Let’s talk about menopause

Health Advice

Article by: Consultant Dietitian Goh Yee Chin


Menopause is a term refers to a stage in a woman’s lifespan whereby her menstrual cycles has stopped.[1] In contrast to the menarche, which is the first menstrual period, menopause is the last menstrual period in a woman’s life. As women age, the reproductive system will start to slow down and prepare to stop. Most women enter menopause between the ages of 49 and 52.[1]

Perimenopause, which means the menopause transition, is when your body starts transitioning to menopause.[2] It generally lasts 7 years, but sometimes may last for 14 years until the woman reach the stage of menopause.[2] In medical, it is generally believed that women enter menopause if they do not have any menstruation for a year.[3] Menopause can also be judged by the decline in the secretion of female hormones of the ovaries.[3]

However, some women will experience early menopause, in which the menopause begins before the age of 45 due to several reasons. For instance, damage to the ovaries from chemotherapy or radiation, or surgical intervention particularly the removal of the ovaries.[3, 4]

Diagnosis

In general, there is no laboratory test required for menopause diagnosis. Healthcare provider may carry out the test to diagnose menopause by measuring the female reproductive hormones (eg. follicle-stimulating hormone, luteinizing hormone, oestrogen, and progesterone) in blood or urine, but it is usually not a necessity.[5]

Nevertheless, there are existing several assessment methods to evaluate the impact of menopause on women, including the Greene Climacteric Scale (GCS) [6], the Cervantes scale [7], and the Menopause rating scale [8].

Premenopause

Premenopause is the time when the level of reproductive hormones begins to decline and the symptoms of insufficiency of reproductive hormones begin to appear.[9] Generally, the onset of premenopause occurs earlier than the irregular menstrual cycle being noticeable.[10]

Perimenopause

Perimenopause refers to the period of transition time before the final episode of the period.[11] In accordance to North American Menopause Society, the stage of perimenopause will generally last four to eight years.[12] During this stage, the concentration of oestrogen in the body will have wide fluctuations, in which will be increased 20% to 30% compared to the stage of premenopause. [13] Women may experience physical changes similar to menopause with the fluctuations in oestrogen, especially in the last one or two years before menopause.[13]

The symptoms that may be observed include hot flashes, night sweats, difficulty falling asleep, mood swings, vaginal dryness or shrinking, incontinence, osteoporosis, and heart disease.[13] During perimenopause, fertility is diminished but infertility cannot be assumed until menopause officially begins. The time to officially enter menopause is 12 months after the last menstrual period.

Typically, perimenopausal changes begin between the ages of forty and fifty, and may last up to eight years.

Postmenopause

Postmenopausal is the phase whereby the period of the woman has stopped for at least twelve months (provided the woman has a uterus and is neither pregnant nor breastfeeding).[14] Whilst for women without a uterus which wish to confirm the phase of the menopause may consider to do a blood test on the levels of follicle-stimulating hormone (FSH).[14]

During postmenopause, the ovaries become inactive and the menstruation cycle has completely stopped. In order to confirm, judgement may be made through 12 menstrual periods as the menstrual cycle during the menopause stage is likely to be not stable. Thus, a longer period is required to observe the trend and for the confirmation of the absence of menstruation.

Women who are not menstruating are generally considered infertile.[14] However, women are actually less likely to be pregnant years before the postmenopause. Women’s reproductive hormones continue to decline and fluctuate during this phase, thus the effects of reproductive hormone deficiencies, for instance hot flashes, may exist for several years.

Nevertheless, it is important to note that if there is a menstrual-like substance secreted during or after the phase of postmenopause, even if it is only punctate, it may be a sign of endometrial cancer.

Symptoms

Most of the women will experience some symptoms of menopause. This include hot flashes, night sweats and/or cold flashes, vaginal dryness, discomfort during sex, urinary urgency (a pressing need to urinate more frequently), difficulty sleeping (insomnia), emotional changes (irritability, mood swings, mild depression), dry skin, dry eyes or dry mouth.[15] 

Management [16]

Menopause is a natural stage in a woman’s lifespan. Therefore, most of the time, there is no treatment needed for the menopause. Instead, the treatment mentioned from the providers will be more towards managing the symptoms of menopause that might be affecting the daily life.

Hot flashes, a common symptom of the menopausal transition, are uncomfortable and can last for many years. When a hot flash occurs, the upper chest will feel hot at first, and then the heat will spread all the way to the cheeks, and finally the face will also become red. In addition, hot flashes are often accompanied by night sweats.

Hot flashes can last up to 5 minutes at a time, after which the body temperature will drop, so it is possible to feel a chill, which may recur for several years during menopause or pre- and postmenopause. 

To manage this, avoid a diet that may worsen the symptoms such as alcohol, spicy foods, and caffeine. Green tea or cold water may exert beneficial effects on the symptoms of hot flashes. Maintain a healthy body weight also important because overweight or obese is found to be higher chances to experience hot flashes. Lifestyle management like staying in a lower temperature room, carrying a portable fan, and quitting smoking may be helpful.

Mood changes

Eating foods rich in omega-3 is also crucial to promote health during the perimenopausal years. Happy brain chemistry relies on getting the proper amounts of omega-3 in the diet. It reduces mood swings and can reduce the risk of developing depression.

