Menopause-More Than Just Cessation Of Menses

Are you experiencing symptoms of menopause or know someone who is? Do you want to learn more about menopause?

When I was somewhere between the ages of  5 and 10, I remember my Mom constantly complaining of irritability, excessive sweating, and episodes of generalized hotness of the body, so intense that she sometimes described it as the heatwave one would get if they were walking close to a row of the raging inferno.

It didn’t just end there; at about the same time, she was also complaining of difficulty sleeping, severe backaches, and increased frequency of urination — so much that I remember she and my dad were at some point wondering whether it was diabetes she was developing.

You see, I am my Mom’s last child, and she had me when she was 39 years old. Looking back now, I realize that what she was, at that time, transitioning into menopause, and was having the classical features of Postmenopausal Syndrome.

menopause
menopause

What is Menopause?

Menopause is the end of a woman’s menstrual cycle and is characterized by cessation of menses, a drastic fall in reproductive hormones, and loss of reproductive potential.

The diagnosis of menopause is a retrospective one: it is made after a woman of appropriate age had stayed 12 months without menstruation.

Before the actual cessation of menses, a woman approaching menopause starts having menstrual irregularities. This is usually in the form of amenorrhea (periods in which the person stays months without bleeding), alternating with prolonged heavy menstrual bleeds. This stage is usually described as Perimenopause.

The age people experience menopause vary from individual to individual and is mainly determined genetically. On average though, people usually experience menopause between 40 to 55 years of age, with 50 years being the peak age of incidence.

If a woman experiences menopause below age 40, it is regarded as Premature Ovarian Failure (note that menopause itself is a primary failure of the ovaries).

Hormonal changes in Menopause

The menstrual cycle is regulated by the pituitary and ovarian hormones. While the pituitary hormones — Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH)— regulate the ovaries, the ovarian hormones (Oestrogen and Progesterone) directly regulate the inner lining of the womb, leading to menstruation proper.

Menopause occurs due to an age-dependent primary failure of the ovaries. This “ovarian failure” leads to a drastic reduction, and final cessation, of production of hormones, especially Oestrogen, from the ovaries.

The symptoms of menopause, including cessation of menses, is actually due to drastically levels of Oestrogen in the body.

Progesterone production is relatively spared, and this leads to a tilt in the net production of hormones from feminine to masculine.

hormonal changes in menopause

Postmenopausal symptoms and complications

The clinical features of menopause are due to Oestrogen lack and are therefore called “Climacteric Symptoms.” They can be classified into the following:

  • Vasomotor symptoms
  • Effect on bone metabolism
  • Urogenital atrophy
  • Psychiatric manifestations
  • Effect on one’s sex life
  • Etc (Note that this is not exhaustive)
symptoms of menopause
symptoms of menopause

Vasomotor symptoms

These occur due to removal of the negative feedback inhibition of the hypothalamus by Oestrogen.

With the hypothalamus being Sherrington’s “head ganglion of the autonomic nervous system,” removal of this inhibition leads to pulses of sympathetic discharge and occasional reset of the body’s thermostat in the hypothalamus.

This leads to the following symptoms:

  • Hot flashes/flushes
  • Excessive sweating

These set of symptoms— which usually occur within 1 to 2 years of onset of menopause but may mast up to 10 years in some— can be so intense as to interrupt sleep, lead to poor concentration at work, emotional lability, and irritability.

They are usually the reasons post-menopausal women seek medical attention first.

Effect of bone metabolism

Usually there is a balance between loss of old bone cells, and production of new ones— a process called bone remodelling.

Menopause tilts this balance negatively, leading to loss of more bone cells without commensurate replacement with new ones.

This leads to osteoporosis— otherwise called brittle bone disease— a condition in which bones are so porous, weak, and brittle, that they can break easily.

It is usually worse in women who smoke, do not have enough calcium, and do not make enough vitamin D.

Urogenital Atrophy

Lack of Oestrogen in menopause leads to vaginal dryness and “shrinking” of the vulva, vagina and other surrounding structures. This leads to the following symptoms:

  • Vulval itching
  • Increase in frequency of urination, with associated urgency
  • Pain during urination [dysuria]
  • Pain during sex [dyspareunia]
  • Etc.

Psychiatric manifestations

Menopause, and the associated hormonal fluctuations, have a serious impact on one’s psychiatric health. It can lead to the following:

  • Insomnia
  • Anxiety disorder
  • Depression
  • Worsening of already existing psychiatric disorders
  • Cognitive impairment, especially memory lapses, and poor concentration, in the peri- and the immediate postmenopausal period.
  • Etc.

Effect on sexual life

Menopause is associated with sexual dysfunction. This is because of the following;

  • Vaginal dryness, and associated pain during sex.
  • The psychological baggage of menopause, including sleep disturbances, depression, anxiety, etc
  • Dwindling hormonal levels leads to decreased libido.

 Treatment of Menopause

The major treatment for post-menopausal syndrome is hormonal replacement therapy (HRT) with Oestrogen.

Depending on the major symptoms, this may be in the form of:

Systemic Oestrogen; for instance, using oestrogen-containing pills, or injections, in the treatment of vasomotor symptoms, or effect on bone metabolism.

Or

Topical Oestrogen: for instance, using oestrogen creams to treat urogenital atrophy.

There are also adjunctive treatments peculiar to the different symptoms. For instance:

  • the use of bisphosphonates, calcium, and vitamin D supplements, for treating osteoporosis.
  • the use of selective serotonin receptor modulators, for treating the vasomotor symptoms, or some of the psychiatric manifestations.
  • Etc.

It is however not that straightforward as a lot of things need to be put into consideration, and indiscriminate use of unopposed Oestrogen is associated with Endometrial cancer.

So, endeavour to see your doctor for a review— if you are post-menopausal and having any of these worrisome symptoms.

Do. Not. Self-medicate!

Share this

Dr Chibuike Joseph Chukwudum

Dr Chibuike Joseph Chukwudum is a doctor who Studied Medicine and Surgery at Nnamdi Azikiwe University Awka. He is the former Medical Officer at Oakland specialist hospital,obosi.He also previously worked at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State.