By Dr Attia Anwar
Women, unlike men, are under the strong influence of changing hormones throughout their lives. Their reproductive hormones are not constant; rather, they come in cycles, which is why women experience cyclical changes, including emotions.
At the age of 40 to 55, there comes a time when their ovaries are depleted of eggs, and these cycles stop. Now, feedback from ovaries is gone, but pituitary hormones continue to produce their reproductive hormone unchecked. At this stage, women experience another group of symptoms which are related to excessive pituitary hormone and a lack of ovarian hormone estrogen and progesterone. This is called menopause. The definition of menopause is the absence of menstruation for twelve consecutive months without any other cause.
“WHO recommends raising awareness about menopause and the well-being of post-menopausal women”
The usual age is 45 to 55. With general longevity and an increase in average age, the number of women living after menopause is increasing. It is important to raise awareness and help these women to live to their full potential. If it happens before the age of 40, then it is called premature menopause. Premature menopause should be properly diagnosed and investigated to find out the reversible causes. After the age of 40, all this is natural and happens in every woman’s lifetime after a certain age. Women experience biological changes in the body due to a lack of female hormones. There are also social implications of menopause, which depend upon how society and culture view menopause. We should educate ourselves about what is happening in our bodies, this will decrease our distress over the symptoms that we experience. Fear of the unknown or something bad happening in our body can increase our stress and risk our well-being.
“An individualized approach to symptoms for every woman is important”
Common symptoms which women experience during the post-menopause period are hot flashes, night sweats, cold sweats, vaginal dryness, mood swings, and insomnia. Some women also experience a racing heart, joint pain, skin changes, difficulty concentrating, memory lapses, and weight gain. Women are more prone to osteoporosis (brittle bone disease) and heart problems after menopause due to a lack of estrogen. Lifestyle modification, medication, and hormone replacement therapy are three ways by which we can handle these changes in our bodies. It is important to know that the menopause journey is different for every woman. Not all women have all the symptoms. Different women experience different symptoms in their unique ways. The intensity of symptoms is also different for everybody’s unique body needs and circumstances.
Menopause is a continuum of stages of life. Our health after menopause depends on our prior health, lifestyle, and environmental factors. A healthy lifestyle before menopause helps us to cope with the symptoms of menopause. Menopause is an important transition socially and biologically. It gives us reasons to revisit our lifestyle choices and make them healthier. It gives us reasons to have health and lifestyle goals. WHO recommends raising awareness about menopause and the well-being of post-menopausal women. Symptoms of menopause can be dealt with by lifestyle adjustments, medication, and hormone replacement therapy.
Lifestyle modifications that can help to relieve the symptoms of menopause are eating healthy, avoiding saturated fats and processed food, eating more fruit and vegetables, exercising 30 minutes a day, and getting good sleep are important. Some women experience more hot flashes with caffeine and spicy food; avoiding them can help decrease the hot flushes. Keeping a diary of symptoms along with the factors that trigger them can help to identify and avoid those triggers. Relaxation exercises, yoga, and meditation help with good sleep, as many women experience disturbed sleep and emotional issues during menopause. An individualized approach to symptoms for every woman is important. However, healthy eating, exercise. Avoidance of smoking and alcohol is important for everyone. For hot flashes, wear breathable clothes. Wearing layers is also a good idea. Keeping the room cool also reduces hot flushes. Other provoking factors for hot flashes, insomnia, headaches, and depression should be identified by keeping a record and should be avoided. Generally, regular exercise and healthy fresh food without any processed ingredients help you to be healthy and energetic and relieve many symptoms. To deal with memory loss and mood swings, some new hobbies like learning a new language, pottery, painting, or music are helpful.
Other supplements and medicines that help to relieve the symptoms are also recommended. The use of additional calcium and vitamin D is important in postmenopausal women. They reduce the chances of the development of osteoporosis and make bones strong and less prone to fractures. The use of micronutrients like multivitamins, zinc, magnesium, and omega-3 fatty acids helps to relieve weakness and joint pain. After doing lifestyle modification, if intractable symptoms that interfere with life and productivity are present. Certain medicines are available after consulting with a doctor. These medicines, like neuropathic and other painkillers or antidepressants, can be used for the short term and will produce good long-term effects.
Hormone replacement therapy was discovered and used to combat these symptoms long ago. Unfortunately, a women’s health initiative study was done to understand the risks of hormone replacement therapy. However, its results were presented in such a way that, to most physicians and gynecologists, this therapy was not considered safe. So many women were not offered hormone replacement therapy, although they would have benefited from that. There is a decline in the use of hormone replacement therapy after 2000. Its results are studied again, and it has been proven that HRT is beneficial for younger women for the relief of symptoms and prevention of long-term diseases. New studies have proven that women who do not have risk factors can use hormones, and the risks of different types of cancer are not increased as was previously thought. As with all other medicines, we should examine the case thoroughly and then prescribe hormones where needed. It should be offered to women who have symptoms and have no risk factors, like smoking. It is important to increase awareness and clinician education regarding current evidence-based practices in menopause management.
To summarize, menopause is a natural phenomenon that gives you a chance to re-evaluate your health priorities. Having a healthy lifestyle, like eating well, exercising, having some hobbies, and having a purpose-driven life, is important in this stage of life. Taking some time for ourselves and making these years the golden years of life, after getting some freedom from conventional responsibilities. We, doctors, can help in selected cases in a meaningful way with medicines when usual lifestyle modifications are not sufficient to control symptoms.
The author, Dr. Attia Anwar, is a consultant family physician with a postgraduate degree from the Royal College of GPs UK. She is a strong advocate of health and well-being and wants patient participation in decision-making regarding health.