Besides, regular exercise like jogging, swimming, mountain climbing, cycling and other sports may be beneficial as it not only stabilises your mood, but also maintains your health.

Vaginal dryness and discomfort

Most of the time, vaginal dryness is due to the levels of oestrogen, which is the female hormone that maintains normal vaginal lubrication, tissue elasticity and acidity has declined. The most common treatment for vaginal dryness due to low oestrogen levels is topical oestrogen therapy. A combination of isoflavones, calcium, vitamin D, and inulin may exert favorable effects on menopausal symptoms, sexual function, and quality of life

Weak bones

Studies shown menopause accelerate the bone loss and increase the risk of osteoporosis, in which every 1 in 10 women may experience osteoporosis. Calcium and vitamin D are well-known to be part of bone health. Calcium functions to build strong and healthy bones, whilst vitamin D is responsible for calcium absorption and regulation. Thus, lacking either one of them may lead to bone loss. 

Treatment

Although most of the time there is no treatment needed for menopause, in some cases, however, there are several therapies that help in managing the menopause symptoms, depending on the severity of cases.

Hormonal therapy[17]

Hormone therapy will provide a combination of the female hormones estrogen and progesterone as the treatment during perimenopause and menopause. Most of the time, hormone therapy will be prescribed in pill form. As for oestrogen, it can also be given by using skin patches and vaginal creams. 

Selective Oestrogen Receptor Modulators (SERMs)[17]

Selective oestrogen receptor modulators exert the effects in modulating oestrogen action, without stimulating endometrial growth or increased risk of cancer. In addition, this treatment is also effective in preventing or treating mild osteoporosis and decreasing serum LDL. The example of modulators are raloxifene, bazedoxifene, and ospemifene.

Non-hormonal therapy[17]

Non-hormonal therapy is the treatment not using hormone in the event of short durations treatment, which generally takes a few months, for menopause symptoms. The examples are selective serotonin re-uptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentin, and clonidine.

Osteoporosis-Specific[17]

For the reason to reduce the risk of fractures in menopausal women with osteoporosis, this osteoporosis-specific treatment may be intervened. The treatment includes bisphosphonates, denosumab, and supplementation with calcium and vitamin D.

Conclusion

To sum up, menopause is a normal and natural event that will occur in a woman’s lifespan. Although some of the women are struggling and suffering from the symptoms of  menopause, it is generally manageable. Whenever necessary, do not hesitate to consult a doctor or other healthcare professional for an individualised treatment plan which will help in improving the quality of life and minimise the symptoms. Do take note that menopause is not a bad thing and you do not need to perceive guilt when experiencing the symptoms.


References:

  1. Roberts H, Hickey M. Managing the menopause: An update. Maturitas. 2016;86:53-8.
  2. Takahashi TA, Johnson KM. Menopause. Med Clin North Am. 2015;99(3):521-34.
  3. Sievert LL. Menopause: A Biocultural Perspective. New Brunswick, N.J.: Rutgers University Press; 2006. p. 81.
  4. International position paper on women’s health and menopause : a comprehensive approach. DIANE Publishing; 2002. p. 36.
  5. Eunice Kennedy Shriver National Institute of Child Health and Human Development. How do health care providers diagnose menopause? 2013.
  6. Greene JG. Constructing a standard climacteric scale. Maturitas. 1998;29(1):25-31.
  7. Monterrosa-Castro A, Romero-Pérez I, Marrugo-Flórez M, Fernández-Alonso AM, Chedraui P, Pérez-López FR. Quality of life in a large cohort of mid-aged Colombian women assessed using the Cervantes Scale. Menopause. 2012;19(8):924-30.
  8. Chedraui P, Pérez-López FR, Mendoza M, Leimberg ML, Martínez MA, Vallarino V, Hidalgo L. Factors related to increased daytime sleepiness during the menopausal transition as evaluated by the Epworth sleepiness scale. Maturitas. 2010;65(1):75-80.
  9. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ; STRAW + 10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Fertil Steril. 2012;97(4):843-51.
  10. Schneider HPG, Frederick N. Climacteric medicine where do we go? London: Taylor & Francis; 2005. p. 28.
  11. McKinlay SM, Bambrilla DJ, Posner JG. The normal menopause transition. Maturitas. 1992;14(2):103–115.
  12. Perimenopause, Early Menopause Symptoms | The North American Menopause Society, NAMS. [Internet]. Menopause.org. [cited 1 May 2022]. Available from: https://www.menopause.org/for-women/menopauseflashes/menopause-symptoms-and-treatments/menopause-101-a-primer-for-the-perimenopausal
  13. Chichester M, Ciranni P. Approaching menopause (but not there yet!): caring for women in midlife. Nurs Womens Health. 2011;15(4):320-4.
  14. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, Sherman S, Sluss PM, de Villiers TJ; STRAW + 10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Fertil Steril. 2012;97(4):843-51.
  15. Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T . Symptoms of menopause — global prevalence, physiology and implications. Nat Rev Endocrinol. 2018;14:199–215.
  16. National Institute for Health and Care Excellence (2015). Menopause: diagnosis and management. (NICE guideline NG23).
  17. Peacock K, Ketvertis KM. Menopause. [Internet]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507826/

Leave a Reply

Your email address will not be published. Required fields are marked *