife was sweating severely and annoyed. “What should I do? Is it something heart attack he questioned. Though similar episodes have been happening for the last year never it was so serious as today.” Then I asked him the age of his wife, he said 44 years. Then I told him probably your wife is in the pre-menopausal or perimenopausal stage. According to a scientific study it is found that about 15% of Indian women are in menopause. The proportion of menopausal women was higher in rural regions than in urban regions. Similarly, the proportion of women in premature menopause was higher in rural regions (5%) than in urban regions (3%). In the country, the natural menopause is 8.4% of women between the ages of 15-49 experience natural menopause. The proportion of women experiencing natural menopause varies by age group, with the highest proportion in the 45-49 age group and the lowest in the 15-29 age group.
The cessation of periods is called menopause. This can happen around 40 years to 50 years. It is a natural phenomenon just like graying of the hair when women reach menopause. The physical symptoms, such as hot flashes, and emotional symptoms of menopause may disrupt sleep, lower energy or disturb the mood and severe weakness in some individuals. Generally, it’s diagnosed after 12 months without a menstrual period, vaginal bleeding or spotting. During the transition, the number of hormones the ovaries make varies. Perimenopause can last 2 to 8 years. The average is about four years. The hormone changes can cause symptoms such as: Irregular bleeding Vaginal dryness, Hot flashes, Night sweats, Sleep disturbance, Mood changes, trouble remembering words, and problems with memory which is often called brain fog.
Different people have different menopause symptoms. Even people living in different environments complain of diverse symptoms. Most often, periods become irregular before they end. Skipped periods during perimenopause are common and expected. Often, menstrual periods skip a month and return. Or they skip a few months and then start monthly cycles again for a few months. Period cycles tend to get shorter in early perimenopause, so periods are closer together. As menopause gets closer, periods get farther apart for months before they end. Women can still get pregnant during this time. When periods are stopped but aren’t sure it’s due to menopause, it is advised to take a pregnancy test. Most often, menopause happens over time. The months or years leading up to menopause are called perimenopause or the menopausal transition.
Menopause can result from the natural decline of hormones. In the late 30s, ovaries start making less of the hormones that control your period. These are called estrogen and progesterone. With lower levels of them, it’s harder to get pregnant. In the 40s, the menstrual periods may get longer or shorter, heavier or lighter, and happen more often or less often. In this time, the ovaries stop releasing eggs, and no more periods. This happens on average around age 51 years.
Other causes
Oophorectomy is a surgery where the ovaries are removed which makes hormones, called estrogen and progesterone, that control the menstrual cycle. Therefore, the removal of the ovaries causes instant menopause. The periods stop and likely to have hot flashes and other menopausal symptoms. Symptoms can be severe because the surgery causes hormones to drop all at once rather than slowly over several years. Surgery that removes the uterus but not the ovaries, called hysterectomy, most often doesn’t cause instant menopause. as ovaries still release eggs and make estrogen and progesterone for a time.
Chemotherapy
Cancer therapies can cause menopause. They can cause symptoms such as hot flashes during or shortly after treatment. Periods sometimes return after chemotherapy and can still get pregnant. In that situation, one may have to use birth control methods. Radiation therapy aimed at the pelvis, belly and lower spine can cause menopause. Radiation to the whole body for stem cell transplant also can cause menopause. Radiation therapy to other parts of the body, such as breast tissue or the head and neck, likely won’t affect menopause.
Primary ovarian insufficiency. About 1% of people who have menopause get it before age 40. This is called premature menopause. Premature menopause may result from the ovaries not making the usual levels of hormones. This is called primary ovarian insufficiency. It can happen from gene changes or an autoimmune disease. Often no cause of premature menopause can be found. Then doctors most often suggest hormone therapy. The hormone therapy can protect the brain, heart, and bones if taken at least until the typical age of menopause.
Management of menopause, the newer research that is emerging ‘linking dietary changes and lifestyle’ which can significantly reduce symptoms of menopause and its complications, sex problems, imitating neuropsychiatric issues, and related dilemmas, will be discussed in the coming issue. (To be concluded)
